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PubMed2002

Industrial medicine and acute musculoskeletal rehabilitation. 2. Acute cervical spine and shoulder injuries in the industrial setting.

UNLABELLED: This self-directed learning module highlights the underlying anatomy and biomechanics of the cervical spine and shoulder as a basis for developing a differential diagnosis of contributing pathology in an industrial injury. This includes components of the history, examination, and appropriate diagnostic testing that are necessary to develop an optimal rehabilitation plan. Treatment options are reviewed and include medications, therapy, selective injections, and return-to-work programs in the industrial setting. OVERALL ARTICLE OBJECTIVES: (a) To be able to identify neck and shoulder pathology, (b) to effectively evaluate cervical spine and shoulder injuries, and (c) to rehabilitate acute cervical spine and shoulder injuries in the industrial setting.

Acute Disease↗
PubMed2000

Hospitalization due to injuries in the military. Evaluation of current data and recommendations on their use for injury prevention.

INTRODUCTION: Injuries inflict the largest health impact on military populations in terms of hospitalization. Hospitalized injuries result in the largest direct costs of medical care and the most lost workdays, include the largest proportion of disabling injuries, and have the largest impact on troop readiness. Efforts are now beginning to focus on how injury surveillance data can be used to reduce the burden of injuries. This article examines the value of administrative hospital discharge databases in the military for routine injury surveillance, as well as investigation of specific injury problems, including musculoskeletal conditions that are frequently sequelae of old injuries. METHODS: Data on hospitalizations for injuries and musculoskeletal conditions were obtained from separate administrative agencies for the Army, Navy, and Air Force. Since 1989, a Standard Inpatient Data Record (SIDR) has been used to ensure uniformity in data collection across the services utilizing standard ICD-9 codes. Cause of injury was coded using special military cause codes (STANAG codes) developed by NATO. Data were analyzed on both nature and cause of injury. Denominator data on troop strength were obtained from the Defense Manpower Data Center (DMDC). RESULTS: Hospital records data indicate that injuries and musculoskeletal conditions have a bigger impact on the health of service members and military/combat readiness than any other ICD-9 Principal Diagnostic Group (higher incidence and higher noneffective rate or days not available for duty). Hospitalization rates for injury appeared to decline for all services from 1980 to 1992. In 1992, service-specific injury hospitalization rates per 1000 person-years were 15.6 for the Army, 8.3 for the Navy (enlisted only), and 7.7 for the Air Force, while the corresponding hospitalization rate for musculoskeletal conditions was higher in all three services: 28.1, 9.7, and 12.0, respectively. CONCLUSIONS: Military hospital discharge databases are an important source of information on severe injuries and are more comprehensive than civilian databases. They include detailed injury information that can be useful for injury prevention and surveillance purposes. Specifically, it can be used to identify high-risk groups or hazards for targeting prevention resources. These may vary widely by service, rank, and job tasks. Hospital discharge data can also be used to evaluate the effectiveness of interventions for reducing injury rates. Recommendations were submitted to further improve data collection and the use of hospital data for research and injury prevention.

Causality↗
PubMed2003

Occupational conditions exceed the importance of non-occupational conditions and ill health in explaining future unemployment among women and men.

BACKGROUND: Unemployment is relatively common today, but the importance of work characteristics in relation to future unemployment has seldom been studied. METHODS: The relation between occupational and non-occupational factors, as well as ill health, in 1993 and unemployment in 1997 has been examined using an exploratory approach. Both analyses of associations and cluster analysis have been performed. RESULTS: Reduced psychological well-being and some occupational factors mainly related to job insecurity and, among women, also few opportunities for development at work--were found to be risk indicators for unemployment later on. To some extent, also earlier unemployment periods predicted unemployment in 1997. The influence of reduced psychological well-being and earlier unemployment periods on the associations between occupational factors in 1993 and 1997 consisted mainly of a decrease of the influence of job insecurity. Seven clusters were identified. One of them was male dominated, where the level of unemployment was very high and the individuals had reduced psychological well-being, insecure working conditions and demanding living conditions. The female equivalent was characterised by a high level of unemployment, multi-demands at work and poor musculoskeletal health. CONCLUSIONS: Reduced psychological well-being and job insecurity were risk indicators for later unemployment among both genders, as were also few opportunities for development at work among women. These factors predicted unemployment, also when age and other non-occupational factors were taken into consideration. The cluster analysis identified groups of individuals with highly demanding occupational and non-occupational conditions in 1993 and a high level of unemployment in 1997.

Adolescent↗
PubMed2002

Generation of genetically altered mouse models for aging studies.

A number of mouse models have been identified and are being used for aging and age-associated disease research. However, the use of the genetically manipulated mouse model is still a relatively untapped resource for the study of the biology of aging. Genetically altered mice can be powerful tools for biology of aging research because gene expression can be controlled and correlated with established biomarkers. Standard transgene overexpression and gene targeting techniques were modified and used to generate 30 mouse lines during a 4-year period. These lines include models of Werner's syndrome (premature aging or progeria), Alzheimer's disease, other neurodegenerative condition, atherosclerosis, diabetes, immune dysfunction, musculoskeletal disorders, and oxidative stress. These new mouse models are providing additional insights into aging processes and will be useful for developing intervention strategies and collaborative interactions.

Aging↗
PubMed1989

Aspects of the spectrum, prevalence and disease susceptibility determinants of Reiter's syndrome and related disorders associated with HIV infection.

Arthrocutaneous disorders including Reiter's syndrome, psoriasiform rashes, and other forms of chronic arthritis and enthesopathy, such as psoriatic arthritis, occur with an increased prevalence in the setting of HIV infection. Herein we describe the spectrum and prevalence of musculoskeletal and allied skin disorders as they occur in the setting of HIV infection. The role of genetic susceptibility in the development of these disorders is addressed. Based on the frequency of infectious agents capable of triggering reactive arthritis and the presence of HLA-B27 in 71% of these individuals, it is suggested that the disorder strongly resembles Reiter's syndrome as it occurs in the not HIV-infected group. Preliminary evidence indicates an enhanced penetrance for susceptibility among HLA-B27 individuals. In contrast, among HIV-infected patients with psoriasiform lesions there was no statistically significant association (P less than 0.05) between the presence of psoriasiform rash and the HLA alleles Cw6, B7, B17, Bw16, or Bw57 when compared with HIV-infected controls. These findings suggest that among HIV-infected individuals the development of Reiter's syndrome involves an immune recognition event primarily dependent upon HLA-B27 molecules in which an unknown antigen in the context of HLA-B27 is presented to CD8 lineage suppressor/cytotoxic cells. In contrast, the pathogenesis of psoriasiform lesions in HIV patients, despite their similarity to certain lesions in Reiter's syndrome, proceeds by distinct pathways that do not involve events influenced by specific polymorphic class I molecules.

Arthritis, Psoriatic↗
PubMedDate not supplied

Evaluation of a protocol for determining the effectiveness of pretreatment with local analgesics for reducing experimentally induced articular pain in domestic fowl.

An experimental paradigm based on the microcrystalline sodium urate-induced arthritis model was developed for determining the effectiveness and optimum dose of drugs with potential local analgesic properties for the diagnosis and alleviation of musculoskeletal pain in birds. The optimum intra-articular injection of sodium urate was 6 mg in 0.2 ml diluent in 12-week-old male domestic fowl of 1.5 kg live weight. The response criteria were changes in behavioural profiles over 60 minutes commencing one hour after intra-articular injection. The testing system was used to determine the optimum rate of intra-articular application of the local anaesthetic bupivacaine hydrochloride. The behavioural profile of treated birds was restored to that of the controls at a minimal injection of 3 mg in 0.3 ml saline. It was concluded that the optimum intra-articular dose of bupivacaine for the treatment of musculoskeletal pain in the domestic fowl was 3 mg bupivacaine in 0.3 ml saline.

Anesthetics, Local↗
PubMedDate not supplied

Scrofuloderma with multiple organ involvement in a 5-year-old child.

Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis seen in children in developing countries. We report a 5-year-old child with cutaneous tuberculosis with involvement of lymph nodes, lungs, and the musculoskeletal and central nervous systems, which was not clinically obvious. Antituberculous treatment led to marked clinical improvement. The importance of a thorough search for internal organ involvement in patients presenting with cutaneous tuberculosis is emphasized.

Antitubercular Agents↗
PubMedDate not supplied

Work load reduction through a new roll container traction device.

PURPOSE: For the distribution of dairy products, crates and roll containers are used. A roll container that is fully stacked with crates has a mass of 600 kg. The forces required to handle these roll containers, often aggravated by rough paving and inclined tailboards, are far in excess of ergonomic standards. This explains the high level of absenteeism among lorry drivers due to musculoskeletal complaints. The aim of this study was to reduce work load. METHOD: A new traction device for roll containers was developed, which couples easily and provides for easy manoeuvring. On a test circuit with obstacles, ten professional lorry drivers (aged 29-53 years) performed a user-test, both with and without the device. During the tests heart rate, blood pressure and time for completion of the track were measured. RESULTS: Heart rates were significantly lower with the traction device, the length of time needed to complete the track showed greater uniformity, and thanks to ease of use no prior lessons were necessary. CONCLUSION: The prototype was also tested by a lorry driver that was disabled by low back pain. With this device he was able to return to work.

Adult↗
PubMed2002

Specialist training in rheumatology in Europe.

Rheumatology is a broad discipline managing a spectrum of different conditions and there are divergences in what is routinely treated by rheumatologists both within and between countries. The free movement of doctors throughout the European Community has lead to moves to harmonize specialist training to ensure common standards of care. The Union Européene des Médecins Spécialistes (UEMS) has developed recommendations for the specialist training of rheumatologists in Europe that recognizes the broad definition of the discipline and the diversity of clinical practice in Europe. The core curriculum aims to provide a common standard around which to develop locally applicable national curricula. The provision of high quality care requires some assessment of training and competency as well as continuing professional development and ways of ensuring the provision of this throughout the European Community to a mutually high standard are being developed. The future may see more overlap in the training of all the disciplines concerned with the management of those with musculoskeletal conditions to their benefit.

Curriculum↗
PubMed2004

Soft tissue neck symptoms following high-energy road traffic accidents.

STUDY DESIGN: A single-blinded prospective study was performed into the occurrence and frequency of soft tissue neck symptoms of patients involved in high-energy road traffic accidents. OBJECTIVES: We studied the occurrence of incidental soft tissue neck symptoms in victims of high energy (defined as those severe enough to cause major trauma leading to an injury severity score >16) vehicular collisions causing significant musculoskeletal trauma requiring operative intervention. SUMMARY BACKGROUND DATA: Whiplash is considered to be a soft tissue injury of the neck sustained by occupants of motor vehicles. Use of the term in the past had been restricted to hyperextension injuries following a rear impact, but is commonly now used for all types of impact. No relationship has been found between velocity or force of injury and incidence or outcome of whiplash. The preponderance of whiplash after relatively minor vehicular accidents, the unpredictability of who will develop chronic symptoms and the lack of clinical and radiological evidence of a pathological mechanism suggests that psychosocial variables are important factors in determining the development of persistent neck pain. METHODS: A total of 36 consecutive patients were recruited who had been involved in high-energy road traffic accidents and had chest, musculoskeletal, or abdominal injuries (ISS > 16) requiring admission for treatment, but who had no diagnosed injury of the cervical spine. Patients were asked in a nonspecific or leading manner at the time of admission and again at least 6 to 8 weeks postinjury if they had any neck symptoms, headaches, or paresthesiae. RESULTS: Only 2 of the patients interviewed described any whiplash symptoms. All symptoms were resolved at the time of second interview. CONCLUSIONS: Our study demonstrates a surprisingly low incidence of neck symptoms following high-energy road traffic accidents in which patients sustained unrelated injuries requiring treatment.

Accidents, Traffic↗
PubMed1990

Interhospital transfer in the management of acute trauma.

During an 8-month period, 538 injured patients were transferred from primary hospitals to a referral hospital for further management of their injuries. Delay at the primary hospital was identified in 20% of all transfers and in 40% of patients transferred for management of head injury or multisystem injury. Delay at the primary hospital resulted in a median time from injury to arrival at the second hospital of 4 h. Defects in clinical management during transport included inexperienced escorts, inadequate airway control, ventilation, fluid resuscitation and stabilization of chest injuries. Nearly half of transfers were inappropriate because of the relatively minor nature of the injuries. Most of these had solitary musculoskeletal injuries to the extremities. These patients reflect the marked deficiency of specialist orthopaedic services in western Sydney during the study. Development of a metropolitan regional system of trauma care in western Sydney requires urgent action towards reducing the frequency of transfer, minimizing delays in transfer and maximizing basic resuscitation of seriously injured patients. Some designation of hospital roles is required and needs to be accompanied by a prehospital triage process. The population also has a right to expect adequate specialty services at suburban hospitals to enable treatment of minor and moderate single system injuries. Future trauma system developments should adequately reflect population growth and technological advances in clinical care.

Adolescent↗
PubMed1983

Treatment of the early manifestations of Lyme disease.

During 1980 and 1981, we compared antibiotic regimens in 108 adult patients with early Lyme disease. Erythema chronicum migrans and its associated symptoms resolved faster in penicillin- or tetracycline-treated patients than in those given erythromycin (mean duration, 5.4 and 5.7 versus 9.2 days, F = 3.38, p less than 0.05). None of 39 patients given tetracycline developed major late complications (meningoencephalitis, myocarditis, or recurrent attacks of arthritis) compared with 3 of 40 penicillin-treated patients and 4 of 29 given erythromycin (chi square with 2 degrees of freedom = 5.33, p = 0.07). In 1982, all 49 adult patients were given tetracycline; again, none of them developed major complications. However, with all three antibiotic agents nearly half of the patients had minor late symptoms such as headache, musculoskeletal pain, and lethargy. These complications correlated significantly with the initial severity of illness. For patients with early Lyme disease, tetracycline appears to be the most effective drug, then penicillin, and finally erythromycin.

Adolescent↗
PubMed1991

Non-steroidal anti-inflammatory drugs and stercoral perforation of the colon.

Within 6 months, three constipated patients have been seen with stercoral perforation of the colon associated with the ingestion of non-steroidal anti-inflammatory drug medications (NSAIDs). These drugs were taken regularly for painful musculoskeletal disorders 6, 8 and 12 months before admission. Constipation is thought to be the most significant contributory factor in the development of colonic stercoral perforation; however, it is unclear why it develops in so few of the many patients with severe constipation. NSAID medications have been associated with the perforation of colonic diverticula, but there are no reports of an association with stercoral perforations. If our finding of the association is substantiated by other reports there may be a need for greater awareness of lower gastrointestinal problems when prescribing such drugs to constipated patients.

Aged↗
PubMed1991

Hereditary onycho-osteodysplasia (nail-patella syndrome). A three-generation familial study.

Hereditary onycho-osteodysplasia or nail-patella syndrome is an uncommon familial musculoskeletal condition that is primarily seen initially in orthopaedic clinics. This three-generation familial review identifies three affected family members, one of whom demonstrated spondylolisthesis, a condition not previously associated with nail-patella syndrome. All affected family members demonstrated the typical radial nail dysplasias, hypoplastic patellae, iliac horns, and posterior dislocation of the radial heads. Overgrowth of the medial femoral condyles caused valgus deformities of the knees that necessitated orthotic treatment in the youngest affected family member. Although this syndrome has classic common musculoskeletal anomalies, the lumbar spine should also be carefully examined for the presence of spondylolysis and for signs of potential spondylolisthetic development.

Adult↗
PubMed1996

Pain and the quality of life in patients referred to a craniofacial pain unit.

Although there are reasons to believe that temporomandibular disorders and other facial pain conditions would have a major impact on the quality of patients' lives, only a small number of studies have attempted to address this in a systematic way. In this study, data on pain and its consequences were assessed for 121 patients making their first visit to a craniofacial pain research unit. The extent to which musculoskeletal and neurologically based facial pain compromised the quality of life was measured using the Oral Health Impact Profile, a recently developed index of the functional and psychosocial outcomes of oral conditions. The data indicated that facial pain had a substantial impact on daily life and that its most common outcomes were psychologic. When compared with a nonpain population, the extent of this impact was striking. There was a four-fold increase in functional problems such as difficulty chewing foods and a nine-fold increase in reports of depression. As anticipated, scores on the Oral Health Impact Profile were associated with the characteristics of the pain and diagnostic subgroups.

Adult↗
PubMed2001

Risk factors for development of lower limb pain in adolescents.

OBJECTIVE: Although many clinicians believe high growth leads to inflexibility, which may lead to lower extremity pain, the only prospective data suggest growth is unrelated to flexibility. However, it is still possible that growth and/or flexibility are related to pain even if they are not related to each other. We investigated the incidence of leg pain in adolescents to determine whether high growth spurt and/or poor flexibility are risk factors for the development of lower extremity pain. METHODS: Repeated measures, prospective cohort study of urban high school students aged 12-18. Subjects were measured at baseline and at 6 and 12 months for flexibility of hamstrings and quadriceps and with the sit-and-reach test. Participants completed a detailed questionnaire on recreational activity, occupational activities, psychosocial variables, and musculoskeletal pain. RESULTS: Poor hamstring flexibility (odds ratio 0.99, confidence interval 0.97-1.01), poor quadriceps flexibility (OR 1.01, CI 0.99-1.03), poor sit-and-reach flexibility (OR 0.99, CI 0.99-1.01), and growth (OR 0.93, CI 0.50-1.71) were not related to the development of lower extremity pain. There was an association between lower extremity pain and occupational activities (OR 2.08, CI 1.45-2.98) and poor mental health (per 1 SD change, OR 1.41, CI 1.19-1.67). CONCLUSION: Neither growth nor flexibility is related to the development of lower extremity pain in adolescents. A poor mental health score and occupational activities may be associated with the development of lower extremity pain.

Adolescent↗
PubMed2003

Matrix metalloproteinase inhibitors for cancer therapy:the current situation and future prospects.

Inhibition of matrix metalloproteinases (MMPs), a family of proteolytic enzymes linked to many aspects of cancer progression, has been explored as a therapeutic goal for almost two decades. Thus far, all tested MMP inhibitors (MMPIs) have failed to reach primary end points in Phase III clinical trials, although secondary analyses suggest benefits in particular patient groups. The clinical development of these agents has been hampered by problems related to determination of effective dosages and side effects that necessitate dose lowering or drug holidays. Imaging technologies offer hope as a means to measure enzyme activity and hence effective enzyme inhibition in vivo. Meanwhile, recent results from genetic studies of both mice and man have given some clues to possible causes of musculoskeletal side effects. Future progress in the therapeutic use of MMPIs is dependent on the ability to selectively target cancer-associated MMPs at the correct stage in tumour progression and the development of surrogate markers of in vivo efficacy.

Antineoplastic Agents↗
PubMed1993

Musculoskeletal involvement in children with gastroschisis and omphalocele.

A review of 58 children with gastroschisis and 8 children with omphalocele showed 14 musculoskeletal problems in 11 children. These problems consisted of limb deformities in 6 children, spinal deformities in 4 children, and osteopenia in 3 children, with 1 of the osteopenic children developing pathological fractures. About one third (5/14) of the problems were arthrogrypotic in nature. The remainder were mild digital deformities, developmental or spondylodysplastic scolioses, and, rarely, congenital spinal deformities.

Abdominal Muscles↗