PubMed · 9866572
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C White. Back breaking work.. https://pubmed.ncbi.nlm.nih.gov/9866572/
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The aim of this investigation was to examine the effectiveness of a graded exposure in vivo treatment with behavioural experiments as compared to usual graded activity in reducing pain-related fears, catastrophising and pain disability in chronic low back pain patients reporting substantial fear of movement/(re)injury. Included in the study were four consecutive CLBP patients who were referred for outpatient behavioural rehabilitation, and who reported substantial fear of movement/(re)injury (Tampa Scale for Kinesiophobia score>40). A replicated single-case cross-over design was used. After a no-treatment baseline measurement period, the patients were randomly assigned to one of two interventions. In intervention A, patients received the exposure first, followed by graded activity. In intervention B, the sequence of treatment modules was reversed. Sixty-three daily measures of pain-related cognitions and fears were recorded with visual analogue scales. Before and after the treatment, the following measures were taken: pain-related fear, pain catastrophising, pain control and pain disability. Using time series analysis on the daily measures of pain-related cognitions and fears, we found that improvements only occurred during the graded exposure in vivo, and not during the graded activity, irrespective of the treatment order. Analysis of the pre-post treatment differences also revealed that decreases in pain-related fear concurred with decreases in pain catastrophising and pain disability, and in half of the cases an increase in pain control. This study shows that the external validity of exposure in vivo also extends to the subgroup of chronic low back pain patients who report substantial fear of movement/(re)injury.
Recent research suggests that a significant proportion of school children aged 10-16 years are employed outside the home during the school term. Delivery work represents only a minority of such employment and children are found working in a wide range of 'adult' jobs, particularly in the service sector. This raises concerns about health and safety hazards faced by working children. There is an absence of data on the effects of different kinds of work and working conditions on child health and development, which is thus a barrier to defining goals, policies and effective action. This paper aims to address these issues through presenting some research findings on child employment and incidences of accident. The study is based on surveys of school children in North Tyneside and Norfolk. Our analysis shows that there is a high level of accidents occurring at work among children aged 10-16 years old. While legislation exists in the UK to prevent children from working in the most hazardous environments and to prohibit young children from undertaking any employment, it is clear that such work does take place. Our findings indicate that it is time to look at the occupational health of children as a major concern.
The use of a free posterior interosseous skin flap should be considered in a single digit degloving injury, especially when replantation of the avulsed skin or the use of skin from the second toe, transferred as a composite-tissue flap, is not feasible. The flap is thin and pliable. It allows early mobilisation with good recovery of joint motion and attains protective sensation of the finger.