Risks Associated With Tendinitis: Effects From Demographic, Socioeconomic, and Psychological Status Among Brazilian Workers

Background Self-reported tendinitis/tenosynovitis was evaluated by gender, age group, skin color, family income, and educational and psychological status. Methods The study was carried out in a representative sample of formally contracted Brazilian workers from a household survey. A total of 54,660 participants were included. Occupations were stratified according to estimated prevalences of self-reported injuries. Non-conditional logistic regression was performed, and all variables were analyzed in two occupational groups. Results The overall prevalence rate of tendinitis/tenosynovitis was 3.1%: 5.5% in high-prevalence occupations (n=10,726); and 2.5% in low-prevalence occupations (n=43,934). White female workers between the ages of 45 and 64 years and at a higher socioeconomic level were more likely to report tendinitis/tenosynovitis regardless of their occupational category. An adjusted OR = 3.59 [95% CI: 3.15-4.09] was found between tendinitis/tenosynovitis and psychological status. Conclusion Among formally contracted Brazilian workers, higher income can imply greater physical and psychological demands that, regardless of occupational stratum, increase the risk of tendinitis/tenosynovitis. Am. J. Ind. Med. 53:72-79, 2010. (C) 2009 Wiley-Liss, Inc.

[Physical and psychological status of 60-70-year-old citizens of Bern with neurotic symptoms in childhood--a study over more than 50 years (Emmental cohort)]

The present study was undertaken to assess the influence of childhood variables (physical and emotional) to later well-being in a group of rural Swiss (Emmental Cohort). Our study is the first prospective cohort over a time period of more than 50 years. It includes 1537 children who were listed and assessed in 1942 (T1) because they had difficulties in school or were otherwise behaviorally disturbed. In 1995 (T2) more than 60% of the initial population could be reassessed by our study group. We found more subjects at T2 who had been rated as intelligent at T1. More subjects responding to T2 belonged to a higher social class, were more anxious, and had more psychosocial problems at T1. Social income at T2 is correlated to the social class at T1. More subjects have died since who were rated at T1 as being less intelligent, less neurotical, and having higher psychosocial problems. Twice as many men died than women. The emotional situation at T2 is significantly correlated to psychological well-being at T1. The somatic complaints at T2 correlate significantly to neurotic symptoms in childhood (T1). The more intelligent the children were rated at T1, the less emotional and somatic complaints were voiced at T2 and the better the psychic well-being was rated (T2). In addition, the former social milieu (T1) significantly determined somatic and psychological complaints at T2. Our data discern a significant correlation between actual status and former childhood variables more than 50 years later in a rural Swiss cohort (Emmental Cohort).

Relationships of dehydroepiandrosterone sulfate in the elderly with functional, psychological, and mental status, and short-term mortality: A French community-based study

In human beings of both sexes, dehydroepiandrosterone sulfate (DHEAS) circulating in blood is mostly an adrenally secreted steroid whose serum concentration (in the micromolar range and 30–50% higher in men than in women) decreases with age, toward ≈20–10% of its value in young adults during the 8th and 9th decades. The mechanism of action of DHEA and DHEAS is poorly known and may include partial transformation into sex steroids, increase of bioavailable insulin-like growth factor I, and effects on neurotransmitter receptors. Whether there is a cause-to-effect relationship between the decreasing levels of DHEAS with age and physiological and pathological manifestations of aging is still undecided, but this is of obvious theoretical and practical interest in view of the easy restoration by DHEA administration. Here we report on 622 subjects over 65 years of age, studied for the 4 years since DHEAS baseline values had been obtained, in the frame of the PAQUID program, analyzing the functional, psychological, and mental status of a community-based population in the south-west of France. We confirm the continuing decrease of DHEAS serum concentration with age, more in men than in women, even if men retain higher levels. Significantly lower values of baseline DHEAS were recorded in women in cases of functional limitation (Instrumental Activities of Daily Living), confinement, dyspnea, depressive symptomatology, poor subjective perception of health and life satisfaction, and usage of various medications. In men, there was a trend for the same correlations, even though not statistically significant in most categories. No differences in DHEAS levels were found in cases of incident dementia in the following 4 years. In men (but not in women), lower DHEAS was significantly associated with increased short-term mortality at 2 and 4 years after baseline measurement. These results, statistically established by taking into account corrections for age, sex, and health indicators, suggest the need for further careful trials of the administration of replacement doses of DHEA in aging humans. Indeed, the first noted results of such “treatment” are consistent with correlations observed here between functional and psychological status and endogenous steroid serum concentrations.

A 12-month randomized controlled trial of balance training in elderly women with ostebporosis: Improvement of quality of life

Objective: Physical and psychological incapacity, including fear of falling is related to decreased satisfaction with life in osteoporosis (OP). The impact of a balance exercise program on improving the quality of life is not well established. We have, therefore, investigated the effect of 12-month Balance Training Program in quality of life, functional balance and falls in elderly OP women. Methods: Sixty consecutive women with senile OP were randomized into a Balance Training Group (BT) of 30 patients and no intervention control group (CG) of 30 patients. The BT program included techniques to improve balance over a period of 12 months (1 h exercise session/week and home-based exercises). The quality of life was evaluated before and at the end of the trial using the Osteoporosis Assessment Questionnaire (OPAQ), functional balance was evaluated by Berg Balance Scale (BBS). Falls in the preceding year were noted and compared to the period of study. Results: The comparison of OPAQ variations (INITIAL-FINAL) revealed a significant improvement in quality of life in all parameters for BT compared to CG: well-being (1.61 +/- 1.44 vs. -1.46 +/- 1.32, p < 0001), physical function (1.30 +/- 1.33 vs. -0.36 +/- 0.82, p < 0.001), psychological status (1.58 +/- 1.36 vs. -1.02 +/- 0.83, p < 0.001), symptoms (2.76 +/- 1.96 vs. -0.63 +/- 0.87, p < 0.001), social interaction (1.01 +/- 1.51 vs. 0.35 +/- 1.08, p < 0.001). Of note, this overall benefit was paralleled by an improvement of BBS (-5.5 +/- 5.67 vs. +0.5 +/- 4.88 p < 0.001) and a reduction of falls in 50% in BT group vs. 26.6% for the CG (RR: 1.88, p < 0.025). Conclusion: The long-term Balance Training Program of OP women provides a striking overall health quality of life improvement in parallel with improving functional balance and reduced falls. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Adverse effect of alcohol drinking: the role of oxidative stress

Atualmente, o álcool tem um papel importante na saúde pública e surge como um dos principais problemas sociais no mundo, dado que é a droga mais viciante aceite em encontros sociais. Provavelmente, por essa razão, os riscos do consumo abusivo do álcool são subestimados pelos jovens, mulheres grávidas e idosos. O álcool, quando ingerido em altas proporções, pode afetar todos os órgãos e desencadear inúmeras doenças, tais como a doença cardíaca coronariana, doença neurodegenerativa, as doenças crónicas e câncer. O álcool afeta ainda o estado psicológico, induzindo a violência, o estado antissocial e situações de risco de comportamentos. Por estas razões, o álcool tornou-se um foco principal da investigação, avaliando os seus efeitos sobre o corpo humano. Nesta pesquisa, foram suscitadas amostras de sangue de um grupo de pacientes em tratamento psicológico e/ou farmacêutico que serão analisadas com quatro métodos: Teste de Radicais Livres do Oxigénio (FORT), Defesa contra Radicais Livres do Oxigénio (FORD), cromatografia gasosa (GC) e cromatografia líquida de alta pressão (HPLC). Ambos os métodos FORT e FORD avaliam o stress oxidativo pela quantificação de radicais livres e a capacidade de antioxidantes em eliminar esses radicais livres, respetivamente. O stress oxidativo é o efeito do excesso de consumo de álcool, que é reduzido pela capacidade de ação dos antioxidantes. A boa reprodutibilidade, precisão e exatidão de ambos os métodos indicam que estes podem ser aplicados em rápidos diagnósticos. Para o método FORT e considerando o início do tratamento, os pacientes alcoólicos apresentaram uma média de 3,59±1.01mmol/LH2O2 e o grupo de controlo uma média de 1,42±0.53mmol/LH2O2, o que mostra uma diferença significativa entre os dois grupos (P=0,0006). Para o método FORD, pacientes alcoólicos apresentam uma média de 1,07±0.53mmol/LH2O2 e o grupo de controlo, uma média de 2,81±0.46mmol/LH2O2, mostrando também uma média significativa (P=0,0075). Após 15 dias de tratamento observou-se que há uma diferença entre os dois grupos de pacientes alcoólicos, mas não há nenhum melhoramento em relação ao grupo de pacientes em tratamento. No método FORT os grupos mostram uma diferença significativa (P=0,0073), tendo os pacientes sem tratamento farmacêutico melhores resultados (2.37±0.44mmol/LH2O2) do que os pacientes com tratamento (3.72±1,04mmol/LH2O2). O oposto ocorre no método FORD, os pacientes em tratamento farmacêutico presentam melhores resultados (1.16±0.65mmol/LH2O2) do que o outro grupo (0.75±0.22mmol/LH2O2), não sendo, no entanto, uma diferença significativa entre os dois grupos (P=0.16). Os resultados obtidos para a concentração de MDA pelo método de HPLC mostraram que o grupo de controlo tem valores mais baixos do que os pacientes alcoólicos, embora a diferença não seja muito significativa (P = 0,084), mas é ainda elevada. Além disso, os dois grupos de pacientes não apresentaram uma diferença significativa entre os seus resultados no início (P=0,77) e no fim (P=0,79) do tratamento. De acrescentar ainda que, os resultados da concentração de álcool no sangue determinados pelo método de CG mostraram que só alguns pacientes sem tratamento consumiram álcool durante o período de tratamento, o que influencia negativamente a conclusão sobre o efeito do tratamento. Contudo, outros fatores externos podem ainda influenciar os resultados finais, tais como o estado nutricional e estado psicológico dos pacientes, se o paciente continua a beber durante o tempo de tratamento ou até mesmo se o paciente é exposto a outros tipos de substâncias nocivas. Existe ainda a possibilidade de o tempo de aplicação do tratamento não ser suficiente para apresentar um efeito positivo em relação ao stress oxidativo e este é um outro fator que contribui para a impossibilidade de confirmar sobre o efeito, quer seja positivo ou negativo, do tratamento antioxidante.

Adverse Effect of Alcohol Drinking: The Role of Oxidative Stress

Atualmente, o álcool tem um papel importante na saúde pública e surge como um dos principais problemas sociais no mundo, dado que é a droga mais viciante aceite em encontros sociais. Provavelmente, por essa razão, os riscos do consumo abusivo do álcool são subestimados pelos jovens, mulheres grávidas e idosos. O álcool, quando ingerido em altas proporções, pode afetar todos os órgãos e desencadear inúmeras doenças, tais como a doença cardíaca coronariana, doença neurodegenerativa, as doenças crónicas e câncer. O álcool afeta ainda o estado psicológico, induzindo a violência, o estado antissocial e situações de risco de comportamentos. Por estas razões, o álcool tornou-se um foco principal da investigação, avaliando os seus efeitos sobre o corpo humano. Nesta pesquisa, foram suscitadas amostras de sangue de um grupo de pacientes em tratamento psicológico e/ou farmacêutico que serão analisadas com quatro métodos: Teste de Radicais Livres do Oxigénio (FORT), Defesa contra Radicais Livres do Oxigénio (FORD), cromatografia gasosa (GC) e cromatografia líquida de alta pressão (HPLC). Ambos os métodos FORT e FORD avaliam o stress oxidativo pela quantificação de radicais livres e a capacidade de antioxidantes em eliminar esses radicais livres, respetivamente. O stress oxidativo é o efeito do excesso de consumo de álcool, que é reduzido pela capacidade de ação dos antioxidantes. A boa reprodutibilidade, precisão e exatidão de ambos os métodos indicam que estes podem ser aplicados em rápidos diagnósticos. Para o método FORT e considerando o início do tratamento, os pacientes alcoólicos apresentaram uma média de 3,59±1.01mmol/LH2O2 e o grupo de controlo uma média de 1,42±0.53mmol/LH2O2, o que mostra uma diferença significativa entre os dois grupos (P=0,0006). Para o método FORD, pacientes alcoólicos apresentam uma média de 1,07±0.53mmol/LH2O2 e o grupo de controlo, uma média de 2,81±0.46mmol/LH2O2, mostrando também uma média significativa (P=0,0075). Após 15 dias de tratamento observou-se que há uma diferença entre os dois grupos de pacientes alcoólicos, mas não há nenhum melhoramento em relação ao grupo de pacientes em tratamento. No método FORT os grupos mostram uma diferença significativa (P=0,0073), tendo os pacientes sem tratamento farmacêutico melhores resultados (2.37±0.44mmol/LH2O2) do que os pacientes com tratamento (3.72±1,04mmol/LH2O2). O oposto ocorre no método FORD, os pacientes em tratamento farmacêutico presentam melhores resultados (1.16±0.65mmol/LH2O2) do que o outro grupo (0.75±0.22mmol/LH2O2), não sendo, no entanto, uma diferença significativa entre os dois grupos (P=0.16). Os resultados obtidos para a concentração de MDA pelo método de HPLC mostraram que o grupo de controlo tem valores mais baixos do que os pacientes alcoólicos, embora a diferença não seja muito significativa (P = 0,084), mas é ainda elevada. Além disso, os dois grupos de pacientes não apresentaram uma diferença significativa entre os seus resultados no início (P=0,77) e no fim (P=0,79) do tratamento. De acrescentar ainda que, os resultados da concentração de álcool no sangue determinados pelo método de CG mostraram que só alguns pacientes sem tratamento consumiram álcool durante o período de tratamento, o que influencia negativamente a conclusão sobre o efeito do tratamento. Contudo, outros fatores externos podem ainda influenciar os resultados finais, tais como o estado nutricional e estado psicológico dos pacientes, se o paciente continua a beber durante o tempo de tratamento ou até mesmo se o paciente é exposto a outros tipos de substâncias nocivas. Existe ainda a possibilidade de o tempo de aplicação do tratamento não ser suficiente para apresentar um efeito positivo em relação ao stress oxidativo e este é um outro fator que contribui para a impossibilidade de confirmar sobre o efeito, quer seja positivo ou negativo, do tratamento antioxidante.

Major depressive disorders in the general hospital: how to implement guidelines.

OBJECTIVE: An implementation study that evaluated the impact of previously adopted guidelines on the clinical practice of medical residents was conducted to improve the recognition and treatment of major depressive disorders (MDDs) in hospitalized patients with somatic diseases. METHODS: Guidelines were implemented in two wards (ENT and oncology) using intranet diffusion, interactive sessions with medical residents, and support material. Discharge letters of 337 and 325 patients, before and after the intervention, respectively, were checked for statement of diagnosis or treatment of MDDs and, in a post hoc analysis, for any mention about psychiatric management. RESULTS: No difference was found in the number of diagnosed or treated MDDs before and after the intervention. However, significantly more statements about psychological status (29/309 vs. 13/327) and its management (36/309 vs. 19/327) were observed after the intervention (P<.01). CONCLUSION: The intervention was not successful in improving the management of MDDs. However, a possible effect on general psychological aspects of medical diseases was observed.

Spirituality and religion in outpatients with schizophrenia: A multi-site comparative study of Switzerland, Canada, and the United States

Objective: To assess the importance of spirituality and religious coping among outpatients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder living in three countries. Method: A total of 276 outpatients (92 from Geneva, Switzerland, 121 from Trois-Rivières, Canada, and 63 from Durham, North Carolina), aged 18-65, were administered a semi-structured interview on the role of spirituality and religiousness in their lives and to cope with their illness. Results: Religion is important for outpatients in each of the three country sites, and religious involvement is higher than in the general population. Religion was helpful (i.e., provided a positive sense of self and positive coping with the illness) among 87% of the participants and harmful (a source of despair and suffering) among 13%. Helpful religion was associated with better social, clinical and psychological status. The opposite was observed for the harmful aspects of religion. In addition, religion sometimes conflicted with psychiatric treatment. Conclusions: These results indicate that outpatients with schizophrenia or schizoaffective disorder often use spirituality and religion to cope with their illness, basically positively, yet sometimes negatively. These results underscore the importance of clinicians taking into account the spiritual and religious lives of patients with schizophrenia.

Relació entre la funcionalitat i l’estat de seguretat amb un mateix i en l’acció motriu després de la readaptació a la lesió de LCA

Els jugadors de futbol sotmesos a una reconstrucció de LCA es veuen afectats per dos vessants. La primera és a nivell funcional de l’articulació del genoll, entenent aquesta com la capacitat que presenta el genoll a suportar pes, generar força, realitzar moviments i mantenir-se estable durant la practica esportiva (Mattacola et. al., 2002). La segona és a nivell psicològic en seguretat amb un mateix i en seguretat a l’acció motriu (Brewer et. al., 1993). Aquesta recerca presenta un estudi sobre la funcionalitat i l’estat psicològic de deu jugadors de futbol amateur un cop ja han estat rehabilitats i readaptats a la practica esportiva. L’objectiu de l’estudi és conèixer la relació entre les respostes funcionals i subjectives. El procés s’ha dividit en tres fases, la primera ha estat la selecció del grup i realització del qüestionari de creació pròpia QSCFEG 2014 (que permet extreure el nivell de seguretat en l’acció motriu i el nivell de seguretat amb un mateix), la segona fase ha consistit en passar les quatre proves del HOP Test i mesurar els perímetres i l’amplitud de moviment de les extremitats inferiors (per mesurar l’índex de simetria de les extremitat inferior i veure el nivell funcional) i la última la recopilació de dades, anàlisi dels resultats i extracció de conclusions. A l’analitzar el grup s’ha comprovat que tots els subjectes presenten un nivell funcional superior al paràmetre mínim, que segon Barber et. al (1990) és del 85%. Tot i això, la gran majoria presenten mancances a nivell psicològic, ja que han demostrat una puntuació baixa en relació als mínims establerts als nivells de seguretat motriu (40 punts mínim) i seguretat amb un mateix (20 punts mínim).

Coronary artery plaque burden and calcium scores in healthy men adhering to long-term wine drinking or alcohol abstinence

Observational studies suggest there are clinical benefits to moderate red wine (RW) consumption. However, the effects on coronary vasculature and overall lifestyle are unclear. We investigated whether a lifestyle of regular long-term RW consumption is associated with changes in coronary plaque burden, calcium score, carotid intima/media thickness, endothelial function, and metabolic variables, compared with alcohol abstinence. Healthy volunteers were evaluated by coronary computed tomography angiography (CTA) as well as carotid and brachial artery ultrasound. Nutritional status, psychological status, and metabolic variables were assessed. The study included 101 drinkers [aged 58.9±7.3 years (means±SD)], from wine brotherhoods, and 104 abstainers, from Anglican, Evangelical and Catholic churches both in the city of São Paulo, Brazil. No significant differences in demographics were noted. Lesion prevalence per patient assessed by coronary CTA and classified as absent (0), 1-25, 26-49, and ≥50% stenosis was similar between groups. When analyzed by individual arteries, i.e., left anterior descending, circumflex, and right coronary, prevalence was also not different. On the other hand, calcium scores were higher among drinkers than abstainers (144.4±362.2 vs 122.0±370.3; P<0.01). However, drinkers reported less history of diabetes and exercised more. RW drinkers consumed 2127.9±387.7 kcal/day while abstainers consumed 1836.0±305.0 (P<0.0001). HDL cholesterol was significantly higher among drinkers compared to abstainers (46.9±10.9 vs 39.5±9.0 mg/dL; P<0.001), while fasting plasma glucose was lower (97.6±18.2 vs 118.4±29.6 mg/dL; P<0.02). Liver enzymes were normal in both groups. In conclusion, long-term wine drinkers displayed a similar plaque burden but greater calcium score than abstainers, despite a more atherogenic diet, and the mechanisms for the increased calcium scores in the former remain speculative.

Evaluación e intervención interdisciplinaria del dolor en Unidades de Cuidado Intensivo

El dolor es un problema importante para los pacientes hospitalizados en las UCI porque genera malestar y distrés. Además, la investigación ha demostrado que en algunos pacientes críticos el dolor agudo puede persistir después de alta y convertirse en crónico. La gestión eficaz del dolor en pacientes críticos requiere un enfoque interdisciplinario, que incorpore la visión y trabajo de expertos que representan una amplia variedad de especialidades clínicas. Así, la utilización de la intervención psicológica en el tratamiento del dolor es una parte integral de un enfoque global. Basado en una revisión de la evidencia científica, se identifican y señalan: (1) los tipos de dolor más comunes; (2) las características del dolor; (3) las patologías más frecuentes asociadas con la presencia de dolor; (4) los procedimientos que generan dolor en la UCI; (5) los métodos de evaluación del dolor; (6) la intervención del mismo y; (7) la contribución del psicólogo en la evaluación y manejo del dolor con el paciente, los familiares y los profesionales de la salud. La revisión realizada indica que los procesos psicológicos influyen tanto en la experiencia del dolor como en los resultados del tratamiento, por lo tanto la integración de los principios psicológicos en el tratamiento del dolor parecen tener potencial mejora de los resultados beneficiando la salud del paciente.

Prostate cancer: important steps and considerations in the design of therapeutic vaccines

Vaccine-based immunotherapy can increase the overall survival of patients with advanced prostate cancer. However, the efficacy of vaccine-elicited anticancer immune responses is heavily influenced by the physical, nutritional, and psychological status of the patient. Given their importance, these parameters should be carefully considered for the design of future clinical trials testing this immunotherapeutic paradigm in prostate cancer patients.

Prosthetic considerations

Implants have changed prosthodontics more than any other innovation in dentistry. Replacement of lost teeth by a fixed or removable prosthesis is considered to be a restitutio ad similem, while implants may provide a feeling of restitutio ad integrum. Implant prosthodontics means restoring function, aesthetics, and providing technology; biology and technology are combined. Placement of implants is a reconstructive, preprosthetic surgical intervention and is therefore different from most goals in oral surgery that consist of tooth extraction, treating infection and removing pathology from soft or hard tissues. Thus, implants are part of the final prosthetic treatment which encompasses functional, aesthetic and social rehabilitation. The patient's needs and functional status determine the goal of prosthetic treatment. Treatment outcomes in implant prosthodontics are survival of implants and prostheses, impact on physiological and psychological status, oral health-related impact on quality of life, and initial and maintenance costs. A variety of prosthetic solutions are available to restore the partially and completely edentulous jaw and more recently specific methods have been developed such as computer guided planning and CAD-CAM technologies. These should allow more uniform quality and passive fit of prostheses, and simultaneously enables processing of biologically well-accepted materials.