Musculoskeletal discomfort and feeling of fatigue among female professional workers: the need for ergonomics consideration.

Subjective feeling of general fatigue and physiological strain were studied in one hundred female professional employees of industrial worker and full-time nurses. Using an interview questionnaire the feeling of fatigue were studied. The subjects were asked to indicate on the body diagram all the areas of musculoskeletal pain from which they perceived discomfort. Furthermore physical strength test consisting of grip test, back and leg strength test were carried out before and after work on all subjects. The results indicated that the two groups of employees showed different symptoms of "pain" and/or "fatigue," with regard to the different parts of body. It was also noted that the physical strength after work was lower for both groups as compared to before work and even lower for the industrial workers than the nurses. The feeling of fatigue between the two investigated groups was not significantly different, but for the musculoskeletal pain was highly significantly different. The worker group used also more pain-killing drugs for releasing the muscle pain. It was evident that ergonomics intervention for female professional workers was of great importance and urgency, particularly for making the workplace more human. Improvement of the working conditions, better organization of work, and ergonomics interventions are suggested as necessary measures for reduction of pain and feeling of discomfort.     

Reliability of spectral EMG parameters of healthy back extensors during submaximum isometric fatiguing contractions and recovery

Spectral EMG parameters are being used as an objective evaluation of low back rehabilitation programs. The reliability of these spectral parameters is important in determining the validity of this evaluation tool. Two groups of eight subjects, with no history of back pain, were measured: the first group every day for one week; the second group one day per week for four weeks. During each session, subjects performed a 30-second isometric fatiguing contraction of the back extensors at 60% MVC followed by a 60-second rest and a 10-second repeat contraction. The intraclass correlation coefficient (ICC) did not demonstrate high reliability (ICC<0.6) for the rate of median power frequency (MedPF) change (Hz/s), the magnitude of the recovery (Hz) and differences between the dominant and the non-dominant sides within a subject. However, the initial MedPF (Hz) of the fatigue and repeat contractions demonstrated excellent reliability (ICC>0.8) with five or more repeated measures. The practical implication of this work is that the experimental condition must have sufficiently large changes in MedPF (signal)—at least larger than the variability inherent in the MedPF (noise)—to constitute a valid measure.     

Preventing disability from work-related low-back pain. New evidence gives new hope -- if we can just get all the players onside

Despite the publication in the mid-1990s of comprehensive practice guidelines for the management of acute low-back pain, both in the United States and elsewhere, this ubiquitous health problem continues to be the main cause of workers'' compensation claims in much of the Western world. This paper represents a synthesis of the intervention studies published in the last 4 years and is based on a new approach to categorizing these studies that emphasizes the stage or phase of back pain at the time of intervention and the site or agent of the intervention. Current thinking suggests that medical management in the first 3-4 weeks after the onset of pain should be generally conservative. Several studies of rather heterogeneous interventions focusing on return to work and implemented in the subacute stage (3-4 to 12 weeks after the onset of pain) have shown important reductions in time lost from work (by 30% to 50%). There is substantial evidence indicating that employers who promptly offer appropriately modified duties can reduce time lost per episode of back pain by at least 30%, with frequent spin-off effects on the incidence of new back-pain claims as well. Finally, newer studies of guidelines-based approaches to back pain in the workplace suggest that a combination of all these approaches, in a coordinated workplace-linked care system, can achieve a reduction of 50% in time lost due to back pain, at no extra cost and, in some settings, with significant savings.     

Biofeedback-assisted relaxation training for the aging chronic pain patient.

The older segments of the U.S. population are expanding rapidly and account for a disproportionate amount of health care, including treatment for pain-related musculoskeletal disorders. In a prospective study with objective measures and one-year follow-up, Middaugh et al. (1988) found that older patients (55-78 yr; N = 17, 76% success) treated in a multidisciplinary chronic pain rehabilitation program enjoyed a success rate equal to that of younger patients (29-48 yr, N = 20, 70% success). The current study presents additional data on these two groups of patients to compare their ability to learn the physiological self-regulation skills taught in the biofeedback/relaxation component of the multimodal program. This component included progressive muscle relaxation training, diaphragmatic breathing instruction, and EMG biofeedback. Repeated measures ANOVA showed significant increases in digital skin temperature (peripheral vasodilation) and decreases in respiration rate both within and across training sessions (p values = .04 to .0001) with no differences between age groups (p greater than .05). EMG measures for the upper trapezius ms in patients with cervical pain showed similar deficits in muscle control at evaluation and similar improvements with biofeedback training for the two age groups. These findings indicate that older pain patients responded well to the biofeedback/relaxation training component of the multimodal pain program.     

Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice.

OBJECTIVE--To describe the natural course of recent acute low back pain in terms of both morbidity (pain, disability) and absenteeism from work and to evaluate the prognostic factors for these outcomes. DESIGN--Inception cohort study. SETTING--Primary care. PATIENTS--103 patients with acute localised non-specific back pain lasting less than 72 hours. MAIN OUTCOME MEASURES--Complete recovery (disappearance of both pain and disability) and return to work. RESULTS--90% of patients recovered within two weeks and only two developed chronic low back pain. Only 49 of 100 patients for whom data were available had bed rest and 40% of 75 employed patients lost no time from work. Proportional hazards regression analysis showed that previous chronic episodes of low back pain, initial disability level, initial pain worse when standing, initial pain worse when lying, and compensation status were significantly associated with delayed episode recovery. These factors were also related to absenteeism from work. Absenteeism from work was also influenced by job satisfaction and gender. CONCLUSIONS--The recovery rate from acute low back pain was much higher than reported in other studies. Those studies, however, did not investigate groups of patients enrolled shortly after the onset of symptoms and often mixed acute low back pain patients with patients with exacerbations of chronic pain or sciatica. Several sociodemographic and clinical factors were of prognostic value in acute low back pain. Factors which influenced the outcome in terms of episode recovery (mainly physical severity factors) were only partly predictive of absenteeism from work. Time off work and return to work depended more on sociodemographic and job related influences.     

Improved protein-ligand docking using GOLD

The Chemscore function was implemented as a scoring function for the protein-ligand docking program GOLD, and its performance compared to the original Goldscore function and two consensus docking protocols, "Goldscore-CS" and "Chemscore-GS," in terms of docking accuracy, prediction of binding affinities, and speed. In the "Goldscore-CS" protocol, dockings produced with the Goldscore function are scored and ranked with the Chemscore function; in the "Chemscore-GS" protocol, dockings produced with the Chemscore function are scored and ranked with the Goldscore function. Comparisons were made for a "clean" set of 224 protein-ligand complexes, and for two subsets of this set, one for which the ligands are "drug-like," the other for which they are "fragment-like." For "drug-like" and "fragment-like" ligands, the docking accuracies obtained with Chemscore and Goldscore functions are similar. For larger ligands, Goldscore gives superior results. Docking with the Chemscore function is up to three times faster than docking with the Goldscore function. Both combined docking protocols give significant improvements in docking accuracy over the use of the Goldscore or Chemscore function alone. "Goldscore-CS" gives success rates of up to 81% (top-ranked GOLD solution within 2.0 A of the experimental binding mode) for the "clean list," but at the cost of long search times. For most virtual screening applications, "Chemscore-GS" seems optimal; search settings that give docking speeds of around 0.25-1.3 min/compound have success rates of about 78% for "drug-like" compounds and 85% for "fragment-like" compounds. In terms of producing binding energy estimates, the Goldscore function appears to perform better than the Chemscore function and the two consensus protocols, particularly for faster search settings. Even at docking speeds of around 1-2 min/compound, the Goldscore function predicts binding energies with a standard deviation of approximately 10.5 kJ/mol.     

Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study

Objective To estimate the one year prognosis and identify prognostic factors in cases of recent onset low back pain managed in primary care.Design Cohort study with one year follow-up.Setting Primary care clinics in Sydney, Australia.Participants An inception cohort of 973 consecutive primary care patients (mean age 43.3, 54.8% men) with non-specific low back pain of less than two weeks’ duration recruited from the clinics of 170 general practitioners, physiotherapists, and chiropractors.Main outcome measures Participants completed a baseline questionnaire and were contacted six weeks, three months, and 12 months after the initial consultation. Recovery was assessed in terms of return to work, return to function, and resolution of pain. The association between potential prognostic factors and time to recovery was modelled with Cox regression.Results The follow-up rate over the 12 months was more than 97%. Half of those who reduced their work status at baseline had returned to previous work status within 14 days (95% confidence interval 11 to 17 days) and 83% had returned to previous work status by three months. Disability (median recovery time 31 days, 25 to 37 days) and pain (median 58 days, 52 to 63 days) took much longer to resolve. Only 72% of participants had completely recovered 12 months after the baseline consultation. Older age, compensation cases, higher pain intensity, longer duration of low back pain before consultation, more days of reduced activity because of lower back pain before consultation, feelings of depression, and a perceived risk of persistence were each associated with a longer time to recovery.Conclusions In this cohort of patients with acute low back pain in primary care, prognosis was not as favourable as claimed in clinical practice guidelines. Recovery was slow for most patients. Nearly a third of patients did not recover from the presenting episode within a year.     

Physical Disability and Motivation

Motivating the physically handicapped individual to assist in his own rehabilitation is a complex problem. Difficulties in motivation are often based on disturbances in body image, which in turn are related both to the premorbid personality and the handicap. Treatment must be directed at the body image as well as the physical disability. Emotional disturbance following body injury should be expected and its absence is abnormal. Adequate rehabilitation entails a consideration of the effect of the rehabilitation process on the disabled person. The patient''s basic abilities must be used to improve motivation. Rehabilitation procedures must focus on practical ways of coping with everyday life. Physical disability can mobilize underlying inferiority feelings and increase the need for dependency. Judicious use must be made of success and frustration in the rehabilitation program.     

Biofeedback-assisted relaxation training for the aging chronic pain patient

The older segments of the U.S. population are expanding rapidly and account for a disproportionate amount of health care, including treatment for pain-related musculoskeletal disorders. In a prospective study with objective measures and one-year follow-up, Middaugh et al. (1988) found that older patients (55–78 yr; N=17, 76% success) treated in a multidisciplinary chronic pain rehabilitation program enjoyed a success rate equal to that of younger patients (29–48 yr; N=20, 70% success). The current study presents additional data on these two groups of patients to compare their ability to learn the physiological self-regulation skills taught in the biofeedback/relaxation component of the multimodal program. This component included progressive muscle relaxation training, diaphragmatic breathing instruction, and EMG biofeedback. Repeated measures ANOVA showed significant increases in digital skin temperature (peripheral vasodilation) and decreases in respiration rate both within and across training sessions (p values=.04 to .0001) with no differences between age groups (p>.05). EMG measures for the upper trapezius ms in patients with cervical pain showed similar deficits in muscle control at evaluation and similar improvements with biofeedback training for the two age groups. These findings indicate that older pain patients responded well to the biofeedback/relaxation training component of the multimodal pain program.This research was supported in part by NIDRR grant No. H133G90085, Department of Education, DHEW, and by the Medical University of South Carolina General Clinical Research Center under NIH grant No. RR1070.     

The effects of Bodymax high-repetition resistance training on measures of body composition and muscular strength in active adult women

The purpose of this study was to investigate the effects of a light, high-repetition resistance-training program on skinfold thicknesses and muscular strength in women. Thirty-nine active women (mean age 38.64 +/- 4.97 years) were randomly placed into a resistance-training group (RT; n = 20) or a control group (CG; n = 19). The RT group performed a resistance-training program called Bodymax for 1 hour, 3 d.wk(-1), which incorporated the use of variable free weights and high repetitions in a group setting. The CG group continued its customary aerobic training for 1 hour 3 d.wk(-1). Five skinfold and 7 muscular strength measures were determined pretraining and after 12 weeks of training. Sum of skinfolds decreased (-17 mm; p < 0.004) and muscular strength increased (+57.4 kg; p < 0.004) in the RT group. Effect sizes for individual skinfold sites and strength measures were "medium" and "high," respectively. Bodymax is an effective resistance-training program for reducing skinfold thickness and increasing muscular strength in active women. Therefore, women with a similar or lower-activity status should consider incorporating such training into their regular fitness programs.     

HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs

There is evidence that HIV prevention programs for sex workers, especially female sex workers, are cost-effective in several contexts, including many western countries, Thailand, India, the Democratic Republic of Congo, Kenya, and Zimbabwe. The evidence that sex worker HIV prevention programs work must not inspire complacency but rather a renewed effort to expand, intensify, and maximize their impact. The PLOS Collection “Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers” highlights major challenges to scaling-up sex worker HIV prevention programs, noting the following: sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; sex worker HIV and sexually transmitted infection services receive limited domestic financing in many countries; many sex worker HIV prevention programs are inadequately codified to ensure consistency and quality; and many sex worker HIV prevention programs have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile- and internet-based sex workers. Based on the wider collection of papers, this article presents three major clusters of recommendations: (i) HIV programs focused on sex workers should be prioritized, developed, and implemented based on robust evidence; (ii) national political will and increased funding are needed to increase coverage of effective sex worker HIV prevention programs in low and middle income countries; and (iii) comprehensive, integrated, and rapidly evolving HIV programs are needed to ensure equitable access to health services for individuals involved in all forms of sex work.

Summary Points

• HIV prevention programs for sex workers, especially female sex workers, are cost-effective.
• There are opportunities to further increase the impact of HIV prevention programs for sex workers and to adapt interventions to a changing context.
• Many sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; receive limited domestic financing in many countries; are inadequately codified to ensure consistency and quality; and have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile and internet-based sex workers.
• We recommend increasing our understanding of HIV epidemic transmission dynamics, improving situation analyses and programmatic mapping, increasing domestic financing for sex worker HIV prevention programs where feasible, delivering well-codified, comprehensive programs using “Science of Delivery” principles and developing more effective models to reach informal sex workers, male and transgender sex workers, and mobile and internet-based sex workers.
• Given their marginalization, concerted efforts must be made to ensure sex workers have equitable access to HIV prevention, care, and treatment services, as well as wider health services, particularly for STIs, mental health, and addictions.

     

Low back pain.

The studies reviewed here show that the duration and severity of individual episodes of back pain can be lessened, reducing recurrences and their cost in terms of suffering and lost work. Frank examines differential diagnosis; acute, chronic, and intractable pain; and service implications. Modern management emphasises self care, and bed rest should usually not be longer than 48 hours. A return to physical fitness and other activities, including employment, is actively encouraged. Medication has a role in facilitating these objectives. Two points are especially emphasised: strategies to manage low back pain must be long term and preventive; and the responsibility to keep fit, maintain an exercise programme, and remain relaxed so as to avoid physically stressing the spine is that of the individual, not of the professionals.     

Industrial epidemiology.

Industrial epidemiology is a specialized discipline concerned with the study of disease occurrence in specific subgroups of the general population, i.e., of relatively healthy members of the work force for whom adequate records are available. Although the ultimate purpose of industrial epidemiology--the prevention of disease--is a logical extension of programs of industrial medicine and occupational and community health, epidemiologic methods must draw on interdisciplinary skills. The existence of centralized records kept in the course of business may make it easier to collect information about industrial populations than to gather data relative to other population subgroups. Many deficiencies in epidemiologic studies of worker groups, however, can be related to poor methods of data-gathering, inadequate record keeping, and an incomplete data base. Sources of information for epidemiologic studies of worker groups may include personnel and medical records, government reports, insurance files, production records, industrial hygiene measurements, surveys and questionnaires, and an organized follow-up program. In some cases, the ready availability of multiple sources of information may lead to differential information bias, and this should be avoided.     

Differences between African-American and Caucasian students on enrollment influences and barriers in kinesiology-based allied health education programs

Kinesiology departments have recently started to offer allied health education programs to attract additional students to teacher education units (9). Although allied health professions offer increased work opportunities, insufficient enrollment and training of minority students in these academic fields contribute to underrepresentation in the workforce (3). To improve workforce diversity, kinesiology departments must understand how enrollment influences and barriers differ by race among prospective students. Therefore, the purpose of this study was to identify differences in allied health education enrollment influences and enrollment barriers between minority and Caucasian students. Participants (n = 601) consisted of students enrolled in kinesiology-based allied health education programs. Multivariate ANOVA was used to compare group differences in enrollment decision making. "Personal influence," "career opportunity," and "physical self-efficacy" were all significantly stronger enrollment influences among African-American students than among Caucasian students, and "social influence," "experiential opportunity," "academic preparation," and "physical self-efficacy" were all perceived as significantly greater barriers compared with Caucasian students. Findings support the need to recruit African-American students through sport and physical education settings and to market program-based experiential opportunities.     

Bugs in computational chemistry software and their consequences: the importance of the source code

The increase in computer power and the development of new mathematical concepts implemented in software have allowed computational chemistry to emerge as a new research field. Although programs were freely distributed during the "golden age" of this discipline, today they are usually copyrighted and have become easier and easier to use through sophisticated graphical interfaces. This "democratization" is a vector of success for this discipline. Nowadays, non-theoreticians can use such programs more easily and solve chemistry-related problems with the computer. The number of program offerings has rapidly grown and private companies specialized in molecular modeling have appeared and compete to sell their products. Thus, numerous software packages, often presenting similar capabilities, are now available on the market. Within this context, the availability of the program source code remains, in our opinion, an important criterion for program selection.     

Outcome of low back pain in general practice: a prospective study

Objectives: To investigate the claim that 90% of episodes of low back pain that present to general practice have resolved within one month. Design: Prospective study of all adults consulting in general practice because of low back pain over 12 months with follow up at 1 week, 3 months, and 12 months after consultation. Setting: Two general practices in south Manchester. Subjects: 490 subjects (203 men, 287 women) aged 18-75 years. Main outcome measures: Proportion of patients who have ceased to consult with low back pain after 3 months; proportion of patients who are free of pain and back related disability at 3 and 12 months. Results: Annual cumulative consultation rate among adults in the practices was 6.4%. Of the 463 patients who consulted with a new episode of low back pain, 275 (59%) had only a single consultation, and 150 (32%) had repeat consultations confined to the 3 months after initial consultation. However, of those interviewed at 3 and 12 months follow up, only 39/188 (21%) and 42/170 (25%) respectively had completely recovered in terms of pain and disability. Conclusions: The results are consistent with the interpretation that 90% of patients with low back pain in primary care will have stopped consulting with symptoms within three months. However most will still be experiencing low back pain and related disability one year after consultation.

Key messages

• It is widely believed that 90% of episodes of low back pain seen in general practice resolve within one month
• In a large population based study we examined the outcome of episodes of low back pain in general practice with respect to both consultation behaviour and self reported pain and disability
• While 90% of subjects consulting general practice with low back pain ceased to consult about the symptoms within three months, most still had substantial low back pain and related disability
• Only 25% of the patients who consulted about low back pain had fully recovered 12 months later
• Since most consulters continue to have long term low back pain and disability, effective early treatment could reduce the burden of these symptoms and their social, economic, and medical impact

     

Cerebral complications in juvenile rheumatoid arthritis.

The antecedents of myocardial infarction have been reviewed in 102 patients (117 episodes) undergoing a program of rehabilitation. The year prior to the first attack was characterized by business and social problems, with some weight gain; in the week before the attach there was added tiredness, poor general health and, in some cases, increasing anginal pain. Heavy lifting and/or unusual exercise were common immediately before or during an attack; five attacks were related to the shovelling of wet snow.Both bed and the normal place of work were uncommon sites for an attack. More than 50% of patients had 30 minutes'' warning of infarction. The relevance of these findings to a safe program of therapeutic exercise is discussed.     

Acute low back pain: systematic review of its prognosis

Objectives To describe the course of acute low back pain and sciatica and to identify clinically important prognostic factors for these conditions.Design Systematic review.Data sources Searches of Medline, Embase, Cinahl, and Science Citation Index and iterative searches of bibliographies.Main outcome measures Pain, disability, and return to work.Results 15 studies of variable methodological quality were included. Rapid improvements in pain (mean reduction 58% of initial scores), disability (58%), and return to work (82% of those initially off work) occurred in one month. Further improvement was apparent until about three months. Thereafter levels for pain, disability, and return to work remained almost constant. 73% of patients had at least one recurrence within 12 months.Conclusions People with acute low back pain and associated disability usually improve rapidly within weeks. None the less, pain and disability are typically ongoing, and recurrences are common.