Interaction of psychosocial risk factors explain increased neck problems among female office workers

This study investigated the relationship between psychosocial risk factors and (1) neck symptoms and (2) neck pain and disability as measured by the neck disability index (NDI). Female office workers employed in local private and public organizations were invited to participate, with 333 completing a questionnaire. Data were collected on various risk factors including age, negative affectivity, history of previous neck trauma, physical work environment, and task demands. Sixty-one percent of the sample reported neck symptoms lasting greater than 8 days in the last 12 months. The mean NDI of the sample was 15.5 out of 100, indicating mild neck pain and disability. In a hierarchical multivariate logistic regression, low supervisor support was the only psychosocial risk factor identified with the presence of neck symptoms. Similarly, low supervisor support was the only factor associated with the score on the NDI. These associations remained after adjustment for potential confounders of age, negative affectivity, and physical risk factors. The interaction of job demands, decision authority, and supervisor support was significantly associated with the NDI in the final model and this association increased when those with previous trauma were excluded. Interestingly, and somewhat contrary to initial expectations, as job demands increased, high decision authority had an increasing effect on the NDI when supervisor support was low. Crown copyright (c) 2006 Published by Elsevier B.V. All rights reserved.

Neuropsychiatric manifestations in inflammatory neuropathies:a systematic review

We conducted a systematic literature review on psychological and behavioral comorbidities in patients with inflammatory neuropathies. In Guillain-Barré syndrome (GBS), psychotic symptoms are reported during early stages in 30% of patients. Typical associations include mechanical ventilation, autonomic dysfunction, inability to communicate, and severe weakness. Anxiety and depression are frequent comorbidities. Anxiety may increase post-hospital admissions and be a predictor of mechanical ventilation. Post-traumatic stress disorder may affect up to 20% of ventilated patients. Sleep disturbances are common in early-stage GBS, affecting up to 50% of patients. In chronic inflammatory demyelinating polyradiculoneuropathy, memory and quality of sleep may be impaired. An independent link between depression and pre-treatment upper limb disability and ascites was reported in POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, Skin) syndrome, with an association with early death. Hematological treatment of POEMS appears effective on depression. Published literature on psychological/behavioral manifestations in inflammatory neuropathies remains scarce, and further research is needed. This article is protected by copyright. All rights reserved.

Desenvolvimento e avaliação do emprego de dispositivo ajustável ao corpo para treinamento de habilidade de acesso venoso periférico no membro superior

OBJECTIVE: To dev elop and evaluate the use of a body adjustable device for training of peripheral venous catheterization for healthcare undergraduate students . METHODS: This study involved two phases: I) development of the innovative simulator and II) a controlled trial co mparing the performance of the body adjustable device in relation to the commercial simulator for the training of venipuncture skills. A total of 79 first - year medical students participated in the intervention phase, which consisted of pretest assessment, lecture on peripheral venous access, randomization into two groups according to the simulator used for training (Commercial Simulator and Experimental Simulator), real venipuncture procedure, post - test assessment and evaluation of satisfaction. RESULTS: Gr oups were homogeneous in age, sex, pre - test and post - test scores, attitudinal assessment and performance in performing the real venipuncture. Students from the Experimental Simulator group performed better on the filling of simulated records. At the end of the study, cognitive gain significantly increased in both groups. The degree of realism perceived by students was equivalent for two groups. A total of 85.7% of students rated the Experimental Simulator as good or excellent. CONCLUSIONS: Experimental simu lator proved to be a low cost alternative for the training of venipuncture skills in upper limb. The cognitive procedural and attitudinal performances of students who used the experimental simulator were similar to those observed in the group trained with commercial simulator.

Atividade eletroencefalográfica de pacientes com acidente vascular cerebral na aprendizagem motora de um jogo baseado em realidade virtual

Stroke is the leading cause of long-term disability among adults and motor relearning is essential in motor sequelae recovery. Therefore, various techniques have been proposed to achieve this end, among them Virtual Reality. The aim of the study was to evaluate electroencephalographic activity of stroke patients in motor learning of a virtual reality-based game. The study included 10 patients with chronic stroke, right-hande; 5 with left brain injury (LP), mean age 48.8 years (± 4.76) and 5 with injury to the right (RP), mean age 52 years (± 10.93). Participants were evaluated for electroencephalographic (EEG) activity and performance while performing 15 repetitions of darts game in XBOX Kinect and also through the NIHSS, MMSE, Fugl-Meyer and the modified Ashworth scale. Patients underwent a trainning with 45 repetitions of virtual darts game, 12 sessions in four weeks. After training, patients underwent reassessment of EEG activity and performance in virtual game of darts (retention). Data were analyzed using ANOVA for repeated measures. According to the results, there were differences between the groups (PD and PE) in frequencies Low Alpha (p = 0.0001), High Alpha (p = 0.0001) and Beta (p = 0.0001). There was an increase in alpha activation powers and a decrease in beta in the phase retention of RP group. In LP group was observed increased alpha activation potency, but without decrease in beta activation. Considering the asymmetry score, RP group increased brain activation in the left hemisphere with the practice in the frontal areas, however, LP group had increased activation of the right hemisphere in fronto-central areas, temporal and parietal. As for performance, it was observed a decrease in absolute error in the game for RP group between assessment and retention (p = 0.015), but this difference was not observed for LP group (p = 0.135). It follows then that the right brain injury patients benefited more from darts game training in the virtual environment with respect to the motor learning process, reducing neural effort in ipsilesionais areas and errors with the practice of the task. In contrast, patients with lesions in left hemisphere decrease neural effort in contralesionais areas important for motor learning and showed no performance improvements with practice of 12 sessions of virtual dart game. Thus, the RV can be used in rehabilitation of stroke patients upper limb, but the laterality of the injury should be considered in programming the motor learning protocol.

Observação da ação na reabilitação do membro superior de pacientes com acidente vascular cerebral: uma revisão sistemática com metanálise

Background: stroke causes long-term impairments, limitation of activities and restriction in participation in daily life situations, especially for upper limb impairment (UL). Action Observation (AO) has been used for the rehabilitation of UL in these patients. It's a multisensory therapy which consists in observing a healthy subject performing a motor task, followed by physical practice. Objectives: assess whether the AO improves motor function of UL and dependence for activities of daily living (ADLs) of stroke patients or cause any adverse effects. Search methods: a search strategy was words and terms used for the identification of articles, in the following scientific basis Cochrane Central Register of Controlled Trials; MEDLINE; PsycINFO; CINAHL and LILACS. In addition to manual search of the references of articles and search for theses and dissertations in Portal Capes and LILACS. The identification of the studies was conducted from October to December 2015, being the last search on December 3. Selection criteria: randomised controlled trials (RCT) involving adults with stroke who had deficits in upper limb function and used AO as an intervention. Data collection and analysis: the data extracted from the studies were used to analyze the risk of bias, the effect of the treatment and the quality of the body of evidence. Main results: 6 studies were included, totaling 270 patients. The primary outcome analyzed was the motor function of MS. Were combined in meta-analyzes studies comparing AO versus placebo or an active control, considering the immediate and long-term effect (n=241). Regarding the motor function of the arm (5 trials), the estimated effect for the therapy was not significant. However, when considering the hand function estimating the effect was favorable to the group that conducted the AO, in short (mean difference = 6.93, 95% CI 1.48 to 12.39; P = 0.01) and long-term (mean difference = 7.57; 95% CI 1.34 the 13.80; p = 0.02). Unable to perform the analysis for functional dependency. The studies showed a low or uncertain risk of bias, but the quality of evidence the body was considered low and very low quality. Authors’ conclusions: AO was effective in improving hand function of stroke patients. Despite the low quality evidence that the use of OA in clinical practice should not be discouraged. RCT new studies should be conducted with greater methodological rigor and larger samples, covering important outcomes such as functional dependence for ADLs.

Cuestionario de calidad de vida ULL-27: un instrumento específico para pacientes con linfedema de miembro superior tras cáncer de mama. Adaptación transcultural y validación de su versión española

En nuestro medio, el linfedema más frecuente es el que aparece en el miembro superior tras los tratamientos del cáncer de mama. Existe un interés creciente acerca de su impacto sobre la Calidad de Vida, entendida ésta como el completo estado de bienestar físico, mental y social de la persona. Para poder medir la CV en esta población, se precisan herramientas específicas, dado que los cuestionarios genéricos no recogen las particularidades de esta enfermedad. El cuestionario ULL-27 (Upper limb lymphedema) fue la primera escala específica desarrollada para valorar la calidad de vida de mujeres con linfedema de miembro superior tras cáncer de mama1. Dada la necesidad de disponer de este tipo de instrumentos en nuestro país, y habiendo mostrado el cuestionario francés ULL-27 buenas propiedades psicométricas en su estudio de validación, se planteó como objetivo su traducción al español y adaptación transcultural a nuestro medio, procediendo a continuación a su validación en una muestra de mujeres con linfedema de miembro superior tras cáncer de mama...

Qualidade dos instrumentos de autorresposta que medem a funcionalidade do membro superior em condições músculo-esqueléticas do ombro : revisão sistemática

Contextualização: Dada a prevalência de disfunções no ombro, os registos de avaliação segundo a perspetiva do utente constituem ferramentas úteis na seleção das estratégias de intervenção. A escolha do instrumento adequado deve-se basear em grande parte na força das suas propriedades psicométricas, contudo não existem estudos que analisem sistematicamente a qualidade destas medidas. Objetivo: Análise de estudos referente às propriedades psicométricas de instrumentos de autorresposta na funcionalidade do ombro. Metodologia: Revisão da literatura em inglês/português, nas bases de dados: PubMed, PEDro, Google Académico, B-On e RCAAP. Foram analisados estudos realizados até 2015. A qualidade metodológica e as propriedades psicométricas foram avaliadas e resumidas através de dois critérios padronizados, seguindo a ideologia COSMIN. Resultados: Nesta revisão foram incluídos 6 estudos. O Disabilities of the Arm Shoulder and Hand (DASH) e o Neck and Upper Limb Index (NULI-20) demonstram boas propriedades psicométricas e uma metodologia de fraca a excelente; o Shoulder Pain And Disability Index (SPADI) e o Weelchair User’s Shoulder Pain Index (WUSPI) exibem boas propriedades psicométricas e qualidade metodológica fraca; tanto no Shoulder Rating Questionnaire (SRQ-PT) como no Upper Extremity Functional Index (UEFI) não foram avaliadas propriedades psicométricas relevantes, contudo as analisadas apresentam boas propriedades psicométricas e uma metodologia fraca. Conclusão: Devido às falhas na metodologia dos estudos incluídos, não é possível inferir qual o questionário mais apropriado à prática clínica. São necessários mais estudos de validação de instrumentos de autorresposta com melhor qualidade metodológica.

Children's Postures While Playing at Computer Workstations

There has been a significant increase in the incidence of musculoskeletal disorders (MSD) and the costs associated with these are predicted to increase as the popularity of computer use increases at home, school and work. Risk factors have been identified in the adult population but little is known about the risk factors for children and youth. Research has demonstrated that they are not immune to this risk and that they are self reporting the same pain as adults. The purpose of the study was to examine children’s postures while working at computer workstations under two conditions. One was at an ergonomically adjusted children’s workstation while the second was at an average adult workstation. A Polhemus Fastrak™ system was used to record the children’s postures and joint and segment angles were quantified. Results of the study showed that children reported more discomfort and effort at the adult workstation. Segment and joint angles showed significant differences through the upper limb at the adult workstation. Of significance was the strategy of shoulder abduction and flexion that the children used in order to place their hand on the mouse. Ulnar deviation was also greater at the adult workstation as was neck extension. All of these factors have been identified in the literature as increasing the risk for injury. A comparison of the children’s posture while playing at the children’s workstation verses the adult workstation, showed that the postural angles assumed by the children at an adult workstation exceeded the Occupational Safety and Health Association (OSHA) recommendations. Further investigation is needed to increase our knowledge of MSD in children as their potential for long term damage has yet to be determined.

Vibrational Feedback Training System for Use with SEMG Controlled Powered Prostheses

Loss of limb results in loss of function and a partial loss of freedom. A powered prosthetic device can partially assist an individual with everyday tasks and therefore return some level of independence. Powered upper limb prostheses are often controlled by the user generating surface electromyographic (SEMG) signals. The goal of this thesis is to develop a virtual environment in which a user can control a virtual hand to safely grasp representations of everyday objects using EMG signals from his/her forearm muscles, and experience visual and vibrotactile feedback relevant to the grasping force in the process. This can then be used to train potential wearers of real EMG controlled prostheses, with or without vibrotactile feedback. To test this system an experiment was designed and executed involving ten subjects, twelve objects, and three feedback conditions. The tested feedback conditions were visual, vibrotactile, and both visual and vibrotactile. In each experimental exercise the subject attempted to grasp a virtual object on the screen using the virtual hand controlled by EMG electrodes placed on his/her forearm. Two metrics were used: score, and time to task completion, where score measured grasp dexterity. It was hypothesized that with the introduction of vibrotactile feedback, dexterity, and therefore score, would improve and time to task completion would decrease. Results showed that time to task completion increased, and score did not improve with vibrotactile feedback. Details on the developed system, the experiment, and the results are presented in this thesis.

Isquemia Crítica dos Membros Superiores. Manifestação Inicial de Arterite de Células Gigantes - Caso Clínico

Introdução: A arterite de células gigantes (ACG), de etiologia desconhecida, é a vasculite sistémica mais comum nos adultos e pode ter uma ampla variedade de apresentações clínicas. Atinge mais frequentemente os ramos extracranianos da artéria carótida mas, em 10-15% dos casos, pode ocorrer o envolvimento das artérias subclávia, axilar e braquial. Caso clínico: Tratava-se de uma doente do sexo feminino, de 80 anos, com antecedentes de HTA e doença cerebrovascular. Foi observada no serviço de urgência por arrefecimento e dor em repouso nos membros superiores, com evidências de cianose digital distal bilateral. As queixas tinham tido início 2 meses antes e agravamento progressivo desde então. Realizou um angio-TC que mostrou a existência de oclusão de ambas as artérias axilares/braquiais proximais e imagens sugestivas de vasculite ao nível de ambas as artérias subclávias, aorta e artérias femorais comuns. Foi medicada com corticoterapia; contudo, por não apresentar melhoria significativa após 5 dias, optou-se por realizar um bypass carotídeo-umeral bilateral. Após a cirurgia, ocorreu resolução completa das queixas e a doente apresentava pulso radial palpável bilateralmente. Seis meses após a cirurgia, a doente encontrava-se assintomática e os bypasses permeáveis. Conclusão: O presente trabalho pretende expor o caso de uma doente com o diagnóstico inaugural e ACG,que se apresentou com isquemia crítica bilateral e simultânea. Este quadro clínico exigiu a realização de um procedimento de revascularização raro.

Arterial entrapment syndrome in the cubital fossa: a rare cause of acute stress-related arterial thrombosis in a patient with brachial artery duplication

Arterial entrapment syndrome (AES) at elbow level is very rare and to our knowledge no case of AES by lacertus fibrosus in the cubital fossa in presence of brachial artery duplication has been described to date. We describe a rare case of acute arterial thrombosis of one of two brachial arteries highlighted in the cubital fossa which developed after strenuous right elbow flexor muscle activity and hyper-extensions presumably related to AES by lacertus fibrosus at elbow level. A 43-year-old right-handed woman, experienced paleness, coldness and numbness of the right hand, after 8 consecutive hours of gardening. As she worked, her ipsilateral flexor elbow muscles remained in prolonged and inappropriate tension. Clinical examination evidenced the absence of radial artery pulse in the wrist and mild hypothermia in the second and third finger. During surgical exploration two anastomosed brachial arteries were detected in the cubital fossa under the lacertus fibrosus. The lateral superficial brachial artery was occluded. Intraoperative arteriography evidenced brachial artery duplication at the third superior of the arm and normal vascular pattern at the forearm level. In cases of unexplained atypical intermittent upper extremity claudication or acute ischemic symptoms an AES should always be ruled out, particularly when symptoms are exacerbated by strenuous upper extremity activity or when upper limb muscular hypertrophy is evident. In these cases a thorough dynamic clinical and instrumental examination is mandatory to confirm a diagnosis of AES and to avoid possible future ischemic complications.

Structure, transports and transformations of the water masses in the Atlantic Subpolar Gyre

We discuss the distributions and transports of the main water masses in the North Atlantic Subpolar Gyre (NASPG) for the mean of the period 2002–2010 (OVIDE sections 2002–2010 every other year), as well as the inter-annual variability of the water mass structure from 1997 (4x and METEOR sections) to 2010. The water mass structure of the NASPG, quantitatively assessed by means of an Optimum MultiParameter analysis (with 14 water masses), was combined with the velocity fields resulting from previous studies using inverse models to obtain the water mass volume transports. We also evaluate the relative contribution to the Atlantic Meridional Overturning Circulation (AMOC) of the main water masses characterizing the NASPG, identifying the water masses that contribute to the AMOC variability. The reduction of the magnitude of the upper limb of the AMOC between 1997 and the 2000s is associated with the reduction in the northward transport of the Central Waters. This reduction of the northward flow of the AMOC is partially compensated by the reduction of the southward flow of the lower limb of the AMOC, associated with the decrease in the transports of Polar Intermediate Water and Subpolar Mode Water (SPMW) in the Irminger Basin. We also decompose the flow over the Reykjanes Ridge from the East North Atlantic Basin to the Irminger Basin (9.4 ± 4.7 Sv) into the contributions of the Central Waters (2.1 ± 1.8 Sv), Labrador Sea Water (LSW, 2.4 ± 2.0 Sv), Subarctic Intermediate Water (SAIW, 4.0 ± 0.5 Sv) and Iceland–Scotland Overflow Water (ISOW, 0.9 ± 0.9 Sv). Once LSW and ISOW cross over the Reykjanes Ridge, favoured by the strong mixing around it, they leave the Irminger Basin through the deep-to-bottom levels. The results also give insights into the water mass transformations within the NASPG, such as the contribution of the Central Waters and SAIW to the formation of the different varieties of SPMW due to air–sea interaction.

Gestural communication of music structure during solo classical piano performance

The production and perception of music is a multimodal activity involving auditory, visual and conceptual processing, integrating these with prior knowledge and environmental experience. Musicians utilise expressive physical nuances to highlight salient features of the score. The question arises within the literature as to whether performers’ non-technical, non-sound-producing movements may be communicatively meaningful and convey important structural information to audience members and co-performers. In the light of previous performance research (Vines et al., 2006, Wanderley, 2002, Davidson, 1993), and considering findings within co-speech gestural research and auditory and audio-visual neuroscience, this thesis examines the nature of those movements not directly necessary for the production of sound, and their particular influence on audience perception. Within the current research 3D performance analysis is conducted using the Vicon 12- camera system and Nexus data-processing software. Performance gestures are identified as repeated patterns of motion relating to music structure, which not only express phrasing and structural hierarchy but are consistently and accurately interpreted as such by a perceiving audience. Gestural characteristics are analysed across performers and performance style using two Chopin preludes selected for their diverse yet comparable structures (Opus 28:7 and 6). Effects on perceptual judgements of presentation modes (visual-only, auditory-only, audiovisual, full- and point-light) and viewing conditions are explored. This thesis argues that while performance style is highly idiosyncratic, piano performers reliably generate structural gestures through repeated patterns of upper-body movement. The shapes and locations of phrasing motions are identified particular to the sample of performers investigated. Findings demonstrate that despite the personalised nature of the gestures, performers use increased velocity of movements to emphasise musical structure and that observers accurately and consistently locate phrasing junctures where these patterns and variation in motion magnitude, shape and velocity occur. By viewing performance motions in polar (spherical) rather than cartesian coordinate space it is possible to get mathematically closer to the movement generated by each of the nine performers, revealing distinct patterns of motion relating to phrasing structures, regardless of intended performance style. These patterns are highly individualised both to each performer and performed piece. Instantaneous velocity analysis indicates a right-directed bias of performance motion variation at salient structural features within individual performances. Perceptual analyses demonstrate that audience members are able to accurately and effectively detect phrasing structure from performance motion alone. This ability persists even for degraded point-light performances, where all extraneous environmental information has been removed. The relative contributions of audio, visual and audiovisual judgements demonstrate that the visual component of a performance does positively impact on the over- all accuracy of phrasing judgements, indicating that receivers are most effective in their recognition of structural segmentations when they can both see and hear a performance. Observers appear to make use of a rapid online judgement heuristics, adjusting response processes quickly to adapt and perform accurately across multiple modes of presentation and performance style. In line with existent theories within the literature, it is proposed that this processing ability may be related to cognitive and perceptual interpretation of syntax within gestural communication during social interaction and speech. Findings of this research may have future impact on performance pedagogy, computational analysis and performance research, as well as potentially influencing future investigations of the cognitive aspects of musical and gestural understanding.

Passive and specific targeting of lymph nodes: the influence of the administration route

Numéro spécial: Translational Nanomedicine

Lateral epicondylitis: New evidence for work relatedness.

International audience