Comportamiento del proceso rehabilitador de pacientes con trastornos musculoesqueléticos en el Hospital Militar de Matanzas / Behavior of the rehabilitative process of patient with muscle skeletal dysfunctions in the Military Hospital of Matanzas

RESUMEN Introducción: las enfermedades musculoesqueléticas son las causas más frecuentes de incapacidad en el mundo, lo que afecta gravemente la capacidad de las personas para desarrollar sus actividades habituales. Objetivos: describir el comportamiento del proceso rehabilitador de pacientes con trastornos musculoesqueléticos. Materiales y Método: se realizó un estudio descriptivo en el Servicio de Rehabilitación del Hospital Militar de Matanzas, desde julio 2017 hasta diciembre de 2017. Se estudiaron las variables: trastorno musculoesquelético diagnosticado, duración de la crisis dolorosa, presencia de vínculo laboral, incapacidad laboral asociada, inicio del tratamiento rehabilitador (precoz o tardío) y cantidad de sesiones de tratamiento fisiátrico Resultados: la sacrolumbalgia afectó al 22,4 % de los pacientes estudiados y la cervicalgia al 20,1 %. La duración media de estas afecciones fue de 14 días. El 64,7 % de los pacientes laboralmente activos presentó incapacidad temporal asociada. El 65 % de los pacientes se incorporó de forma tardía a la rehabilitación. Conclusiones: la sacrolumbalgia fue el diagnóstico más frecuente y con mayor incapacidad laboral asociada. La afección con la duración media más extensa fue la cervicalgia. La mayor parte de los pacientes se incorporó tardíamente al tratamiento fisiátrico (AU).

SUMMARY Introduction: The muscle skeletal illnesses are the most frequent causes of inability in the world, what affects the capacity of people gravely to develop their habitual activities. Objective: To describe the behavior of the rehabilitative process of patient with muscle skeletal dysfunctions. Materials and methods: A descriptive study was carried out in the Service of Rehabilitation of the Military Hospital of Matanzas, from July 2017 until December of 2017. The variables studied were: muscle skeletal dysfunctions diagnosed duration of the painful crisis, presence of labor bond, associate labor inability, beginning of the rehabilitative treatment (precocious or late) and quantity of sessions of physiotherapy treatment. Results: The sacrolumbalgia affected to 22,4% of the studied patients and the cervicalgia to 20,1%. The half duration of these affections was of 14 days. 64,7% of the patients laborly assets presented associated temporary inability. 65% of the patients incorporated from a late way to the rehabilitation. Conclusions: The sacrolumbalgia was the most frequent diagnosis and with more associate labor inability. The affection with the most extensive half duration was the cervicalgia. Most of the patients incorporated from a late way to the rehabilitation (AU).

Análise da capacidade no trabalho e estresse entre profissionais de enfermagem com distúrbios osteomusculares / Análisis de la capacidad en el trabajo y estrés entre profesionales de enfermería con trastornos musculoesqueléticos / Analysis of work capacity and stress among nursing professionals with musculoskeletal disorders

RESUMO Objetivo Caracterizar os aspectos sociodemográficos, capacidade no trabalho e o estresse dos trabalhadores de enfermagem acometidos por distúrbios osteomusculares e analisar a associação entre comorbidades osteomusculares, capacidade, estresse e o apoio social. Métodos Estudo transversal, realizado em dois hospitais de Manaus. Utilizou-se o Índice de Capacidade para o Trabalho e o Job Stress Scale, traduzidos e validados, em trabalhadores há mais de um ano na enfermagem, com dor osteomuscular nos últimos três meses, de duração mínima de duas horas. Resultados O estudo apresentou maioria de mulheres e técnicos, com idade de 42 ± 10,7 anos, sendo a capacidade moderada (34,7 ± 5,11) associada às comorbidades osteomusculares. O estresse acometeu 56% e a capacidade correlacionou-se fraca e inversa ao estresse e direta ao apoio social. Conclusões Houve predomínio de mulheres e técnicos, sendo que as dores osteomusculares foram associadas a uma diminuição da capacidade. O apoio social associou-se ao aumento da capacidade e diminuição do estresse.

RESUMEN Objectivo Caracterizar los aspectos sociodemográficos, capacidad en el trabajo y el estrés de los trabajadores de enfermería acometidos por trastornos musculoesqueléticos y analizar la asociación entre comorbilidades musculoesqueléticas, capacidad, estrés y apoyo social. Métodos Estudio transversal, realizado en dos hospitales de Manaus. Se utilizó el Índice de Capacidad para el Trabajo y el Job Stress Scale, traducidos y validados, en trabajadores desde hace más de un año en la enfermería, con dolor musculoesquelético en los últimos tres meses, de una duración mínima de dos horas. Resultados El estudio presentó la mayoría de mujeres y técnicos, con edad de 42 ± 10,7 años, siendo la capacidad moderada (34,7 ± 5,11) asociada a las comorbilidades musculoesqueléticas. El estrés acomete 56% y la capacidad se correlacionó débil e inversamente al estrés y directa al apoyo social. Conclusiones Predominio de mujeres y técnicos, siendo que los dolores musculoesqueléticos se asociaron a una disminución de la capacidad. El apoyo social se asoció al aumento de la capacidad y disminución del estrés.

ABSTRACT Objective To characterize the sociodemographic aspects, work capacity and stress of nursing workers affected by musculoskeletal disorders and to analyze the association between musculoskeletal comorbidities, capacity, stress and social support. Methods Cross-sectional study, conducted in two hospitals in Manaus. The Work Capacity Index and the Job Stress Scale were used, translated and validated in nursing workers for more than one year, with musculoskeletal pain in the last three months, with a minimum duration of two hours. Results The study had a majority of women and technicians, aged 42 ± 10.7 years, with moderate capacity (34.7 ± 5.11) associated with musculoskeletal comorbidities. The stress affected 56% and the capacity correlated weak and inverse to stress and direct to the social support. Conclusions There was a predominance of women and technicians, and musculoskeletal pain was associated with a decrease in capacity. Social support was associated with increased capacity and decreased stress.

Condicionantes de género, empleo y trabajo y su posible vínculo con afecciones y dolencias musculoesqueléticas y psicosociales de temporeras frutícolas de packing agroindustrial de la Región del Libertador General Bernardo O'Higgins, Chile / Determinants of gender, employment and working and their possible link with and musculoskeletal and psychosocial complaints and diseases of fruit temporary workers of the agro-industrial in Libertador General Bernardo O'Higgins Region, Chile

El trabajo de temporera de packing representa una pieza fundamental en la creciente agro-exportación chilena; sin embargo, el daño físico y psicosocial que sufren estas trabajadoras es observado en el largo plazo, lo cual hace que las actuales medidas que buscan protegerlas resulten insuficientes. El objetivo de esta investigación es detectar y relacionar posibles causas de dolencias musculoesqueléticas y psicosociales de las temporeras a partir de una perspectiva global que integra: género, condicionantes de trabajo y empleo. La metodología para detectar y medir factores de riesgo asociados al trabajo temporero se diseñó a partir de la realización de entrevistas en profundidad y encuestas a 132 temporeras de empresas agroindustriales con más de 200 trabajadores de la VI región. Los resultados obtenidos muestran que las exigencias en trabajo de packing, más las exigencias propias por condición de mujer, son aspectos que deterioran la salud física y mental de las trabajadoras. Las conclusiones y discusiones derivaron en la necesidad de buscar mecanismos que hagan conciliar salud y calidad de vida de temporeras frente a la necesidad de productividad de la empresa, dado que las actuales condiciones de trabajo y empleo se levantan mayormente a partir del fomento productivo empresarial.

Female temporary packing workers play a key role in the growing agro-export business in Chile. Yet, the physical and psychosocial damage suffered by those workers can be observed in the long term. This very fact proves the current measurements that seek to protect them to be insufficient. This research aims at identifying possible causes of musculoskeletal and psychosocial diseases of the temporary workers from a global perspective that seeks to integrate issues of gender, as well as of labour and employment conditions, putting them in connection to those causes. The methodology for detecting and measuring those risk factors associated to temporary job was designed after conducting interviews and surveys to one hundred and thirty two (132) temporary agribusiness companies with more than two hundred (200) workers in the province of Libertador General Bernardo O'Higgins. The obtained results suggest that the specific requirements of the packing job, in addition to the specific requirements of the gender, have an active role in the spoil of both physical and mental health of female temporary workers. The conclusions drawn from these results point to the need for finding mechanisms to reconcile health and well-being criteria related to the workers, and productivity criteria related to the business; since the current conditions of employment are mostly raised in view to the corporate productive model of development.

Tensión muscular percibida en operarias de máquinas de moldeo por inyección de plástico / Perceived muscle tension in female workers of plastic injection molding machines

OBJETIVO: Identificar la incidencia de Tensión Muscular Percibida (TMP) según edad, antigüedad y tipo de jornada en operarias de máquinas de moldeo por inyección de plástico. MÉTODOS: se aplicó el cuestionario Nórdico Estandarizado a 86 de 128 trabajadoras con mínimo 1 año de antigüedad. RESULTADOS: Según el estudio transversal, el 84,9% de trabajadoras presentó TMP, con mayor incidencia en aquellas de 40 años de edad o más (90,2%), y mayor aun en el grupo de 6 a 10 años de antigüedad en el puesto (93,2%). Respecto al tipo de jornada laboral, la mayor incidencia de TMP fue en trabajadoras del horario nocturno (95,2%). El segmento corporal más afectado fue el cuello (63%), seguido por hombros y manos/muñecas (60,3%, respectivamente), y columna lumbar (50,7%). Del total de operarias con TMP, el 64,4% refirió impedimento para el desempeño de su trabajo en el último año, mientras que el 80,8% indicó manifestaciones corporales durante la última semana. CONCLUSIONES: No hubo significancia estadística de TMP con respecto a edad (X2 = 1,798; p > 0,05) o jornadas de trabajo (X2 = 3,636; p > 0,05), pero sí en relación con antigüedad (X2 = 13,881; p < 0,05). Las posturas estáticas y movimientos repetitivos pueden ser algunos factores de riesgo ocupacionales causales de TMP.

OBJECTIVE: To identify relationships between Perceived Muscular Tension (PMT), age, time-on-job, and labor shifts for female operators of plastic molding injection machines. METHODS: a standardized Nordic questionnaire was administered to 86 of the 128 workers with at least 1 year on job. RESULTS: Cross-sectional study, of an average population of 39.9 years of age, yielded 84.9% of workers affected with PMT, with a higher incidence amongst individuals 40 years or older (90.2%). The highest incidence of affected individuals was noticed in the group with 6 to 10 years on the job (93.2%). With regards to work shift, the highest prevalence of TMP was amongst night shift workers (95.2%). Regarding the affected body part; neck (63%), followed by: (i) shoulders and (ii) hands / wrists (both with 60.3%), and lower back (50.7%). From those that reported PMT, 64.4% reported some impairment in the performance of their work duties in the past year, while 80.8% indicated having symptoms during the immediately preceding week. CONCLUSIONS: as it relates to PMT, there is no statistical significance for the variables age (X2 = 1.798, p > 0.05) or work shift (X2 = 3.636, p > 0.05). However, time-on-job (X2 = 13.881; p < 0.05) has statistical relevance.

Factores asociados a lesiones músculo-esqueléticas por carga en trabajadores hospitalarios de la ciudad de Torreón, Coahuila, México / Musculoskeletal lesions while lifting-related factors in workers at 3 hospitals in Torreon, Coahuila, Mexico

OBJETIVO. Identificar factores asociados en la aparición de lesiones músculo-esqueléticas por carga en trabajadores hospitalarios. MÉTODOS. Se aplicó el cuestionario estandarizado nórdico de sintomatologías músculo-esqueléticas con corte transversal que evaluó la frecuencia y factores asociados para las lesiones músculo-esqueléticas en 48 trabajadores. RESULTADOS. La media de edad en hombres fue de 29,1+6,7 y en mujeres 26,5+6,9. El turno matutino tiene mayor actividad laboral. El 43,75% eran paramédicos y el 22,92% enfermeras. La espalda fue la región más afectada en los camilleros y paramédicos; mientras que enfermería reportó más dolor en pies y piernas. Se presentaron correlaciones significativas entre la antigüedad y los días que se presenta el dolor en la región anatómica. El 81,9% no usa equipo de protección contra lesiones en espalda. El 91,67% refirió capacitación previa para desarrollar actividades de cargas dentro del hospital. CONCLUSIONES. Consideramos la importancia de la higiene ocupacional en las actividades hospitalarias y la capacitación del uso del equipo de protección personal en las actividades laborales que se realizan, la falta de uso puede ser uno de los factores determinantes para el incremento en los días con dolor en alguna región anatómica cuando incrementan los años laborables, principalmente lo que corresponde a espalda alta y baja.

OBJECTIVE: To identify musculoskeletal lesions while lifting-related factors in hospital workers and lifting. METHODS: A transversal study was carried out evaluating the prevalence and associated factors to musculoskeletal lesions in 48 workers, using the Nordic Standardized Questionnaire of musculoskeletal symptoms. RESULTS: The mean age was 29.1+6.7 for males and 26.5+6.9 for females. The morning shift had greater activity, Paramedics accounted for the 43.75% and nurses for the 22.92%. Back pain was the most reported symptom among paramedics and auxiliary personnel; nurses reported feet and legs pain. Significant correlations were observed between seniority and the days with pain in the different anatomical regions. 81.9% of the workers do not use safety equipment against back injuries, and 91.67% stated receiving previous training course on lifting activities within the hospital. CONCLUSIONS: We evaluated the importance of occupational hygiene within the hospital activities, as well as training of personal safety equipment. The lack of such may be a determining factor that increases days in pain in specific anatomic regions as the working years go by, particularly those pertaining to both upper and lower back.

Trastornos osteomusculares en auxiliares de enfermería en la unidad de cuidados intensivos / Musculoskeletal disorders in auxiliary nursing in intensive care unit

Introducción: Los trastornos osteomusculares representan un problema importante en los países en desarrollo por sus altos costos económicos y son reconocidos como una causa importante de ausentismo laboral e incapacidad. Objetivos: Identificar la aparición de trastornos osteomusculares en auxiliares de enfermería que trabajan en la unidad de cuidados intensivos. Materiales y métodos: Estudio descriptivo transversal. Se tomó una muestra 86 auxiliares de enfermería. Se aplicó un cuestionario con 24 preguntas, dentro de un enfoque ergonómico, adaptado a partir del cuestionario Nórdico de Síntomas osteomusculares. Los datos se procesaron en Epi Info 7. Resultados: Se encontró que las auxiliares de enfermería de la unidad de cuidados intensivos presentaron una alta prevalencia de sintomatología osteo-muscular (79%), las partes más afectadas fueron la espalda inferior (24,5%), y la espalda superior (17,5 %). La mayoría de las auxiliares ha recibido incapacidad médica por esta causa (65%). Conclusiones: Las altas demandas laborales en las unidades de cuidados intensivos generan la aparición de trastornos osteomusculares en las auxiliares de enfermería.

Introduction: musculoskeletal disorders represent major problems in developing countries because of their high economic costs and are recognized as a major cause of work absenteeism and disability. Objective: identify the onset of skeletal muscle symptoms in nursing assistants working in the intensive care unit. Materials and methods: Descriptive cross-sectional study. A nursing auxiliary 86 sample was taken. A questionnaire with 24 questions, within an ergonomic approach, adapted from the symptoms of Nordic questionnaire musculoskeletal. The data were processed in Epiinfo 3.3.2. Results: found that the auxiliary nurses in the intensive care unit have a high prevalence of symptoms of musculoskeletal (79%), the most affected part was the lower back (24.5%), and upper back (17.5%). Most of the assistants has received medical disability for this cause (65%). Conclusions: The high labor demands in intensive care units generate the appearance of musculoskeletal disorders in nursing assistants.

Síntomas músculo-esqueléticos en trabajadores operativos del área de mantenimiento de una empresa petrolera ecuatoriana / Musculoskeletal symptoms in the area of operational maintenance of an oil company workers

CONTEXTO: Al ser considerada la ergonomía como una disciplina de carácter científico, que evalúa los riesgos ergonómicos en el medio ambiente laboral, puede evitar enfermedades ocupacionales y accidentes del trabajo, contribuyendo a mejorar las condiciones laborales en una organización. OBJETIVO: Determinar la prevalencia de síntomas músculo-esqueléticos en trabajadores operativos del puesto de trabajo mantenimiento de una Empresa Petrolera Ecuatoriana. METODOLOGÍA: Se llevó a cabo un estudio transversal en 102 trabajadores de sexo masculino, correspondientes al puesto de trabajo de mantenimiento de una empresa petrolera, situada en una locación de la Provincia de Sucumbíos, durante el año 2013; la edad comprendida estuvo entre 18 y 49 años. Para la recolección de datos a cada uno de los trabajadores, previo consentimiento informado se aplicó: un Cuestionario Socio-Demográfico, una Historia Médica Ocupacional y el Cuestionario Nórdico Estandarizado. RESULTADOS: La mayor prevalencia de síntomas músculo-esqueléticos, se encuentra en el grupo de trabajadores de entre 30 y 40 años de edad, en las regiones anatómicas: espalda baja 66 (64,7%), seguido de espalda alta 44 (43,1%), cuello 38 (37,3%) y hombro 27 (26,5%), siendo los más afectados los puestos de trabajo técnico-eléctrico y técnico-mecánico. La regresión logística binaria determinó que las variables no son estadísticamente significativas y, por lo tanto, por sí solas no explican la aparición de síntomas Músculo-Esqueléticos. CONCLUSIÓN: Se concluye que existe una elevada prevalencia de síntomas músculo-esqueléticos en la población estudiada, por lo que se recomienda efectuar una evaluación ergonómica exhaustiva de los puestos de trabajo y posteriormente buscar mecanismos y estrategias de control y prevención de riesgos ergonómicos, con la finalidad de minimizar el desarrollo de lesiones músculo-esqueléticos en la población de estudio.

CONTEXT: When considered ergonomics as a scientific discipline that evaluates ergonomic hazards in the working environment, you can prevent occupational diseases and industrial accidents, helping to improve working conditions in an organization. OBJECTIVE: To determine the prevalence of musculoskeletal symptoms in workers operating as a maintenance work Ecuadorian Oil Company. METHODOLOGY: A cross-sectional study was conducted on 102 male workers, job for the maintenance of an oil company, situated in a location in the province of Sucumbíos, in 2013, the age range was between 18 and 49. To collect data for each worker, informed consent was applied: A Socio-Demographic Questionnaire an Occupational Medical History and the Standardized Nordic Questionnaire. RESULTS: The highest prevalence of musculoskeletal symptoms are in the group of workers between 30 and 40 years old, in the anatomical regions: lower back 66 (64,7%), followed by upper back 44 (43,1% ), neck 38 (37,3%) and shoulder 27 (26,5%) being the most affected stations mechanical technician and electrician work. Binary logistic regression determined that the variables are not statistically significant, and thus alone do not explain the occurrence of musculoskeletal symptoms. CONCLUSION: We conclude that there is a high prevalence of musculoskeletal symptoms in the study population, so it is recommended that a comprehensive ergonomic evaluation of jobs and then find mechanisms and strategies for control and prevention of ergonomic hazards, with the aim minimize the development of musculoskeletal injuries in the study population.

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.

Toe thumb: A musculoskeletal disorder related to transesophageal echocardiography.

The musculoskeletal disorders (MSD) are common in healthcare providers and those who are doing sonography are also affected. There are reports of MSD in healthcare providers who do transthoracic echocardiography. Transesophageal echocardiography (TEE) is being regularly used in peri‑operative setting. We describe MSD of hand in a cardiovascular and thoracic anesthesiologist who has been performing TEE scanning for 10% of his work‑time in operating room and critical care area for the last 8 years. As the role of TEE is increasing and many doctors are doing it on a routine basis, the knowledge of association of MSD with TEE and measures to prevent it is important.

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 ...

Prevalence of musculoskeletal symptoms in hospital nurse technicians and licensed practical nurses: associations with demographic factors

Objective : This cross-sectional study aimed at analyzing: 1. the main musculoskeletal symptoms (MSS) presented by hospital nursing workers and; 2. personal, occupational, and health factors related to MSS among them. Method : Two questionnaires were filled in by 245 nurse technicians (NTs) and licensed practical nurses (LPNs) (response rate 95%) associated with direct patient care sectors from a hospital. These questionnaires were: the standardized version of the Nordic Musculoskeletal Questionnaire (NMQ) and one including questions on 15 demographic independent variables potentially related to outcomes from the NMQ. Univariate analyses and binary logistic regression analyses were performed to identify which variables would explain the occurrence of MSS in different body regions. Results: The low back (57%), shoulder (52%), and neck (48%) were identified as the most affected regions. The logistic regression analysis showed that low back symptoms in the last 12 months were significantly associated with LPN activities (OR=2.36; CI=1.24-4.5) and previous sick leave due to MSS (OR=5.97; CI=1.2-29.1). Smoking was significantly associated with symptoms in the low back (OR=2.77; CI=1.13-6.8) and thoracic spine (OR=2.37; CI=1.04-5.40). Physical exercise showed a protective effect on the cervical spine (OR=0.42; CI=0.23-0.77). Previous sick leave was significantly associated with pain in the knees (OR=4.24; CI=1.33-13.5) and in the upper limbs (OR=5.36; CI=1.07-26.7). Conclusions: The nursing workers who were evaluated presented a high prevalence of MSS. Previous history of sick leave was strongly associated with the presence of symptoms in various body regions. These results indicate the need for preventive programs in the hospital environment in order to control more severe MSS in nursing professionals. .

Translation, cross-cultural adaptation to Brazilian- Portuguese and reliability analysis of the instrument Rapid Entire Body Assessment-REBA / Tradução, adaptação transcultural para o português-brasileiro e análise da confiabilidade do instrumento Rapid Entire Body Assessment-REBA

Background: Observational instruments, such as the Rapid Entire Body Assessment, quickly assess biomechanical risks present in the workplace. However, in order to use these instruments, it is necessary to conduct the translational/cross-cultural adaptation of the instrument and test its measurement properties. Objectives: To perform the translation and the cross-cultural adaptation to Brazilian-Portuguese and test the reliability of the REBA instrument. Method: The procedures of translation and cross-cultural adaptation to Brazilian-Portuguese were conducted following proposed guidelines that involved translation, synthesis of translations, back translation, committee review and testing of the pre-final version. In addition, reliability and the intra- and inter-rater percent agreement were obtained with the Linear Weighted Kappa Coefficient that was associated with the 95% Confidence Interval and the cross tabulation 2×2. Results : The procedures for translation and adaptation were adequate and the necessary adjustments were conducted on the instrument. The intra- and inter-rater reliability showed values of 0.104 to 0.504, respectively, ranging from very poor to moderate. The percentage agreement values ranged from 5.66% to 69.81%. The percentage agreement was closer to 100% at the item 'upper arm' (69.81%) for the Intra-rater 1 and at the items 'legs' and 'upper arm' for the Intra-rater 2 (62.26%). Conclusions: The processes of translation and cross-cultural adaptation were conducted on the REBA instrument and the Brazilian version of the instrument was obtained. However, despite the reliability of the tests used to correct the translated and adapted version, the reliability values are unacceptable according to the guidelines standard, indicating that the reliability must be re-evaluated. Therefore, caution in the interpretation of the biomechanical risks measured by this instrument should be taken. .

Contextualização: Instrumentos observacionais como o Rapid Entire Body Assessment avaliam de forma rápida os riscos biomecânicos presentes no ambiente de trabalho. No entanto, para a utilização desses instrumentos, é necessário realizar tradução, adaptação transcultural e testar propriedades de medida. Objetivos: Realizar a tradução, adaptação transcultural para o português-brasileiro e testar a confiabilidade do instrumento REBA. Método: Foram realizados os procedimentos de tradução e adaptação para o português-brasileiro seguindo as diretrizes propostas, por meio da realização da tradução, síntese das traduções, retrotradução, comitê de revisão, pré-teste da versão pré-final, além do teste de confiabilidade e percentual de concordância intra e interavaliadores calculados pelo Coeficiente Kappa ponderado linear associado ao intervalo de confiança de 95% e pela tabela 2×2, respectivamente. Resultados: Os procedimentos realizados para tradução e adaptação foram apropriados, as adequações necessárias foram realizadas no instrumento. A confiabilidade intra e interavaliadores apresentou valores de 0,104 a 0,504, variando de muito pobre a moderada. Para o percentual de concordância, os valores encontrados variaram de 5,66% a 69,81%. O percentual de concordância apresentou-se mais próximo de 100% no item antebraço (69,81%) do intra-avaliador 1 e no item pernas e antebraço (62,26%) do intra-avaliador 2. Conclusões: Os processos de tradução e adaptação transcultural foram realizados no REBA permitindo obter a versão brasileira do instrumento. Contudo, apesar de a confiabilidade da versão traduzida e adaptada ter sido testada adequadamente, ...

Dependency coefficient in computerized GALS examination utilizing motion analysis techniques

The GALS [Gait, Arms, Legs and Spine] examination is a compact version of standard procedures used by rheumatologists to determine musculoskeletal disorders in patients. Computerization of such a clinical procedure is necessary to ensure an objective evaluation. This article presents the first steps in such an approach by outlining a procedure to use motion analysis techniques as a new method for GALS examination. A 3D motion pattern was obtained from two subject groups using a six camera motion analysis system. The range of motion associated with GALS was consequently determined using a MATLAB program. The range of motion [ROM] of the two subject groups was determined, the validity of the approach was outlined, and the symmetry of movement on both sides of the body was quantified through introduction of a dependency coefficient. Analysis of GALS examination and diagnosis of musculoskeletal problems could be addressed more accurately and reliably by adopting motion analysis techniques. Furthermore, introduction of a dependency coefficient offers a wide spectrum of prospective applications in neuromuscular studies

Consultation Outcomes for Musculoskeletal Conditions at two Community Health Centres in Cape Town

"Objectives: To compare the proportion of patients with documented diagnoses and management plans when they presented with musculoskeletal complaints at two community health centres (CHCs) using two models of care: one with a rheumatology outreach service and the other with none. Secondly; to describe the profile of patients with rheumatoid arthritis (RA) who attended the CHC with the outreach service. Design: Cross-sectional. Subjects: A group of 59 patients at each CHC were compared regarding engagement of their musculoskeletal complaints by doctors and clinical nurse practitioners (CNPs). Secondly; 24 RA patients who attended Heideveld CHC were profiled. Results: A comparison of the ""overall engagement"" between the two CHCs [risk difference (RD) -0.06; 95 confidence interval (CI): -0.17-0.05; odds ratio (OR) 0.79; 95 CI: 0.51-1.24; chi-square 0.82; p-value 0.36] was not significantly different. Comparison between doctors (RD -0.05; 95 CI: -0.05-0.08; OR 0.80; 95 CI: 0.46-1.40; chi-square 0.41; p-value 0.52) was also not significantly different. The comparison between the CNPs at the two CHCs was statistically significant (RD 0.30; 95 CI: 0.14-0.45; OR 8.37; 95 CI: 1.05-66.60; Fisher's exact test 0.01); but the CI around OR was large. Patients with RA had a mean age of 60 years; an average of two co-morbidities and an average of three annual clinic visits. Eighty-three per cent resided in the drainage area of the clinic. Conclusion: There was no significant difference in engagement between the CHCs. The potential that CNPs seemed to show of being positively influenced by the outreach service should be further researched. Patients with RA had comorbidities that required management at primary healthcare level."

Clinimetric properties of the Brazilian-Portuguese version of the Quick Exposure Check (QEC) / Propriedades clinimétricas da versão para o português-brasileiro do "Quick Exposure Check" (QEC)

BACKGROUND: Most of the available instruments aimed to assess risk exposure associated with work-related musculoskeletal disorders were originally developed in English, which makes their use difficult in countries such as Brazil. OBJECTIVE: To test the clinimetric properties of the Quick Exposure Check (QEC) instrument previously adapted into Brazilian-Portuguese. METHOD: The original version of the QEC was translated and cross-culturally adapted into Brazilian-Portuguese and tested with 107 workers in two sectors of a textile factory. The internal consistency and construct validity were tested using only baseline values from the participants while reproducibility (reliability and agreement) was evaluated in a test-retest design with a seven-day interval. RESULTS: The adapted version presented appropriate levels of internal consistency (Cronbach's α=0.76); moderate intra-observer reliability (ICCs ranging from 0.41 to 0.60); moderate to substantial inter-observer reliability (ICCs ranging between 0.62 and 0.86). The standard error of the measurement (SEM) ranged from 8.3 to 11.2 points. Moderate levels of construct validity (Pearson's r=0.38) were observed. CONCLUSIONS: The Brazilian version of the QEC has appropriate clinimetric properties for measuring different levels of exposure to ergonomics risk factors and can now be used by Brazilian researchers and Occupational Health professionals.

CONTEXTUALIZAÇÃO: A maior parte dos instrumentos utilizados para avaliação dos fatores de risco de desenvolvimento dos distúrbios musculoesqueléticos relacionados ao trabalho foram originalmente desenvolvidos em língua inglesa, dificultando seu uso em países cuja língua primária não é o inglês, como é o caso do Brasil. OBJECTIVO: Testar as propriedades clinimétricas do instrumento Quick Exposure Check (QEC) para o português-brasileiro. MÉTODO: A versão original do QEC foi traduzida e adaptada transculturalmente para o português-brasileiro e testada em 107 trabalhadores de dois setores de produção de uma indústria têxtil. A consistência interna e a validade de construto foram testadas utilizando apenas valores basais dos participantes, enquanto a reprodutibilidade foi avaliada em um delineamento de teste e reteste, com intervalo de sete dias. RESULTADOS: A versão adaptada apresentou níveis adequados de consistência interna (α Cronbach=0,76), confiabilidade intraobservador moderada (ICC entre 0,41 e 0,60) e confiabilidade interobservador variando de moderada a substancial (ICC entre 0,62 e 0,86). O erro-padrão da medida (EPM) variou de 8,3 a 11,2 pontos. Níveis moderados de validade de construto foram observados (r de Pearson=0,38). CONCLUSÃO: A versão do QEC para o português-brasileiro possui propriedades clinimétricas adequadas para mensuração de diferentes níveis de exposição aos fatores de risco ergonômicos, podendo ser utilizada por pesquisadores e profissionais da saúde e segurança ocupacional.

Manifestações musculoesqueléticas em diabetes mellitus / Musculoskeletal disorders in diabetes mellitus

O diabetes mellitus está associado a uma grande variedade de manifestações musculoesqueléticas. Muitas delas são subclínicas e correlacionadas com tempo de evolução e controle inadequado da doença, e devem ser reconhecidas e adequadamente tratadas, pois sua abordagem melhora a qualidade de vida desses pacientes. Nesta revisão são discutidas as principais manifestações musculoesqueléticas encontradas em diabetes mellitus.

Diabetes mellitus is associated with a great variety of musculoskeletal manifestations, many of which are subclinical and correlated with disease duration and its inadequate control. They should be recognized and treated properly, because their management improves the patients' quality of life. This review discusses the major musculoskeletal manifestations found in diabetes mellitus.

Preliminary Application of High-Definition CT Gemstone Spectral Imaging in Hand and Foot Tendons

OBJECTIVE: To assess the feasibility of visualizing hand and foot tendon anatomy and disorders by Gemstone Spectral Imaging (GSI) high-definition CT (HDCT). MATERIALS AND METHODS: Thirty-five patients who suffered from hand or foot pain were scanned with GSI mode HDCT and MRI. Spectrum analysis was used to select the monochromatic images that provide the optimal contrast-to-noise ratio (CNR) for tendons. The image quality at the best selected monochromatic level and the conventional polychromatic images were compared. Tendon anatomy and disease were also analyzed at GSI and MRI. RESULTS: The monochromatic images at about 65 keV (mean 65.09 +/- 2.98) provided the optimal CNR for hand and foot tendons. The image quality at the optimal selected monochromatic level was superior to conventional polychromatic images (p = 0.005, p 0.05), compression (chi2 = 0.5, p > 0.05), absence (chi2 = 0, p > 0.05) and rupture (chi2 = 0, p > 0.05). GSI was significantly less sensitive than MRI in displaying tendon adhesion (chi2 = 4.17, p < 0.05), degeneration (chi2 = 4.17, p < 0.05), and tendinous sheath disease (chi2 = 10.08, p < 0.05). CONCLUSION: GSI with monochromatic images at 65 keV displays clearly the most hand and foot tendon anatomy and disorders with image quality improved, as compared with conventional polychromatic images. It may be used solely or combined with MRI in clinical work, depending on individual patient disease condition.

Avaliação do sistema musculoesquelético na unidade de emergência / Musculoskeletal system assessment in an emergency room

OBJETIVO: As condições musculoesqueléticas possuem um enorme e crescente impacto no mundo. A despeito disso, alguns médicos não estão confiantes em suas próprias habilidades para a realização do exame clínico musculoesquelético. Este estudo teve como objetivo avaliar a prevalência dos sintomas musculoesqueléticos em uma unidade de emergência e a frequência de descrição do exame físico musculoesquelético nesses casos. MÉTODOS: Trata-se de estudo transversal. Foi realizada uma análise sistemática das fichas de atendimento na unidade de emergência do hospital da Universidade Federal de Santa Catarina, Brasil, de 24 a 30 de abril de 2009. RESULTADOS:Foram analisadas 392 fichas de atendimento, onde 41,5 por cento dos pacientes eram do sexo masculino e a idade média de 38,7 ± 17,2 anos. Sessenta e nove dos 392 pacientes (17,6 por cento) apresentaram-se com queixa musculoesquelética. A queixa musculoesquelética mais comum foi lombalgia (33/69). Somente 49,2 por cento dos pacientes que apresentavam distúrbios musculoesqueléticos como queixa principal tiveram exame físico específico descrito nas fichas. Pacientes com queixas musculoesqueléticas tiveram menor frequência de registro de exame abdominal (46 por cento versus 62 por cento, P = 0,01) e sinais vitais (46 por cento versus 66 por cento, P = 0,00), porém maior frequência de registro do exame musculoesquelético (49 por cento versus 0,6 por cento, P = 0,00). CONCLUSÕES:Este estudo confirma outras observações em todo o mundo. Queixas musculoesqueléticas são frequentes em uma unidade de emergência e, apesar disso, sugere-se que os sintomas musculoesqueléticos são insuficientemente avaliados, o que pode estar relacionado a uma educação médica insuficiente. É fundamental que escolas médicas coloquem maior ênfase nessas condições para que jovens médicos estejam mais preparados para lidar com essas doenças comuns.

OBJECTIVE: Musculoskeletal conditions have an enormous and growing impact worldwide. In spite of that, some clinicians are not confident in their own musculoskeletal examination skills. This study aimed to evaluate the prevalence of musculoskeletal symptoms in an emergency room, and the frequency of musculoskeletal physical examination description on those cases. METHODS: This was a cross-sectional study. We performed a systematic analysis of medical files at the emergency room of the University Hospital of the Federal University of Santa Catarina, Brazil, from April 24th to 30th, 2009. RESULTS: We analyzed 392 files, where 41.5 percent of patients were male and mean age was 38.7 ± 17.2 years-old. Sixty nine out of 392 patients (17.6 percent) presented with a musculoskeletal complaint. The most common musculoskeletal complaint was low back pain (33/69). Only 49.2 percent of patients with a musculoskeletal chief complaint had a specific physical examination registered on the files. Patients with musculoskeletal complaints had lower registrations of abdominal examination (46 percent versus 62 percent, P = 0.01) and vital signs (46 percent versus 66 percent, P = 0.002), but a higher frequency of musculoskeletal examination registration (49 percent versus 0.6 percent, P = 0.00). CONCLUSIONS: Our study confirms other observations worldwide. Musculoskeletal complaints are frequent in a emergency room setting and in spite of that it is suggested that musculoskeletal symptoms are poorly evaluated, which is probably related to an insufficient musculoskeletal education. It is essential that medical schools place more emphasis on these conditions so that young physicians will be more prepared to deal with these common diseases.

Factores asociados a desórdenes musculoesqueléticos de miembro superior en ordeñadoras manuales, Cajamarca 2009 - 2010 / Factors associated with musculoskeletal disorders of the upper limb in the manual milkmaids of Cajamarca, Cajamarca 2009-2010

Objetivo: Determinar los factores asociados a desórdenes musculoesqueléticos de miembro superior en las ordeñadoras manuales de Cajamarca. Metodología: Se realizó un estudio cuantitativo, descriptivo de corte transversal en una muestra de 102 mujeres ordeñadoras que residen en la provincia de Cajamarca. Se aplicó una encuesta para obtener datos demográficos, datos laborales y valores antropométricos; la evaluación clínica se basó en los criterios diagnósticos para desórdenes de miembro superior del Instituto de Salud Ocupacional de la Universidad de Birmingham (Inglaterra) publicado en el Atlas de Reumatología Clínica de la Universidad de Querétaro (México). Se hizo un análisis descriptivo univariado de las prevalencias y las proporciones entre las diferentes variables fueron evaluadas por medio de la prueba de Chi cuadrado, con un nivel de significancia de 0.05. Resultados: En este estudio se evidencia que 33,3 por ciento presentan algún desorden musculoesquelético (DME) de miembro superior, presentándose con más frecuencia el síndrome del túnel carpiano 24,5 por ciento, epicondilitis lateral 9,8 por ciento y tendinitis bicipital 8,8 por ciento. En miembro superior derecho 57.7 por ciento, en miembro superior izquierdo 33.8 por ciento y en algunos casos ambos miembros superiores 8.5 por ciento. Se evidencia la asociación con edad y factores laborales como tipo de ordeño, permanencia en el trabajo y postura. Conclusión: El ordeño manual es un factor relacionado con el desarrollo de DME de miembro superior

Objective: To determine the factors associated with musculoskeletal disorders of the upper limb in the manual milkmaids of Cajamarca. Methodology: A quantitative and descriptive of cross sectional study was conducted in a sample of 102 milkmaids that reside in the province of Cajamarca. A survey to obtain demographic and employee data, and anthropometric values was performed. The clinical evaluation was based on the diagnostic criteria for disorders of the upper limb of the Institute of Occupational Health of the University of Birmingham (England) published in the Atlas of Clinic Rheumatology at the University of Queretaro (Mexico). A descriptive univariate analysis of the prevalences was done and the proportions between the different variables were evaluated by the Chisquare test, with a significance level of 0.05. Results: This study showed that 33.3 per cent presented some musculoskeletal disorder (MED) of the upper limb, appearing more frequently the carpal tunnel syndrome 24.5 per cent, lateral epicondylitis 9.8 per cent and bicipital tendinitis 8.8 per cent. In right upper limb 57.7 per cent, in left upper limb 33.8 per cent and in some cases both upper limbs 8.5 per cent. There is evidence of association with age and occupational factors such as type of ordered, stay in a job and position. Conclusion: The manual ordered is a factor related to the development of MED of upper limb