[Prevention of low back pain diseases in a center for the disabled]. / Prevenzione delle patologie del rachide nelle operatrici di un centro di lungo-degenza per disabili.

Our unit of occupational medicine has been asked to solve the problem of an incrising percentage of workers affected by low-back pain in a clinic for patients with handicaps. The consequence of this affections caused frequently absences at work. We organized a course for training about correct methods for moving patient not self-sufficient. The 84 workers, all female (aged 30-45), had to sign on a card all the problems they found at work and their possible solutions according to them. Then we put the cards in a box and we red each one, signing on a blackboard the problems, using a red pen and the solutions proposed, in blue. Bed organization, turnation of patient, and the difficulties in the use of lifter were the principal problems, solved trought the training course made. Then we obtained a reduction in absence at work for low-back pain of about 40% after six months since the beginning of a course of posture exercises made in the same clinic one day a week after work.

[The perception of risk in construction workers]. / La percezione del rischio negli operatori edili.

Accidents in building sites led us to study risk perception in workers employed in this field. We disposed of 300 workers, aged 18-65, who had to answer to a questionnaries were signing among seven risks the more present in their activity, chosing among five levels. So for each risk the worker had to quantify parameters such as: danger, frequence of accidents, actitude to risk-control, training on risk. The risk of falling from high sites has been perceived as extremely dangerous but it is possible to control it. Less dangerous is eyes exposition to chemical agents or dust. Manual movementation of weight and lacerations would be the most frequent source of accidents. Moreover would be insufficient the capacity to control the rick related to Weight manual movementation and vibrations. Workers answered in questionnaries that risk training on vibration was not sufficient, on the contrary they knew the risk of falling from high site. So we conclude that to reduce accidents in building sites it is necessary make better training on field, modifying the individual behavior among workers.

Relationships with serum parathyroid hormone in old institutionalized subjects.

OBJECTIVE AND BACKGROUND: Old people in residential care are at the highest risk of any group for hip fracture. This may relate to their high prevalence of hyperparathyroidism. There are few data, however, on relationships with serum parathyroid hormone (PTH) in these individuals. This study therefore examined complex associations with serum PTH in nursing home and hostel residents. DESIGN: Cross-sectional analysis. PATIENTS: One hundred and forty-three nursing home and hostel residents of median age 84 years. MEASUREMENTS: Serum PTH, 25-hydroxyvitamin D (25OHD), 1,25-dihydroxyvitamin D (1,25-(OH)2D), plasma creatinine, phosphate, calcium, albumin, Bsm-1 vitamin D receptor genotype, age, weight and use of frusemide or thiazide. RESULTS: The statistical models determined accounted for half the interindividual variation in serum PTH. Heavier weight was associated with both the prevalence of secondary hyperparathyroidism and the serum concentration of PTH. Novel interactions with serum PTH were identified between: weight and 25OHD; 25OHD and phosphate; and phosphate and thiazide diuretic use. Plasma phosphate was associated with PTH independently of calcium and 1,25-(OH)2D. There was no independent association between PTH and nuclear vitamin D receptor genotype. CONCLUSIONS: Heavier weight is associated with both the prevalence and severity of secondary hyperparathyroidism and consistent with animal models of secondary hyperparathyroidism, phosphate may relate to serum PTH independently of 1,25-(OH)2D or calcium.

Urine calcium and urine sodium concentrations are not related, after adjustment for urine magnesium.

BACKGROUND AND OBJECTIVES: Urine calcium correlates with urine sodium. The aims of this study were to investigate whether the urine sodium-calcium relationship persists into old age and whether it holds after adjustment for urine magnesium. DESIGN: Cross-sectional descriptive analysis. PATIENTS: Residents of two aged care institutions (median age 84 years) who were not taking diuretics, calcium or vitamin D supplements. MEASUREMENTS: Early morning urine calcium, sodium and magnesium, plasma creatinine and serum 25-hydroxyvitamin D and parathyroid hormone. RESULTS: Urine calcium correlated with urine sodium (r = 0.29, P < 0.01) and with urine magnesium (r = 0.56, P < 0.001). After adjustment for urine magnesium, the relationship between urine sodium and urine calcium was no longer significant. Forty-five percent of the interindividual variation in urine calcium was explained by a linear model on the basis of urine magnesium and plasma creatinine. CONCLUSION: The data indicate that a correlation between urine sodium and calcium persists in very old age. However, this correlation no longer holds after adjustment for urine magnesium. Further studies examining urine calcium excretion should also consider urine magnesium.

Falls relate to vitamin D and parathyroid hormone in an Australian nursing home and hostel.

OBJECTIVES: To determine whether falling relates to serum levels of vitamin D and parathyroid hormone. DESIGN: A cross-sectional study with retrospective analysis. SETTING: An aged-care institution in Melbourne Australia. PARTICIPANTS: Ambulant nursing home and hostel residents (n = 83). MEASUREMENTS: Frequency of falling, frequency of going outdoors, use of cane or walker, age, sex, weight, type of accommodation, and duration of residence. Serum concentrations of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and parathyroid hormone (PTH). Plasma concentrations of albumin, calcium, phosphate, and creatinine. Use of furosemide or non-benzodiazepine anticonvulsants. RESULTS: Median age of residents was 84 years. The cohort was vitamin D deficient with a median (interquartile range) 25-hydroxyvitamin D level of 27 (18-37) nmol/L (one-third the reference range median), P < .001. The median (interquartile range) PTH of 5.2 (3.8-7.7) pmol/L exceeded the reference range median, P < .001. Residents who fell (n = 33) had lower serum 25-hydroxyvitamin D levels than other residents (medians 22 vs 29 nmol/L, P = .02) and higher serum PTH levels (medians 6.2 vs 4.8 pmol/L, P < .01). Sixty residents lived in the hostel (72%), and 41 (49%) walked without any walking aid. In a multiple logistic regression for falling, higher serum PTH remained independently associated with falling, with an odds ratio (95% confidence interval) for falling of 5.6 (1.7-18.5) per unit of the natural logarithm of serum PTH. Other terms in the regression were hostel accommodation, odds ratio .04 (.01-.25), and ability to walk without aids, odds ratio .07 (.01-.37). CONCLUSIONS: In ambulant nursing home and hostel residents, residents who fall have lower serum 25-hydroxyvitamin D and higher serum parathyroid hormone levels than other residents. The association between falling and serum PTH persists after adjustment for other variables.

Relationship between immune system and gram-negative bacteria, binding of Salmonella pullorum-gallinarum to chicken lymphocytes.

Salmonella pullorum-gallinarum binding to chicken lymphocytes has been evaluated in individuals of different age (1-20 wks). Bacterial adherence has been studied on lymphoid cells recovered from thymus, spleen, bursa and peripheral blood. Binding was age-dependent and neuraminidase treatment of lymphoid cells led to an increase of adherence. In addition, by using two monoclonal antibodies, the CT-1, which defines thymocytes and the M-4 which identifies surface IgM and an avian homologue of mammalian IgD on B lymphocytes, distribution of Salmonella pullorum-gallinarum binding to T and B lymphocytes has been analyzed. Results show that either T lymphocytes or B lymphocytes have the capacity to form rosettes with Salmonella. In particular, B cells from bursa and spleen display the highest capacity of adherence to bacteria, this supporting the defence function which has been attributed to bursa of Fabricius.