Lesiones musculoesqueléticas no específicas de la musculatura proximal del miembro superior en el personal sanitario: un análisis de la presencia de puntos gatillo / Non-specific musculoskeletal disorders in the proximal upper limb muscles in health workers: Analysis of the presence of trigger points

Altos niveles de exigencia laboral en el medio hospitalario están asociados con dolor muscular, hiperalgesia, restricciones funcionales y trastornos comportamentales acompañados de lesiones musculares. Sin embargo, la mayoría de las investigaciones se han interesado en evaluar la ergonomía, el estrés y la carga de trabajo. Objetivos: Determinar cuántos trabajadores de un centro hospitalario presentaban lesiones musculoesqueléticas no específicas confirmadas por la presencia de puntos gatillo (PG); establecer los músculos (esternocleidomastoideo, elevador de la escápula, trapecio, infraespinoso y redondo menor) más afectados por el dolor según el lado (izquierdo o derecho), e identificar el comportamiento que se asumía frente al dolor. Material y método: Se realizó un estudio transversal en el Centro Hospitalario Loire Vendée Océan, Francia. El umbral de dolor a la presión por algometría fue evaluado y comparado bilateralmente en la musculatura proximal del miembro superior (MPMS). El comportamiento hacia el dolor se evaluó mediante un cuestionario autoadministrado. Resultados: 21 mujeres presentaron lesiones musculoesqueléticas no específicas en la MPMS confirmadas por la presencia de PG. El umbral del dolor fue significativo y bilateralmente menor en el esternocleidomastoideo (F4,200 = 48,879; p < 0,01) en comparación con los otros músculos evaluados. El 61,90% de los pacientes recurría a la automedicación para calmar el dolor muscular. Conclusiones: Se requiere implementar programas de pausas activas dirigidos a grupos musculares específicos, para reducir el riesgo de lesiones musculoesqueléticas de la MPMS en el medio hospitalario. Futuros estudios podrían indagar si el dolor aumentado en el esternocleidomastoideo podría explicarse por episodios de contracción cortos de baja amplitud, pero de una duración prolongada

High labor demands in hospitals are associated to muscle pain, hyperalgesia, functional restrictions and behavioral disorders accompanied by muscle injuries. However, most of the research has focused on evaluating ergonomics, stress and workload. Objectives: To determine how many workers in a hospital showed non-specific musculoskeletal disorders (MSDs) confirmed by the presence of Trigger Points (TrPs); to establish the most affected muscles (i. e., sternocleidomastoid, levator scapula, trapeze, infraspinatus, teres minor) by pain according to the side (left or right); and to identify the pain behavior assumed. Material and method: A cross-sectional study was conducted at the Loire VendéeOcéan Hospital, France. The pressure pain threshold measured by algometry was bilaterally compared and evaluated in the proximal upper limb muscles (PULM). Pain behavior was assessed using a self-administered questionnaire. Results: 21 women suffered from non-specific MSDs in PULM, confirmed by TrPs. The pressure pain threshold at the sternocleidomastoid was significant and bilaterally lower compared to other muscles (F4,200 = 48.879; P < .01). Self-medication for pain relief was frequent in 61.90% of patients. Conclusions: Implementation of active break-time programs aimed to specific muscular groups is required to reduce the risk musculoskeletal disorders in the PULM in the hospital setting. Future studies could investigate if the increased pain in the sternocleidomastoid may be explained by short episodes of low-amplitude but long-duration contractions

[Cognitive-motor interactions: the role of motor representation]. / Interacciones cognitivo-motoras: el papel de la representación motora.

INTRODUCTION: In the last decade, studies in cognitive neuroscience have considerably furthered our knowledge about the interactions between cognition and action. In particular, motor representation is seen to be one of the cognitive processes involved in the production of movement. This motor representation was deduced from comparisons between cognitive (e.g. motor imagination) and motor processes (e.g. motor performance). Yet, the interactions between this representation and other cognitive-motor processes such as motor planning eclipse the importance of the function of motor representation in action. In addition, this situation often gives rise to confusion when it comes to interpreting the function of motor representation. Consequently, the exact role it plays in producing movement is not very clear. DEVELOPMENT: In order to clarify this role, we analyse imagination, preparation, planning, motor performance, affordances and automated movements. At the same time, we also propose a hypothetical scheme of the functioning of motor representation during the execution of a movement and an action. CONCLUSIONS: Motor representation can be considered as an active component in certain cognitive-motor processes that enables motor response to be updated online, as well as allowing the optimisation and acquisition of new motor skills.

Interacciones cognitivo-motoras: el papel de la representación motora / Cognitive-motor interactions: the role of motor representation

En la última década, los estudios en neurociencia cognitiva han permitido avanzar considerablementeen el conocimiento de las interacciones entre la cognición y la acción. En particular, la representación motora aparece como uno de los procesos cognitivos implicados en la producción del movimiento. Esta representación motora se dedujo a partirde la comparación entre procesos cognitivos (p. ej., imaginación motora) y motores (p. ej., ejecución motora). Sin embargo, las interacciones entre dicha representación y otros procesos cognitivo-motores como la planificación motora ocultan la importancia de la función de la representación motora en la acción. Además, esta situación genera muchas veces una confusiónen la interpretación de la función de la representación motora. En consecuencia, su rol exacto en la producción del movimiento no está bien establecido. Desarrollo. Para aclarar este papel, analizamos la imaginación, la preparación, la planificación, la ejecución motora, las affordances y los movimientos automatizados. A la vez, proponemos un esquema hipotético del funcionamiento de la representación motora durante la ejecución de un movimiento y de una acción. Conclusión. La representaciónmotora puede considerarse como un componente activo de ciertos procesos cognitivo-motores que permite laactualización on line de la respuesta motora, así como la optimización y la adquisición de nuevas habilidades motoras

In the last decade, studies in cognitive neuroscience have considerably furthered our knowledgeabout the interactions between cognition and action. In particular, motor representation is seen to be one of the cognitive processes involved in the production of movement. This motor representation was deduced from comparisons between cognitive (e.g. motor imagination) and motor processes (e.g. motor performance). Yet, the interactions between this representation and other cognitive-motor processes such as motor planning eclipse the importance of the function of motorrepresentation in action. In addition, this situation often gives rise to confusion when it comes to interpreting the function of motor representation. Consequently, the exact role it plays in producing movement is not very clear. Development. In order toclarify this role, we analyse imagination, preparation, planning, motor performance, affordances and automated movements. At the same time, we also propose a hypothetical scheme of the functioning of motor representation during the execution of amovement and an action. Conclusions. Motor representation can be considered as an active component in certain cognitivemotor processes that enables motor response to be updated online, as well as allowing the optimisation and acquisition of new motor skills

Family interventions with "troubled" Mexican American teens: an extrapolation from a review of the literature.

This article discusses therapeutic guidelines for family interventions with troubled Mexican American (MA) teenagers based on reports informing on MA teens and MA families. The typical MA teenager does not exist, and little is known about the complex variations in this population. What is known about some groups of MA teens is alarming and significant enough to provide some direction for serving this population. Existing data regarding teen social class levels, school performance, substance abuse, pregnancy and parenthood, and suicide are presented. Because knowledge about MA families is essential to guide interventions with MA teens in distress, the known traditional MA family is described, and the troubles that confront some MA families today are included. Findings from family cohesion studies, including those not involving MA teens in particular, are summarized to lend support to the guidelines presented. Associations found between family cohesion and various physical and psychiatric problems are noted to support the importance of the concept of cohesion in working with troubled teenagers and their families.

Minority adolescent mothers who reported childhood sexual abuse and those who did not: perceptions of themselves and their relationships.

Perceptions of two groups of minority adolescent mothers (those who reported childhood sexual abuse and those who did not) were examined by analyzing their responses to four open-ended questions. Responses of sexually abused (SA) and non-sexually abused (NSA) respondents were studied, and themes that emerged from the data were derived. The responses from the groups were compared, and major thematic differences between the two groups identified. Distinct differences between the SA (n = 51) and NSA groups (n = 60) were detected in their responses to questions that related to their perceptions of themselves, their sexuality, and their relationships with men. Both SA and NSA groups had positive feelings about being parents, although the SA group expressed feelings of anxiety about the safety of their children.

Preparing psychiatric mental health nurses for the future. A baccalaureate curriculum design.

In the future, nurses can expect to provide holistic care for clients with increasingly complex health concerns. The current shift toward wellness and renewed emphasis on treating the whole person means that nurses must be prepared to meet their clients biopsychosocial health promotion and health restoration needs. The authors outline the efforts of faculty members to create and implement an innovative curriculum design for the psychiatric mental health component in a baccalaureate program. Evaluation data also are included.

The effects of childhood sexual abuse on minority adolescent mothers.

OBJECTIVE: To examine the incidence and effects of childhood sexual abuse experiences on the lives of adolescent mothers who were Mexican American and African American. Specifically, the personality characteristics of the adolescent mothers who experienced sexual abuse as assessed using the Millon Adolescent Personality Inventory were compared with those of minority adolescent mothers who were not abused sexually. DESIGN: An exploratory descriptive design. SETTING: Four public agencies caring for adolescent mothers in two urban centers in Texas. PARTICIPANTS: Mexican American and African American adolescent mothers (N = 124), ages 13-20 years. MAIN OUTCOME MEASURES: The Millon Personality Inventory, the Life Event Scale-Adolescents, the Childhood Sexual Experience Survey, and a demographic data sheet. RESULTS: Forty-four percent (n = 54) of the respondents reported childhood sexual abuse experience. Data from 111 subjects (two groups, abuse and nonabuse) were analyzed by MANCOVA techniques. Significant differences were found between the two groups when the effect of the Life Event Scale-Adolescents was controlled (Multivariate F[12, 97] = 3.055, p = 0.001). Univariate F tests (df1, 108) showed significant differences in self-concept (F = 18.434, p < 0.000), personal esteem (F = 8.819, p = 0.004), body comfort (F = 10.442, p = 0.002), sexual acceptance (F = 9.918, p = 0.002), peer security (F = 10.412, p = 0.002), family rapport (F = 9.801, p = 0.002), academic confidence (F = 5.764, p = 0.018), social conformity (F = 4.552, p = 0.035), scholastic achievement (F = 19.991, p < 0.000), and attendance consistency (F = 10.009, p = 0.002). The mothers in the abuse group had consistently poorer scores than those in the nonabuse group. CONCLUSIONS: These findings suggest that childhood sexual abuse may be related to vulnerability for adolescent motherhood.

PIP: In 2 urban areas of Texas, 124 mothers, 13-20 years old, all but 6% of whom were Mexican American or African American, were recruited from 4 public agencies to a study designed to determine the incidence and effects of childhood sexual abuse on the lives of these adolescent mothers. The study used the Millon Adolescent Personality Inventory (MAPI) to compare the personality characteristics of those mothers who had experienced sexual abuse with their nonabused counterparts. Most adolescent mothers were single (80%), lived with their parents (63%), were pregnant for the first time (56%), currently attended school (84%), and lived in a family whose annual income was less than $12,000. 44% of the mothers had experienced some form of childhood sexual abuse. More than 50% reported oral, anal, or vaginal intercourse with their abusers. The abusers tended to be male (97%) and known to the victim (66%). Male strangers accounted for 19% of abusers. The researchers were able to use data from 111 subjects to compare the 2 groups. The abused adolescent mothers always had clinically and statistically significant poorer scores than nonabused mothers. Abused mothers had greater difficulties in self-concept (p 0.0001), self-esteem (p = 0.004), body comfort (p = 0.002), sexual acceptance (p = 0.002), peer security (p = 0.002), and family rapport (p = 0.002). They also had clinically significant lower levels of academic confidence (p = 0.018), social conformity (p = 0.035), scholastic achievement (p 0.0001), and attendance consistency (p = 0.002). When researchers controlled for the effect of the Life Event Scale-Adolescents, abused mothers had differences that were significantly different than those of nonabused mothers (p = 0.001). These findings suggest that nurses within prenatal or well-baby care agencies should guide adolescent mothers who experienced childhood sexual abuse as they learn to communicate with their family or refer them to existing support services. It is important to ask adolescent mothers about a history of sexual abuse.

Suicidality correlates in Mexican American teens.

This study was conducted to determine the relationships between suicidality and life stress, coping, depression, and family dysfunction in Mexican American teens. The research question was: What are the magnitude of the relationships between suicidality and life stress, coping, depression, and family dysfunction in Mexican American teenagers? The investigators discuss the findings of the study from the perspective of the Mexican American culture, followed by specific conclusions and recommendations drawn from the results of the study. In this article, the term teen is used interchangeably with the terms teenager, youth, and adolescent; suicidality is used interchangeably with suicide risk.

[Behavior of Streptococcus mutans under prolonged exposure to xylitol, without reculture]. / Comportamiento de Streptococcus mutans bajo exposición prolongada a xilitol, sin recultivo.

Previous studies carried out in our laboratory showed that Streptococcus mutans--a cariogenic oral bacteria--did not metabolize an anticariogenic sugar alcohol, xylitol, even after a 10-month adaptative period with monthly transfers to a fresh medium. Due to the potential risk to adaptation observed in bacterias, it was studied the behavior of Streptococcus mutans (Strain 1161, Ingbritt) exposed to the polyol during 7 months, without monthly transfers to a new medium. After 7 months the cells were monthly transferred to a fresh medium for 7 more months. The cells were maintained and grown in a Trypticase-soytone-base medium without dextrose which contained xylitol (0.25 g/100 mL) or no sugar added. The control was represented by cells of Streptococcus mutans growing in Trypticase- soytone-base medium containing dextrose (0.25 g/100 mL). The growth pattern in the presence of xylitol was similar to that obtained in the cultures without sugar added, but it was 63-78% lower when compared with the control. The final pH in the cultures with xylitol was around 6.0; in the control it was very low (4.69 +/- 0.12). When the cells maintained in xylitol were transferred to the medium containing dextrose, the growth pattern was similar to that of the control. Any cultures fermented xylitol; the pH of the fermentation medium remained around 6.00 when the xylitol was present. No uptake of 14C-xylitol was observed and the activity of the enzyme xylitol dehydrogenase could not be detected with the experimental procedure used. The present study confirmed the Streptococcus mutans inability to metabolize xylitol, even after a prolonged adaptative period in the sugar alcohol. Moreover, it demonstrated that xylitol could be considered an inert substance to Streptococcus mutans since the cells were viable in the presence of the xylitol, or in the medium without sugar added.

Maternal support and stress response in sexually abused girls ages 6-12.

The relationships between maternal support and stress response are examined in this study of sexually abused girls, ages 6-12. Study participants included 20 mother-daughter pairs in which the daughter had been sexually abused, and 50 mother-daughter pairs in which the daughter was not known to have been sexually abused. Both groups were convenience samples. When the variables that significantly differentiated between the two groups (abused, nonabused) were held constant, the relationship between maternal support both as perceived by the mothers (Pr = -.58, p < .02) and as perceived by the daughters (Pr = -.68, p < .003) and stress response (as perceived by the mothers) was significant in the abused group and was not significant in the nonabused group. No significant differences were found in the levels of maternal support and stress response between the two groups when controlling for other stressful life events. However, the abused group had significantly higher levels of stress response overall (F [1, 68] = 2774.56, p < .02) and had significantly more (one and a half times as many) stressful life events (M = 15.10, SD = 6.39) than the nonabused group (M = 10.55, SD = 6.39).

A comparative study among college students of sexual abuse in childhood.

A disproportionate random sample (200 women, 400 men) of students attending a major university was invited to participate in a mailed survey to study differences in self-efficacy, coping, and well-being between men and women who were sexually abused in childhood and those who were not. A total of 271 students (111 women, 160 men) responded by returning the completed survey. Fifty percent of the women and 22% of the men in the sample reported one or more unwanted sexual experiences in childhood. Multivariate analysis of variance (MANOVA) techniques to analyze differences in self-efficacy, coping (confrontive, emotive, palliative), and well-being between women and men who reported childhood sexual abuse and those who did not showed significant interaction effects by sex for abuse (F = 2.609, P = .025, df 5,263) and significant effects by sex (F = 3.356, P = .006), but no significant differences for abuse alone. Univariate F tests were significant (F = 5.386, P = .021) for palliative coping with abused men reporting the highest scores, abused and nonabused women having the highest scores on emotive coping (F = 9.049, P = .003), and nonabused men and women having highest scores on well-being (F = 7.276, P = .007). A second MANOVA was performed on data from 245 students (nonabused and those who reported contact sexual abuse). Significant interaction effects by sex for abuse (F = 2.259, P = 0.49, df 5,237) and main effects for abuse (F = 3.225, P = .008) were found. Although abused men scored lowest on well-being, both abused men and abused women scored higher on emotive coping and lower on well-being than nonabused subjects. These are new findings with implications for developing and testing nursing interventions for this vulnerable group of young adults.

Barriers to disclosure among sexually abused male children. Implications for nursing practice.

This article identifies, through a critical review of current research, several factors that may account for the reluctance of male children to disclose details of sexual abuse. The factors then are related to implications for practice and research that are relevant for child and adolescent mental health nurses.

Effective planning for office and outpatient chemotherapy administration.

The trend in cancer care today is to successfully maintain the patient outside the traditional inpatient setting. This review has focused on some of the advantages and disadvantages in the administration of chemotherapy at home, the physician's office, and the ambulatory care facility. Effective planning for chemotherapy administration and the selection process for each of these settings depends on the needs of the patient and family. We can conclude that, although it is possible to use a combination of setting to maximize patient care, the ambulatory care concept provides broader choices for patients, families, and clinicians.

Tooth loss in 1535 treated periodontal patients.

Of 1535 treated recall patients surveyed over an average time of 12.9 years since treatment was completed, 1371 had lost no teeth from periodontal disease. The total number of teeth lost was 444, with the average tooth loss for the 1535 patients being 0.29. In the three full arch splinted cases, the loss rate was 14.67 teeth per patient. Patients treated without any excisional or flap surgical procedures made up 26.5% of those surveyed, whereas 73.5% had required various surgical procedures. No attempt was made to compare different pocket therapy procedures. Although many patients developed recurrent periodontal problems during recall, only 15.9% of the 1535 patients required surgical retreatment. Teeth that were originally given a doubtful prognosis often were responsible for recurrent problems and sometimes required extraction.