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PubMed2002

The physical impact of computers and electronic game use on children and adolescents, a review of current literature.

Children using computers and electronic games may adopt the kinds of sustained and awkward postures that are associated with musculoskeletal disorders in working adults. If they do, the physical demands of extensive use could lead to a wide range of adverse effects on developing children, including visual, neurological and physical changes. This article reviews the literature related to media use, ergonomics, epidemiology and pediatrics that address the physical impact of computer use by children. The literature establishes that computer use is common, but does not demonstrate a causal or statistical association with any physical disorders. Laboratory studies on vision, case reports of game-related tendonitis and ergonomic analyses of classroom computers suggest that concern is warranted.

Adolescent↗
PubMed2002

Health, mental well-being, and musculoskeletal disorders: a comparison between Swedish and Australian dental hygienist.

PURPOSE: This study was conducted to compare Swedish and Australian dental hygienist in regards to working conditions, health, and mental well being and to further develop a health model for this profession. METHODS: Questionnaires (a 275-item instrument) were sent to all 376 Australian dental hygienist and a random sample of 26% (n=575) of Swedish dental hygienist. Country-specific factors--such as work characteristics and life style--and their relationships to self-related health and mental well being were analyzed. Interaction effects of age times country were studied by two-factor ANOVA. Discriminant functions were used to predict country and age group memberships, and multiple logistic regression modeling for a health model was tested. RESULTS: The response rate was 86% (N=495) in Sweden and 71% (N=254) in Australia. Work-related musculoskeletal disorders, professional ambition, and demands from difficult patients were the factors most different for the two countries--generally the values were higher for Australia than Sweden. Arthritic hands/loss of sensitivity in the arm-hand and intellectual job satisfaction were found more often in dental hygienist more than 42 years old. than in dental hygienist ages under 42 years old. Professional ambition was higher for those under 42. Working 25 hours or more per week with clinical work, engaging in active leisure, being under age 42, and high management support at work, relate to good general health. Work-family overload was associated with lower general health, while higher mental well-being was related to high perception of personal mastery and high management support. There also was a correlation between lower mental well-being was and high work-family overload, work efficiency, and practicing in Australia. Work-family overload, scaling procedures, work relations, practicing in Australia, and being under 42 years of age were associated with more musculoskeletal disorders. CONCLUSION: An earlier hypothetical work and health model, on which this study was based, was expanded with these factors: country-specific work setting, age, and work relations. Australian dental hygienist and more musculoskeletal disorders and experienced lower mental well being related to organizational work factors than did Swedish dental hygienist. The results suggest a need to consider sociodemographic, occupational, and cultural aspects in future studies of work, health, and well being.

Adult↗
PubMed2005

[Future research in immunology for composite tissue allotransplantation].

Hand and composite tissue allotransplantation (CTA) holds great potential for reconstructive surgery but its development is currently limited by the side-effects of the immunosuppressive drugs. Induction of specific tolerance, a situation where the recipient does not mount an immune response against the allograft but remains fully immunocompetent, holds exciting promise. Generation of mixed hematopoietic chimerism by infusing the recipient with donor bone marrow cells has been shown to induce tolerance without chronic immunosuppression. Genetic matching of the donor and the recipient is another option for transplanting composite tissues with only an initial course of immunosuppression. Experiments demonstrated long-term survival of musculoskeletal allografts between MHC-matched miniature swine. Finally, new immunosuppressive agents with a more targeted action will reduce side-effects and may prevent the development of chronic rejection. Skin-specific immunosuppression is particularly useful for limb transplants since skin, regarded as the most antigenic component, is easily accessible to topical or irradiation therapies.

Allergy and Immunology↗
PubMedDate not supplied

Development of an objective structured clinical examination (OSCE) for physical medicine and rehabilitation residents.

Clinical competency is poorly measured by knowledge-based written examinations. A five-station, four-interstation objective structured clinical examination (OSCE) has been developed in consultation with the National Board of Medical Examiners as a pilot study to standardize assessment methods that serve to evaluate the clinical competency of senior physical medicine and rehabilitation residents. Various stations demonstrating musculoskeletal and neurologic conditions commonly encountered in physiatric practice were included, incorporating the use of standardized patients into the OSCE format. This is a descriptive study of individual stations-evaluated history-taking, physical examination, and communication skills, whereas the interstations measured the residents' ability to write therapy and prosthetic/orthotic prescriptions, as well as interpret x-ray and electrodiagnostic data. The OSCE program development including case background, principal tasks, time allotment, evaluation objectives, performance criteria, therapeutic plan, standardized patients case descriptions, and assessment checklists as well as the training procedure is discussed. Additionally, cost analysis and scheduling issues are reviewed. This information should aid other training programs or consortiums in developing similar clinical evaluation tools.

Clinical Competence↗
PubMed2002

Musculoskeletal implications of preterm infant positioning in the NICU.

Alignment and shaping of the musculoskeletal system occur during each body position that infants experience while in neonatal intensive care. Neonatal nurses and physical therapists can play a major role in designing, modeling, and teaching positioning strategies that promote skeletal integrity, postural control, and sensorimotor organization. Musculoskeletal maturation processes and adverse musculoskeletal consequences are reviewed with an emphasis on clinical implications for neonatal care, discharge teaching, and follow-up. Recommendations are offered for neonatal positioning procedures to prevent extremity malalignment, skull deformities, and gross motor delay.

Child Development↗
PubMed1993

Postoperative pulmonary complications in patients with preoperative lung disease.

A prospective study was carried out on the incidence of pulmonary complications in 728 patients who underwent major surgical procedures at a reputed hospital in New Delhi. These patients were preoperatively assessed on the basis of history, clinical examination and bedside pulmonary function tests including PEFR, VC, FVC and FEV1. On the basis of these criteria, 212 patients had significant preoperative pulmonary disease, while 516 had normal lung functions. Postoperative pulmonary complications developed in 7.69 per cent of the patients. They were more frequent in smokers (P < 0.001) and in those with preoperative pulmonary dysfunction (P < 0.001). Their incidence was greater following thoraco-abdominal and musculoskeletal and miscellaneous operations compared to lower abdominal surgery (P < 0.001). The incidence was also higher following exposure to general anaesthesia compared to regional anaesthesia (P < 0.05). Pneumonia and atelectasis were the most common postoperative pulmonary complications. It was observed that the recovery of pulmonary functions was delayed in patients who developed postoperative pulmonary complications.

Adult↗
PubMed1999

Recent advances in matrix metalloproteinase inhibitors research.

Excess MMP proteolytic activity has been associated with a wide variety of pathological conditions such as arthritis, cancer and heart failure. The potential utility of MMP inhibitors as therapeutic interventions in these diverse and important disease states has led to an intense effort toward the development of such inhibitors. The first generation of compounds were peptide-like broad spectrum inhibitors, active against a broad range of MMPs. However, the induction of musculoskeletal side effects seen in clinical trials with these agents has emphasized the need for a better understanding of the role that each of the MMPs plays in normal tissue turnover and disease progression. Advances in our ability to engineer and synthesize selective inhibitors as well as the discovery of small molecule, non-peptidic inhibitors has spurred an intense effort to identify potent and bioavailable second generation compounds. There are now several such compounds targeted against various subsets of the MMPs in clinical development. This review will focus on the design and structure activity relationships of these second generation compounds.

Clinical Trials as Topic↗
PubMed2006

Musculoskeletal problems in Iranian hand-woven carpet industry: guidelines for workstation design.

Long hours of static work with awkward posture at traditionally designed looms can cause high prevalence of musculoskeletal disorders (MSDs) among carpet weavers. A comprehensive study was conducted in this industry with the objectives of determination of MSDs symptoms prevalence; identification of major factors associated with MSDs symptoms in carpet weaving occupation; and development of guidelines for weaving workstation design. In the present paper, this ergonomics study is presented. The study consisted of two phases. In the first phase, MSDs symptoms in nine Iranian provinces were surveyed by questionnaire among 1439 randomly selected weavers. Working posture and weaving workstations were ergonomically assessed as well. The results of this phase revealed that symptoms from the musculoskeletal system occurred in high rate among weavers with the prevalence significantly higher than that of the general Iranian population (P<0.001). It was found that the majority of ergonomics shortcomings originated from ill-designed weaving workstation. Based on the findings, some general guidelines for workstation design were presented. In the second phase, considering the general guidelines, an adjustable workstation was designed and constructed. To develop quantitative guidelines for optimizing workstation set-up, in the laboratory, nine sets of experimental conditions were tested, and working posture and weavers' perceptions were measured. The results of this lab work showed that working posture was acceptable for both the researchers and the weavers when the weaving height was adjusted 20 cm above the elbow height and a high seat with forward slope was used. By combining the results of the two phases, guidelines for weaving workstation design were presented. In this ergonomics-oriented workstation, loom is vertical. Seat, loom and weaving heights are adjustable. There is enough leg room under the loom. The seat with 10 degrees forward slope is adjusted 15 cm above the popliteal height of the weaver. Weaving height is set at 20 cm above the elbow height. It is believed that the recommended workstation improves working posture and results in reduced postural stress on weavers' bodies and, consequently, reduced prevalence of MSDs symptoms.

Equipment Design↗
PubMed1992

Health policy and musculoskeletal conditions.

This paper reviews two strains of research within rheumatology relevant to contemporary health policy debates. The first concerns studies of the effectiveness of medical care on outcomes among persons with musculoskeletal conditions; the second, studies of functional status and disability among such persons. The studies of the effectiveness of medical care, largely funded by the Agency for Health Care Policy and Research, are designed to assist in the development of practice guidelines concerning lower back pain, knee replacement, hip disease, and other conditions for use by physicians and other providers as well as third party payers. The studies of functional status and disability in arthritis, largely funded by the National Institute of Arthritis, Musculoskeletal, and Skin Diseases as part of its Multipurpose Arthritis Center Program, are designed to provide measures of outcome for use in studies of medical effectiveness and to assess the societal impacts of musculoskeletal conditions.

Disability Evaluation↗
PubMed2000

Educational issues in rheumatology.

Musculoskeletal conditions are the most common cause of severe long-term pain and physical disability, affecting hundreds of millions of people around the world. Nearly a quarter of all consultations in primary care are concerned with rheumatic disease, yet undergraduate education in rheumatology is under-developed all over the world and does not get the attention it deserves. This has important consequences for the early diagnosis of rheumatic disease and the proper care of rheumatic patients in general, as well as for the esteem of rheumatology as a profession. Because the high prevalence and impact of rheumatic disease are not reflected in medical curricula, the International League of Associations for Rheumatology developed the Undergraduate Medical Education in Rheumatology 2000 Project. The project embodies three fundamental concepts: (1) to convince medical faculties and schools educating health professionals world wide that skills in examination, a knowledge of the management of musculoskeletal disease and a positive attitude to disability are the basis of good medical practice; (2) that rheumatology is valuable for acquiring skills in problem-solving, clinical reasoning and understanding basic genetic, immunological and biochemical mechanisms, as illustrated by rheumatic disease; and (3) to orient these programmes to the needs of individual patients in the context of the population at large, knowing that 20% of all primary care consultations involve musculoskeletal disease. The movement of doctors throughout the world, especially within Europe, is leading to initiatives to harmonize standards of specialist training. The importance of ensuring the highest standard of clinical care, achieving the greatest gain in health alongside a rapid advance in knowledge and clinical practice, is increasing the priority for continuing medical education and methods to ensure that doctors remain competent at all stages of their career.

Education, Medical↗
PubMed2006

Peripheral musculoskeletal manifestations in polymyalgia rheumatica.

OBJECTIVES: The objectives of this study were to evaluate the frequency and characteristics of the peripheral musculoskeletal manifestations in polymyalgia rheumatica (PMR), evaluate if PMR with peripheral synovitis represents a subset with a more severe disease, and examine for clinical and laboratory characteristics at onset of PMR that might later predict rheumatoid arthritis (RA). PATIENTS AND METHODS: Patients were diagnosed with PMR according to the 1982 Chuang criteria. Patients were followed up between 1990 and 2002. The following musculoskeletal manifestations at onset and during the follow up were considered: peripheral synovitis, distal extremity swelling with pitting edema, carpal tunnel syndrome, and distal tenosynovitis. RESULTS: Thirty-eight of the 74 patients (51%) showed distal musculoskeletal symptoms: 29 (39%) had peripheral synovitis, 4 (5%) presented pitting edema, 4 (5%) experienced carpal tunnel syndrome, and one (1.3%) had distal tenosynovitis. These manifestations resolved completely after corticosteroid therapy was initiated. Peripheral synovitis was oligoarticular and often transient. The joints most frequently involved were the wrist, metacarpophalangeal, and knee. Erythrocyte sedimentation rate (ESR) was normal in 7 patients. When comparing patients with PMR with and without peripheral synovitis, no statistically significant differences were found in the studied variables. Through the first year of follow up, 7 patients fulfilled the American College of Rheumatology 1987 criteria for RA, 2 patients developed giant cell arteritis, and 3 had associated malignancy. Patients who developed RA had statistically significantly increased presence of persistent synovitis and a smaller decrease in mean ESR after treatment with corticosteroids. CONCLUSION: Fifty-one percent of the patients with PMR presented distal musculoskeletal manifestations, with peripheral synovitis being the most frequent one. Patients with PMR with peripheral synovitis did not represent a high-risk subgroup with more severe disease. Seven patients who developed criteria for seronegative RA within the first year of follow up had presented statistically significant persistent synovitis compared with those who continued as PMR and also showed a smaller initial decrease in mean ESR after steroid treatment was initiated. The absence of persistent arthritis and the benign course of the arthritis permit the distinction of PMR from other inflammatory arthropathies.

Aged↗
PubMedDate not supplied

Screening to identify patients at risk: profiles of psychological risk factors for early intervention.

There is a serious need to provide effective early interventions that prevent the development of persistent pain and disability. Identifying patients at risk for this development is an important step. Our aim was to explore whether distinct subgroups of individuals with similar response patterns on a screening questionnaire exist. Moreover, the objective was to then relate these groups to future outcomes, for example, sick leave as an impetus for developing tailored interventions that might better prevent chronic problems. A total of 363 patients seeking primary care for acute or subacute spinal pain completed the Orebro Musculoskeletal Pain Screening Questionnaire and were then followed to determine outcome. Cluster analysis was used to identify subgroups. Validity was tested using 3 methods including the split-half technique. The subgroups were compared prospectively on outcome measures obtained 1 year later. Using pain intensity, fear-avoidance beliefs, function, and mood, we found 4 distinct profiles: Fear-Avoidant, Distressed Fear-Avoidant, Low Risk, and Low Risk-Depressed Mood. These 4 subgroups were also robust in all 3 of the validity procedures. The 4 subgroups were clearly related to outcome. Although the low risk profiles had virtually no one developing long-term sick leave, the Fear-Avoidant profile had 35% and the Distressed Fear-Avoidant profile 62% developing long-term sick leave. Our results suggest that fear-avoidance and distress are important factors in the development of pain-related disability and may serve as a key for early identification. Providing interventions specific to the factors isolated in the profiles should enhance the prevention of persistent pain and disability.

Adult↗
PubMed2003

Development of a dual luciferase reporter screening assay for the detection of synthetic glucocorticoids in animal tissues.

Synthetic glucocorticoids belong to the most frequently administered drugs in livestock production. These synthetic hormones are employed for therapeutic purposes against inflammatory reactions, disorders of the musculoskeletal system, bovine ketosis and many other diseases of farm animals. A widespread illegal use of synthetic glucocorticoids to improve feed intake and weight gain has also been observed. To enforce the residue limits imposed on glucocorticoid drugs and preclude their illicit administration as growth promoters, it is necessary to establish high throughput analytical methods that can be applied to the screening of animal tissues. Here, we developed a dual luciferase reporter assay that detects residues or contaminants with glucocorticoid activity. This screening assay is performed by transfection of human cell lines with two reporter constructs followed by the measurement of two distinct luminescence signals, one of which serves as internal control to correct for assay variabilities and unspecific matrix effects. The limit of detection (1.25 microg for dexamethasone in liver) depends on the biological potency of each synthetic glucocorticoid but, with all drugs tested, the maximal response reaches a 20 to 30 fold induction of luciferase activity. In combination with an appropriate sample clean-up method (recovery of 82%), this luciferase assay has been applied to the analysis of liver samples from calves treated with a single therapeutic injection of either dexamethasone or flumethasone. Thus, the dual luciferase reporter assay provides a new screening tool to detect unwanted glucocorticoid activities in animal tissues or other crude biological samples without knowledge of the precise chemical entity of the parent compounds or their metabolites.

Animals↗
PubMed2000

Interaction of Helicobacter pylori eradication and non-steroidal anti-inflammatory drugs on gastric epithelial apoptosis and proliferation: implications on ulcerogenesis.

BACKGROUND: Apoptosis is associated with loss of gastric mucosal integrity and may play an important role in ulcer development. AIM: To examine how Helicobacter pylori and NSAIDs interact to effect apoptosis and proliferation of the gastric mucosa. METHODS: Patients presenting with musculoskeletal pain requiring NSAID treatment and without previous exposure to NSAID or pre-existing ulcers were recruited. Patients were divided into three groups: (A) H. pylori-infected; (B) H. pylori-eradicated; and (C) non-infected patients. They were given naproxen for 8 weeks. Patients with non-ulcer dyspepsia and H. pylori infection who were given anti-Helicobacter therapy were recruited as controls (D). Endoscopy was performed at baseline and 8-weeks after receiving naproxen. Gastric antral biopsies were obtained to assess apoptosis by terminal uridine deoxynucleotidyl nick end-labelling (TUNEL) and proliferation by Ki67 immunostaining. RESULTS: A total of 55 patients were studied. H. pylori-positive patients had a higher apoptosis and proliferation index at baseline than non-infected patients (P < 0.0001), and eradication of H. pylori resulted in a significant reduction in these parameters. The NSAID induced apoptosis in non-infected subjects (P=0.03) whilst apoptosis was reduced in H. pylori-positive patients receiving NSAID (P=0.02). After 8 weeks of NSAID, post-treatment apoptosis was significantly higher in patients with persistent H. pylori infection than in non-infected patients (P=0.01). CONCLUSIONS: Eradication of H. pylori prior to NSAID therapy significantly reduces the level of apoptosis in the gastric mucosa, which may contribute to maintaining mucosa integrity and preventing ulcer development.

Adult↗
PubMed1999

Treatment of Wegener's granulomatosis with immune globulin: CNS involvement in an adolescent female.

OBJECTIVE: To describe the use of intravenous immune globulin (IVIG) to treat Wegener's granulomatosis (WG) in an adolescent female with an abnormal magnetic resonance imaging (MRI) scan and electroencephalogram (EEG), as well as central nervous system involvement manifesting as generalized seizures. CASE SUMMARY: A 15-year-old white girl diagnosed with WG and receiving prednisone and cyclophosphamide was admitted with new-onset tonic-clonic seizures. The patient received phenobarbital and phenytoin to control seizures and was receiving cyclophosphamide and corticosteroids for WG. She developed cyclophosphamide-induced cystitis and was started on a four-day therapeutic course of IVIG following the discontinuation of cyclophosphamide. After 16 days of hospitalization, repeat EEG and MRI were within normal limits, and laboratory and clinical improvement was evident in at least nine of the affected organ systems including pulmonary, hematologic, renal, ocular, cutaneous, musculoskeletal, central nervous system, gastrointestinal, and genitourinary. The patient was discharged with clinical involvement of WG documented in two organ systems, hematologic and renal. DISCUSSION: WG is a form of vasculitis believed to develop due to an autoimmune disorder. The diagnosis is based on radiographic and histopathologic findings, as well as the presence of elevated antineutrophil cytoplasmic antibodies and a suggestive clinical presentation. The presentation is widely variable and is most commonly associated with upper-airway involvement such as sinusitis, cough, pulmonary infiltrates, and cavitary nodules. Renal involvement signifies generalized disease. Conventional treatment for WG includes cyclophosphamide and prednisone. Little information is available describing therapeutic alternatives. Cytotoxicity related to immunosuppressant regimens limits continuous treatment and may necessitate the use of alternative agents. CONCLUSIONS: This case describes the use of IVIG in an adolescent patient presenting with WG as a generalized, active disease with neurologic complications. IVIG may be useful in generalized, active WG complicated by intolerance to cyclophosphamide and seizures, but further study is necessary to define its role.

Adolescent↗