Intervenciones ergonómicas y su impacto en la profesión odontológica / Ergonomic interventions and their impact on the dental profession / Intervenções ergonômicas e seu impacto sobre a profissão odontológica

Introducción: los desórdenes músculoesqueletales tienen una alta prevalencia en la población general y en particular, en el área salud, los profesionales de la odontología representan una población altamente vulnerable, debido a características particulares del ejercicio de su profesión. Es creciente el estudio de diferentes intervenciones ergonómicas y el impacto que estas pueden tener sobre la reducción de la sintomatología muscular y en el desarrollo y/o la perpetuación de estos cuadros disfuncionales. Materiales y método: se realizó una revisión, de tipo narrativa, entre los meses de abril de 2022 y agosto de 2022. Se consultaron base de datos tales como MedLine/PubMed y Scielo, incluyendo artículos publicados en los últimos diez años. Resultados: se obtuvieron un total de 71 artículos, de los cuales, se excluyeron 30 trabajos, resultando en 41 los artículos incluidos en la presente síntesis cualitativa. Conclusiones: las intervenciones ergonómicas están dirigidas básicamente, a cambios en los ambientes de trabajo de los profesionales y/o a la implementación de programas que tienen como objetivo instruir y concientizar a los profesionales sobre criterios ergonómicos para su incorporación en el desempeño de su trabajo. Ambos enfoques intervencionistas, han sido evaluados con herramientas validadas de autopercepción, exámenes clínicos y evaluaciones instrumentales. Las estrategias que focalizan el problema, en los espacios de trabajo, y aquellas que, incluyen educación y formación en ergonomía, disminuyen el impacto de los desórdenes músculoesqueletales en esta población. Estas últimas, tienen la potencialidad de provocar cambios en los hábitos de los profesionales, con conductas que se mantienen a mediano plazo.

Introduction: musculoskeletal disorders have a high prevalence in the general population and in particular, in the health area, dental professionals represent a highly vulnerable population, due to the particular characteristics of the practice of their profession. The study of different ergonomic interventions and the impact they can have on the reduction of muscular symptomatology and on the development and/or perpetuation of these dysfunctional conditions is growing. Method: a narrative review was carried out between April 2022 and August 2022. Databases such as MedLine/PubMed and Scielo were consulted, including articles published in the last ten years. Results: a total of 71 articles were obtained, of which 30 were excluded, resulting in 41 articles included in this qualitative synthesis. Conclusions: ergonomic interventions are basically aimed at changes in the working environments of professionals and/or the implementation of programs aimed at instructing and making professionals aware of ergonomic criteria for their incorporation in their work performance. Both interventionist approaches have been evaluated with validated self-perception tools, clinical examinations and instrumental evaluations. Strategies that focus the problem in the workplace and those that include education and training in ergonomics reduce the impact of musculoskeletal disorders in this population. The latter have the potential to provoke changes in the habits of professionals, with behaviors that are maintained in the medium term.

Introdução: os distúrbios músculo-esqueléticos são altamente prevalentes na população em geral e, em particular, na área da saúde, os profissionais da odontologia representam uma população altamente vulnerável, devido às características particulares do exercício de sua profissão. O estudo de diferentes intervenções ergonômicas e o impacto que elas podem ter na redução dos sintomas musculares e no desenvolvimento e/ou perpetuação dessas condições disfuncionais está crescendo. Materiais e métodos: foi realizada uma revisão narrativa entre abril de 2022 e agosto de 2022. Bases de dados como MedLine/PubMed e Scielo foram consultadas, incluindo artigos publicados nos últimos dez anos. Resultados: foram obtidos um total de 71 artigos, dos quais 30 foram excluídos, resultando em 41 artigos incluídos nesta síntese qualitativa. Conclusões: as intervenções ergonômicas visam basicamente a mudanças nos ambientes de trabalho dos profissionais e/ou a implementação de programas que visam instruir e conscientizar os profissionais sobre critérios ergonômicos para sua incorporação em seu trabalho. Ambas as abordagens intervencionistas foram avaliadas com ferramentas validadas de autopercepção, exames clínicos e avaliações instrumentais. As estratégias que visam o problema no local de trabalho e aquelas que incluem educação e treinamento em ergonomia reduzem o impacto dos distúrbios músculo-esqueléticos nesta população. Estes últimos têm o potencial de provocar mudanças nos hábitos dos profissionais, com comportamentos que são mantidos a médio prazo.

Manifestaciones Musculoesqueléticas de Neoplasias en Pediatría a propósito de tres Casos Clínicos / Musculoskeletal manifestations of neoplasms in children: three reported cases

Introducción: El dolor musculoesquelético (ME) es un motivo de consulta común en la infancia originado en su mayoría por causas banales. Entre las causas menos frecuentes encontramos las patologías reumatológicas y neoplásicas. Se presentan tres casos clínicos que debutaron con artritis o artralgia en los cuales el diagnóstico final fue neoplásico. Casos clínicos: el primer caso fue una Leucemia Linfoblástica Aguda (LLA) de alto riesgo, el segundo caso fue un sarcoma de Ewing y el tercer caso fue una LLA común. Dos de los casos tuvieron evolución desfavorable con fallecimiento. Revisión de la literatura: Se describen hallazgos que deben hacer sospechar una causa neoplásica tales como el dolor ME desproporcionado, alteraciones en el hemograma, velocidad de eritrosedimentación globular y lactato deshidrogenasa elevados, y radiografía con alteraciones sugerentes. Conclusiones: Frente a un dolor ME en el niño se debe tener presente las causas neoplásicas a pesar de su baja frecuencia dado su mal pronóstico.

Introduction: Musculoskeletal (MS) pain is a common complaint in childhood, usually caused by trivial ailments. Among less frequent causes we may find rheumatological and neoplastic pathologies. We present 3 clinical cases in which a rheumatological cause was initially suspected, as they started out with arthritis or arthralgia, but where the diagnosis was finally a neoplasm. Clinical cases: the first case was a high-risk Acute Lymphoblastic Leukemia (ALL), the second case was a Ewing's sarcoma, and the third case was a common ALL. Two of the cases had unfavourable outcomes and passed away. Literature review: Findings that should make us suspect neoplastic causes are disproportionate MS pain, altered hemogram, elevated erythrocyte sedimentation rate and lactate dehydrogenase, and an x ray with suggestive alterations. Conclusions: When faced with MS pain in children, neoplastic causes must be taken into account despite their low frequency given the poor prognosis associated with the diagnosis.

A painful symphony: the presence of overuse syndrome in professional classical musicians / Una sinfonía dolorosa: la presencia del síndrome de uso excesivo en músicos clásicos profesionales

Musculoskeletal problems are common in instrumental musicians. Little is known about the factors that place musicians at risk, and the ways in which musicians can prevent these problems. Overuse syndrome is the most reported diagnosis among instrumental musicians suffering from playing related musculoskeletal injuries. The study group comprised 50 musicians employed in Symphony Orchestra of the Serbian National Theatre of Novi Sad. Out of the 50 musicians, 30 (60 %) are male and 20 (40 %) female. Higher frequencies of the presence of musculoskeletal symptoms were neck, region of trapezius, back, shoulder, wrist, hand and arm. A larger number of musicians (81.8 %) had perception of high demand of the profession. This investigation with professional classical musicians should show the music-medical interest.

Los problemas musculo-esqueléticos son comunes en los músicos instrumentales. Poco se sabe sobre los factores que ponen en riesgo a los músicos y las formas en que los ellos pueden prevenir estos problemas. El síndrome de uso excesivo es el diagnóstico más informado entre los músicos instrumentales que sufren lesiones musculo-esqueléticas relacionadas al uso de instrumentos musicales. El grupo de estudio estuvo compuesto por 50 músicos de la Orquesta Sinfónica del Teatro Nacional Serbio de Novi Sad. De los 50 músicos, 30 (60 %) eran hombres y 20 (40 %) mujeres. La frecuencia más alta de presencia de síntomas musculoesqueléticos se produjo en el cuello, músculo trapecio, espalda, hombro, muñeca, mano y brazo. Un mayor número de músicos (81,8 %) tuvo una percepción de alta demanda de la profesión. Esta investigación con músicos clásicos profesionales debería ser de interés médico-musical.

Trends in renal calculus composition and 24-hour urine analyses in patients with neurologically derived musculoskeletal deficiencies

ABSTRACT Purpose: To better characterize metabolic stone risk in patients with neurologically derived musculoskeletal deficiencies (NDMD) by determining how patient characteristics relate to renal calculus composition and 24-hour urine parameters. Materials and Methods: We performed a retrospective cohort study of adult patients with neurologically derived musculoskeletal deficiencies presenting to our multidisciplinary Kidney Stone Clinic. Patients with a diagnosis of NDMD, at least one 24-hour urine collection, and one chemical stone analysis were included in the analysis. Calculi were classified as primarily metabolic or elevated pH. We assessed in clinical factors, demographics, and urine metabolites for differences between patients who formed primarily metabolic or elevated pH stones. Results: Over a 16-year period, 100 patients with NDMD and nephrolithiasis were identified and 41 met inclusion criteria. Thirty percent (12 / 41) of patients had purely metabolic calculi. Patients with metabolic calculi were significantly more likely to be obese (median body mass index 30.3kg / m2 versus 25.9kg / m2), void spontaneously (75% vs. 6.9%), and have low urine volumes (100% vs. 69%). Patients who formed elevated pH stones were more likely to have positive preoperative urine cultures with urease splitting organisms (58.6% vs. 16.7%) and be hyperoxaluric and hypocitraturic on 24-hour urine analysis (37mg / day and 265mg / day versus 29mg / day and 523mg / day). Conclusions: Among patients with NDMD, metabolic factors may play a more significant role in renal calculus formation than previously believed. There is still a high incidence of carbonate apatite calculi, which could be attributed to bacteriuria. However, obesity, low urine volumes, hypocitraturia, and hyperoxaluria suggest an underrecognized metabolic contribution to stone formation in this population.

O tempo e maneira de utilização do celular podem predispor à lesões musculoesqueléticas: estudo caso-controle / Time and characteristics of cell phone usage may predispose musculoskeletal injuries: case-control study

Objetivo:avaliar e comparar o tempo de utilização, postura e o manuseio do celular entre voluntários com e sem dor na região dos membros superiores ou da coluna cervical. Métodos:Este estudo possui um delineamento observacional transversal. Foram avaliados o tempo e finalidade, a maneira e postura de utilização do celular utilizando questionários com questões abertas de 24 participantes com dor na região da coluna cervical ou membro superior e 24 do grupo controle, que não apresen-tavam dor, com gênero e idade pareados entre os grupos. As comparações entre grupos foram realizadas por meio do Teste T de student para as variáveis contínuas e para as categóricas o Qui quadrado. Resultados: o grupo com dor apresentou maior utilização do celular sem apoio, tempo para digitar, internet e chamada do que o grupo controle (p<0,05). Não houve diferen-ça entre os grupos para a utilização da agenda, ouvir músicas e jogar no celular e tipo de manuseio (p>0,05). Conclusão:O tempo de utilização do celular para digitar, usar a internet e chamadas, a maneira de digitar e a postura sem apoio foram maiores em voluntários com dor, sugerindo que esses fatores podem influenciar no desenvolvimento de dor musculoesque-léticas na região de cervical e de membros superiores. (AU)

Objective: To evaluate and compare the time of cell phone use among volunteers with and without pain in the upper limbs and cervical spine area. Methods:This is an observational cross-sectional study. Questionnaires about cell phone usage were applied in 24 participants reporting pain in the cervical spine or upper limb and 24 participants without pain, aged 20 to 32 years old. The exclusion criteria were history of previous surgery, trauma and orthopedic injury or usage of upper limbs immobilization over the past six months. The comparisons between groups were performed using the t student test for continuous data, and Chi-square test for categorical data. Results: The pain group showed greater use of cell phone in a sitting position and without any support, while the control group used it in a sitting position with support (p< 0.05). Cell phone usage time for typing messages, browsing the web and making phone calls were greater in the pain group than in the control group (p< 0.05). There was no difference between the groups for using the calendar, listening to music and playing games on mobile (p> 0.05). Conclusion: The time using the cell phone to type, use the internet and make calls, as well as the posture adopted and the usual handling of these devices are different between groups, suggesting that these factors may influence the musculoskeletal pain in the cervical region and upper limbs development.(AU)

Trastornos musculoesqueléticos del miembro superior en el Hospital Militar de Matanzas / Muscle skeletal dysfunctions of superior member in the Military Hospital of Matanzas

RESUMEN Introducción: Los trastornos musculoesqueléticos constituyen uno de los problemas más comunes relacionados con las enfermedades en el trabajo. Objetivo: caracterizar algunas variables clínicas y epidemiológicas de los pacientes con trastornos musculoesqueléticos del miembro superior atendidos en el Servicio de Rehabilitación del Hospital Militar de Matanzas. Materiales y métodos: se desarrolló un estudio descriptivo, durante el primer semestre del año 2017. Las variables estudiadas fueron: sexo, actividad laboral desarrollada, factores de riesgos ergonómicos, trastorno musculoesquelético diagnosticado, antecedentes de crisis similares anteriores y tiempo de incapacidad laboral relacionado con estas afecciones durante los últimos 12 meses. Resultados: el 59,4 % de los pacientes correspondieron al sexo femenino, la actividad laboral más afectada fue la de camareras y auxiliares de limpieza (18,9 %), la repetitividad estuvo presente como factor de riesgo en el 64,5 % de los pacientes y la epicondilitis afectó al 38,5 % de los mismos. El 60,4 % de los pacientes habían presentado crisis anteriores y el 72,9 % de ellos presentó incapacidad laboral. Conclusiones: predominó el sexo femenino, las actividades laborales más afectadas fueron las de limpieza, la repetitividad fue el principal factor de riesgo y la epicondilitis fue el diagnóstico que predominó. La mayor parte de los pacientes habían presentado crisis similares anteriores y períodos de incapacidad laboral relacionados con el trastorno musculoesquelético (AU).

ABSTRACT Introduction: The muscle skeletal dysfunctions constitute one of the more common problems related with the illnesses in the work. Objective: To characterize several clinical and epidemiologic variables of the patients with muscle skeletal dysfunctions of the superior member assisted in the Military Hospital of Matanzas. Materials and methods: A descriptive study was developed during the first semester of 2017 year. The studied variables were: developed labor activity, factors of ergonomic risks, muscle skeletal dysfunctions diagnosed, antecedents of previous similar crisis and time of labor inability related with these affections in the last 12 months. Results: 59,4 % of the patients corresponded to the female sex, the labor activity more affected was waitresses and auxiliary of cleaning (18,9 %), the repetitive were present as factor of risk in 64,5 % of the patients and the epicondylitis affected to 38,5 % of them. Conclusions: Predominated the female sex, the labor activities more affected were the cleaning, the repetitive was the main factor of risk and the epicondylitis was the diagnose that prevailed. Most of the patients had presented previous similar crisis and periods of labor inability related with muscle skeletal dysfunction (AU).

Musculoskeletal pain and musculoskeletal syndromes in adolescents are related to electronic devices / Dor musculoesquelética e síndromes musculoesqueléticas em adolescentes relacionadas a dispositivos eletrônicos

Abstract Objective: To evaluate television and simultaneous electronic devices use in adolescents with musculoskeletal pain and musculoskeletal pain syndromes. Methods: A cross-sectional study was performed in 299 healthy adolescents of a private school. All students completed a self-administered questionnaire, including: demographic data, physical activities, musculoskeletal pain symptoms, and use of simultaneous television/electronic devices (computer, internet, electronic games, and cell phones). Seven musculoskeletal pain syndromes were also evaluated: juvenile fibromyalgia, benign joint hypermobility syndrome, myofascial syndrome, tendinitis, bursitis, epicondylitis, and complex regional pain syndrome. Results: Inter-rater agreement between pretest and retest was 0.83. Musculoskeletal pain and musculoskeletal pain syndrome were found in 183/299 (61%) and 60/183 (33%), respectively. The median age (15 [10-18] vs. 14 [10-18] years, p = 0.032) and years of education (10 [5-12] vs. 9 [5-12] years, p = 0.011) were significantly higher in adolescents with musculoskeletal pain when compared with those without this condition. The frequencies of female gender (59% vs. 47%, p = 0.019), cell phone use (93% vs. 81%, p = 0.003), and simultaneous use of at least two electronic devices (80% vs. 67%, p = 0.011) were significantly higher in the former group. Further comparisons between adolescents with and without musculoskeletal pain syndromes revealed that the frequency of female gender was significantly higher in the former group (75% vs. 25%, p = 0.002), and with a significantly reduced median of weekends/holidays electronic games use (1.5 [0-10] vs. 3 [0-17] h/day, p = 0.006). Conclusions: A high prevalence of musculoskeletal pain/syndromes was observed in female adolescents. Musculoskeletal pain was mostly reported at a median age of 15 years, and students used at least two electronic devices. Reduced use of electronic games was associated with musculoskeletal pain syndromes.

Resumo Objetivo: Avaliar o uso de televisão e dispositivos eletrônicos em adolescentes com dor e síndromes musculoesqueléticas. Métodos: Foi feito um estudo transversal com 299 adolescentes saudáveis de uma escola particular. Todos os alunos responderam a um questionário autoaplicável, que incluiu perguntas sobre: dados demográficos, prática de atividade física, sintomas de dor musculoesquelética e o uso de televisão/dispositivos eletrônicos (computador, internet, jogos eletrônicos e celular). Sete síndromes musculoesqueléticas foram avaliadas: fibromialgia juvenil, síndrome de hipermobilidade articular benigna, síndrome miofascial, tendinite, bursite, epicondilite e síndrome de dor regional complexa. Resultados: A concordância entre o pré-teste e reteste foi de 0,83. Dor musculoesquelética e síndromes musculoesqueléticas foram encontradas em 183/299 (61%) e 60/183 (33%), respectivamente. As medianas de idade [15 (10-18) versus 14 (10-18) anos, p = 0,032] e de anos de escolaridade [10 (5-12) vs. 9 (5-12) anos, p = 0,010] foram significantemente maiores em adolescentes com dor musculoesquelética em comparação com aqueles sem essa condição. As frequências do sexo feminino (59% versus 47% p = 0,019), uso do telefone celular (93% contra 81%, p = 0,003) e do uso simultâneo de pelo menos dois dispositivos eletrônicos (80% vs. 67%, p = 0,011) foram significantemente maiores no grupo de adolescentes com dor musculoesquelética. Comparações adicionais entre os adolescentes com e sem síndromes musculoesqueléticas revelaram que a frequência do sexo feminino foi significantemente maior no primeiro grupo (75% versus 25%, p = 0,002) e com mediana significantemente reduzida de horas de jogos eletrônicos nos fins de semana e feriados [1,5 (0-10) vs. 3 (0-17) horas/dia, p = 0,006]. Conclusões: Uma alta prevalência de dor/síndromes musculoesqueléticas foi observada em adolescentes do sexo feminino. A dor musculoesquelética foi predominantemente relatada entre alunos com mediana de idade de 15 anos e que usavam pelo menos dois dispositivos eletrônicos simultaneamente. O uso reduzido de jogos eletrônicos foi associado à presença de síndromes musculoesqueléticas.

Distúrbios osteomusculares relacionados ao trabalho autorreferidos por profissionais de saúde de um hospital em Portugal / Self-reported work-related musculoskeletal disorders among health professionals at a hospital in Portugal

Introdução: Os distúrbios osteomusculares relacionados com o trabalho (DORT) são responsáveis pela morbidade de muitos profissionais de saúde. Objetivo: Realizar um diagnóstico da prevalência de DORT autorreferidos por profissionais de saúde. Métodos: Foi realizado um estudo, descritivo e exploratório, envolvendo profissionais de saúde de uma instituição hospitalar no norte de Portugal. Os dados foram coletados ao longo do mês de dezembro de 2017, mediante aplicação de questionário eletrônico à população total (n=435). Foram utilizados instrumentos de caracterização sociodemográfica, percepção de conhecimentos sobre ergonomia e mobilização manual de cargas, avaliação da percepção de carga (Escala de Percepção de Carga de Manuseio do Paciente ­ EPCMP) e sintomas osteomusculares autorreferidos (Questionário Nórdico de Sintomas Osteomusculares ­ QNSO). Resultados: A amostra foi constituída de 105 profissionais, essencialmente enfermeiros e assistentes operacionais, apresentando uma ocorrência elevada de sintomas em diversas regiões corporais, maioritariamente na coluna vertebral. Conclusões: DORT em profissionais de saúde devem ser considerados um problema nas instituições de saúde que carecem de intervenções além dos tradicionais programas formativos, especialmente programas multifatoriais de natureza sistémica

Background: Work-related musculoskeletal disorders (WMSDs) are responsible for morbidity among many health professionals. Objective: To establish the prevalence of self-reported WMSDs among health professionals. Methods: Descriptive and exploratory study with health professionals at a hospital in northern Portugal. Data were collected in December 2017 by means of an electronic questionnaire applied to the total target population (n=435). We applied instruments for sociodemographic characterization, perception of knowledge on ergonomics and manual mobilization of loads, the Patient Handling Burden Scale (PHBS) and the Nordic Musculoskeletal Questionnaire (NMQ) for self-reporting musculoskeletal symptoms. Results: The sample comprised 105 professionals, mainly nurses and nursing assistants, who exhibited high frequency of symptoms in several body areas, mainly the spine. Conclusions: WMSDs involving health professionals should be considered a problem for health institutions which do not implement interventions beyond traditional training programs, especially multifactorial programs of systemic nature

Vitamin D deficiency in orthopedic patients, Riyadh, Saudi Arabia

BackgVound: Low levels of blood serum vitamin D have been connected to various musculoskeletal and non musculoskeletal conditions. Vitamin D lack shows up moderately high among different patient subpopulations, including patients with break non-union. We directed a review study to decide the pervasiveness of vitamin D lack what's more, inadequacy in an expansive populace of patients with orthopedic trauma

Methods: The review incorporated all patients who were over age 18 years, had no hazard components for vitamin D inadequacy and was dealt with for an intense break at a Level 1 injury focus

Results: Between April 2016 and October 2016, 100 injury patients had recorded serum 25-hydroxyvitamin D levels. The general commonness of joined vitamin D inadequacy/deficiency was 77%; commonness of vitamin D inadequacy alone was 39%. There were no actually critical [P < .05] age or sex contrasts among the populace. There did not seem, by all accounts, to be a regular distinction. Vitamin D inadequacy and deficiency in intense orthopedic injury, patients showed up extremely normal

Assist examination is expected to completely comprehend the clinical noteworthiness

Conclusion: The Pervasiveness of low serum levels of vitamin D among patients experiencing orthopedic trauma is extremely normal. Given the significance of vitamin D in musculoskeletal wellbeing, such low levels may adversely affect tolerant results

Factores de riesgo relevantes vinculados a molestias musculoesqueléticas en trabajadores industriales / Relevant risk factors linked to musculoskeletal discomfort in industrial workers

Los trastornos musculoesqueléticos (TME) de origen laboral representan una de las enfermedades profesionales más comunes que afectan a gran cantidad de trabajadores industriales. El objetivo de la investigación fue identificar los factores de riesgo relevantes asociados a la existencia de molestias o dolores musculoesqueléticos, según la parte del cuerpo afectada. Para ello se llevó a cabo un estudio transversal de campo, sobre una muestra de 174 trabajadores pertenecientes al área productiva de tres empresas venezolanas del sector cárnico. Para la identificación de TME se utilizó el cuestionario nórdico estandarizado y para la selección de los factores relevantes se emplearon los métodos de minería de datos CfsSubsetEvaly ConsistencySubsetEval, disponibles en Weka. Se encontró una prevalencia general de TME de 77%, destacando los hombros (49,4%) y la espalda (47,1%) como las partes del cuerpo que aquejan a mayor cantidad de trabajadores. Luego de relacionar esta prevalencia con diferentes factores de riesgo biomecánicos, psicosociales e individuales se determinó que los factores que mayor correspondencia presentan con las molestias de los hombros son: la sobrecarga postural, la repetitividad, las exigencias psicológicas y la antigüedad en el puesto de trabajo; mientras que en el caso de las molestias de espalda resaltan: la sobrecarga postural, el levantamiento de cargas, el empuje o arrastre de cargas, el bajo apoyo social y los antecedentes médicos vinculados a TME. Se confirma de esta forma la etiología multifactorial de los TME(AU)

Work-related musculoskeletal Disorders (MSDs) are one of the most common occupational diseases, affecting large numbers of industrial workers. The aim of this study was to identify relevant risk factors associated with the presence of musculoskeletal discomfort or pain, according to the affected body part. A cross-sectional field study was conducted in a sample of 174 workers at three Venezuelan meat processing plants. The standardized Nordic questionnaire was used for the identification of MSDs and the CfsSubsetEvaly ConsistencySubsetEvaldata mining methods, available in Weka,were used to select the relevant factors. MSDs prevalence was 77%; shoulders (49.4%) and back (47.1%) were the most commonly involved body parts. After relating this prevalence to different biomechanical, psychosocial and individual risk factors, those most commonly associated with shoulder discomfort were postural overload, repetitive motion, psychosocial demands and tenure at work. For back discomfort, postural overload, lifting of loads, pushing or pulling loads, low social support and past medical history were the most frequent associations. This study confirms the multifactorial etiology of MSDs(AU)

Factores de riesgo ergonómico en personal de atención hospitalaria en Chile / Ergonomic risk factors in hospital care in Chile

RESUMEN Los factores de riesgo ergonómico en el personal de atención hospitala ria en Chile corresponden a una problemática actual en donde se iden tifican factores de riesgo de índole física y mental, generando falencias en el estado de salud de los trabajadores. Por esto, se identifican elemen tos en el lugar de trabajo como deficiencias biológicas, físicas y quími cas, factores de riesgo psicosociales y organizacionales en el proceso de atención en salud. Esta revisión busca identificar riesgos en actividades hospitalarias, defi niciones de conceptos pertinentes al tema, identificar estudios que evalúen riesgos ocupacionales en el puesto de trabajo, dolencias mús culo-esqueléticas, sistema de trabajo y la carga mental asociada. Por esto, se analiza la séptima encuesta laboral 2011 obteniendo un 18,6% en organizaciones con trabajadores expuestos a posturas incómodas, 14,2% en movimientos repetitivos, 23,7% con exposición a turnos y un 10,7% con exposición a ruído en el ambiente físico. Posteriormente, se analiza una comparación del sistema de turnos entre el sector público y privado, encuestando a una muestra de 44 trabaja dores de un hospital privado y 43 trabajadores de un hospital público, concluyendo que no se presenta riesgo significativo en ambas. Respecto a la carga mental, se analiza una investigación de 782 trabajadores, concluyendo la existencia de niveles de estrés psicosocial en los traba jadores de la salud. En conclusión, es importante desarrollar investigación y realizar un seguimiento anual sobre el estado de salud de la población chilena perteneciente al área hospitalaria, con el objetivo de identificar variables deficientes y mejorar las condiciones del personal.

ABSTRACT The ergonomic risk factors in hospital care personnel in Chile corre spond to a current problem in which physical and mental risk factors are identified, gene rating shortcomings in the health status of work ers. For this reason, elements in the workplace are identified as bio logical, physical and chemical deficiencies, psychosocial and organi zational risk factors in the health care process. This review seeks to identify risks in hospital activities, definitions of concepts pertinent to the subject, to identify studies that evaluate occupational hazards in the workplace, musculoskeletal conditions, work system and the associated mental load. For this reason, the seventh labor survey 2011 is analyzed, obtaining 18.6% in organiza tions with workers exposed to uncomfortable postures, 14.2% in repetitive movements, 23.7% with shift exposure and 10.7% with exposure to Noise in the physical environment. Subsequently, a comparison of the shift system between the public and private sector is analyzed by surveying a sample of 44 employees of a private hospital and 43 workers of a public hospital, concluding that there is no significant risk in both. With respect to the mental load, an investigation of 782 workers is analyzed concluding the existence of levels of psychosocial stress in the health workers. In conclusion, it is important to develop research and annual moni toring of the health status of the Chilean population in the hospital area, in order to identify poor variables and improve staff conditions.

Is Antegrade Transmalleolar Drilling Method for Osteochondral Lesion of Talus Necessary? Iatrogenic Cystic Formation at the Tibia: A Report of Five Cases

Antegrade transmalleolar drilling method is one of the options for the treatment of osteochondral lesion of talus (OLT). We present five patients who underwent tibial drilling for treatment of OLT and later developed distal tibial cystic formation induced by cartilage opening or heat necrosis during drilling. Antegrade transmalleolar drilling can be a possible option for the treatment of OLT if the lesion is not easily reachable; however, other viable treatment should be considered due to its possibility of distal tibial pathologic change.

Qualidade de vida relacionada à saúde avaliada pelo Inventário Pediátrico de Qualidade de Vida 4. 0 em pacientes pediátricos com hanseníase e manifestações musculoesqueléticas / Health-related quality of life evaluated by Pediatric Quality of Life Inventory 4. 0 in pediatric leprosy patients with musculoskeletal manifestations

RESUMOObjetivo:Avaliar a qualidade de vida relacionada à saúde (QVRS) em pacientes pediátricos com hanseníase.Métodos:Estudo transversal com 47 pacientes com hanseníase e 45 indivíduos saudáveis. A QVRS foi mensurada pelo Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) e os domínios físico, emocional, social e escolar foram avaliados. Os pacientes com hanseníase foram classificados pelos critérios de Ridley e Jopling e avaliados de acordo com manifestações clínicas musculoesqueléticas, laboratoriais e exames radiográficos.Resultados:A média de idade atual foi similar em pacientes com hanseníase e controles [12(6-18) vs. 15(5-18) anos, p = 0,384], assim como frequências do sexo feminino (p = 0,835) e classes socioeconômicas brasileiras média/baixa (p = 1,0). De acordo com a autoavaliação da criança relacionada com as atividades escolares, esse domínio foi significativamente menor nos pacientes com hanseníase em relação aos controles de 13-18 anos [75(45-100) vs. 90(45-100), p = 0,021]. Os outros domínios foram semelhantes em ambos os grupos (p > 0,05). Pelo menos uma manifestação musculoesquelética (artralgia, artrite e/ou mialgia) foi observada em 15% dos pacientes com hanseníase e nenhuma nos controles (p = 0,012). Uma comparação mais detalhada entre pacientes com hanseníase mostrou que a mediana do domínio de capacidade física [81,25(50-100) vs. 98,44(50-100), p = 0,036] e de atividades escolares pela autoavaliação da criança [60(50-85) vs. 80(45-100), p = 0,042] era significantemente menor nos pacientes com manifestações musculoesqueléticas em comparação com a dos pacientes sem essas manifestações. (1) Nenhuma diferença foi evidenciada entre os outros parâmetros de QVRS em ambos os grupos relatados pelos pacientes e pais (p > 0,05).Conclusões:Diminuições dos domínios capacidade física e escolar foram observadas em pacientes com hanseníase pediátrica e manifestações musculoesqueléticas.

ABSTRACTObjective:To evaluate the health-related quality of life (HRQL) in pediatric leprosy patients.Methods:A cross-secal study included 47 leprosy patients and 45 healthy subjects. The HRQL was measured by Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0), and evaluated physical, emotional, social and school domains. The leprosy patients were classified by Ridley and Jopling classification criteria and assessed according to clinical musculoskeletal manifestations, laboratory and radiographic examinations.Results:The median of current age was similar in leprosy patients and controls [12 (6-18) vs. 15 (5-18) years, p = 0.384], likewise the frequencies of female gender (p = 0.835) and middle/lower Brazilian socio-economic classes (p = 1.0). The domain school activities according the child-self report was significantly lower in leprosy patients compared to controls in the age group of 13-18 years [75 (45-100) vs. 90 (45-100), p = 0.021]. The other domains were alike in both groups (p > 0.05). At least one musculoskeletal manifestation (arthralgia, arthritis and/or myalgia) was observed in 15% of leprosy patients and none in controls (p= 0.012). Further comparison between all leprosy patients showed that the median of the physical capacity domain [81.25 (50-100) vs. 98.44 (50-100), p = 0.036] and school activities domain by child-self report [60 (50-85) vs. 80 (45-100), p = 0.042] were significantly lower in patients with musculoskeletal manifestations compared to patients without these manifestations. No differences were evidenced between the other HRQL parameters in both groups, reported by patients and parents (p > 0.05).Conclusions:Reduced physical capacity and school activities domains were observed in pediatric leprosy patients with musculoskeletal manifestations.

Musculoskeletal Disorders among Dentists: A Review.

Dental professionals are facing a variety of occupational hazards. Technological advancements in the field of dental equipment and materials have not fully eliminated the musculoskeletal problems of dentists. When practicing, dentists sometimes are forced to adopt unhealthy postures that depend mainly on factors related to the working conditions. These lesion starts to appear at beginning of clinical practice as a student, and it will persist as they acquire independent posture and working habits during the professional life. Th e pervasive of musculoskeletal complaints among dentists is high and well documented. Based on the relevant literature, the present manuscript discusses the musculoskeletal problems of dental professionals.

Absenteísmo dos profissionais de enfermagem de um hospital universitário do estado de São Paulo, Brasil / Absenteeism of professional nursing in a public hospital in the state of São Paulo

Introdução: Características próprias do processo de trabalho em saúde em um hospital público universitário, incluindo a dimensão interpessoal entre os profissionais e usuários, durante a prestação do cuidado e assistência, podem comprometer a saúde e a integridade dos trabalhadores. Os trabalhadores da saúde podem manifestar sinais de sofrimento e adoecimento. O absenteísmo por doença traz prejuízos para o profissional de saúde, para a instituição e compromete a qualidade do cuidado em saúde. Objetivos: Descrever as causas do absenteísmo entre os profissionais de enfermagem de um hospital público universitário de Campinas ? São Paulo. Métodos: Trata se de uma pesquisa descritiva de analise dos dados sociodemograficos de 1.028 profissionais de enfermagem que se afastaram do trabalho devido doença não relacionada com o trabalho entre 1º de setembro de 2012 a 31 de agosto de 2013. Resultados: Entre os profissionais da equipe de enfermagem de um hospital universitário do estado de São Paulo, os técnicos de enfermagem apresentaram maior número de afastamentos por doença. Os transtornos mentais e comportamentais com 24,80% e as doenças osteomusculares com 17,86% foram os principais grupos de causas de afastamento do trabalho, no período estudado. Conclusão: Evidencia se a necessidade de a instituição de saúde estabelecer programas e políticas direcionadas ao atendimento e a prevenção de doenças para a preservação da saúde dos profissionais de enfermagem.

Introduction: Characteristics own work process in health care in a public hospital, including the relational dimension between professionals and users while providing care and assistance, may compromise the health and safety of workers. Due to specific conditions of the work process in health, workers tend to adopt defensive attitudes as a way to counteract their suffering and neutralize the installation of illnesses. The absenteeism due to sickness is hazardous to health professionals and the institution and also compromises the quality of health care. Objectives: To study the causes of absenteeism among nurses in the public hospital. Methods: This study analyzed sociodemographic and Professional data of 1,028 workers from the nursing staff who have been absent from work due to illness in the period from September 1st, 2012 to August 31st, 2013. Results: The nursing technicians had a higher number of sick leaves. The disease groups characterized by mental/behavioral disorders with 24.80% and musculoskeletal deseases, with 17.86% were the main causes of absenteeism for these professionals, respectively. Discussion: This study highlights the need of health facilities to make program to preserving the health of these professionals without losses to the quality of care provided to patients and users of health services.

Identificación de riesgos biomecánicos de los/as trabajadores en plantas de proceso de salmón para la prevención de disfunción dolorosa de extremidad superior (DDES) / Identification of biomechanical risks / as workers salmon processing plants for the prevention of upper extremity painful dysfunction (DDES)

Investigación realizada en 3 plantas procesadoras de Salmón de la Provincia de Chiloé, Chile. Se obtuvo una muestra de 150 trabajadores sanos, de ambos sexos, los que fueron grabados en 2 planos y 2 ciclos de trabajo. Los datos que se obtuvieron fueron analizados a través de CheckList-OCRA y procesados estadísticamente mediante el Software IBM SPSS Statistics. Los resultados indican que en las tareas realizadas por los trabajadores los factores de riesgo biomecánicos más críticos y que tienen mayor importancia en el valor del índice intrínseco (CheckList OCRA) son: Postura (valores de correlación 0,89 y 0,87 para la extremidad superior derecha e izquierda, respectivamente); Fuerza (valores de correlación 0,86 y 0,87 para la extremidad superior derecha e izquierda, respectivamente); y, Frecuencia (valores de correlación 0,81 y 0,71 para la extremidad superior derecha e izquierda, respectivamente). Por otra parte, de un total de 21 puestos evaluados, un 67% (14) presentan un nivel de riesgo "alto" (valores de índice intrínseco sobre 22,5). De estos, la mayor cantidad de trabajadores se concentra en los puestos de Despinado Manual y Decorado (70% del total de la muestra). Las conclusiones de la investigación apuntan a que los mayores esfuerzos de prevención se debieran enfocar en los puestos críticos (nivel de riesgo alto-medio), principalmente hacia aquellos que involucran a una mayor masa de trabajadores (Despinado Manual y Decorado). Estas indicaciones debiesen estar dirigidas al mejoramiento de la técnica de trabajo, eliminación de acciones técnicas inútiles, perfeccionamiento de herramientas, rediseño de la línea de producción y layout, además de rotación de funciones.

Research conducted in 3 salmon processing plants in the province of Chiloé, Chile. A sample of 150 healthy workers of both sexes was obtained, which was recorded in 2 planes and 2 cycles. The data obtained were analyzed through CheckList-OCRA and processed statistically using IBM SPSS Statistics Software. The results indicate that the tasks performed by workers factors most critical biomechanical risk and that are most important intrinsic value index (CheckList OCRA) are: Posture (correlation values 0,89 and 0,87 for the tip upper right and left, respectively); Strength (correlation values 0,87 and 0,86 for the upper right and left end, respectively); and frequency (correlation values 0,81 and 0,71 for the right upper extremity and left, respectively). Moreover, a total of 21 seats tested, 67% (14) have a level of "high" (values intrinsic rate of 22,5) risk. Of these, the largest number of workers are concentrated in positions of despinado Manual and Scenery (70% of total sample). The research findings suggest that older Prevention efforts should focus on critical positions (middle-level high risk), mainly to those involving a greater mass of workers (despinado Manual and decorado). These indications are slated to be aimed at improving technical work, elimination of unnecessary technical actions, improved tools, redesigning the production line layout, plus rotation functions.

Ergonomic risk factors and their association with musculoskeletal disorders among Indian dentist: A preliminary study using Rapid Upper Limb Assessment.

Context: Ergonomics is the scientific study of people and their work. The manufacturers typically do not design to accommodate the dimensions of the individual user. Work‑related musculoskeletal disorders (MSDs) have emerged as major health problem among workers in both industrialized and industrially developing countries. Rapid Upper Limb Assessment (RULA) was developed to investigate the exposure of the individual workers to risk factors associated with work‑related upper limb disorders. Aims: The assessment of the posture using RULA, which is quick reliable tool to determine the posture, has not been done in the Indian dentist population, indicating the need for the same. Settings and Design: A total of 104 subjects were included from New Delhi/NCR. Subjects and Methods: The procedure was explained, and the questionnaire was distributed and assessment was done using RULA. The MSDs can be recorded using the standard Nordic questionnaire. Statistical Analysis Used: The data were collected from 104 subjects out of the 192 evaluated and was statistically analyzed using SPSS software. Results: The study sample included 70 male and 34 female dentists. The posture of the subjects and the MSDs are not associated with a significant difference as according to Pearson’s Chi‑square test (0.231). Conclusions: RULA can be used as a screening tool for postural risks following a short training session regardless of the assessor’s experience in postural risk assessments.

Aptidão física e trabalho físico pesado: como interagem para a ocorrência de distúrbio musculoesquelético? / How do physical fitness and heavy physical work interact in the occurrence of musculoskeletal disorders? / Aptitud física y trabajo físico pesado: ¿cómo interactúan entre sí para la aparición de trastornos musculoesqueléticos?

Estudo transversal com 577 trabalhadores investigou associação entre aptidão física autopercebida e distúrbios musculoesqueléticos em pescoço, ombro ou parte alta das costas, em trabalhadores de 14 indústrias de plástico, em Salvador, Bahia, Brasil. A aptidão física autopercebida foi avaliada em escala de 0-5 pontos. Caso de distúrbios musculoesqueléticos: dor nos últimos 12 meses, superior a uma semana ou frequência mensal, restringindo o trabalho, ou provocando assistência médica, ou gravidade 3 ou maior, em escala de 0-5. A regressão logística investigou interação entre aptidão física e demanda física no trabalho para ocorrência de distúrbios musculoesqueléticos. Precária aptidão física resultou em 3,19 vezes a chance de distúrbios musculoesqueléticos, mas apenas entre aqueles submetidos a baixa demanda física no trabalho. Entre expostos a alta demanda física no trabalho, boa aptidão física não foi fator de proteção para distúrbios musculoesqueléticos, ou seja, trabalho físico pesado está associado a alta prevalência de distúrbios musculoesqueléticos, mesmo quando trabalhadores referem boa aptidão física. Apesar da importância da boa aptidão física, programas de atividade física não devem substituir intervenções nas condições de trabalho.

A cross-sectional study investigated the association between self-reported physical fitness and musculoskeletal disorders in the neck, shoulder, or upper back among workers in 14 plastics factories in Salvador, Bahia State, Brazil. Physical fitness was assessed on a scale from 0 to 5. Cases were defined as self-reported pain in the previous 12 months, lasting more than a week or having monthly minimum frequency, with restrictions at work or seeking medical care, or where respondents’ severity was greater than 2 (on a scale from 0 to 5). Logistic regression was performed to investigate statistical interaction between physical fitness and physical demands from work in the occurrence of musculoskeletal disorders. Precarious physical fitness resulted in 3.19 times greater odds of musculoskeletal disorders among workers exposed to light physical demands on the job. Among workers exposed to heavy physical demands, physical fitness failed to protect against musculoskeletal disorders. Heavy physical work was always associated with high prevalence of musculoskeletal disorders. Despite the importance of physical fitness, physical exercise programs should not be used to replace improvements in working conditions.

Este estudio transversal con 577 trabajadores investigó la asociación entre aptitud física autopercibida y trastornos musculoesqueléticos en cuello, hombro o parte alta de la espalda, en trabajadores de 14 industrias de plástico, en Salvador, Bahía, Brasil. La aptitud física fue evaluada en una escala de 0 a 5 puntos. Los casos de disturbios musculoesqueléticos: dolor en los últimos 12 meses, duración de más de una semana o incidencia mensual con restricción al trabajo o buscar asistencia médica, o gravedad 3 o mayor, en escala de 0 a 5. La regresión logística investigó la interacción entre aptitud física y demanda física en el trabajo para la aparición de trastornos musculoesqueléticos. La precaria aptitud física evidenció en 3,19 veces la posibilidad de trastornos musculoesqueléticos, pero sólo entre aquellos sometidos a una baja demanda física. Entre los expuestos a una alta demanda física, una buena aptitud física no fue un factor de protección para los trastornos musculoesqueléticos, o sea, el trabajo físico pesado se asocia con una alta prevalencia de trastornos musculoesqueléticos, aún cuando trabajadores refieren una buena aptitud física. Programas de actividad física no deben sustituir intervenciones en las condiciones de trabajo.

Musculoskeletal manifestations and autoantibodies in children and adolescents with leprosy / Manifestações musculoesqueléticas e autoanticorpos em crianças e adolescentes com hanseníase

Objective: To evaluate musculoskeletal involvement and autoantibodies in pediatric leprosy patients. Methods: 50 leprosy patients and 47 healthy children and adolescents were assessed according to musculoskeletal manifestations (arthralgia, arthritis, and myalgia), musculoskeletal pain syndromes (juvenile fibromyalgia, benign joint hypermobility syndrome, myofascial syndrome, and tendinitis), and a panel of autoantibodies and cryoglobulins. Health assessment scores and treatment were performed in leprosy patients. Results: At least one musculoskeletal manifestation was observed in 14% of leprosy patients and in none of the controls. Five leprosy patients had asymmetric polyarthritis of small hands joints. Nerve function impairment was observed in 22% of leprosy patients, type 1 leprosy reaction in 18%, and silent neuropathy in 16%. None of the patients and controls presented musculoskeletal pain syndromes, and the frequencies of all antibodies and cyoglobulins were similar in both groups (p > 0.05). Further analysis of leprosy patients demonstrated that the frequencies of nerve function impairment, type 1 leprosy reaction, and silent neuropathy were significantly observed in patients with versus without musculoskeletal manifestations (p = 0.0036, p = 0.0001, and p = 0.309, respectively), as well as multibacillary subtypes in leprosy (86% vs. 42%, p = 0.045). The median of physicians' visual analog scale (VAS), patients' VAS, pain VAS, and Childhood Health Assessment Questionnaire (CHAQ) were significantly higher in leprosy patients with musculoskeletal manifestations (p = 0.0001, p = 0.002, p = 0002, and p = 0.001, respectively). Conclusions: This was the first study to identify musculoskeletal manifestations associated with nerve dysfunction in pediatric leprosy patients. Hansen's disease should be included in the differential diagnosis of asymmetric arthritis, especially in endemic regions. .

Objetivo: Avaliar o envolvimento musculoesquelético e os autoanticorpos em pacientes pediátricos com hanseníase. Métodos: Foram avaliados 50 pacientes com hanseníase e 47 crianças e adolescentes saudáveis de acordo com manifestações musculoesqueléticas (artralgia, artrite e mialgia), síndromes dolorosas musculoesqueléticas (fibromialgia juvenil, síndrome de hipermobilidade articular benigna, síndrome miofascial e tendinite) e painel de autoanticorpos e crioglobulinas. Escores de avaliação de saúde e tratamento foram realizados nos pacientes com hanseníase. Resultados: Pelo menos uma manifestação musculoesquelética foi observada em 14% dos pacientes com hanseníase e em nenhum controle. Dentre os pacientes com hanseníase, cinco tinham poliartrite assimétrica das pequenas articulações das mãos. Comprometimento da função do nervo foi observado em 22% dos pacientes com hanseníase, reação tipo I hansênica em 18% e neuropatia silenciosa em 16%. Nenhum dos pacientes e controles apresentou síndromes de dor musculoesquelética e as frequências dos anticorpos e crioglobulinas foram semelhantes nos dois grupos (p > 0,05). Comprometimentos da função nervosa, reação hansênica tipo I e neuropatia silenciosa foram observados em pacientes com vs sem manifestações musculoesqueléticas (p = 0,0036, p = 0,0001 e p = 0,309, respectivamente), bem como subtipos de hanseníase multibacilar (86% vs 42%, p = 0,045). A escala visual analógica (EVA) do médico, dos pacientes, e da dor e o Questionário de Avaliação de Saúde Infantil foram maiores em pacientes com manifestações musculoesqueléticas (p = 0,0001, p = 0,002, p = 0002 e p = 0,001, respectivamente). Conclusão: Este foi o primeiro ...