Reproductive factors and Parkinson's disease risk in Danish women.

BACKGROUND AND PURPOSE: Parkinson's disease is more common in men than women by a ratio of about 1.5:1 and yet there is no consensus to date as to whether female reproductive factors including hormone use affect Parkinson's disease risk. Our objective was to examine the relationship between Parkinson's disease and female reproductive factors in the largest population-based Parkinson's disease case-control study to date. METHODS: Seven hundred and forty-three female Parkinson's disease cases diagnosed between 1996 and 2009 were selected from the Danish National Hospital Register, diagnoses confirmed by medical record review, and the cases were matched by birth year to 765 female controls randomly selected from the Danish Civil Registration System. Covariate information was collected in computer-assisted telephone interviews covering an extensive array of topics including reproductive and lifestyle factors. RESULTS: After adjusting for smoking, caffeine and alcohol use, education, age, and family Parkinson's disease history, inverse associations between Parkinson's disease and early menarche (first period at ≤11 years), oral contraceptives, high parity (≥4 children) and bilateral oophorectomy were found; adjusted odds ratios and 95% confidence limits were respectively 0.68 (0.45-1.03) for early menarche, 0.87 (0.69-1.10) for oral contraceptives, 0.79 (0.59-1.06) for high parity and 0.65 (0.45-0.94) for bilateral oophorectomy. Little support for associations between Parkinson's disease and fertile life length, age at menopause or post-menopausal hormone treatment was found. CONCLUSIONS: Reproductive factors related to women's early- to mid-reproductive lives appear to be predictive of subsequent Parkinson's disease risk whereas factors occurring later in life seem less important.

Computer mouse use predicts acute pain but not prolonged or chronic pain in the neck and shoulder.

BACKGROUND: Computer use may have an adverse effect on musculoskeletal outcomes. This study assessed the risk of neck and shoulder pain associated with objectively recorded professional computer use. METHODS: A computer programme was used to collect data on mouse and keyboard usage and weekly reports of neck and shoulder pain among 2146 technical assistants. Questionnaires were also completed at baseline and at 12 months. The three outcome measures were: (1) acute pain (measured as weekly pain); (2) prolonged pain (no or minor pain in the neck and shoulder region over four consecutive weeks followed by three consecutive weeks with a high pain score); and (3) chronic pain (reported pain or discomfort lasting more than 30 days and "quite a lot of trouble" during the past 12 months). RESULTS: Risk for acute neck pain and shoulder pain increased linearly by 4% and 10%, respectively, for each quartile increase in weekly mouse usage time. Mouse and keyboard usage time did not predict the onset of prolonged or chronic pain in the neck or shoulder. Women had higher risks for neck and shoulder pain. Number of keystrokes and mouse clicks, length of the average activity period, and micro-pauses did not influence reports of acute or prolonged pain. A few psychosocial factors predicted the risk of prolonged pain. CONCLUSIONS: Most computer workers have no or minor neck and shoulder pain, few experience prolonged pain, and even fewer, chronic neck and shoulder pain. Moreover, there seems to be no relationship between computer use and prolonged and chronic neck and shoulder pain.

Does computer use pose an occupational hazard for forearm pain; from the NUDATA study.

AIMS: To determine the occurrence of pain conditions and disorders in the forearm and to evaluate risk factors for forearm pain in a cohort of computer workers. METHODS: A total of 6943 participants with a wide range of computer use and work tasks were studied. At baseline and at one year follow up participants completed a questionnaire. Participants with relevant forearm symptoms were offered a clinical examination. Symptom cases and clinical cases were defined on the basis of self reported pain score and palpation tenderness in the muscles of the forearm. RESULTS: The seven days prevalence of moderate to severe forearm pain was 4.3%. Sixteen of 296 symptom cases met criteria for being a clinical forearm case, and 12 had signs of potential nerve entrapment. One year incidence of reported symptom cases was 1.3%; no subjects developed new signs of nerve entrapment. Increased risk of new forearm pain was associated with use of a mouse device for more than 30 hours per week, and with keyboard use more than 15 hours per week. High job demands and time pressure at baseline were risk factors for onset of forearm pain; women had a twofold increased risk of developing forearm pain. Self reported ergonomic workplace factors at baseline did not predict future forearm pain. CONCLUSION: Intensive use of a mouse device, and to a lesser extent keyboard usage, were the main risk factors for forearm pain. The occurrence of clinical disorders was low, suggesting that computer use is not commonly associated with any severe occupational hazard to the forearm.

[Infectious arthritis in a patient with rheumatoid arthritis]. / Infektiøs arthritis hos en patient med reumatoid arthritis.

Patients with rheumatoid arthritis are at greater risk of developing joint infections than any other group of patients. Diagnosis is often delayed because of the difficulties in distinguishing between a flare-up and a septic affection of the joint. A case of septic arthritis with multiple joint involvement and lethal outcome despite extensive antibiotic treatment and successive surgical procedures is presented. The patient developed osteomyelitis and multiple organ failure. In order to reduce morbidity and mortality from septic arthritis, early joint puncture and subsequent antibiotic treatment is essential.

New-building occupancy. The role of nursing staff development.

Orienting hospital staff to a new patient care facility presents many unique challenges for the Nursing Staff Development Department. Today's healthcare climate demands that staff orientation to a new facility be done quickly and with few disruptions to patient care. Nursing staff development specialists are well positioned to lead this process. Their expertise in program design, implementation and evaluation, problem solving and communication skills, and ability to view the learning needs of hospital staff holistically are vital to a successful facility move. This article will describe the opening of a new 150-bed inpatient facility in a large acute rehabilitation center. The principles used by the Nursing Staff Development Department in this new facility orientation process can be applied in multiple health care settings.

[Reconstructive joint surgery and rheumatoid arthritis. Status over a developing field]. / Rekonstruktiv ledkirurgi og reumatoid arthritis. Status over et udviklingsområde.

Rheumatoid arthritis has a prevalence of between 1% and 2%. The majority of patients face the prospect of surgical treatment of joints, that do not respond to medical treatment. With respect to the extensive development in joint surgery during the last decade, today's recommendations for surgical treatment of the individual joints are surveyed.

[Synovectomy in rheumatoid arthritis]. / Synovektomi ved reumatoid arthritis.

Surgical synovectomy in the treatment of rheumatoid arthritis has been performed for more than a 100 years, and yet the definite indication has not been made clear. Synovectomy has a convincing, but mostly time-limited effect on pain and articular hydrops, but the radiological progression continues almost undisturbed. Histological evaluation of the regenerating synovial membrane has now shown a tendency towards reversing to baseline within about a year. The difficulties in evaluating the operation are caused by the lack of comparable randomized studies performed on large populations, treated in a double-blind fashion and examined in cooperation between surgeon and rheumatologist.

Benefits of training physicians in advanced cardiac life support.

Unexpected cardiopulmonary arrests occur commonly both in the prehospital setting and in the course of hospital care. Survival after prehospital arrest is improved if bystanders and paramedics are trained in basic and advanced cardiac life support. However, within the hospital, the bystanders are the physicians; it is not known if life support training of these hospital-based physician bystanders leads to improved survival. Therefore, we reviewed the outcome of resuscitation attempts in a teaching hospital during two matching six-month periods, before (period 1) and after (period 2) institution of a mandatory course in Advanced Cardiac Life Support (ACLS) for medical houseofficers. It was concluded that survival after inhospital cardiopulmonary arrest is significantly increased if house officers who staff the Code teams are trained in ACLS.