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At least 1,099 records · Page 61Linked to original sources
PubMed2005

Hand disability and related variables in patients with rheumatoid arthritis.

OBJECTIVE: To carry out a cross-sectional study of patients with rheumatoid arthritis (RA) for hand disability, articular damage and to define their relation with demographic, laboratory and clinical parameters. METHODS: The study included 105 RA patients with a mean age of 49.4 years. Demographic parameters of the patients were recorded. Clinical parameters including disease duration, duration of morning stiffness, pain assessed by visual analog scale, Ritchie Articular Index, grip strength, lateral, tip and three-fingered pinch, and laboratory parameters comprising C-reactive protein, erythrocyte sedimentation rate and rheumatoid factor were evaluated in all patients. The Rheumatoid Arthritis Articular Damage (RAAD) score was used to assess the irreversible articular damage and deformities of the hand. Hand disability was assessed by the special hand disability index of Standford Health Assessment Questionnaire (HAQ). RESULTS: Hand disabilities of various levels were detected in 81% of the patients. Disease duration, grip strength, pinch measurements, clinical and laboratory activity parameters were strongly correlated with hand disability (p<0.01). Hand disability was more related to disease activity parameters than articular damage (p<0.01 and p<0.05, respectively). Grip strength and pinch measurements were the most related parameters with hand disability. The disability scores were significantly higher in female patients (p<0.01). The RAAD score was correlated with disease duration and grip strength (p<0.01). The clinical and laboratory parameters and seropositivity were not correlated with articular damage assessed by RAAD score (p>0.05). CONCLUSION: Our data suggest that grip strength and pinch measurements seem to be the most related variables with hand disability and articular damage. Therefore, grip strength and pinch measurement should be included in the evaluation and follow-up of the patients with RA in hand rehabilitation units.

Adult↗
PubMed2005

An alcohol hand rub containing a synergistic combination of an emollient and preservatives: prolonged activity against transient pathogens.

A new alcohol-based hand antiseptic (Octoxy hand rub) containing a synergistic combination of an emollient (Octoxyglycerine) and preservatives was developed and evaluated for immediate and prolonged activity against transient bacteria. The in vitro and in vivo antimicrobial efficacy was compared with other alcohol hand rubs containing preservative/antimicrobial (Prevacare and Avagard). In vitro evaluation was carried out using a tube-dilution method and a pig-skin model. Rapid and prolonged efficacy in vivo was evaluated against Staphylococcus epidermidis on the hands of volunteers. Octoxy hand rub was 100% effective in rapidly killing pathogens including methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium in vitro. In volunteers, all three hand rubs gave a significant reduction in microbial count within 15s. Octoxy hand rub showed significantly higher efficacy against S. aureus and Escherichia coli than Avagard and Prevacare 15 min after application to the pig-skin model, and against S. epidermidis in both the pig-skin model and in volunteers. Use of Octoxy hand rub with broad-spectrum immediate and prolonged antimicrobial activity may be a very effective way of improving hand hygiene without exposing the hands to higher concentrations of antimicrobials.

Administration, Cutaneous↗
PubMed2006

Relationship of global assessment of change to AUSCAN and pinch and grip strength among individuals with hand osteoarthritis.

OBJECTIVE: This study assessed the utility and construct validity of a new patient global assessment of symptom change for hand osteoarthritis (OA) by examining its associations with change over time in grip strength, pinch strength, and AUStralian CANadian Osteoarthritis Hand Index (AUSCAN). METHODS: Participants (N=531, 80% female, mean age=68) were part of a study on the Genetics of Generalized Osteoarthritis (GOGO) and completed two assessments (average 4 years apart). At the second assessment, participants described change in their right and left hand pain, aching, and stiffness on a 15-point scale with descriptors ranging from "Great deal worse" to "Great deal better". Linear regression models examined associations of global change scores with changes in hand strength and AUSCAN, controlling for age, gender, number of hand joints with OA, and time between assessments. RESULTS: Both right and left hand global assessment of change scores were significantly associated with change in AUSCAN, grip strength, and right hand pinch strength (P<0.05), and approached significance for left hand pinch strength (P=0.06). The strongest associations were between global change scores and AUSCAN change (right hand: beta=0.29, P<0.001; left hand: beta=0.27, P<0.001). Associations of change scores with grip and pinch strength were stronger among participants with greater radiographic OA severity at baseline. CONCLUSION: Results support the validity of this new global assessment of symptom change. This measure is particularly useful for assessing change over time when no baseline data are available. Additional research should examine this measure's responsiveness in the context of clinical trials.

Aged↗
PubMed2005

Fibers connecting the primary motor and sensory areas play a role in grasp stability of the hand.

The goal of this study was to evaluate the function of fibers that connect the hand area of the primary motor and sensory cortices. A 63-year-old male with a metastatic brain tumor located in the left primary motor area underwent awake surgery. During removal of the tumor, the posterior end of the primary motor cortex, including the fibers between the motor and sensory cortex, was resected, as confirmed by 3D reconstruction of fMRI and diffusion tensor imaging (DTI). Preoperative fMRI with right hand clenching revealed activation in the area around the tumor in the primary motor area. Postoperative fMRI with right hand clenching showed posterior shift of the activation to the sensory area. In contrast, 3D reconstruction of fMRI and DTI with left hand clenching showed activation of cortex corresponding to the motor and sensory hand area. Postoperative neurological examination revealed no change in right hand strength, but the patient complained of decrease right hand grasp stability when he concentrated on using his left hand. These findings suggest that the fibers connecting the primary hand motor and sensory areas play a role in the hand grasp stability.

Brain Neoplasms↗
PubMed2005

Frequency of hand use in healthy older persons.

The aim of this study was to describe the type and frequency of hand use in healthy older adults. Observational studies were conducted involving structured observations at five-minute intervals on 15 healthy older adults as they went about their normal daily routine between 10.00 am and 2.00 pm. Overall, the dominant hand was used more frequently than the non-dominant hand. Subjects used their hands predominantly to hold and manipulate objects, and not for balance. There was no significant difference between the frequency of manipulating objects with the fingers and the frequency of use of the whole hand. Subjects used their hands significantly more often in bimanual activities than in unimanual activities or in no activity. Although subjects usually stood while they held or manipulated objects, they also sat or walked while manipulating them. The present study provides insights into how healthy older adults naturally use their hands in performing everyday activities. While the dominant hand is used more than the non-dominant hand, the hands are used predominantly together to perform bimanual tasks.

Activities of Daily Living↗
PubMed2003

A comparison of the bacteria found on the hands of 'homemakers' and neonatal intensive care unit nurses.

This prevalence study was conducted to compare the counts, types and antimicrobial resistance profiles of bacterial flora on the hands of individuals in the community to that of nurses at a nearby university teaching hospital, with an intense hand hygiene regimen. Hand cultures were obtained from 204 individuals during a home visit and 119 nurses in two neonatal intensive care units (NICUs). The mean total log counts of organisms were 5.73 and 5.24 for the homemakers [defined as the person (usually the mother) who is the primary person responsible for arranging childcare, cooking, cleaning etc] and nurse hands, respectively (P<0.0001). Significantly more homemakers had Acinetobacter lwoffii, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, P. fluorescens/putida, and Staphylococcus aureus on their hands compared with the nurses (all P<0.05). However, significantly more nurses had Enterococcus faecalis, S. epidermidis, and S. warneri on their hands (P<0.05). Of note, the hands of nurses harboured significantly more S. epidermidis strains resistant to amoxicillin/clavulanate, cefazolin, clindamycin, erythromycin, and oxacillin and S. warneri resistant to amoxicillin/clavulanate, cefazolin, clindamycin, and oxacillin (P<0.05). Surprisingly, significantly more trimethoprim/sulfamethoxazole-resistant S. epidermidis and ciprofloxacin-resistant S. warneri was recovered from the hands of homemakers (P<0.05). This study demonstrates differences in prevalence, bacterial composition and antimicrobial resistance of hand flora of hospital personnel compared with homemakers. Moreover, the hands of homemakers may serve as community reservoirs for antimicrobial resistant strains of clinical importance.

Adult↗
PubMed1998

Changes in bacterial flora associated with skin damage on hands of health care personnel.

In a prospective observational study of 40 nurses (20 with diagnosed hand irritation and 20 without), nurses with damaged hands did not have higher microbial counts (P = .63), but did have a greater number of colonizing species (means: 3.35 and 2.63, P = .03). Although numbers were small, nurses with damaged hands were significantly more likely to be colonized with Staphylococcus hominis (P = .03). Fifty-nine percent of S hominis isolates from nurses with damaged hands were resistant to methicillin compared with 27% of isolates from those with healthy skin (P = .14). Twenty percent of nurses with damaged hands were colonized with Staphylococcus aureus compared with none of the nurses with normal hands (P = .11). Nurses with damaged hands were also twice as likely to have gram-negative bacteria (P = .20), entercocci (P = .13), and Candida (P = .30) present on the hands. Antimicrobial resistance of the coagulase-negative staphylococcal flora (with the exception of S hominis) did not differ between the 2 groups, nor did a trend toward increasing resistance exist when compared with other studies during the past decade. Skin moisturizers and protectant products were used almost universally by nurses at work, primarily products brought from home. Efforts to improve hand condition are warranted because skin damage can change microbial flora. Such efforts should include assessment or monitoring of hand care practices, formal institutional policy adoption and control of use of skin protectant products or lotions, and prudent use of latex gloves or more widespread use of powder-free and nonlatex products.

Adult↗
PubMedDate not supplied

Correlation between objective and subjective measures of hand function in patients with rheumatoid arthritis.

The association between the Sollerman test of hand grip and the Sequential Occupational Dexterity Assessment (SODA) and their relationship to impairment and subjective disability measures were examined. Twenty-five patients with rheumatoid arthritis affecting their hands participated in a clinical and subjective evaluation. Clinical evaluation included the use of the two hand function instruments and measurement of finger range of motion. Subjective evaluation was done by means of a patient questionnaire comprising 20 questions from the Health Assessment Questionnaire and by visual analog scales for rating pain severity and hand function. Results confirmed a strong association between the Sollerman test of hand grip and the SODA. Both instruments were found to correlate significantly with subjectively assessed hand function. Associations between the results of the two hand function tests and subjective pain and disability assessments in global daily tasks were weak. The SODA instrument more consistently correlated to the limitations in finger motion than did the Sollerman test of hand grip. This study demonstrates that the SODA and the Sollerman test of hand grip produce similar information under controlled conditions in this patient group despite their differences in conceptual development and measurement properties. A generalized measure such as the Health Assessment Questionnaire or the pain visual analog scale alone is insufficient to represent what patients can do with their hands in daily life.

Activities of Daily Living↗
PubMed2000

Evolution of the human hand: approaches to acquiring, analysing and interpreting the anatomical evidence.

The discovery of fossil hand bones from an early human ancestor at Olduvai Gorge in 1960, at the same level as primitive stone tools, generated a debate about the role of tools in the evolution of the human hand that has raged to the present day. Could the Olduvai hand have made the tools? Did the human hand evolve as an adaptation to tool making and tool use? The debate has been fueled by anatomical studies comparing living and fossil human and nonhuman primate hands, and by experimental observations. These have assessed the relative abilities of apes and humans to manufacture the Oldowan tools, but consensus has been hampered by disagreements about how to translate experimental data from living species into quantitative models for predicting the performance of fossil hands. Such models are now beginning to take shape as new techniques are applied to the capture, management and analysis of data on kinetic and kinematic variables ranging from hand joint structure, muscle mechanics, and the distribution and density of bone to joint movements and muscle recruitment during manipulative behaviour. The systematic comparative studies are highlighting a functional complex of features in the human hand facilitating a distinctive repertoire of grips that are apparently more effective for stone tool making than grips characterising various nonhuman primate species. The new techniques are identifying skeletal variables whose form may provide clues to the potential of fossil hominid hands for one-handed firm precision grips and fine precision manoeuvering movements, both of which are essential for habitual and effective tool making and tool use.

Animals↗
PubMed2001

A cross-sectional study of the association between Heberden's nodes, radiographic osteoarthritis of the hands, grip strength, disability and pain.

OBJECTIVE: To describe the associations between hand osteoarthritis (OA), pain and disability in males and females and to further validate the Australian/Canadian OA hand index (AUSCAN LK3.0). DESIGN: Cross-sectional study of 522 subjects from 101 Tasmanian families (males N=174, females N=348). Hand OA was assessed by two observers using the Altman atlas for joint space narrowing and osteophytes at distal interphalangeal and first carpometacarpal joints as well as a score for Heberden's nodes based on hand photography. Hand pain and function were assessed by the AUSCAN LK3.0 and grip strength by dynamometry in both hands on two occasions. RESULTS: The prevalence of hand OA was high in this sample at 44-71% (depending on site). Pain and dysfunction increased with age while grip strength decreased (all P< 0.001). All three measures were markedly worse in women, even after taking the severity of arthritis into account. Hand OA explained 5.7-10% of the variation in function, grip strength and pain scores, even after adjustment for age and sex. Further adjustment suggested that the osteoarthritic associations with function and grip strength were largely mediated by pain. Severity of disease was more strongly associated with these scores than presence or absence. Lastly, the AUSCAN LK3.0 showed a comparable association to grip strength with structural damage providing further evidence of index validity. CONCLUSIONS: Hand OA at these two sites makes substantial contributions to hand function, strength and pain. The associations with function and strength measures appear mediated by pain. Gender differences in all three measures persist after adjustment for variation in age and OA severity indicating that factors apart from radiographic disease are responsible.

Age Factors↗
PubMed2003

Introduction of a waterless alcohol-based hand rub in a long-term-care facility.

OBJECTIVE: To examine the impact of introduction of an alcohol-based hand rub on hand hygiene knowledge and compliance and hand colonization of healthcare workers (HCWs) in a long-term-care facility (LTCF). METHODS: Two floors of an LTCF participated. Ward A used the hand rub as an adjunct to soap and water; ward B was the control. HCWs' hands were cultured using the bag-broth technique for Staphylococcus aureus, gram-negative bacilli (GNB), Candida, and vancomycin-resistant enterococci (VRE). HCWs completed a questionnaire at baseline and after an educational intervention and introduction of rub. RESULTS: Hand hygiene practices, knowledge, and opinions did not change after the educational or rub intervention. Ward A HCWs thought that the rub was faster (P = .002) and less drying (P = .04) than soap. Hand hygiene frequency did not differ at baseline between the two floors, but increased on ward A by the end of the study (P = .04). HCWs were colonized frequently with GNB (66%), Candida (41%), S. aureus (20%), and VRE (9%). Although colonization did not change from baseline on either ward, the rub was more effective in clearing GNB P =.03) and S. aureus (P = .003). Nosocomial infection rates did not change. CONCLUSION: The alcohol-based hand rub was a faster, more convenient, less drying method of hand hygiene for HCWs in an LTCF, and it improved compliance. Although microbial colonization did not change, the rub was more efficacious in removing pathogens already present on the hands of HCWs.

Anti-Infective Agents, Local↗
PubMed2004

Dynamics of bacterial hand contamination during routine neonatal care.

OBJECTIVE: To evaluate the dynamics of bacterial contamination of healthcare workers' (HCWs) hands during neonatal care. SETTING: The 20-bed neonatal unit of a large acute care teaching hospital in Geneva, Switzerland. METHODS: Structured observation sessions were conducted. A sequence of care began when the HCW performed hand hygiene and ended when the activity changed or hand hygiene was performed again. Alcohol-based handrub was the standard procedure for hand hygiene. An imprint of the five fingertips of the dominant hand was obtained before and after hand hygiene and at the end of a sequence of care. Regression methods were used to model the final bacterial count according to the type and duration of care and the use of gloves. RESULTS: One hundred forty-nine sequences of care were observed. Commensal skin flora comprised 72.4% of all culture-positive specimens (n = 360). Other microorganisms identified were Enterobacteriaceae (n = 55, 13.8%); Staphylococcus aureus (n = 10, 2.5%); and fungi (n = 7, 1.8%). Skin contact, respiratory care, and diaper change were independently associated with an increased bacterial count; the use of gloves did not fully protect HCWs' hands from bacterial contamination. CONCLUSIONS: These data confirm that hands become progressively contaminated with commensal flora and potential pathogens during neonatal care, and identify activities at higher risk for hand contamination. They also reinforce the need for hand hygiene after a sequence of care, before starting a different task, and after glove removal.

Alcohols↗
PubMed1998

Hand dermatitis in intensive care units.

An investigation of the prevalence of occupational hand dermatitis in two intensive care units at a large teaching hospital was conducted. Information concerning the presence of occupational hand dermatitis, frequency of hand-washing, severity of the rash, aggravating conditions, history of atopy, and demographic factors (age, race, gender, and occupation) was collected via a self-administered questionnaire. The prevalence of occupational hand dermatitis was found to be 55.6% in the total reporting population of the units and was 69.7% in the most highly exposed workers (those reporting a frequency of hand-washing exceeding 35 times per shift). No relationship was found between occupational hand dermatitis and reported age, gender, race, atopic status, history of previous hand dermatitis, and duration of employment. Hand-washing frequency greater than 35 times per shift was strongly associated with occupational hand dermatitis (odds ratio = 4.13, P < 0.005). The high prevalence of occupational hand dermatitis found in this study of intensive care unit workers causes concern regarding the risk of health care workers in such units when exposed to blood-borne diseases.

Adult↗
PubMed2000

Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use.

BACKGROUND: Hand decontamination is crucial to control nosocomial infections. The utility of hand decontamination is related not only to its antimicrobial effectiveness, but also to its acceptability by hospital staff. OBJECTIVES: We aimed to assess skin tolerance and antimicrobial effects of two widely accepted hand hygiene measures under in-use conditions. METHODS: Fifty-two nurses were randomly assigned for an 8-day period to either an alcohol-based disinfectant or a hand wash with a non-antiseptic soap. At baseline and at the end of the test period, microbiological hand samples were obtained both before and after a hand hygiene procedure, and skin tolerance was assessed using clinical scores and measurement of transepidermal water loss. RESULTS: Self-assessment of skin condition and grade of skin damage worsened significantly more in the group using soap than in the group using alcoholic disinfectant (P = 0.004 and P = 0.01, respectively). The alcohol-based rinse was significantly more effective than liquid soap in removing transient contaminant micro-organisms (P = 0.016). Twenty of 50 hand washes with non-antiseptic soap apparently resulted in bacterial contamination of the hands. At the end of the study, the total bacterial count increased with the increasing number of hand washes in the soap group (P = 0.003), and with the degree of skin damage (P = 0.005) in the antiseptic group. CONCLUSIONS: In everyday hospital practice, alcohol-based disinfectant is more effective and better tolerated than non-antiseptic soap; soap is at risk of spreading contamination; and skin comfort strongly influences the number and the quality of hand hygiene procedures.

Alcohols↗
PubMed2003

Normative data and developmental characteristics of hand function for elementary school children in Suwon area of Korea: grip, pinch and dexterity study.

This study was designed to establish norms of hand function, and to identify developmental characteristics of hand function among the Korean children. 712 elementary school children participated in measurement of grip strength, three kinds of pinch strength, and dexterity. The hand strength of the Korean children appeared to be weaker than that of western children. The grip strength of boys was significantly stronger than that of girls in all ages for both hands. The order of magnitude of three kinds of pinch strength was, in descending order, lateral pinch, palmar pinch and tip pinch for both boys and girls. There was no significant difference of hand function according to the type of hand dominance in boys. However, girls with left hand dominance showed weakness of bilateral grip, right tip pinch, and bilateral lateral pinch strength compared with girls with right hand dominance. In conclusion, this study provided normative data of hand functions including dexterity, and enabled us to identify some developmental characteristics of hand functions for the Korean elementary school children.

Age Factors↗
PubMedDate not supplied

The functional repertoire of the hand and its application to assessment.

Functional assessment of the hand typically involves evaluation of proficiency using a test battery rather than identifying the range of hand skills available to a client. Establishing a clients hand function by reference to the movement repertoire of his or her fully-functioning hand offers numerous benefits for clinicians and researchers. A functional repertoire model of the hand is proposed as a framework for guiding assessment and therapy. The model identifies four main components relating to hand function: personal constraints, hand roles, hand actions, and task parameters. The model provides a common language for assessment, program development, and research across populations. Application here is to hand-injured clients, but the framework is equally valuable for hand function assessment of developmentally and physically challenged individuals, persons with neuromuscular disorders, or geriatric populations.

Guidelines as Topic↗
PubMed2000

Relation between grip strength and hand bone mineral density in healthy women aged 30-70.

AIM OF STUDY: To determine the site-specific relationship between grip strength and hand bone mineral density (BMD) measured with dual energy x-ray absorptiometry (DXA) in healthy women. The correlation of hand BMD and BMD at axial sites has also been assessed. METHOD: Twenty-nine healthy housewives, aged 30-70, were included in the study. Women were grouped according to their menopausal status (12 premenopausal and 17 postmenopausal). Grip strength of the dominant hand was measured using a Jamar dynamometer. BMD of the antero-posterior spine, femoral neck, trochanter, and Ward's triangle were measured with DXA. For the hand BMD measurements, the analysis software, which was modified from the software of small animals and developed for hand BMD measurements, was used. RESULTS: Hand BMD moderately correlated with grip strength in postmenopausal women. There was no significant correlation between grip strength and hand BMD in premenopausal women. Significant positive correlations were determined between the hand BMD and BMD at axial sites. CONCLUSION: Grip strength may be an independent indicator of hand BMD in postmenopausal women, and also a site-specific relationship. Hand BMD measurements may indirectly reflect the BMD of axial sites especially in postmenopausal women.

Absorptiometry, Photon↗
PubMed2005

[An assessment of the influence of the severity of Dupuytren's contracture on the dexterity of the hand before and after surgery].

It seems to evident that deformation of the hand as a result of Dupuytren's contracture should cause weakness and overall functional impairment of the hand, and an increase of range of motion of the fingers as a result of the operation should effect in improvement of these parameters. The objective of this study was to investigate the effect of extension loss of fingers, number of fingers involved and age of the patients on the power and dexterity of the hand, as well as influence of the age of the patients and recovery of extension of the fingers on the power and dexterity of the hand after surgery for Dupuytren's contracture. 54 patients in an age range 32-83 years (mean 60) with the disease lasting av. 5 years underwent subtotal fasciectomy. Total extension loss of the fingers and total grip strength were measured and dexterity of the hand was assessed with DASH questionnaire prior to surgery. Patients were followed-up for 1 year and assessments were repeated at 1, 3 and finally at 12 months. Median values of measured variables at presentation were as follows: extension loss 80 degrees, total grip strength 41 kG, and DASH score 54. At 12 months median extension loss decreased to 10 degrees (stat. sign.), DASH score to 32 (stat. sign. improvement of dexterity) and grip strength decreased slightly to 40 kG. An analysis of the relationship between the variables showed that severity of the contracture (expressed as an extension loss) had no effect on dexterity of the hand but had significant influence on deterioration of the total grip strength. Number of fingers involved did affect neither dexterity nor power of the hand. Age of the patients did not influence subjective feeling of dexterity of the hand, however, older patients experienced lesser functional benefit from the operation, than younger patients. An increase of extension of the fingers following surgery had significant beneficial effect on subjective improvement of the dexterity of the hand, but had not effect on the increase of power of the hand.

Adult↗