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At least 577 records · Page 32Linked to original sources
PubMed2004

Postoperative mortality after nontraumatic lower extremity amputation in patients with renal insufficiency.

Mortality rates after lower extremity amputation are extremely high among dialysis patients. However, the impact of milder degrees of renal insufficiency on death rates after lower extremity amputation has not been carefully examined. In this study, the authors used data from the Department of Veterans Affairs' National Surgical Quality Improvement Program (NSQIP) to measure the association between renal dysfunction and 30-d mortality after nontraumatic amputation adjusted for confounders. The study population consisted of 16,994 patients undergoing their first NSQIP recorded amputation from January 1, 1994 through September 30, 2001. Thirty-five percent of all cohort patients had at least moderate renal insufficiency, and 52% of all postoperative deaths occurred in this group. Postoperative mortality was 9% in patients with moderate renal insufficiency, 15% in patients with severe renal insufficiency, and 16% in dialysis patients, compared with 6% in patients with normal or mildly reduced renal function. Renal insufficiency remained associated with death after adjustment for confounders (adjusted odds ratio [OR] 3.36, 95% confidence interval [CI] 2.75 to 4.10 [dialysis patients]; OR 2.54, CI 2.06 to 3.14 [severe renal insufficiency]; and OR 1.52, CI 1.32 to 1.76 [moderate renal insufficiency]). In conclusion, even moderate renal insufficiency is independently associated with postoperative death after lower extremity amputation. This finding highlights the need for a targeted approach to improving the care of patients with renal insufficiency undergoing lower extremity amputation.

Aged↗
PubMed2005

An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients.

STUDY DESIGN: Prospective study of patients with lumbar disc herniations who were operated on with a full-endoscopic uniportal transforaminal approach using an extreme lateral access. OBJECTIVES: To examine the technical possibilities of an extreme lateral access for full-endoscopic uniportal transforaminal surgery of lumbar disc herniations within the spinal canal. Also, to assess sufficient decompression, and the advantages and disadvantages of the minimally invasive procedure. SUMMARY OF BACKGROUND DATA: Conventional prolapsed disc operations can result in consecutive damage as a result of traumatization. The usual transforaminal access is posterolateral, and is associated with problems in reaching the epidural space directly with unhindered vision and, thus, with problems of sufficient decompression in lumbar disc herniations within the spinal canal. METHODS: A total of 463 patients were observed for 1 year. In addition to general and specific parameters, the following measuring instruments were used: visual analog scale, German version North American Spine Society Instrumentarium, Oswestry low back pain disability questionnaire. RESULTS: There were no complications. Of the patients, 81% reported no longer having leg pain, and 14% had occasional pain. There was no worsening. The results were constant and are equal to those of conventional procedures. No patients presented with neural scarring; 7% had recurrence of the prolapse. The extreme lateral access was necessary to reach the sequestered material. CONCLUSIONS: The technique presented is an adequate and safe alternative to conventional procedures, and has the advantages of a truly minimally invasive procedure. The extreme lateral access is required for the indications described. There are clear limitations outside these indications. The possibility of selecting an access from posterolateral to extreme lateral now enables surgery of lumbar disc herniations inside and outside the spinal canal.

Adolescent↗
PubMed2003

Free tissue transfer: an advanced strategy for postinfection soft-tissue defects in the upper extremity.

Surgical treatment of severe, necrotizing infections frequently leave compound defects that require complex reconstructive procedures. In the upper extremity, local flap coverage is limited because of the size of the lesions. Regarding the results of early microsurgical coverage of complex postinfectious defects of the lower extremity, the goal of this study was to evaluate the role of free tissue transfer in the treatment of severe infections in the upper extremity. Between 1994 and 1999, 24 patients with major defects as a result of severe necrotizing infections in the upper extremity underwent free tissue transfer. Parameters assessed included the success of infection control, flap survival rate, salvage of the extremity, and an outcome analysis by the Disability of Arm-Shoulder-Hand score and a visual analog scale. Patient age ranged from 17 to 75 years (average age, 50.8 years). Previous treatment of 11 patients in outlying hospitals included 4.2 operative procedures and a delay of admission to the authors' unit of 89 days. The average defect size after debridement was 10.0 x 14.4 cm. Twenty-four free flaps including 16 muscle or musculocutaneous flaps, 4 chimeric flaps from the subscapular system, and 4 osteocutaneous flaps were performed for reconstruction. The overall flap survival was 95.8%. One temporalis fascia flap (TPF) was lost as a result of vascular thrombosis, and three flaps underwent successful revision of the anastomoses. Eight patients required further minor surgical treatment. The Disability of Arm-Shoulder-Hand score yielded an average of 41.5 points, which represents a moderate impairment of activities of daily living. Visual analog scale assessment demonstrated an overall high satisfaction (9.5 points; range, 1-10 points). The data demonstrate that even in severe necrotizing infections resulting in complex acute or chronic defects, limb salvage and infection control can be achieved successfully with radical debridement and early free tissue transfer.

Adolescent↗
PubMed2004

The use of free anterolateral thigh flap for reconstructing soft tissue defects of the lower extremities.

The goal of soft tissue reconstruction in the lower extremities is to provide a functional and cosmetically acceptable limb. The anterolateral thigh flap has become one of the most popular options for soft tissue defect reconstruction recently because of the large amount of skin available and the reliable and versatile nature of this material. The purpose of this article is to present our experiences with the free anterolateral thigh flap for the reconstruction of soft tissue defects of the lower extremity. From April 2002 to October 2003, 31 consecutive free anterolateral thigh flaps were used. There were 24 male and 7 female patients, and their ages were between 3 and 78 years. The size of the flaps ranged from 11 to 34 cm long and 6 to 16 cm wide. In 9 patients, the flaps were harvested in a flow-through manner to both reconstruct soft tissue defects and protect and maintain the vascular status of the lower extremities. In these patients, the pedicle was interposed between vascular gaps, either present or created, in the extremity. The patency of distal anastomosis with the course of the distal vessel was confirmed by using conventional Doppler flow monitoring in flow-through flaps. In 4 cases, thinning of the flap was performed. In 3 patients, flaps were used in a neurosensorial fashion. Four flaps required reoperation due to vascular compromises. While 3 of these were salvaged, 1 flap was lost due to recipient arterial problems. Sixteen cases underwent split-thickness skin grafting of the donor site. No infection or hematomas were observed. We conclude that the anterolateral thigh flap is an ideal and versatile material, especially for lower extremity reconstructions, with its functional and cosmetic advantages, and it can be considered a suitable alternative to the most commonly used conventional soft tissue flaps.

Adolescent↗
PubMed2002

Predictions of extreme precipitation and sea-level rise under climate change.

Two aspects of global climate change are particularly relevant to river and coastal flooding: changes in extreme precipitation and changes in sea level. In this paper we summarize the relevant findings of the IPCC Third Assessment Report and illustrate some of the common results found by the current generation of coupled atmosphere-ocean general circulation models (AOGCMs), using the Hadley Centre models. Projections of changes in extreme precipitation, sea-level rise and storm surges affecting the UK will be shown from the Hadley Centre regional models and the Proudman Oceanographic Laboratory storm-surge model. A common finding from AOGCMs is that in a warmer climate the intensity of precipitation will increase due to a more intense hydrological cycle. This leads to reduced return periods (i.e. more frequent occurrences) of extreme precipitation in many locations. The Hadley Centre regional model simulates reduced return periods of extreme precipitation in a number of flood-sensitive areas of the UK. In addition, simulated changes in storminess and a rise in average sea level around the UK lead to reduced return periods of extreme high coastal water events. The confidence in all these results is limited by poor spatial resolution in global coupled models and by uncertainties in the physical processes in both global and regional models, and is specific to the climate change scenario used.

Altitude↗
PubMed2002

Determination of redundancy and systems properties of the metabolic network of Helicobacter pylori using genome-scale extreme pathway analysis.

The capabilities of genome-scale metabolic networks can be described through the determination of a set of systemically independent and unique flux maps called extreme pathways. The first study of genome-scale extreme pathways for the simultaneous formation of all nonessential amino acids or ribonucleotides in Helicobacter pylori is presented. Three key results were obtained. First, the extreme pathways for the production of individual amino acids in H. pylori showed far fewer internal states per external state than previously found in Haemophilus influenzae, indicating a more rigid metabolic network. Second, the degree of pathway redundancy in H. pylori was essentially the same for the production of individual amino acids and linked amino acid sets, but was approximately twice that of the production of the ribonucleotides. Third, the metabolic network of H. pylori was unable to achieve extensive conversion of amino acids consumed to the set of either nonessential amino acids or ribonucleotides and thus diverted a large portion of its nitrogen to ammonia production, a potentially important result for pH regulation in its acidic habitat. Genome-scale extreme pathways elucidate emergent system-wide properties. Extreme pathway analysis is emerging as a potentially important method to analyze the link between the metabolic genotype and its phenotypes.

Amino Acids↗
PubMed2001

Extremal properties of random trees.

We investigate extremal statistical properties such as the maximal and the minimal heights of randomly generated binary trees. By analyzing the master evolution equations we show that the cumulative distribution of extremal heights approaches a traveling wave form. The wave front in the minimal case is governed by the small-extremal-height tail of the distribution, and conversely, the front in the maximal case is governed by the large-extremal-height tail of the distribution. We determine several statistical characteristics of the extremal height distribution analytically. In particular, the expected minimal and maximal heights grow logarithmically with the tree size, N, h(min) approximately v(min) ln N, and h(max) approximately v(max) ln N, with v(min)=0.373365ellipsis and v(max)=4.31107ellipsis, respectively. Corrections to this asymptotic behavior are of order O(ln ln N).

Journal Article↗
PubMed2005

Heterogeneous beliefs, segregation, and extremism in the making of public opinions.

The connection between contradictory public opinions, heterogeneous beliefs, and the emergence of majority- or minority-induced extremism is studied, extending our former two-state dynamic opinion model. Agents are attached to a social-cultural class. At each step they are distributed randomly in different groups within their respective classes to evolve locally by majority rule. In case of a tie the group adopts one or another opinion with respective probabilities k and (1-k) . The value of k accounts for the average of individual biases driven by the existence of heterogeneous beliefs within the corresponding class. It may vary from class to class. The process leads to extremism with a full polarization of each class along one opinion. For homogeneous classes the extremism can be along the initial minority making it minority induced. In contrast, heterogeneous classes exhibit more balanced dynamics, which results in a majority-induced extremism. Segregation among subclasses may produce a coexistence of opinions at the class level, thus averting global extremism. Insight into the existence of contradictory public opinions in similar social-cultural neighborhoods is given.

Journal Article↗
PubMed2005

The CAFE computer program for nutritional analysis of the EPIC-Norfolk food frequency questionnaire and identification of extreme nutrient values.

BACKGROUND: Food frequency questionnaires (FFQs) are widely used in nutritional epidemiology but no papers detail the development of the supporting programs and nutritional databases. The principles involved in data collection, processing and treatment of the European Prospective Investigation into Cancer Study (EPIC)-Norfolk Study FFQ and development of the structure and content of the Compositional Analyses from Frequency Estimates (CAFE) program for calculating nutrient intakes are described. Extreme nutrient values and derivation of cut-points for data exclusion are also discussed. METHODS: The FFQ was sent to 25,637 participants. To exclude extreme (nonphysiological) outliers of nutrient intakes, the extreme top and bottom 0.5% of the ratio of energy intake to estimated basal metabolic rate was used. RESULTS: The CAFE computer program modifies nutrient intake according to specific fats used in food preparation and the amount of visible fat on meat. It incorporates different breakfast cereals and distinguishes between text for brands and types. After exclusion of outliers of nutrient intake some extreme values remained for energy, carbohydrate, protein, fat and alcohol, because of high reported frequencies of certain foods. CONCLUSIONS: The features of CAFE include flexible, updateable, databases and a novel method for matching text. The effect of extreme nutrient values on the accuracy of the FFQ in estimating diet in nutritional epidemiology should be investigated further.

Adult↗
PubMed2006

Upper extremity arteriovenous fistula does not affect pulse oximetry readings.

AIM: Arteriovenous fistula (AVF) is usually surgically created in a patient's upper extremity to provide adequate blood flow during haemodialysis. Blood flow distal to an AVF is altered and theoretically could change pulse oximetry (SpO2) reading, systemic blood pressure and skin temperature. The authors conducted a prospective case-control study to measure changes in these parameters in the upper extremity of patients who have had an AVF. METHODS: In patients with an upper extremity AVF, the authors conducted a prospective case-control study using the patient's own non-AVF upper extremity as the control. The authors evaluated other factors that may have influenced blood flow changes distal to an AV fistula like gender, presence of AVF aneurysm, peripheral vascular disease, diabetes mellitus and vasodilator therapy. RESULTS: Thirty patients were enrolled, skin temperature and blood pressure were significantly altered in the hand distal to the AVF, but there was no significant change in the SpO2. CONCLUSION: An upper extremity AVF alters blood pressure and temperature measurements when compared with the contralateral non-AVF side, but there is no difference in SpO2 provided an adequate signal quality is detected.

Arm↗
PubMed1994

Structural characteristics of term human fetal membranes: a novel zone of extreme morphological alteration within the rupture site.

OBJECTIVE: To determine the structural characteristics of the rupture site of term fetal membranes (amniochorion and decidua) that rupture spontaneously after the onset of labour. DESIGN: Fourteen term fetal membranes were examined immediately after delivery at the light microscope level. Multiple samples were taken along the whole rupture site and long an axis between this site and placental edge. Morphometric analysis of the thickness of the constituent layers of the fetal membranes was performed. SETTING: Leicester Royal Infirmary Maternity Hospital. RESULTS: A restricted zone of extreme altered morphology, characterised by marked swelling and disruption of the connective tissue, thinning of the trophoblast layer and thinning or absence of decidua, was identified in the rupture site of all patients. Morphometric analysis of the thickness of membrane layers showed that these changes and the ratio between the thickness of the connective tissue layers and that of the trophoblast and decidua (termed fetal membrane morphometric index) were significant between the zone of extreme altered morphology and the rest of the membranes. CONCLUSIONS: The morphological features of the zone of extreme altered morphology suggests that it represents an area of structural weakness of the membranes. Since this zone did not include the whole length of the rupture site, it is likely that it was present before membrane rupture and was generated during pregnancy. We hypothesise that the zone of extreme altered morphology represents the site of initial rupture after which the tear is transmitted through the membranes to produce the rupture site. It is possible that if these changes become more extreme, then prelabour membrane rupture may occur. Further characterisation of this zone may help to understand the mechanism of its genesis and its role in predisposing the fetal membranes to rupture.

Amnion↗
PubMed1998

Lower-extremity functioning in older Mexican Americans and its association with medical problems.

OBJECTIVE: To describe lower-extremity functioning in community-dwelling older Mexican Americans and to examine its relationship with medical problems. DESIGN: Cross-sectional analyses of survey and performance-based data obtained in a population-based study employing area probability sampling. SETTING: Households within selected census tracts of five Southwestern states: Arizona, California, Colorado, New Mexico, and Texas. PARTICIPANTS: A total of 2873 Mexican Americans aged 65 years and older. MEASUREMENTS: A multidimensional questionnaire assessing demographic, sociocultural, and health variables. Standardized tests of lower-extremity physical functioning included measures of standing balance, repeated chair stands, walking, and an overall summary measure. RESULTS: Regression analyses revealed that being more than age 75 and female, having arthritis diabetes, visual impairments, or being obese or underweight were all significantly associated with performance on both individual and summary tests of lower-extremity functioning. In separate regression analyses, the total number of medical conditions was also associated with performance. CONCLUSIONS: The likelihood of predicting performance or inability to complete tests of lower-extremity functioning was greatest for those aged 80 and older, those with arthritis or diabetes, and those with three or more medical conditions. Because of the high prevalence of diabetes in Mexican Americans, documentation of the association of diabetes with performance-based tests of lower-extremity functioning may help guide early interventions targeted to prevent progression to more severe limitations or disability.

Activities of Daily Living↗
PubMed2001

The effect of lower-extremity position on cerebrospinal fluid pressures.

OBJECTIVE: To determine the effects of lower-extremity positioning on cerebrospinal fluid opening pressure (CSFp). The authors believed that during lumbar puncture (LP), CSFp does not meaningfully decrease when the lower extremities are extended from flexion, as is often suggested. METHODS: In a convenience sample of adult patients who clinically required LP in an urban emergency department, three sequential CSFp measurements were obtained in either sequence A (knee, hip, and neck flexion [90 degrees ], then extension, then flexion) or sequence B (extension, flexion, then extension) prior to CSF withdrawal. The neck was flexed at 30 degrees when the lower extremities were flexed, while the thoracolumbar spine was kept in the neutral position for all measurements. RESULTS: Nineteen patients were studied in each sequence. Although variable, overall within-patient changes between positions were not clinically meaningful. Mean and 95% confidence intervals (95% CIs) for the decrease in CSFp from position 1 to position 3 (same position) were 0.2 cm H(2)O (1.7%) and 0.9 to -0.6 cm H(2)O (6% to -2.7%), respectively. Changing from flexion to extension decreased pressure measurements by a mean of 0.9 cm H(2)O (2.5%) [95% CI = 2.1 to -0.1 cm H(2)O (7.6% to -2.4%)]. Changing from extension to flexion increased CSFp by a mean of 1.1 cm H(2)O (6.1%) [95% CI = 0.2 to 2.0 cm H(2)O (1.3% to 11.5%)], a statistically but not clinically meaningful change. CONCLUSIONS: Changing lower-extremity position did not meaningfully change mean CSFp. These data do not support the common suggestion that extending the lower extremities during LP meaningfully decreases CSF opening pressures.

Adolescent↗
PubMed2005

Extreme hyperbilirubinaemia in term and near-term infants in Denmark.

AIM: To determine the incidence amongst infants born at term or near-term of extreme hyperbilirubinaemia, i.e., with a serum concentration of unconjugated bilirubin exceeding the limit above which an exchange transfusion was indicated according to the authorized guidelines. METHOD: The investigation period covered 2 y, 1 January 2000 to 31 December 2001, and included all infants born alive at term or near-term in Denmark. All infants with extreme hyperbilirubinaemia admitted to paediatric departments were recorded. RESULTS: Thirty-two infants developed extreme hyperbilirubinaemia, i.e., an incidence of 25 per 100 000. The maximum total serum bilirubin concentration (TSB) was 492 (385-689) micromol/I (median (range)). The median value of the exchange transfusion limits was 450 micromol/l. Twelve infants had signs and symptoms of central nervous system involvement; 11 had acute bilirubin encephalopathy phase-1 symptoms; and one had phase-2 symptoms. Nineteen infants developed extreme hyperbilirubinaemia during primary admission to the maternity ward or neonatal department; the others after having been discharged. There was no difference in maximum TSB between those infants not discharged from hospital and those infants admitted to hospital from home. Maximum TSB appeared latest amongst those infants admitted from home (p < 0.01), and these more often had signs and symptoms of central nervous system involvement (p < 0.05). Ten infants were of non-Caucasian extraction. Less than half of all Danish mothers receive both verbal and written information after birth on jaundice in the infant. CONCLUSION: Twenty-five per 100 000 infants born at term or near-term developed extreme hyperbilirubinaemia, the majority of them whilst in hospital. Infants admitted from home more often had signs and symptoms of central system involvement.

Bilirubin↗
PubMed2001

An analysis of the effect of lower extremity strength on impact severity during a backward fall.

At least 280 000 hip fractures occur annually in the U.S. at an estimated cost of $9 billion. While over 90 percent of these are caused by falls, only about 2 percent of all falls result in hip fracture. Evidence suggests that the most important determinants of hip fracture risk during a fall are the body's impact velocity and configuration. Accordingly, protective responses for reducing impact velocity and the likelihood for direct impact to the hip, strongly influence fracture risk. One method for reducing the body's impact velocity and kinetic energy during a fall is to absorb energy in the lower extremity muscles during descent, as occurs during sitting and squatting. In the present study, we employed a series of in verted pendulum models to determine: (a) the theoretical effect of this mechanism on impact severity during a backward fall, and (b) the effect on impact severity of age-related declines (or exercise-induced enhancements) in lower extremity strength. Compared to the case of a fall with zero energy absorption in the lower extremity joints, best-case falls (which involved 81 percent activation of ankle and hip muscles, but only 23 percent activation of knees muscles) involved 79 percent attenuation (from 352 J to 74 J) in the body's vertical kinetic energy at impact (KEv), and 48 percent attenuation (from 3.22 to 1.68 m/s) in the downward velocity of the pelvis at impact (v(v)). Among the mechanisms responsible for this were: (1) eccentric contraction of lower extremity muscles during descent, which resulted in up to 150 J of energy absorption; (2) impact with the trunk in an upright configuration, which reduced the change in potential energy associated with the fall by 100 J; and (3) knee extension during the final stage of descent, which "transferred" up to 90 J of impact energy into horizontal (as opposed to vertical) kinetic energy. Declines in joint strength reduced the effectiveness of mechanisms (1) and (3), and thereby increased impact severity However, even with reductions of 80 percent in available torques, KEv was attenuated by 50 percent. This indicates the importance of both technique and strength in reducing impact severity. These results provide motivation for attempts to reduce elderly individuals' risk for fall-related injury through the combination of instruction in safe falling techniques and exercises that enhance lower extremity strength.

Accidental Falls↗
PubMed2004

Variations in the morphology of retinopathy of prematurity in extremely low birthweight infants.

AIMS: To investigate the clinical observations that arteriovenous shunts typical of threshold retinopathy of prematurity (ROP) are morphologically different in extremely low birthweight infants weighing less than 1000 g. METHODS: An observational case series of six extremely low birthweight infants displaying specific features of threshold retinopathy of prematurity enrolled between 1998 and 2001 at one centre. The variant morphology was documented with colour photography and fundus fluorescein angiography before laser therapy. RESULTS: Stage 3 threshold ROP in extremely premature infants may be characterised by a different morphology not demonstrating classic shunt formation. A poorly developed capillary bed is present in already vascularised retina in these cases. CONCLUSIONS: This case series of extremely low birthweight infants display variations in the typical morphological appearance of threshold ROP. In these cases, established plus disease may be present in the absence of arteriovenous shunting. Delaying treatment until a classic stage 3 ridge with extraretinal neovascularisation develops may be detrimental to controlling the disease process. The authors propose that the criteria for threshold disease requiring treatment do not accurately apply in this extremely low birthweight group as defined by the CRYO-ROP study and that treatment should be instituted before the typical threshold features arise. Plus disease remains the most reliable sign indicating the need for treatment.

Acute Disease↗
PubMed2004

Extremity injuries remain a high surgical workload in a conflict zone: experiences of a British Field Hospital in Iraq, 2003.

BACKGROUND: During this conflict 34 Field Hospital, the sole Coalition field hospital located in Iraq, received and treated casualties with a wide range of injuries. Located very close to the front line during the period of combat hostilities, it was potentially going to deal with relatively fewer battle-injured extremities. METHOD: A retrospective review of battle casualties admitted to the hospital was carried out based on casualty records and operating theatre logbooks. Data was collected for the period between the 26th March and the 8th May, focusing on casualties who had surgery for battle-injured extremities during the conflict. RESULTS: Sixty eight (55%) of the 124 casualties who underwent surgery did so for battle injuries to extremities. 139 (58%) of all operating theatre episodes and 189 (53%) of all surgical procedures undertaken were for battle-injured extremities. Fourteen major limb amputations were carried out from a total of 87 battle-injured limbs that had surgery, giving an amputation rate of sixteen percent (14/87). CONCLUSION: The experience at 34 Field Hospital confirms that extremity injuries do confer a high surgical workload in war. Surgical resources should, therefore, be aimed at this and surgical teams deployed to such environments should be well versed in the surgical management of casualties with limb trauma.

Abdominal Injuries↗
PubMed1998

Ergonomic stressors and upper extremity disorders in vehicle manufacturing: cross sectional exposure-response trends.

OBJECTIVE: To evaluate the association between upper extremity soft tissue disorders and exposure to preventable ergonomic stressors in vehicle manufacturing operations. METHODS: A cross sectional study was conducted in one vehicle stamping plant and one engine assembly plant. A standardised physical examination of the upper extremities was performed on all subjects. An interviewer administered questionnaire obtained data on demographics, work history, musculoskeletal symptoms, non-occupational covariates, and psycho-physical (relative intensity) ratings of ergonomic stressors. The primary exposure score was computed by summing the responses to the psychophysical exposure items. Multivariate regression analysis was used to model the prevalence of disorders of the shoulders or upper arms, wrists or hands, and all upper extremity regions (each defined both by symptoms and by physical examination plus symptoms) as a function of exposure quartile. RESULTS: A total of 1315 workers (85% of the target population) was examined. The prevalence of symptom disorders was 22% for the wrists or hands and 15% for the shoulders or upper arms; cases defined on the basis of a physical examination were about 80% as frequent. Disorders of the upper extremities, shoulders, and wrists or hands all increased markedly with exposure score, after adjustment for plant, acute injury, sex, body mass index, systemic disease, and seniority. CONCLUSIONS: Musculoskeletal disorders of the upper extremities were strongly associated with exposure to combined ergonomic stressors. The exposure-response trend was very similar for symptom cases and for physical examination cases. It is important to evaluate all dimensions of ergonomic exposure in epidemiological studies, as exposures often occur in combination in actual workplaces.

Adult↗