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PubMed2006

Risk factors associated with work-related musculoskeletal disorders among female flight attendants: using a focus group to prepare a survey.

In preparation for surveying female flight attendants about work-related musculoskeletal disorder risk factors and symptoms, a focus group study was completed with members of the target population. The aims of this study were to ensure completeness of a previously developed list of physically strenuous job tasks performed by female flight attendants and assess the clarity, appropriateness, and applicability of existing self-reported measures to be used in the survey. Female flight attendants who worked one or more long-haul international flights in the prior 3 months and 75 or more hours in the prior month were recruited from the union membership. A trained moderator led a 2-hour discussion with the flight attendants. With use of a transcript-based analysis, a final list of 41 job tasks was created. Useful comments on a set of self-reported measures were obtained. The

Adult↗
PubMed1999

Transitions in employment, morbidity, and disability among persons ages 51-61 with musculoskeletal and non-musculoskeletal conditions in the US, 1992-1994.

OBJECTIVE: To provide estimates of the prevalence of musculoskeletal conditions in a sample of persons ages 51-61 living in the community in the US in 1992, to indicate the incidence of such conditions between 1992 and 1994, and to describe the proportion of individuals with these conditions who developed or recovered from disability and who left and entered employment during this time. METHODS: The estimates were derived from the Health and Retirement Survey, consisting of data on a national probability sample of 8,739 persons, ages 51-61, who were interviewed in the community in 1992 and reinterviewed in 1994. RESULTS: In 1992, 62.4% of persons (14.4 million) between the ages of 51 and 61 years reported at least 1 musculoskeletal condition; the rate increased to 70.5% by 1994. More than 40% of persons with musculoskeletal conditions reported disability, which was almost 90% of all persons with disability in this age group. Persons with musculoskeletal conditions had lower employment rates, were less likely to enter employment, and were more likely to leave employment compared with persons without these conditions. High rates of disability account for much of these differences. CONCLUSION: Musculoskeletal conditions affected more than two-thirds of persons ages 51-61 and accounted for all but 10% of those with disabilities. The prevention of disability among such persons should improve their employment prospects.

Chronic Disease↗
PubMed1996

Lower extremity musculoskeletal problems in dancers.

Ankle and foot problems are extremely common in the high-performance dance population. To adequately evaluate and treat these problems, the physician must possess knowledge of how the physical demands of dance affect the performer's body. A routine evaluation of the dancer, involving a team of orthopedists, dance instructors, and physical therapists familiar with dance mechanics, has been developed to facilitate recognition of the abnormal mechanics responsible for injury. This technique can be useful in prevention and early diagnosis of injury, thus minimizing lost performance time.

Back↗
PubMed2003

Determination of the effectiveness of materials in attenuating high frequency shock during gait using filterbank analysis.

OBJECTIVE: To develop an accurate method for quantifying the frequency content of the ground reaction force transient. DESIGN: Repeated measures design comparing the impact severity during walking with different insole materials. BACKGROUND: The body experiences a brief but sizeable impact upon heel strike during walking. This impact transient is believed to result in musculoskeletal injuries. It is important to accurately quantify this impact as a step towards decreasing the risk of injury. METHODS: Seven subjects walked barefoot at their normal cadence across a force platform, while insole materials (Spenco, Microcel-puff, and Plastazote) were placed on the surface of the force platform. A filterbank program was developed to determine the percent root mean square in 10 Hz frequency bands from zero to 400 Hz. Analysis focused on the impact transient contained in a 20 ms window after heel contact. RESULTS: The high frequency (>60 Hz) power was significantly larger in the barefoot condition compared to the insole conditions. The barefoot condition also resulted in significantly higher initial peak forces and force loading rates. CONCLUSIONS: The frequency content of the ground reaction force can be effectively quantified using a filterbank approach. Shoe insole materials can reduce the initial peak force, force loading rate, and frequency content of the impact transient in walking. The frequency content of the initial ground reaction force extends up to 400 Hz in some footwear conditions. RELEVANCE: The new filterbank procedure illustrates that the vertical ground reaction force in walking has a higher frequency content than previously thought. This signal requires high sampling rates to avoid aliasing, and appropriate signal processing algorithms, such as filter banks, for analysis.

Adult↗
PubMed2006

Assessing the instrumentalist interface: modifications, ergonomics and maintenance of play.

Awareness of the tasks required to play a particular instrument requires observation of technique and understanding of the dynamic and static loads placed on the musculoskeletal system to play a particular instrument. Anatomic differences, variation in hand size, gender, instrument choice, and maintainance of the instrument all may play a role in the development of playing-related complaints. Simply observing particular instruments, we can see a variety of positions that are required to play the instrument. Important to the discussion of overuse syndromes, we must evaluate the duration of practice sessions and warm-up and cool down periods, which may help minimize playing-related problems. Avoid absolute rest and opt for relative rest for playing-related problems. Immobilization for more than 3 to 4 weeks may lead to greater risk of injury when playing is resumed. Return to play schedules should start with simple, soft music, doubling minutes of playing every few days, dropping back if pain develops. Practical advice may include building up practice times gradually with 5- to 10-minute intervals in 60- to 90-minutes sessions. This recommendation is supported by the findings of Lutz and colleagues who showed decreased blood flow to the forearm after repetitive hand and wrist activities for 90 minutes. This decrease in blood flow normalized after 5 to 10 minutes of stretching exercises. Players with hypermobility should consider limiting practice sessions to 45 minutes allowing for rest breaks of 10 to 15 minutes. Fry suggested a shift in thinking of ergonomics as sa reactive strategy to one in which we anticipate and prevent problems before they become insidious or severe enough to limit the ability of the instrumentalist to play. Joint protection is important in all musicians, and although youth can be forgiving for many, we must remind our patients about joint protection as it applies to activities of daily living. Instrumentalists rely on their hands and finger joints to allow them to perform. Basic principles that apply to patients with all types of arthritis also apply to our patients when activities that worsen symptoms or place unnecessary stress on joints are identified. Using adaptive equipment to open jars is an obvious example. Overall, engaging the patient to observe routine behaviors may lead to the identification of modifiable activities, which might be aggravating or manifesting as a playing-related discomfort. Although some injury patterns can be associated with particular instruments, remember that your guitar-playing patient may be taking drum lessons on the side, Which could result in lateral epicondylitis that bothers him when he plays the guitar.

Biomechanical Phenomena↗
PubMed2001

Occupational health and safety in physiotherapy: guidelines for practice.

Most physiotherapists (91%) experience work related musculoskeletal disorders (WMSDs) at some time, and one in six makes a career change as a consequence. Many of these disorders are attributed to manual handling of patients. This paper proposes guidelines to reduce the risk of WMSDs based on Australian legislative requirements, the results of a survey of Australian physiotherapists and the literature surrounding injury prevention. These guidelines address the areas of environmental and job design, and the personal physical capabilities of physiotherapists, within the context of law. The paper concludes by calling for further research to explore and develop this area of injury prevention in the physiotherapy profession.

Australia↗
PubMed2006

Autoclaved tumor bone for reconstruction: an alternative in developing countries.

The options for reconstruction after excision of skeletal tumors include reimplanting the autoclaved tumor-bearing bone. We asked whether such bone will survive and unite with normal bone and whether the local tumor recurrence rate increases after its use. We ascertained the functional outcome (Musculoskeletal Tumor Society score) and complications in 19 patients. After wide excision, the bony segment was autoclaved at 120 degrees for 10 minutes and reimplanted at the original defect with intramedullary nails and compression plates. Twelve of our 19 patients were available for followup. The autoclaved segment united with the normal bone in 11 of the 12 patients. No patients had fracture or resorption of the autoclaved segment. Two patients had local tumor recurrence in nearby soft tissues, apparently unrelated to the autoclaved bone. The mean functional score was 70%. Complications included fatigue failure of the nail in one patient, superficial infection in three patients, and deep infection in two patients. Reconstruction with autoclaved tumor-bearing bone is a simple and effective tool in limb salvage. This technique is a cost-effective alternative for developing countries circumventing complications of prosthetic and allograft reconstruction.

Adolescent↗
PubMed2001

Anatomy and development of the koala, Phascolarctos cinereus: an evolutionary perspective on the superfamily Vombatoidea.

Fifteen koalas (Phascolarctos cinereus)--5 pouched young from 4 to 6.5 months and 10 adults from 5 to 16.5 years--were analyzed for functional parameters (body composition, limb segment and muscle mass, post-cranial skeletal characters) and developmental expressions (growth of body, brain, musculature). These data were compared with a convergent eutherian, the three-toed sloth, Bradypus infuscatus, and with the koala's distant (Macropodid; wallabies) and proximate (Vombatid; wombats) marsupial relatives. Musculoskeletal structures correlated with sitting and climbing; the growth of the young and the physiological demands of adulthood correlated with the low-quality diet of Eucalyptus foliage. The gestalt of the ancestral Vombatoids (pronograde quadrupeds, generalist browsers and social conservatives with low basal metabolism and attenuated development) provided the baseline essential for their locomotor and nutritional divergence into arboreal browsers, the koalas, and fossorial grazers, the wombats.

Animals↗
PubMed1997

[Musculoskeletal problems and physical activity. Results from a long-term study].

In two Norwegian industrial companies 42 employees (24 female/18 male) with shoulder, neck and back problems took part in a training programme for a period of 12 months. The programme comprised of daily relaxation exercises at work combined with training at home three times a week for about 30 minutes on each occasion. The physical therapy and training apparatus, TerapiMaster, which was constructed in Norway was used both at work and at home. The training programme was developed and monitored by an experienced physiotherapist. The observations of the training programme focused on changes in absenteeism during the training period compared with pre-study absenteeism. For employees with musculo-skeletal ailments the combination of relaxation exercises and physical training with professional instruction and follow-up significantly reduced absenteeism from 11.2 days per year (pre-study) to 0.2 days per year (at the end of the 12-month training period) (p < 0.001). A follow-up 30 months after completion of the formal study showed that absenteeism remained at the reduced rate, probably because positive experiences and "good habits" developed during the study encouraged the participants to continue with the training programme.

Adult↗
PubMed1999

Analgesia for trauma and burns.

This article has described the physiologic impact of trauma- and burn-related pain as well as the effect of a clinician's choice of analgesic method, using the specific example of regional analgesia for pain caused by chest trauma. It has been observed that trauma exerts a holistic influence upon the organism, marshalling reflexes, multi-system physiologic stress responses, and psychologic responses--some adaptive and others maladaptive. There is reason to consider that timely analgesia can intervene in this dynamic process and interdict the establishment of a debilitated state. A key finding of these studies is that a report of pain relief may not be the best outcome measure since the choice of analgesic method(s) has a significant impact on the secondary effects of pain. Although extrapolated from studies of perioperative pain, findings do suggest that there may be a critical period of time during which the secondary effects of a painful stimulus may be attenuated or reversed. How long this period of reversibility exists has not been determined, so planning for the level and goals of analgesia intervention should occur early on. Analgesia should be viewed not only as a humanitarian gesture, but also a therapeutic maneuver with the goal being the early restoration of function and the mitigation of a chronic debilitated state. There is scattered evidence that regional analgesic techniques using local anesthetics have some advantages over other analgesic modalities, particularly in the trauma patient with pulmonary compromise; however, as with other medical interventions, one should develop a strategic plan of application which includes consideration of potential complications and side effects, in addition to the potential therapeutic effects. The traumatized body, as well as the attending physician, must deal with inflammation, the neurohumoral reaction, musculoskeletal reflex responses, and numerous other reactions designed to stabilize an acutely destabilized systemic entity. Multimodal analgesia, with the balanced use of systemic and regional medications, has given the best short- and long-term results in studies of postthoracotomy pain. The use of a similar combined plan for posttraumatic analgesia seems logical; however, many questions remain as yet unanswered. In particular, what are the optimal combinations of techniques/medications to employ to maximize analgesia and minimize secondary effects of trauma? Can an aggressive multimodal approach intervene effectively in the development of chronic pain states, and if so, for how long? What are the long-term benefits to be derived from making a significant impact on the stress response? Last, but not least, can analgesic interventions be shown to be cost-effective according to current societal pressures to reduce the cost of health care? These and other questions are not easy to answer. Trauma strikes, in a variable fashion, patients of all ages, with all forms of comorbidity, and is treated by a technology that continues to evolve. Previous research related to the effects of analgesic treatments has been hampered by the limitations that arise when isolated groups embark on vast projects with limited numbers of patients available. It is time for investigators at multiple centers to embark on coordinated efforts to address long-term questions related to trauma and the therapeutic efficacy of analgesia.

Analgesia↗
PubMed1988

Adverse reactions to isotretinoin. A report from the Adverse Drug Reaction Reporting System.

Between October 1982 and June 1985 the Adverse Drug Reaction Reporting System received reports of 104 suspected adverse reactions occurring in 93 patients who took isotretinoin. Adverse reactions involving the skin and mucous membranes (29 reports), central nervous system (23), musculoskeletal system (12), pregnancy (11), and eyes (8) were most commonly reported. Severe headache was the most frequently reported adverse reaction (15 reports). In four cases headaches were attributed to pseudotumor cerebri. Some of the reported reactions, for example, a disulfiram (Antabuse)-like reaction and oculogyric crisis, have not been described previously in the literature. Other reports, such as congenital malformations, serve to emphasize some of the serious reactions that are known to occur. These spontaneous reports of adverse reactions associated with isotretinoin use, together with the literature we review, may help alert physicians to the diverse spectrum of adverse reactions that may develop in patients taking isotretinoin.

Abnormalities, Drug-Induced↗
PubMedDate not supplied

Problems in postoperative renal transplant recipients who present to the emergency unit: experience at one center.

When a renal recipient in Turkey develops a postoperative problem, consultation by the transplant team in the emergency unit is often the first step toward a solution. The main aim of this study was to identify the types of postoperative problems that cause renal transplantation patients to visit the emergency room. Gathering this information was believed to be an important step toward developing new management strategies for these problems, in line with the quality management systems used throughout our hospital network. We collated the physical signs in the 78 patients when they presented to the emergency room. The most common one was fever (26.9%) followed by nausea/vomiting, diarrhea, abdominal pain, dyspnea, skin lesions, headache, musculoskeletal trauma, hematuria/dysuria, epistaxis, psychological disorders, angina pectoris, hypertension, epilepsy, and rectal bleeding. Among the 78 patients, 45 (57.7%) were hospitalized and 33 (42.3%) were discharged with medical advice or drug treatment. Among the 45 hospitalized patients, 97.8% were initiated on medical treatment. Knowing the surgical and medical emergency issues prevalent in recipients enables the development of new procedures and algorithms, leading to more effective management and follow-up of renal transplant recipients.

Emergency Service, Hospital↗
PubMed2003

Engineering of muscle tissue.

The loss or failure of an organ or tissue is one of the most frequent, devastating, and costly problems in health care. Tissue engineering and regenerative medicine is an emerging interdisciplinary field that applies the principles of biology and engineering to the development of viable substitutes that restore, maintain, or improve the function of human tissues and organs. Tissue engineering science has provided critical new knowledge that will deepen our understanding of the phenotype of an important category of cell types-the muscle cells-and this knowledge may enable meaningful advances in musculoskeletal tissue engineering. There are two principle strategies for the replacement of impaired muscle tissues. One approach uses the application of isolated and differentiated cells (in vivo tissue engineering), using a transport matrix for the cell delivery; the other uses in vitro-designed and pre-fabricated tissue equivalents (in vitro tissue engineering). Future developments and the decision regarding which approach is more promising depend on the elucidation of the relationships among cell growth and differentiation, the three-dimensional environment, the architecture of the cells, and gene expression of the developmental process and the survival of the cells and integration in the host in in vivo experiments. As the techniques of tissue engineering become more sophisticated and as issues such as vascularization and innervation are addressed, the usefulness of these methods for reconstructive surgery may grow significantly.

Humans↗
PubMed2001

Questionnaire versus direct technical measurements in assessing postures and movements of the head, upper back, arms and hands.

OBJECTIVES: This study compares questionnaire-assessed exposure data on work postures and movements with direct technical measurements. METHODS: Inclinometers and goniometers were used to make full workday measurements of 41 office workers and 41 cleaners, stratified for such factors as musculoskeletal complaints. The subjects answered a questionnaire on work postures of the head, back, and upper arms and repeated movements of the arms and hands (3-point scales). The questionnaire had been developed on the basis of a previously validated one. For assessing worktasks and their durations, the subjects kept a 2-week worktask diary. Job exposure was individually calculated by time-weighting the task exposure measurements according to the diary. RESULTS: The agreement between the self-assessed and measured postures and movements was low (kappa = 0.06 for the mean within the occupational groups and kappa = 0.27 for the whole group). Cleaners had a higher measured workload than office workers giving the same questionnaire response. Moreover, the subjects with neck-shoulder complaints rated their exposure to movements as higher than those without complaints but with the same measured mechanical exposure. In addition, these subjects also showed a general tendency to rate their postural exposure as higher. The women rated their exposure higher than the men did. CONCLUSIONS: The questionnaire-assessed exposure data had low validity. For the various response categories the measured exposure depended on occupation. Furthermore, there was a differential misclassification due to musculoskeletal complaints and gender. Thus it seems difficult to construct valid questionnaires on mechanical exposure for establishing generic exposure-response relations in epidemiologic studies, especially cross-sectional ones. Direct technical measurements may be preferable.

Adult↗
PubMed2005

Musculoskeletal ultrasound training in rheumatology: the Belfast experience.

OBJECTIVES: Despite the increasing use of musculoskeletal ultrasound (MSUS) as a clinical tool in rheumatology, there is no consensus yet regarding the standards required to achieve a basic level of competence in the use of this imaging technique. A number of sonographers worldwide are developing curricula and standardizing teaching methods in order to improve training in MSUS for rheumatologists. In the meantime, clinicians are devising informal means of training in order to acquire these new skills. Here we describe the informal team approach to MSUS training adopted by a group of rheumatologists from the Regional Rheumatology Centre in Belfast, UK. METHODS: Over a 5-yr period, eight rheumatologists from Musgrave Park Hospital in Belfast used a variety of means to learn the basic skills of MSUS. RESULTS: Seven of the team underwent a formal assessment of their competency in a practical examination devised by an experienced sonographer. All were judged to have attained a basic competency in MSU. CONCLUSIONS: This Belfast experience shows what can be achieved despite the absence of formal MSUS training. Nevertheless, the development of recognized training programmes and international standards of competency are important goals on the way to achieving more widespread acceptance of MSUS as a useful tool in everyday clinical practice.

Clinical Competence↗