Psychiatric emergencies in migrant adolescents.

BACKGROUND: Stress factors associated with migration may expose minor immigrants to mental health problems. The aim of the study was to describe acute psychiatric problems, in terms of reasons for hospitalization and diagnosis at discharge, in a sample of Italian and Migrant adolescents (both first and second generation). METHODS: We collected data on socio-demographic and clinical-diagnostic characteristics of 423 Italian and Migrant adolescents (mean age: 15 years ± 1.44; range 12-17.91), hospitalized at the Child and Adolescent Neuropsychiatry Unit of the Spedali Civili of Brescia between 2014 and 2019, period prior to the coronavirus disease 19 (COVID-19) pandemic. RESULTS: A reduction in the percentage of hospitalized Italian subjects and an increase of Migrant ones was found among years (p<0.001). Suicidal attempts and psychomotor agitation were the main reasons for hospitalization in both Italian and Migrant groups; in addition, the former presented a higher number of accesses for eating disorders, while the latter for psychotic disorders. Comparing the two groups at discharge, a higher frequency of anxiety disorders (p<0.001), eating disorders (p<0.001), somatic and conversion disorders (p=0.013), and obsessive-compulsive disorder (p=0.022) was detected in the Italian sample; conversely, there was a higher frequency of suicidal attempt (p=0.025), personality disorders (p<0.001), disruptive behavior, impulse control and conduct disorders (p=0.014), and post-traumatic stress disorder (p=0.019) in the Migrant group. CONCLUSIONS: These observations, carried out during a pre-COVID-19 period, provide a starting point for understanding the psychopathology of Migrant adolescents and underline the importance of early diagnosis to guide appropriate interventions.

Ultrasonography of the shoulder: asymptomatic findings from working-age women in the general population.

[Purpose] The aim of this study was to estimate the prevalence of abnormal shoulder ultrasonographic findings in a sample of asymptomatic women. [Subjects and Methods] A secondary analysis of a cross-sectional study was performed. We recruited 305 women (aged 18-56 years). All the subjects had a structured interview screening for self-reported symptoms and underwent a shoulder ultrasonographic examination, in which both shoulders were examined. The radiologist was blinded to the clinical history of the participants. All detectable shoulder abnormalities were collected. [Results] Of the subjects, 228 (74.75%) were asymptomatic at both shoulders, and 456 asymptomatic shoulders were analyzed. Lack of uniformity (supraspinatus, infraspinatus, subscapularis, and biceps brachii long head) was found in 28 shoulders (6.14%), 19 (4.17%) on the dominant side and 9 (1.97%) on the non-dominant side. Tendinosis (supraspinatus, infraspinatus, subscapularis, and biceps brachii long head) was found in 19 shoulders (5.32%), 12 (2.63%) on the dominant side and 7 (1.53%) on the non-dominant side. Calcification and other abnormal findings were reported. [Conclusion] The most common abnormalities were calcifications within the rotator-cuff tendons and humeral head geodes; other degenerative findings were less common.

Distal pain and carpal tunnel syndrome diagnosis among cashiers: a longitudinal study.

OBJECTIVE: To estimate in a longitudinal study the yearly incidence of carpal tunnel syndrome (CTS) in a cohort of women working as cashiers. METHOD: A total of 198 cashiers, belonging to a cohort investigated in 2011-2012 for arm pain, were screened for re-assessment in 2015 (at least 40 months from the first examination), and 156 women had complete demographic, personal and working data allowing to be included in this study. On the basis of self- and clinician-administered questionnaires investigating the presence of CTS, all symptomatic patients underwent clinical and neurophysiological [nerve conduction studies (NCS) of median and ulnar nerves] assessments. RESULTS: NCS confirmed the presence of CTS in 17 out of 149 workers; however, seven of them already received the diagnosis of CTS at the previous assessment in 2011-2012, leading to an overall incidence of new cases equal to 7.0%. Cumulative working time at the cashier of the women with CTS in the period 2012-2015 was highly variable (1744-4479 h) without an evident association with the severity of CTS. No differences in general demographic data were found in the women with vs. without CTS. Comorbidities potentially associated with increased risk of CTS were present in 21 women in the entire cohort (14.0% of the population, 40.0% in the subgroup of women with newly assessed CTS). Overweight/obesity and hypothyroidism were the most frequent comorbidities. CONCLUSION: The results of this prospective study showed that the annualized incidence of CTS in our population of cashier was 2.0%; 40% of the new CTS cases had comorbidities.

Are occupational repetitive movements of the upper arm associated with rotator cuff calcific tendinopathies?

Calcifying tendinopathy (CT) of the shoulder is a common painful disorder, although the etiology and pathogenesis remain largely unknown. Recent theories about the role of excessive mechanical load in the genesis of CT have been proposed. Driven by the interest for these new theories, we investigated the hypothesis of a relationship between work-related repetitive movements of the upper arm, considered a potential cause of shoulder overload, and the presence of shoulder CT. A secondary aim was to obtain data on CT prevalence in a female sample from the working-age general population, as little data currently exist. 199 supermarket cashiers and 304 female volunteers recruited from the general population underwent a high-resolution ultrasonography of the rotator cuffs of both shoulders, and the presence of tendinopathies, with or without calcification, was recorded. The prevalence of calcific tendinopathy was 22.6 % in the cashiers group and 24.4 % in the control group. There were no statistically significant differences in the prevalence of calcifications between the two groups (p = 0.585), either for the dominant shoulder [OR = 0.841 (95 % CI 0.534-1.326)] or for the non-dominant shoulder [OR = 0.988 (95 % CI 0.582-1.326)]. We observed bilateral calcifications in 8.5 % of cashiers, and 9.6 % of controls, and an increase in prevalence of CT with age in both groups. Work-related repetitive movements of the upper arm did not induce a higher prevalence of shoulder CT compared with the female sample from the general population. If CT etiopathogenesis is related to mechanical load, CT onset may be influenced not only by loading history, but also by individual factors. Level of evidence Prognosis study, Level II.

Women performing repetitive work: is there a difference in the prevalence of shoulder pain and pathology in supermarket cashiers compared to the general female population?

OBJECTIVES: Shoulder disorders in the occupational environment have been widely studied, but the quality of research and methodology applied vary. Little has been done to ascertain whether shoulder pain in female repetitive workers is due to any verifiable pathology, or to compare findings with the general population. Therefore, we decided to evaluate the prevalence of self-reported shoulder pain in a group of female supermarket cashiers and in the general female population using a standardized questionnaire. Shoulder pain prevalence was then compared to imaging findings in order to assess specific and non-specific pain prevalence. MATERIAL AND METHODS: 196 cashiers and 302 controls filled in a standardized shoulder questionnaire and underwent an imaging examination of a shoulder. RESULTS: The prevalence of shoulder pain was significantly higher in the group of cashiers (46.4%) than in the general population (25.5%) (OR = 1.821; 95% CI: 1.426-2.325). Specific pain prevalence was higher among the controls (19.5%) than among the cashiers (13.2%). CONCLUSIONS: The more frequent reports of shoulder pain in the supermarket cashiers are not correlated with a higher prevalence of imaging abnormalities. The causes of these more frequent complaints should be probably sought in the psycho-social and occupational environment.

Shoulder disorders in female working-age population: a cross sectional study.

BACKGROUND: Musculoskeletal disorders (MSDs) are among the most common pathologies in the general population. However, research into the prevalence of upper arm MSDs is hampered by a lack of uniformity in case definition, and by the absence of a gold standard for measurement. Furthermore, some sectors of the population have benefited from extensive research whilst others have largely been ignored. STUDY DESIGN: Cross-sectional study. OBJECTIVES: to investigate the prevalence of shoulder MSDs in a working age female population not exposed to specific occupational risk factors such as heavy and/or repetitive work, assessing the differences in prevalence recorded by using three different standard measurement tools. METHODS: 302 working aged women were enrolled in this study (age 20-55 years). Each subject underwent three different assessments: standardized questionnaires for symptoms and disability and the SF36 health survey, a clinical assessment performed by a blinded orthopaedic specialist, and an imaging assessment by means of ultrasound (US) and Magnetic Resonance (MR) if indicated. RESULTS: According to the questionnaire 77 subjects (25.5%) complained of shoulder pain whilst 225 (74.5%) were asymptomatic. According to the clinical examination, 31 subjects (10.3%) resulted positive, whereas 271 subjects (89.7%) had normal shoulders. According to the imaging findings, 26 subjects (8.6%) had alterations to the anatomical structures of the shoulder, whilst 276 subjects (91.4%) had no detectable abnormalities in either shoulder. In all assessments, the prevalence increased with age (p = 0.001). CONCLUSION: Depending on the outcome measure used, the prevalence of reported MSDs of the shoulder varies considerably. There is a striking difference between the prevalence of subjective reported symptoms and the standardized clinical/imaging examinations. However, the results of all the assessments did concur in one aspect; there was a significant trend of increased prevalence of shoulder MSDs with age. When looking at reported prevalence, this study shows the importance of noting the measurement method used before making comparisons, as it can vary considerably. The epidemic of shoulder pain reported is not indicative of an epidemic of shoulder pathology.

17p13.1 microdeletion: genetic and clinical findings in a new patient with epilepsy and comparison with literature.

Array comparative genomic hybridization is now a powerful tool to investigate patients with multiple congenital abnormalities and intellectual/motor impairment, and genomic imbalances are identified in a growing number of children with intellectual disability. Deletions in the 17p13.1 region have been reported in patients with dysmorphic features and developmental delay but a consistent phenotype has yet to emerge. Here, we report on the diagnosis of a 17p13.1 microdeletion of 829 kb in an 8-year-old girl presenting with profound cognitive disability, psychomotor delay, facial dysmorphisms, and refractory epilepsy. This deletion comprises 44 genes, including 8 OMIM morbid genes. We discuss genetic, clinical, and epileptic features comparing our patient with those previously reported in the literature.

Ambulatory phonation monitoring in a sample of 92 call center operators.

OBJECTIVES: The voice is a primary work tool for call center operators, but the main risk factors for voice disorders in this category have not yet been clarified. This study aimed to analyze the vocal behavior in call center operators and search for correlations between the daily voice dose and the self-perceived voice-related handicap. STUDY DESIGN: Prospective. SUBJECTS AND METHODS: Ninety-two call center operators (aged 24-50 years) underwent ambulatory phonation monitoring during a working day and were administered the Voice Handicap Index (VHI) questionnaire and a questionnaire concerning smoking habits, symptoms, and extrawork activities requiring intensive voice use. RESULTS: Mean percentage phonation time (PT) during work was 14.74% and ranged from 4% to 31%. There was a significant difference between the percentage PT in working time and in extrawork time; however, subjects with high percentage PT in working time maintained a high value also in extrawork time. The mean PT was 87.5 ± 35.8 minutes and was not correlated with age, gender, number of work hours, symptoms, extraprofessional voice use, and VHI scores. The mean amplitude was significantly higher in subjects with longer PT and higher pitch (P < 0.001). VHI score (median = 9) was slightly higher than in the general population but not related to the number of work hours, indicating that work time was not a critical factor in causing the perception of voice problems. CONCLUSION: Our study provides data about the voice behavior of a large cohort of call center operators and demonstrates that the number of work hours and the percentage PT are not statistically related to the perception of voice disturbances in this working category.