Observational stress factors and musculoskeletal disorders in urban transit operators.

Associations and pathways between observed (rather than self-reported) job stressors and musculoskeletal disorders in 66 transit operators were investigated to determine specific stressors and vulnerable body regions affected, while adjusting for physical workload. Job stressors, defined as barriers to progress with work, comprised 7 categories and the sum of stressors. Outcomes included back and neck pain, low back pain, neck pain, pain of the upper extremities and the lower extremities, and any combination of these. Stressors were significantly associated with the combined musculoskeletal disorders category (odds ratio [OR] = 1.55), back and neck pain (OR = 1.41), low back pain (OR = 1.46), and pain in the lower extremities (OR = 1.44) after controlling for confounders. Five barrier categories had at least 1 significant association with outcomes. Results provide specific intervention targets by avoiding common method variance bias. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community survey of factors associated with consultation for low back pain

OBJECTIVE: To investigate the psychosocial factors associated with consultation for low back pain. DESIGN: Two phase cross sectional postal survey. SETTING: Bradford Metropolitan Health District. SUBJECTS: 1813 adults responding to the phase 1 questionnaire. 540 of the 782 with an episode of low back pain in the past 12 months completed the second questionnaire. MAIN OUTCOME MEASURES: Six psychosocial constructs. RESULTS: 406 (52%) of the respondents reporting back pain in the past 12 months had not consulted a health professional. Logistic regression showed that consultation was associated with externalised beliefs regarding pain management (odds ratio 3.6; 95% confidence interval 2.1 to 6.0). Duration of pain affected the factors associated with consultation. Consultation for episodes lasting less than two weeks (n=290) was associated with greater than median pain (3.0; 1.7 to 5.5), consultation for episodes over two weeks (n=243) was associated with increased disability (3.7; 1.5 to 9.0), and consultation for episodes over three months (n=143) with increased depression (3.9; 1.3 to 11.8). CONCLUSIONS: The results support a role for psychosocial factors in consultation for low back pain and suggest that the reasons for consultation vary with duration of pain. Duration of the episode may be a useful guide to management of non-specific low back pain.     

Physical therapy in low back pain

We report on physical measures in the treatment of patients with lower back pain due to mechanical factors. Acute low back pain improves mostly without specific measures. Intervention for this condition is useful for prevention of relapses. More demanding and difficult is the treatment of chronic lumbar back pain. After an exact diagnosis, information about the disease, the therapeutic procedure and the prognosis follow in order to agree on a common therapeutic goal. To this goal, a close cooperation between physician, physiotherapist, possibly a psychologist and a social worker, is optimal. The employer should be involved in the rehabilitation on the workplace. Patients should become mobilized inspite of pain, and the return to their workplace should be prepared step by step. The most important physiotherapeutic modalities are demonstrated.     

Objective measurement of occupational stress factors--an example with San Francisco urban transit operators

Eighty-one observational work analyses were conducted to measure stressors independently of worker appraisal in the San Francisco transit system. On the basis of action regulation theory, stress factors were defined as hindrances for task performance due to poor work organization or technological design. Stressors included (a) work barriers, defined as obstacles that cause extra work or unsafe behavior; (b) time pressure; (c) monotonous conditions; and (d) time binding, defined as control over timing. Reliability, measured as interrater agreement, ranged between 80 and 97%, with kappas of .46-.70. Validity analyses were done with 71 transit operators who participated in the observations and 177 operators who were assigned mean line-specific observational stressor measures. High odds ratios (ORs) were found for barriers and psychosomatic complaints (OR = 3.8, p = .00), time pressure and relaxation time needed after work (OR = 3.1, p = .05), and barriers and smoking to cope (OR = 3.8, p = .02). Using observational data in conjunction with self-report data can reduce confounding and improve interpretability of stress and health studies.     

Coping with neck and low back pain in the general population.

This study had 2 objectives: (a) to assess the psychometric properties of the Pain Management Inventory (PMI; G. K. Brown & P. M. Nicassio, 1987) with individuals in the general population with neck or low back pain, and (b) to assess the relationship between pain severity and coping. Data were taken from a mailed survey of a random sample of adults residing in Saskatchewan, Canada. Results validated the 2-factor structure of the PMI and provided evidence for the internal consistency of the coping subscales. Regression analyses revealed that passive coping was associated with being married, greater pain severity, depression, and poor health. Active coping was associated with female gender, higher education, less depression, good health, and frequent exercise. This study provides psychometric data to support the use of the PMI and information about factors associated with use of active and passive coping strategies in pain sufferers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prevalence of diabetes and associated coronary risk factors in urban and rural older Mexican populations

OBJECTIVE: To determine the prevalence of diabetes and examine its association with food intake, anthropometric and metabolic variables, and other coronary risk factors in urban and rural older Mexican populations. DESIGN: A cross-sectional study. SETTING: Three Mexican communities (urban areas of medium and low income and a rural area). PARTICIPANTS: A total of 121 men and 223 women aged 60 years and older and 93 men and 180 women aged 35 to 59 years were selected randomly for inclusion in the survey, which was derived from the CRONOS study (Cross-Cultural Research on Nutrition in the Older Adult Study Group) promoted by the European Economic Community. MEASUREMENTS: A personal interview assessed demographic information, personal medical history, and functional status, and a 24-hour diet recall was obtained. A physical examination included anthropometric and blood pressure measurements. A fasting blood sample was obtained for measurements of lipids, insulin, and glucose. RESULTS: Diabetes prevalence was higher in men than in women for all age groups: 16.7% versus 9.5% in younger adults and 30.8% versus 22.8% in older adults. For all age groups, diabetes was more highly prevalent in urban communities. Using a multivariate stepwise logistic regression, variables associated independently with diabetes in older individuals were: gender (male sex: OR = 2.1; P < .009); diminished carbohydrate intake in the diet (OR = 0.77; P < .03); central distribution of adiposity (OR = 1.9; P < .03); and functional disability (OR = 2.3; P < .01). This relationship was not observed with living area, income, education, fiber and alcohol intake, body mass index, or age. Individuals 80 years and older had a diminished atherogenic risk profile. Diabetes in older people was associated significantly with hypertriglyceridemia, impaired functional status, and an increased prevalence of ischemic heart disease; in younger adults diabetes was associated with low density lipoprotein (LDL) hypercholesterolemia, hypertriglyceridemia, and a proportionally higher fat intake. CONCLUSION: This survey confirms the high prevalence of diabetes in the older Mexican population - particularly in men and in individuals living in urban areas - associated with an increased prevalence of other coronary risk factors. Diabetes was associated with higher fat, low carbohydrate, low fiber diets and increased prevalence of central distribution of adiposity. In the older subjects, diabetes was associated significantly with hypertriglyceridemia, impaired functional status, and increased prevalence of ischemic heart disease. A bias produced by early mortality and a survivorship effect must be considered in studies of older individuals. The health situation in the older Mexican population presents a complex problem that needs correct diagnosis and better strategies to benefit those segments of the population at increased risk.     

The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults

STUDY DESIGN: Population-based, cross-sectional, mailed survey. OBJECTIVES: To determine the lifetime, 6-month period, and point prevalence of low back pain and its related disability among Saskatchewan adults and to investigate the presence and strength of selective response bias. SUMMARY OF BACKGROUND DATA: There have been many reports of the prevalence of low back pain in different populations, and the estimates vary widely depending on case definition. However, most studies fail to differentiate between trivial and disabling back pain, which raises the issue of the usefulness of these estimates. No studies have yet documented the prevalence of graded low back pain severity and its related disability in a North American, general, population-based survey. METHODS: The Saskatchewan Health and Back Pain Survey was mailed to a probability sample of 2184 Saskatchewan adults between 20 and 69 years of age. Fifty-five percent of the eligible population responded to the survey. Respondents were compared with nonrespondents, and the presence of selective response bias by back pain status was investigated by wave analysis. The point and lifetime prevalence of low back pain was determined by simple questions, and the 6-month period prevalence of low back pain was determined by the Chronic Pain Questionnaire. All estimates were age standardized to the Saskatchewan population. RESULTS: The authors estimate that at the time of the survey 28.4% (95% confidence interval, 25.6-31.1) of the Saskatchewan adult population were experiencing low back pain, and 84.1% (95% confidence interval, 81.9-86.3) had experienced it during their lifetime. Overall, 48.9% (95% confidence interval, 45.9-52.0) of the population had experienced low intensity/low-disability low back pain in the previous 6 months, 12.3% (95% confidence interval, 10.3-14.4) had experienced high-intensity/low-disability low back pain, and an additional 10.7% (95% confidence interval, 8.8-12.5) had experienced high-disability low back pain in the previous 6 months. There was little variation in the estimates over age groups, but women experienced more high-disability back pain than men. There was no evidence of selective response bias by low back pain status in the survey. CONCLUSION: Low-intensity/low-disability low back pain is a common problem in the general population. Approximately 11% of the adult population studied had been disabled by low back pain in the previous 6 months.     

Risk factors associated with acute dental pain in children

We have previously shown that high altitude pulmonary edema-susceptible subjects (HAPE-S) have an accentuated pulmonary vascular response to hypoxia. In this study, we investigated the relationship between plasma endothelin-1 (ET-1) levels and the acute hypoxic pulmonary vascular response in HAPE-S and control subjects. In six HAPE-S and seven healthy subjects, we evaluated acceleration time/right ventricular ejection time (AcT/RVET) using Doppler echocardiography, and measured plasma ET-1 levels by radioimmunoassay (RIA) before and after 5 minutes of breathing 10% oxygen. The HAPE-S showed a significantly increased pulmonary vascular response to hypoxia compared with healthy subjects. However, no statistically significant changes of plasma ET-1 levels were observed before and after hypoxia in both groups. We conclude that the increased pulmonary vascular response to acute hypoxia in HAPE-S may not be related to ET-1 release.     

Clinical factors associated with pain in acute myocardial infarction

In an unselected population of 921 consecutive patients with acute myocardial infarction admitted to one single hospital, regardless of age and whether they were admitted to the coronary care unit or not, we describe the course of pain during hospitalization. Patients with a history of angina pectoris, patients with a particularly long delay time, and patients not transported by ambulance had the longest duration of pain.     

Attributions (beliefs) and job satisfaction associated with back pain in an industrial setting

Transient cerebral ischemia can produce irreversible neuronal damage and permanent learning and memory impairments in humans. This study examined whether ischemia-induced brain damage in rats results in impairments on the delayed nonmatching-to-sample (DNMS) task, a nonspatial recognition task analogous to tests on which amnesic patients display impairments. Male Wistar rats received either sham surgery or 20-min forebrain ischemia induced by bilateral carotid occlusion and hypotension. Four weeks after surgery, ischemic rats were significantly impaired in both learning and performing the DNMS task at retention intervals up to 5 min. Extensive presurgical training did not reduce this impairment. Observable cell loss in ischemic rats was limited to CA1 pyramidal neurons and a subset of cells in the dentate gyrus. The results indicate that ischemic damage to the hippocampus in rats results in recognition memory deficits similar to those produced by ischemic damage in humans.     

Risk factors for the prevalence of malnutrition among urban children in Ghana

Alternative splicing has been shown to occur at the metabotropic glutamate receptor 1 (mGluR1) gene. Three main isoforms that differ in their carboxy-termini have been described so far and named mGluR1alpha, mGluR1beta and mGluR1c. These variants when expressed in recombinant systems all activate phospholipase C, although the [Ca2+] signals generated have different kinetics. Tissue distribution studies of specific mGluR1 splice variants are limited to the mGluR1alpha isoform. In the present work, we examined the localization of mGluR1beta in the adult rat and mouse forebrain by using a specific antipeptide antibody. Furthermore, the mGluR1beta immunostaining was compared with that obtained with antibodies specific for mGluR1alpha or with a pan-mGluR1 antibody which recognizes all isoforms. mGluR1beta-like immunoreactivity (LI) was found confined to the neuropil and neuronal perikarya and appeared discretely distributed in the rodent forebrain. Differential cellular distribution between mGluR1alpha and mGluR1beta was observed. In the hippocampus, mGluR1alpha-LI was restricted to non-principal neurons in all fields, whereas mGluR1beta-LI was strongest in principal cells of the CA3 field and dentate granule cells but absent in CA1. We have also shown that the vast majority of neurons in the striatum express mGluR1. The predominant form appeared to be mGluR1beta, with a distribution pattern reflecting the patch-matrix organization of the striatum. The specificity of the immunoreactivity described for mGluR1 splice variants was confirmed in mGluR1-deficient mice. The observation of a different cellular and regional distribution of mGluR1 splice variants, in particular in the hippocampus, suggests that they may mediate different roles in synaptic transmission.     

Positioning for clinical dental hygiene care. Preventing back, neck and shoulder pain

Spasmodic dysphonia is a focal dystonia that effects the proximal muscles (adduction dystonia) or dilatory (abduction dystonia) of the larynx. Botulinum toxin (BTX), generally delivered by percutaneous injection, is the treatment of choice. Recently, use has been made of a transoral route of delivery, with BTX injected through a curved device with visual control. It remains to be determined which route is better. Percutaneous injection is simple and well-tolerated, but the transoral route is theoretically more effective. We assessed the efficacy of both techniques in 19 patients with adduction dystonia, conducting 55 treatment sessions by percutaneous injection and 20 by transoral injection. All the transoral treatments were effective (20/20, 100%), but only 81% (45-155) of the percutaneous treatments were (p < 0.05). Two patients who had doubtful responses after percutaneous delivery improved considerably when the transoral approach was used. In spite of its greater complexity, the transoral approach is probably more effective than the percutaneous route. We describe a curved device for transoral injection that is composed of simple elements available at any health center.     

Enuresis: prevalence and associated factors among primary school children in Saudi Arabia

The aim of this study was to determine the prevalence of enuresis and the factors associated with it among primary school children. This is a cross-sectional population-based study. Data were collected using a self-administered questionnaire. Six hundred and forty school children aged 6-16 years were selected randomly. Enuresis prevalence was 16.3% among boys and 13.8% among girls. The overall prevalence was 15%. Breastfeeding, first born children, family integrity and stability were found to be protective. Stressful life events before the age of 6 years, deep sleep, acute family psycho-social problems, recurrent urinary tract infection, constipation and congenital defects were found to be strongly associated with enuresis. Enuresis was also found to be associated with family history of enuresis. An important finding is that of the 83 children who had enuresis during sleep, 25 (30.1%) wet their beds during day time sleep (day sleep wetting). The importance of enuresis as a health problem has been affirmed and specific guidelines were suggested.     

The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults

STUDY DESIGN: Population-based, cross-sectional mailed survey. OBJECTIVE: To determine the lifetime, period, and point prevalence of neck pain and its related disability among Saskatchewan adults and investigate the presence and strength of nonresponse bias. SUMMARY OF BACKGROUND DATA: In Europe, the lifetime and point prevalence of neck pain is almost as high as the prevalence of low back pain. Similarly, chronic neck pain is highly prevalent and a common source of disability in the working-age population. However, no studies specifically have documented the prevalence of neck pain and its related disability in North America. METHODS: The Saskatchewan Health and Back Pain Survey was mailed to 2184 randomly selected Saskatchewan adults aged 20-69 years. Fifty-five percent of the study population participated. The presence of nonresponse bias was investigated through logistic regression and wave analysis. The Chronic Pain Questionnaire was used to classify the severity of chronic neck pain. RESULTS: The age-standardized lifetime prevalence of neck pain is 66.7% (95% confidence interval, 63.8-69.5), and the point prevalence is 22.2% (95% confidence interval, 19.7-24.7). The age-standardized 6-month prevalence of low-intensity and low-disability neck pain is 39.7% (95% confidence interval, 36.7-42.7), whereas it is 10.1% (95% confidence interval, 8.2-11.9) for high-intensity and low-disability neck pain and 4.6% (95% confidence interval, 3.3-5.8) for significantly disabling neck pain. The prevalence of low-intensity and low-disability neck pain decreases with age. More women experience high-disability neck pain than men. Wave analysis suggests that the point prevalence and 6-month prevalence of high-intensity and low-disability neck pain are overestimated in this survey. CONCLUSION: This cross-sectional study shows that neck pain is highly prevalent in Saskatchewan and that it significantly disables 4.6% (95% confidence interval, 3.3-5.8) of the adult population.     

Predictors of outcome in patients with chronic back pain and low-grade spondylolisthesis

STUDY DESIGN: Retrospective case series. OBJECTIVES: To determine the factors influencing symptom relief after uninstrumented posterolateral spinal fusion with or without decompression in adult patients with chronic back pain and previously asymptomatic low-grade isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA: The role of previously asymptomatic low-grade isthmic spondylolisthesis in chronic adult low back pain is unclear. Operative intervention in this setting is controversial. METHODS: Twenty-four consecutive adult patients with chronic low back pain and low-grade isthmic spondylolisthesis first detected during routine work-up of new onset low back pain underwent spinal fusion with or without decompression. The influence of active worker's compensation or litigation claims, radicular pain, concomitant laminectomy, age, gender, fusion to L4, intervertebral disc bulge, and pseudarthrosis were investigated. RESULTS: All 13 patients involved in worker's compensation claims or pending litigation had fair or poor results. Nine of 11 patients without such issues had good or excellent results. Although the strong association of worker's compensation with poor results made it difficult to assess the importance of other risk factors, the data suggest that good results may be more likely in patients with radiculopathy who undergo laminectomy. CONCLUSIONS: This investigation, although limited by a number of factors including small sample size and retrospective, unblinded review, suggests that active worker's compensation and litigation issues are associated strongly with poor results of operative management for chronic low back pain in adult patients with low-grade spondylolisthesis.