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PubMed2006

Efficacy of an alcohol-based healthcare hand rub containing synergistic combination of farnesol and benzethonium chloride.

Healthcare workers are required to disinfect the hands several times a day using hand disinfectants, which leads to chronic hand exposure to high levels of antimicrobials contained in the disinfectants, which could compromise the skin integrity. This problem may be addressed by developing hand disinfectants containing synergistic combinations of small amounts of antimicrobials and other agents. The synergistic effect of farnesol and essential oils with several antimicrobials was studied in vitro to select an effective antimicrobial system in preservative concentration for use in healthcare hand rub. Farnesol and lemon oil showed synergistic activity against S. aureus, in combination with benzalkonium chloride and benzethonium chloride, but not with other antimicrobials studied. All essential oils studied showed synergy with benzethonium chloride against Staphylococcus aureus and Escherichia coli. An alcohol-based healthcare hand rub (ZBF hand rub) containing this unique synergistic combination of farnesol and benzethonium chloride was then developed and its efficacy as a healthcare hand rub was evaluated in human volunteers according to the US FDA-TFM protocol using Serratia marcescens as a marker organism. The ZBF hand rub showed a 3.22 log(10) reduction in the microbial count after the first application and a 5.49 log(10) reduction after the tenth application in vivo and exceeds the US FDA-TFM criteria for healthcare hand rub. The ZBF hand rub did not irritate the hands when tested on human volunteers when applied 10 times everyday for five consecutive days. The ZBF hand rub exhibits more than 5.5 log(10) reduction in the microbial count within 15s and more than 2.8 log(10) reduction in the two types of viruses tested within 30s in vitro. When evaluated in an in vitro pig skin model, the ZBF hand rub shows better prolonged activity (20-35 min post-application) against transient bacteria (S. aureus and E. coli) compared to other alcohol-based hand rubs. These findings suggest that the use of the ZBF hand rub amongst health care workers may lower the risk of chronic hand exposure to high levels of antimicrobials without compromising the efficacy.

Animals↗
PubMed2006

Extent of occupational hand use among persons with rheumatoid arthritis.

OBJECTIVE: Occupational hand use is increasing due to increased computer use and could place persons with rheumatoid arthritis (RA) at risk for work disability. Although hand involvement in RA is typical, there is little information about occupational hand use in relation to RA. Study objectives were to describe the extent of occupational hand use by persons with RA; the types of jobs that require extensive hand use; the relationship between occupational hand use and joint pain; and the extent of occupational hand use among persons with shorter versus longer disease duration. METHODS: Cross-sectional survey data from 2,761 employed participants with RA from a US national cohort were used. Extent of occupational hand use was measured by the hand-use item from a job physical demand scale used in prior RA studies. Analyses included descriptive statistics and chi-square tests. RESULTS: The mean age was 50.6 years, 78.5% were women, 91.8% were white, and 68.8% had more than a high school education. Eighty-three percent of participants reported extensive occupational hand use. Large portions of participants in all types of jobs reported extensive hand use, 92% with administrative support jobs and 69% with operator/laborer jobs. Participants with extensive occupational hand use were more likely to have hand joint pain than those with moderate hand use (66% versus 58%; P = 0.004). Extensive hand use did not vary by disease duration (83% and 84% in participants with < or =15 and >15 years' duration, respectively). CONCLUSION: Extensive occupational hand use was ubiquitous among employed persons with RA and was associated with greater hand pain.

Adolescent↗
PubMed2006

Joint-specific prevalence of osteoarthritis of the hand.

PURPOSE: To quantify the prevalence of radiographic hand osteoarthritis (OA) among a group of community-dwelling individuals. Joint-specific prevalence rates/100 of radiographic OA of the hand were quantified and reported by age, gender, and dominant hand. METHODS: Data from a community-based, longitudinal study designed to follow the natural history of OA were used. Participants were ambulatory men and women, ages 40 years and older, with and without radiographic hand OA (N = 3327). Bilateral hand OA was examined at three joints: second distal interphalangeal joints (DIP), third proximal interphalangeal joints (PIP), and first carpometacarpal joint of the thumb (CMC). The ordinal scale of Kellgren and Lawrence (0-4) was used to determine OA status (grades 2+). RESULTS: Radiographic hand OA status was determined for all persons in the study group comprised of 2302 women (69%) and 1025 men (31%). The sample sizes for the age groups (years) were 532 (40-49), 905 (50-59), 998 (60-69), 749 (70-79), and 143 (80+). Overall, the DIP joint demonstrated the highest OA prevalence, while the PIP joint showed the lowest prevalence. Joint-specific hand OA prevalence rates for second DIP, third PIP, and first CMC were 35%, 18%, and 21%, respectively. Expectedly, hand OA prevalence for all joints increased with age. With exceptions, women demonstrated higher hand OA prevalence rates for the three sites examined. However, among men aged 40-49, the second DIP joint OA rate was higher (13%) compared with women (8%). Additionally, men in that age group demonstrated an elevated first CMC joint OA rate (9%) compared with women (5%). Gender-specific hand dominance analyses demonstrated that the majority of individuals with unilateral second DIP or third PIP OA presented in their dominant hand. However, among those with unilateral first CMC OA, both genders displayed a tendency to present in their nondominant hand. CONCLUSION: These findings suggest the need for further investigation of the role gender can play in the development of hand OA in populations under 60 years of age. Additional epidemiological studies addressing hand OA will serve to bridge the gap between the current levels of knowledge about the knee and the hand. The disease burden of hand OA affects a large percentage of the population. Research efforts that more exhaustively characterize the prevalence of hand OA may contribute toward interventions that, ultimately, impact a rapidly growing segment of our population.

Adult↗
PubMed2004

Bare hands and attention: evidence for a tactile representation of the human body.

If brain lesions impair the allocation of attention to a representation of the body surface and the hand may serve as an attentional focus or "wand", one might expect that somatosensory deficits caused by cerebral lesions would be ameliorated by contact with the ipsilesional hand. To test this prediction, tactile detection tasks were administered to two subjects with right hemisphere lesions. Subject CB's left tactile extinction was investigated in conditions in which the degree of contact between the right and left hands and the spatial relationship between his hands was systematically varied. His left tactile extinction was significantly reduced by touch of the right hand. Similarly, extinction at the left knee was ameliorated by touch of the knee by the right hand; touch of the right foot had no effect. Subject NC's ability to detect a tactile stimulus delivered to the left side was systematically assessed in conditions in which the hands touched and the spatial relationship between the hands was varied. His ability to detect a touch on the left hand improved in conditions in which the left hand was touched by the right hand. This effect was not observed if direct contact between the two hands was prevented by inserting a thin cloth between the hands. For both subjects, placing the right hand in close proximity to the left hand or altering the spatial location of the hands relative to the body did not influence performance. These data demonstrate that the hand may serve as a conduit for attention and provide strong evidence for a distinct representation of the body surface that is at least in part independent of spatial representations.

Attention↗
PubMed2003

Eye-hand coupling during closed-loop drawing: evidence of shared motor planning?

Previous paradigms have used reaching movements to study coupling of eye-hand kinematics. In the present study, we investigated eye-hand kinematics as curved trajectories were drawn at normal speeds. Eye and hand movements were tracked as a monkey traced ellipses and circles with the hand in free space while viewing the hand's position on a computer monitor. The results demonstrate that the movement of the hand was smooth and obeyed the 2/3 power law. Eye position, however, was restricted to 2-3 clusters along the hand's trajectory and fixed approximately 80% of the time in one of these clusters. The eye remained stationary as the hand moved away from the fixation for up to 200 ms and saccaded ahead of the hand position to the next fixation along the trajectory. The movement from one fixation cluster to another consistently occurred just after the tangential hand velocity had reached a local minimum, but before the next segment of the hand's trajectory began. The next fixation point was close to an area of high curvature along the hand's trajectory even though the hand had not reached that point along the path. A visuo-motor illusion of hand movement demonstrated that the eye movement was influenced by hand movement and not simply by visual input. During the task, neural activity of pre-motor cortex (area F4) was recorded using extracellular electrodes and used to construct a population vector of the hand's trajectory. The results suggest that the saccade onset is correlated in time with maximum curvature in the population vector trajectory for the hand movement. We hypothesize that eye and arm movements may have common, or shared, information in forming their motor plans.

Biomechanical Phenomena↗
PubMed1984

Hand behaviors of women during childbirth.

An exploratory study was conducted to determine what could be inferred from the hand behaviors of women during childbirth. The specific study questions were: What are the hand actions? What are the objects of the hand actions? What are the purposes of the hand actions? The influence of the uterine state, i.e., contraction or relaxation, on the hand behaviors was also explored. A preliminary study was conducted from which three components of hand behaviors were identified: the hand action, the object of the action, and the purpose of the action. Nine discrete hand actions were defined according to the inter-relationship of the posture, characteristic motion, and the mode of contact of the hand upon the object: grasping, pressing, rubbing, non-moving, gesticulating, holding, playing, palpating, and striking. The objects of the hand actions were grouped into three distinct groups including: the self, inanimate items, and other persons. Eleven purposes of the hand action were inductively defined from the preliminary study: attacking, augmenting, bracing, caretaking, comforting, containing, inactivating, informing, orienting, regulating, and requesting. A data collection instrument, in grid form, to accommodate the rapid recording of the nine types of hand action, the three objects of the actions, and the eleven purposes of the actions, was constructed. The study was conducted in the labor and delivery unit of an urban university-related teaching and research hospital. The specific setting for the study included two sites: the single bed labor room, the primary site; and the delivery room, the secondary site. Thirty women, 10 primigravida and 20 multigravida, ranging from 17 to 34 years of age were the subjects of the study. Of the 30 subjects, 23 experienced a normal onset of labor and 7 had labor induced. The duration of labor ranged from 1 1/2 to 16 1/2 hours with the mean duration 8 3/4 hours. Direct observation was the method for data collection. Observations were conducted once every half hour throughout the subjects' labor experience. During each observation session, the hand behaviors were recorded during one uterine contraction and during 60 seconds of uterine relaxation. The data were tabulated by frequency and by percentage in relation to the hand action, the object of the hand action, the purpose of the hand action, and the uterine state. Findings related to the hand actions demonstrated a predominance of grasping (28%; 765/2,724) and pressing (25%; 670/2,724) actions. Rubbing actions (16%; 421/2,724) and non-moving actions (11%; 313/2,724) were the next most frequently observed actions.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1999

Changes of somatosensory evoked potentials during writing with the dominant and non-dominant hands.

Since close attention and special effort are necessary to perform difficult unskilled movements, particular brain activities underlying such movements could be expected to take place in the primary sensori-motor cortices (SI and MI). In this study we focused on such activities by analyzing the difference in the somatosensory evoked potential (SEP) in presence to the electrical stimulation of the median nerve during writing using the dominant and non-dominant hands in twelve right-handed and eight left-handed normal subjects. By alternately stimulating the right and left median nerves during the writing with either hand, SEPs were recorded from both hemispheres. During the dominant hand writing, the middle latency SEP components, i.e., parietal P25 and N33 and frontal N30, were significantly attenuated only in the hemisphere contralateral to the writing hand, corresponding to the conventional gating effect. During the non-dominant hand writing, not only those components recorded from the hemisphere contralateral to the writing hand, but also those from the hemisphere ipsilateral to the writing hand were significantly attenuated. In addition, N20 in the hemisphere contralateral to the writing hand was also significantly attenuated. There was no significant difference in the attenuation between the right-handed and left-handed subjects. The results indicated that the specific interaction between the signals after electrical stimulation and the sensory cortical activities related to the writing using the non-dominant hand occurred in both hemispheres, while it was recognized only in the hemisphere contralateral to the writing hand during the dominant hand writing. We speculate that the somatosensory cortex was more activated and thus interacted with the applied stimulation during the unskilled movement of the non-dominant hand compared to the movement of the dominant hand.

Adult↗
PubMed2006

The influence of proprioceptive impairment on hand function in patients with cervical myelopathy.

STUDY DESIGN: A prospective clinical study. OBJECTIVES: To quantitatively evaluate hand function in patients with cervical myelopathy and to assess the influence of proprioceptive impairment on hand function in patients with cervical myelopathy. SUMMARY OF BACKGROUND DATA: Clumsiness of the hands is one of the most common complaints in patients with cervical myelopathy. However, few reports have been published that evaluate hand dysfunction, and no reports have assessed the association between hand function and proprioceptive impairment. PATIENTS AND METHODS: A total of 129 patients (36 women and 93 men) with cervical myelopathy were examined. Hand function was evaluated as scores of ten subtests designed on the basis of various hand activities. The degree of proprioceptive impairment of the hand as well as that of light touch sensation loss is classified into four grades. Scores of the hand function test are compared according to the grade of proprioceptive impairment of the hands. RESULTS: Significant relation between the impairment of hand function and the extent of cervical myelopathy was observed. There was good correlation between the hand function scores and the grade of impairment of proprioception and light touch sensation. Furthermore, patients with impairment of proprioception obtained significantly lower scores in the hand function test than those with loss of light touch sensation. CONCLUSIONS: The hand function test is a useful battery to objectively and quantitatively evaluate impairment of cervical myelopathy, although longitudinal studies are needed to determine its practical usability. There was some relation between scores of hand function test and the extent of proprioceptive impairment. Thus, hand function test may be partly influenced by proprioceptive loss.

Adult↗
PubMed2005

Analysis of burned hand function (early versus delayed treatment).

UNLABELLED: The aim of this study was analyze the results of hand function in adult patients with deep partial thickness hand burns. All patients were treated in Kaunas University of Medicine Hospital in Lithuania during the period 2001-2004. MATERIAL AND METHODS: A total of 79 cases were reviewed prospectively. We divided the studied patients into two groups by the envelope method (A group of early and B of delayed necrectomy and plasty). Two treatment methods--early and delayed surgery--have been analyzed. We present results of analysis of hand function in the periods of 3 and 12 months after the burn injuries of the hands. RESULTS: During the study we ascertain that the deficiency of hand function in group A 3 and 12 months after the injury was lower than that in group B. The deficiencies of hand and arm functions decreased over time. After a period of 12 months the deficiency of hand and arm functions in group A reached 12%, while in group B the deficiencies of hand and arm function reached 23% and 26.5%, respectively. The study revealed that the deficiency of hand function because of wrist and hand burn depended on the age of patient, the area of hand burn, time period from the injury to the arriving to a hospital and time to the operation. The strength of digit pinch and hand grasp was larger in group A. Twelve months after the burn the strength measured in A and B groups was larger than that measured 3 months after the burn. The strength of hand grasp in group A in male patients regenerated up to 76%, in female--61% of norm. In group B the strength of hand grasp in male patients regenerated up to 60.8% and in female--39.36%. CONCLUSIONS: During the perspective analysis it was determined that after periods of 3 and 12 months after the injury the strength pinch and grip was statistically significantly larger in group A. The deficiency of hand function, which indicates the general hand function, was statistically significantly lower in group A.

Adult↗
PubMed1986

[Morphology and classification of cleft hands].

It is the intention of this study to present a more profound investigation of the morphology of cleft hands and to provide a new classification based on the results of that investigation. After a short review of the literature, which shows the different opinions regarding heredity, pathogenesis and classification of cleft hand, the authors demonstrate their own patients with 35 cleft hands: The deformities were mostly bilateral and associated with cleft feet. In unilateral cases the right side was more common. Males were in the majority. This paper puts emphasis on the analysis of X-ray morphology. The authors are able to demonstrate that the cleft hand shows several peculiarities which have not been yet sufficiently respected. It was found out, that, apart from aplasia of the bones and soft tissue, synostosis is often the origin of clefting. In 40% of our cases the cleft was caused exclusively by synostosis, in a further 34% it derived partly from synostosis of the phalanges and the metacarpal bones. In the carpus we found osseous deformities surprisingly often, a feature which has hardly been mentioned in former studies. Among the numerous associated malformations emphasis must be placed on the osseous syndactylies and the central polydactylies, because they are closely related to the cleft hand as shown by Ogino. 18 of our own cases belong to this group. Our investigations lead us to the following classification: Cleft hand type 1: Cleft hands with osseous defects (aplasias) Cleft hand type 2: Cleft hands with synostosis Cleft hand type 3: Cleft hands with aplasias and synostosis Hands with central polydactyly and synostosis as preforms of the cleft hand could be classified in type 4. These phenomena form the beginning of the teratological row towards the completely developed cleft hand. In combination with Blauth's distribution of cleft hands, who distinguished the median and medio-lateral form (1976, 1978) this new classification enables each cleft hand to be placed into one of the different types, which are analysed: Type 1 mostly shows a medio-lateral form, is always combined with cleft feet and shows heredity in 50% of the cases. It cannot be classified by the Ogino method. Type 2 mostly shows a median form, is not frequently combined with cleft feet, heredity occurs in one third of the cases. This type can very often be classified by the Ogino method. Type 3 varies from case to case because of the different items of defects.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1999

Hand specialization, sympatry, and mixed-species associations in callitrichines.

Hand morphology in callitrichines (i.e., tamarins, marmosets, and Goeldi's monkey) is correlated with positional and foraging behaviors. This study examines hand shape in callitrichines using an allometric approach. It addresses a series of questions relating hand anatomy, insect foraging behavior, and resource partitioning in callitrichines. The main questions are: 1. Do the hands of Leontopithecus differ in shape from all other callitrichine taxa allowing it to perform highly manipulative prey foraging behaviors? 2. Are the hands of Saguinus fuscicollis adapted to manipulative foraging, and are they functionally similar to Leontopithecus' hands? 3. Is hand morphology in S. fuscicollis more similar to the hand morphology of sympatric tamarin species with whom it does not form mixed species troops (S. nigricollis and S. tripartitus) than to those sympatric tamarin species with whom it does form mixed troops (S. mystax, S. labiatus, and S. imperator)? Measurements of hand length (HL), width (HW), and thickness (HT) were taken from 1350 museum specimens of callitrichines (Callithrix, Cebuella, Leontopithecus, Saguinus, and Callimico), squirrel monkeys (Saimiri), and owl monkeys (Aotus). The analysis indicates that hand shape covaries with foraging strategy. Specifically, the hands of Leontopithecus are adapted for manipulative foraging and are relatively longer and more slender than the hands of other callitrichines. A similar pattern is observed in the hands of S. fuscicollis, S. tripartitus and S. nigricollis. These latter species, however, differ significantly in shape from all other tamarin species. Large differences in hand morphology are observed among tamarin species that form mixed-species troops. These anatomical differences may permit resource partitioning and coexistence among these closely related taxa. Hand shape, expressed as log HLGM (logged hand length divided by the geometric mean of all measurements), is a good predictor of manipulative and non-manipulative prey foraging techniques employed by callitrichines.

Animals↗
PubMed1992

Human control of a simple two-hand grasp.

We investigated how people control fast, accurate movements of a load using a simple two-hand grasp. By providing a clear instruction to several subjects, we isolated a single control strategy. The kinematics produced by this control strategy are nearly indistinguishable from those produced during singlehand movements, but the torques are quite different: one hand accelerates not only itself, but also the load and the other hand, while the other hand brakes the hand-load-hand system. As a result, the hands squeeze the load with a large force during the movement. The dynamics of the hand-load-hand system are of the same form as the dynamics of a single-hand system. Apparently, by taking advantage of this dynamic similarity and of the spring-like properties of muscle, the human motor control system can control the two-hand grasp system simply by modifying the muscle activation patterns used to control single-hand movements. The task dynamics of two-hand grasp do not require that the load be squeezed during the movement, and squeezing the load wastes torque that could be used to move more quickly. However, the human motor control system may choose this squeezing strategy because it reliably brakes the hand-load-hand system despite inherent variability in the braking of individual hands.

Acceleration↗
PubMed2006

Hierarchies of synergies: an example of two-hand, multi-finger tasks.

We explored the ability of the central nervous system (CNS) to assemble synergies stabilizing the output of sets of effectors at two levels of a control hierarchy. Specifically, we asked a question: can the CNS organize both two-hand and within-a-hand force stabilizing synergies in a simple two-hand force production task that involves two fingers per hand? Intuitively, one could expect a positive answer; that is, forces produced by each hand are expected to co-vary negatively across trials to bring down the total force variability, while forces produced by each finger within-a-hand are expected to co-vary negatively to reduce the variability of that hand's contribution to the total force. The subjects were instructed to follow a trapezoidal time profile with the signal corresponding to the force produced by a set of instructed fingers in one-hand tasks with two-finger force production and in two-hand tasks with involvement of both symmetrical and asymmetrical finger pairs in the two hands. Finger force co-variation across trials was quantified and used as an index of stabilization of the force produced by all the instructed fingers, and of the force produced by finger pairs within-a-hand. No major differences were seen between the dominant and the non-dominant hand and between the two-hand tasks with symmetrical and asymmetrical finger involvement. Stronger synergies were seen in the index-middle finger pair as compared to the ring-little finger pair. The main result of the study is the significantly weaker or even lacking two-finger force stabilizing synergies within-a-hand during two-hand tasks while such synergies were present in one-hand tasks. This observation points at a potential limitation in the ability of the CNS to organize synergies at two levels of a control hierarchy simultaneously. It also allows suggesting a hypothesis on two types of synergies in the human motor repertoire, well-practiced synergies that form a library serving as the foundation for all novel actions, and freshly assembled synergies.

Adult↗
PubMed2005

A review of hand surgery provision in England.

This study reviews hand surgical activity and the resources available for provision of hand surgery in England in 2001. Operation rates for three common procedures, viz. carpal tunnel release, Dupuytren's surgery and ganglion surgery, were considered. The local population and the number of hand surgeons in each NHS Hospital Trust were compared. We identified 275 consultant surgeons with an interest in hand surgery working in the NHS in England. Approximately two-thirds were orthopaedic surgeons, almost one-third were plastic surgeons and a small number were accident and emergency surgeons. Half of all hand surgeons worked in large units, with three or more hand surgeons, but almost 20% of hand surgery was delivered in hospitals in which there was no surgeon with a declared interest in hand surgery. Surgery rates for Dupuytren's contracture varied from 0.04 to 0.36 cases per 1,000 population per annum and for carpal tunnel syndrome varied from 0.25 to 1.31 cases per 1,000 per annum. We found a correlation between rates of surgery and the number of hand surgeons, locally. A recent audit (Burke, Dias, Heras-Pelou, Bradley, & Wildin, 2004. Providing care for hand disorders, a reappraisal of need. Journal of Hand Surgery, 29B: 575-579.) has suggested that one hand surgeon is required to meet the needs of a population of 125,000, with a national requirement for 393 hand surgeons. We conclude that there are insufficient hand surgeons in England and believe that the wide local variations in hand surgery rates are indicative of a significant unmet demand for hand surgery in the English population.

Carpal Tunnel Syndrome↗
PubMed2000

Fist position for skin grafting on the dorsal hand: II. Clinical use in deep burns and burn scar contractures.

The fundamental problem in all types of hand burns is a loss of skin and subsequent deformities. The goal of skin grafting on the dorsal hand is to graft a sufficient amount of skin, as much as the original amount, and to restore normal hand function without secondary deformities. The safe, or Michigan, position commonly has been used for immobilizing the hand. However, this position is to protect hand function rather than to provide for adequate skin grafting. This institution has developed a new hand position (the fist position) for grafting the greatest amount of skin on the dorsal side of the hand. In the fist position, the hand is positioned flexing all joints of the wrist and the fingers and maximally stretching the dorsal surface of the hand before skin grafting. Ten hands with deep second- or third-degree burn (n = 6) and burn scar contracture (n = 4) of the dorsal hand in eight patients were treated with split-thickness skin grafting after immobilizing in the fist position. The burns and contractures involved nearly the total area of the dorsal hand. The hand was kept in the fist position for 7 to 9 days after skin grafting. Excellent functional and cosmetic results were observed in all cases during the follow-up period of 6 months to 2 years. Complications resulting from hand immobilization for a short period did not occur. The fist position may be a proper hand position for skin grafting to reconstruct the dorsal hand.

Adolescent↗
PubMed2004

Coerced training of the nondominant hand resulting in cortical reorganization: a high-field functional magnetic resonance imaging study.

OBJECT: The authors investigated brain strategies associated with hand use in an attempt to clarify genetic and nongenetic factors influencing handedness by using high-field functional magnetic resonance imaging. METHODS: Three groups of patients were studied. The first two groups comprised individuals in whom handedness developed spontaneously (right-handed and left-handed groups). The third group comprised individuals who were coercively trained to use the right hand and developed mixed handedness, referred to here as trained ambidexterity. All trained ambidextrous volunteers were certain that they were innately left-handed, but due to social pressure had modified their preferred hand use for certain tasks common to the right hand. Although right-handed and left-handed volunteers displayed virtually identical cortical activation, involving homologous cortex primarily located contralateral to the hand motion, trained ambidextrous volunteers exhibited a clearly unique activation pattern. During right-handed motion, motor areas in both hemispheres were activated in these volunteers. During left-handed motion, the right supplemental motor area and the right intermediate zone of the anterior cerebellar lobe were activated significantly more frequently than observed in naturally right-handed or left-handed volunteers. CONCLUSIONS: The results provide strong evidence that cortical organization of spontaneously developed right- and left-handedness involves homologous cortex primarily located contralateral to the hand motion, and this organization is likely to be prenatally determined. By contrast, coerced training of the nondominant hand during the early stages of an individual's development results in mixed handedness (trained ambidexterity), indicating cortical reorganization.

Cerebral Cortex↗
PubMed2004

[Emergency treatment of hand trauma in France, an important public health challenge].

For decades hand trauma surgery was a small branch of general surgeons' practice. Only after the second world war did some orthopaedic or plastic surgeons with specific training in microsurgery start to sub-specialize in hand surgery. In the past 50 years, National Hand Societies have been created all over the world Hand trauma represents a significant proportion of emergency room attendance, and 20-25 % of traumatic emergencies. Most hand trauma patients are manual workers, who are sometimes injured at work. Hand injuries can result in lengthy periods off work. Incorrect emergency assessment and treatment by a non specialist surgeon can lead to poor outcomes. This can also increase the costs to society, owing to the need for further surgical procedures and physiotherapy. Hand trauma can be prevented by providing a safer environment at home, at work and in the playground Better trauma outcomes can be achieved by early referral to a Hand Center. In France, there are now almost 50 hand trauma centers. These are open 24 hours a day, 365 days a year, with a specialist hand surgeon on call. The latter will have diplomas in microsurgery and in hand and upper limb surgery, plus two years of experience as a fellow in a hand surgery unit. There is now a European Federation of Hand Trauma Centers (FESUM: Federation Européenne des services d'Urgence-mains) with hand centers in Belgium, Italy, Germany, the UK, Luxembourg, Spain and Switzerland These work under the umbrella of the European Federation of Societies for Surgery of the Hand (FESSH). However, only a small percentage of hand trauma victims are referred to such a centers. Awareness of these centers must be improved among both health care professionals and the public.

Ambulatory Care Facilities↗
PubMed2003

Lower prevalence of hand osteoarthritis among Chinese subjects in Beijing compared with white subjects in the United States: the Beijing Osteoarthritis Study.

OBJECTIVE: Fewer Chinese subjects in Beijing have hip osteoarthritis (OA) compared with whites in the United States, but as many or more Chinese subjects have knee OA. If these differences are due to a systemic predilection for disease, then the prevalence of hand OA, the best indicator of generalized disease, should be different in China. The goals of this study were to estimate the prevalence of hand OA among elderly Chinese in Beijing, and to compare it with that among elderly whites in the United States. METHODS: We recruited a random sample of Beijing residents ages > or =60 years. Subjects answered questions on joint symptoms and provided posteroanterior radiographs of the hand. The protocol was identical to that used in the Framingham, Massachusetts OA Study. The hand radiographs from the Beijing OA Study were read intermingled with films from the Framingham OA Study. We defined a hand joint as having radiographic OA if it had a Kellgren and Lawrence grade >/=2. Symptomatic OA was present when both radiographic OA and self-reported pain were present in the same joint. We classified a subject as having radiographic or symptomatic hand OA if at least 1 hand joint had radiographic or symptomatic OA. We estimated the prevalence of hand OA in elderly subjects in Beijing and compared it with the prevalence of hand OA in elderly subjects from Framingham, using an age-standardized prevalence ratio. RESULTS: We obtained both symptom information and hand radiographs from 2,525 subjects. Despite the older age of the group, only 44.5% of men and 47.0% of women had radiographic hand OA. Symptomatic hand OA occurred in 3.0% of men and 5.8% of women. Compared with white men in Framingham, the Beijing Chinese men had a much lower prevalence of radiographic hand OA (age-adjusted prevalence ratio 0.64, 95% confidence interval [95% CI] 0.58-0.70) and symptomatic hand OA (age-adjusted prevalence ratio 0.25, 95% CI 0.16-0.34). The proportion of multiple hand joints affected by OA in Chinese men was also significantly lower than in white men. A similar magnitude of difference was also observed in the women. However, prevalence of symptomatic OA at the metacarpophalangeal (MCP) joints in Chinese men and prevalence of radiographic OA at the MCP joints in Chinese women were similar to those in their white counterparts in Framingham. CONCLUSION: Elderly Chinese subjects in Beijing had a much lower prevalence of hand OA than did elderly whites in Framingham, Massachusetts. Coupled with the exceedingly low prevalence of hip OA in China, these results may suggest that the overall predilection for OA is less among subjects in China than among whites in the United States.

Aged↗