Reincorporación al trabajo tras una incapacidad temporal por trastornos músculo-esqueléticos: Revisión sistemática de guías de buenas prácticas

Objetivo: identificar las guías de retorno al trabajo (GRAT) después de un proceso de Incapacidad temporal (IT) por trastorno músculo esquelético (TME) para evaluar su calidad metodológica.Método: Se realizó una búsqueda sistemática de guías específicas de retorno al trabajo en inglés, castellano y catalán cuyo contenido tenía en forma total o parcial información sobre TME. 6 guías fueron identificadas (3 específicas sobre TME) las cuales fueron evaluadas por 7 expertos utilizando el método validado AGREE. Para cada dominio de cada una de las guías se calcularon las puntuaciones estandarizadas y para cada ítem las medianas de puntajes de los evaluadores. Además, cada evaluador hizo un juicio cualitativo de la calidad de la guía.Resultados: De las 6 guías seleccionadas para su valoración cualitativa y cuantitativa, sólo dos: Official disability guidelines (ODG) y Work related Muskuloskequeletal disorders Guide &Tools for modified work (WRGT), podrían utilizarse sin modificaciones. El resto de guías deben ser revisadas y modificadas antes de utilizarse sistemáticamente. En general, todas las guías definen bien sus objetivos y a quien van dirigidas, además, las opciones de manejo de retorno al trabajo se presentan en forma clara y precisa. Sin embargo, todas excepto una (ODG) tienen limitaciones en los criterios para seleccionar la evidencia científica y ni se comentan potenciales conflictos de interés.Conclusiones: Solo dos guías identificadas serían recomendables su uso sin modificaciones. Si nuestro objetivo es proponer la utilización de una guía en nuestro entorno es necesario complementar la evaluación de la calidad metodológica de estas dos GRAT, con una evaluación basada en la evidencia de la calidad de las recomendaciones incluidas en ellas.

Importancia de los factores de riesgo psicosocial y clima organizacional en el ámbito laboral

El trabajo es una de las actividades sobre las que se organizan las sociedades y por ello en los Estados modernos se incluye entre las responsabilidades de los poderes públicos el velar por la salud, seguridad e higiene en el trabajo. El reconocimiento del derecho de los trabajadores, en el ámbito laboral, a la protección de su salud y de su integridad, implica trabajar con seguridad y sin riesgos. En este estudio se describen los riesgos Psicosociales como: bienestar, satisfacción, y la calidad de vida laboral de los profesionales y trabajadores dentro de una organización y su relación con el clima organizacional, el cual hace relación al pensar, sentir y actuar de cada individuó para lograr un desempeño adecuado y eficiente dentro de la organización. Por lo tanto los factores de riesgo psicosocial y clima organizacional tienen una importancia significativa en la medida que permite conocer las condiciones al interior de las organizaciones que están afectando el ambiente laboral y como son percibidas por los trabajadores.

Study of postures in sugarcane cutters in the Pontal of Paranapanema-SP, Brazil

The expansion of sugarcane monoculture in Brazil in the last decades has pointed out to the necessity of considering the question of sugarcane cutters occupational health. In this work we present a cross-sectional study aiming to examine the occupational posture of a group of sugarcane cutters, which work in a cane field located in the region of Pontal do Paranapanema-SP, Brazil. The study was made using the Ergonomic Analysis of Work - EAW methodology and the postural analysis method by Win-OWAS. Through the obtained records of postures, it was observed that during a workday the sugarcane cutters remain standing erect on two legs or in one leg 66% of the time and that their trunk remain tilted and in rotation, according to 63% of the positions categorized. It was also observed that the sugarcane cutter trunk performs repetitive and boundless movements during his routine of work, which can expose this individual to additional wear of their musculoskeletal functions. The activities in which the individual engages have favorable or adverse influence on his posture. The repetitive movements involved in specialized occupations are equivalent to repeated exercises, thus may be responsible for the excessive development of certain muscle groups. The study suggests that the postures adopted by sugarcane cutters can overload their musculoskeletal system and predispose the cutters to work-related musculoskeletal diseases.

Saúde do trabalhador: entre os dispositivos legais e as práticas efetivas

The health worker is seized in this research beyond the mere applicability of legal devices concerning the legislation of Labor, in order to be established correlations with activities alluding to the public power in the ambit of State of Rio Grande do Norte (RN). This dissertation is an cutting of analysis circumscribed in the research, "Accidents at work: law, citizenship and justice," of the Grupo de Estudos Seguridade Social e Trabalho (GESTO) of Universidade Federal do Rio Grande do Norte (UFRN). The overall goal turned to apprehend and relate contradictory elements inherent compliance of Occupational Health and Safety (OHS) in the supermarket which showed the highest occurrence of legal violations recognized by the Labor Justice of RN in the period between 2006 and 2008 . The specific objectives turned to identify, from the condemnatory sentences, violations inherent in the protective direction of the OH & S legislation; analyze the relationship of health damages to workers at the supposed recognition of rights claimed in condemnatory sentences and correlate violations inherent in the legislation OSH impacts on the health of workers, from data contained in expert reports. The justification for perform the research backed up, among other factors, in the fact that class of activity has been presented as the most recurrent in condemnatory sentences, since it chose to focus the analysis on documentary evidence from the supermarket which showed greater expression in relation to violations of the OSH legislation. From a qualitative perspective, the methodological approach was based on content analysis of thirteen condemnatory sentences, handed down by the potiguar labor justice, and three expert reports from a large supermarket in the city of Natal/RN. Aftermaths are evidenced relating to the cyclical processes of reorganization of capital, demanding requirements for labor organizations whose strategies for survival include identifying mechanisms to extract as much of the work force. Structural determination and ideological context that puts into question the historical achievements of workers, for example the legal devices aimed at preventing workplace accidents, expressed in this research as relativized, showing limitations of reach, as was inferred the indemnities, by material and moral damages, arising from Work-Related Musculoskeletal Diseases (MSDs'S), recognized by the laborite judiciary

Mapping the BDA20 Gene to BTAX

The lipocalin family is a large group of proteins that exhibits great structural and functional variation both within and among species, including a significant number of animal-derived aeroallergens, such as the bovine BDA20 (major cow dander allergen). This protein is classified as an occupational allergen causing asthma and other work-related allergic disorders among dairy farmers. Using a somatic cell panel the BDA20 gene was assigned to the bovine X chromosome (BTAX) with a significant concordant value of 97% to the previously mapped reference marker MAF45. A radiation hybrid (RH) mapping approach confirmed the assignment of BDA20 to BTAX. Two-point LOD scores showed that BDA20 is linked to XBM451 with a LOD score of 22.1 for a 0 value of 0.03.

Study of postures in sugarcane cutters in the Pontal of Paranapanema-SP, Brazil

The expansion of sugarcane monoculture in Brazil in the last decades has pointed out to the necessity of considering the question of sugarcane cutters occupational health. In this work we present a cross-sectional study aiming to examine the occupational posture of a group of sugarcane cutters, which work in a cane field located in the region of Pontal do Paranapanema-SP, Brazil. The study was made using the Ergonomic Analysis of Work - EAW methodology and the postural analysis method by Win-OWAS. Through the obtained records of postures, it was observed that during a workday the sugarcane cutters remain standing erect on two legs or in one leg 66% of the time and that their trunk remain tilted and in rotation, according to 63% of the positions categorized. It was also observed that the sugarcane cutter trunk performs repetitive and boundless movements during his routine of work, which can expose this individual to additional wear of their musculoskeletal functions. The activities in which the individual engages have favorable or adverse influence on his posture. The repetitive movements involved in specialized occupations are equivalent to repeated exercises, thus may be responsible for the excessive development of certain muscle groups. The study suggests that the postures adopted by sugarcane cutters can overload their musculoskeletal system and predispose the cutters to work-related musculoskeletal diseases.

The influence of task design on upper limb muscles fatigue during low-load repetitive work: A systematic review

Ergonomic interventions such as increased scheduled breaks or job rotation have been proposed to reduce upper limb muscle fatigue in repetitive low-load work. This review was performed to summarize and analyze the studies investigating the effect of job rotation and work-rest schemes, as well as, work pace, cycle time and duty cycle, on upper limb muscle fatigue. The effects of these work organization factors on subjective fatigue or discomfort were also analyzed. This review was based on relevant articles published in PubMed, Scopus and Web of Science. The studies included in this review were performed in humans and assessed muscle fatigue in upper limbs. 14 articles were included in the systematic review. Few studies were performed in a real work environment and the most common methods used to assess muscle fatigue were surface electromyography (EMG). No consistent results were found related to the effects of job rotation on muscle activity and subjective measurements of fatigue. Rest breaks had some positive effects, particularly in perceived discomfort. The increase in work pace reveals a higher muscular load in specific muscles. The duration of experiments and characteristics of participants appear to be the factors that most have influenced the results. Future research should be focused on the improvement of the experimental protocols and instrumentation, in order to the outcomes represent adequately the actual working conditions. Relevance to industry: Introducing more physical workload variation in low-load repetitive work is considered an effective ergonomic intervention against muscle fatigue and musculoskeletal disorders in industry. Results will be useful to identify the need of future research, which will eventually lead to the adoption of best industrial work practices according to the workers capabilities.

Patient satisfaction of primary care for musculoskeletal diseases: A comparison between Neural Therapy and conventional medicine

Background The main objective of this study was to assess and compare patient satisfaction with Neural Therapy (NT) and conventional medicine (COM) in primary care for musculoskeletal diseases. Methods A cross-sectional study in primary care for musculoskeletal disorders covering 77 conventional primary care providers and 18 physicians certified in NT with 241 and 164 patients respectively. Patients and physicians documented consultations and patients completed questionnaires at a one-month follow-up. Physicians documented duration and severity of symptoms, diagnosis, and procedures. The main outcomes in the evaluation of patients were: fulfillment of expectations, perceived treatment effects, and patient satisfaction. Results The most frequent diagnoses belonged to the group of dorsopathies (39% in COM, 46% in NT). We found significant differences between NT and COM with regard to patient evaluations. NT patients documented better fulfilment of treatment expectations and higher overall treatment satisfaction. More patients in NT reported positive side effects and less frequent negative effects than patients in COM. Also, significant differences between NT and COM patients were seen in the quality of the patient-physician interaction (relation and communication, medical care, information and support, continuity and cooperation, facilities availability, and accessibility), where NT patients showed higher satisfaction. Differences were also found with regard to the physicians' management of disease, with fewer work incapacity attestations issued and longer consultation times in NT. Conclusion Our findings show a significantly higher treatment and care-related patient satisfaction with primary care for musculoskeletal diseases provided by physicians practising Neural Therapy.

Carpal tunnel syndrome and computer exposure at work in two large complementary cohorts.

International audience

Contributo da análise ergonómica do trabalho para o estudo de acidentes de trabalho em enfermeiros no serviço de urgência

Mestrado em Segurança e Higiene no Trabalho.

Estudo da prevalência de sintomas de lesões músculoesqueléticas ligadas ao trabalho nos profissionais de educação de infância: educadores de infância e auxiliares de acção educativa

Mestrado em Segurança e Higiene no Trabalho.

Development of a model for occupational risk acceptance criteria definition in industrial settings

Doctoral Dissertation for PhD degree in Industrial and Systems Engineering

Adipose tissue gene expression of factors related to lipid processing in obesity.

BACKGROUND Adipose tissue lipid storage and processing capacity can be a key factor for obesity-related metabolic disorders such as insulin resistance and diabetes. Lipid uptake is the first step to adipose tissue lipid storage. The aim of this study was to analyze the gene expression of factors involved in lipid uptake and processing in subcutaneous (SAT) and visceral (VAT) adipose tissue according to body mass index (BMI) and the degree of insulin resistance (IR). METHODS AND PRINCIPAL FINDINGS VLDL receptor (VLDLR), lipoprotein lipase (LPL), acylation stimulating protein (ASP), LDL receptor-related protein 1 (LRP1) and fatty acid binding protein 4 (FABP4) gene expression was measured in VAT and SAT from 28 morbidly obese patients with Type 2 Diabetes Mellitus (T2DM) or high IR, 10 morbidly obese patients with low IR, 10 obese patients with low IR and 12 lean healthy controls. LPL, FABP4, LRP1 and ASP expression in VAT was higher in lean controls. In SAT, LPL and FABP4 expression were also higher in lean controls. BMI, plasma insulin levels and HOMA-IR correlated negatively with LPL expression in both VAT and SAT as well as with FABP4 expression in VAT. FABP4 gene expression in SAT correlated inversely with BMI and HOMA-IR. However, multiple regression analysis showed that BMI was the main variable contributing to LPL and FABP4 gene expression in both VAT and SAT. CONCLUSIONS Morbidly obese patients have a lower gene expression of factors related with lipid uptake and processing in comparison with healthy lean persons.

Differences in osteogenic and apoptotic genes between osteoporotic and osteoarthritic patients.

BACKGROUND Osteoporosis is a metabolic disorder characterized by a reduction in bone mass and deterioration in the microarchitectural structure of the bone, leading to a higher risk for spontaneous and fragility fractures.The main aim was to study the differences between human bone from osteoporotic and osteoarthritic patients about gene expression (osteogenesis and apoptosis), bone mineral density, microstructural and biomechanic parameters. METHODS We analyzed data from 12 subjects: 6 with osteoporotic hip fracture (OP) and 6 with hip osteoarthritis (OA), as the control group. All subjects underwent medical history, analytical determinations, densitometry, histomorphometric and biochemical study. The expression of 86 genes of osteogenesis and 86 genes of apoptosis was studied in pool of bone samples from patients with OP and OA by PCR array. RESULTS We observed that most of the genes of apoptosis and osteogenesis show a decrease in gene expression in the osteoporotic group in comparison with the osteoarthritic group. The histomorphometric study shows a lower bone quality in the group of patients with hip fractures compared to the osteoarthritic group. CONCLUSIONS The bone tissue of osteoporotic fracture patients is more fragile than the bone of OA patients. Our results showed an osteoporotic bone with a lower capacities for differentiation and osteoblastic activity as well as a lower rate of apoptosis than osteoarthritic bone. These results are related with structural and biochemical parameters.

Telehealth system (e-CUIDATE) to improve quality of life in breast cancer survivors: rationale and study protocol for a randomized clinical trial.

BACKGROUND Breast cancer survivors suffer physical impairment after oncology treatment. This impairment reduces quality of life (QoL) and increase the prevalence of handicaps associated to unhealthy lifestyle (for example, decreased aerobic capacity and strength, weight gain, and fatigue). Recent work has shown that exercise adapted to individual characteristics of patients is related to improved overall and disease-free survival. Nowadays, technological support using telerehabilitation systems is a promising strategy with great advantage of a quick and efficient contact with the health professional. It is not known the role of telerehabilitation through therapeutic exercise as a support tool to implement an active lifestyle which has been shown as an effective resource to improve fitness and reduce musculoskeletal disorders of these women. METHODS / DESIGN This study will use a two-arm, assessor blinded, parallel randomized controlled trial design. People will be eligible if: their diagnosis is of stages I, II, or IIIA breast cancer; they are without chronic disease or orthopedic issues that would interfere with ability to participate in a physical activity program; they had access to the Internet and basic knowledge of computer use or living with a relative who has this knowledge; they had completed adjuvant therapy except for hormone therapy and not have a history of cancer recurrence; and they have an interest in improving lifestyle. Participants will be randomized into e-CUIDATE or usual care groups. E-CUIDATE give participants access to a range of contents: planning exercise arranged in series with breathing exercises, mobility, strength, and stretching. All of these exercises will be assigned to women in the telerehabilitation group according to perceived needs. The control group will be asked to maintain their usual routine. Study endpoints will be assessed after 8 weeks (immediate effects) and after 6 months. The primary outcome will be QoL measured by The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 version 3.0 and breast module called The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life questionnaire. The secondary outcomes: pain (algometry, Visual Analogue Scale, Brief Pain Inventory short form); body composition; physical measurement (abdominal test, handgrip strength, back muscle strength, and multiple sit-to-stand test); cardiorespiratory fitness (International Fitness Scale, 6-minute walk test, International Physical Activity Questionnaire-Short Form); fatigue (Piper Fatigue Scale and Borg Fatigue Scale); anxiety and depression (Hospital Anxiety and Depression Scale); cognitive function (Trail Making Test and Auditory Consonant Trigram); accelerometry; lymphedema; and anthropometric perimeters. DISCUSSION This study investigates the feasibility and effectiveness of a telerehabilitation system during adjuvant treatment of patients with breast cancer. If this treatment option is effective, telehealth systems could offer a choice of supportive care to cancer patients during the survivorship phase. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01801527.