Dissertations / Theses on the topic 'Musculosketal condition'
To see the other types of publications on this topic, follow the link: Musculosketal condition.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 dissertations / theses for your research on the topic 'Musculosketal condition.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Piedrahita, Hugo. "Working in cold conditions indoors : effects on musculoskeletal symptoms and upper limb movements /." Luleå : Luleå tekniska universitet, 2008. http://epubl.ltu.se/1402-1544/2008/16/.
Full text
2
Welsh, Claire Elizabeth. "Heritability analyses of musculoskeletal conditions and exercise-induced pulmonary haemorrhage in thoroughbred racehorses." Thesis, University of Glasgow, 2014. http://theses.gla.ac.uk/4862/.
Full textAbstract:
Musculoskeletal conditions and exercise-induced pulmonary haemorrhage are commonly diagnosed in Thoroughbred racehorses worldwide, and have serious consequences for racehorse welfare and the racing economy. Despite increasing interest in the study of genetic susceptibility to disease from the veterinary research community as a whole over past decades, the Thoroughbred has been largely ignored as a study group. The availability of software capable of complex genetic analyses using large, unbalanced pedigrees has made the study of genetic susceptibility to disease a realistic prospect for veterinary researchers. This study aimed to complete preliminary analyses of the genetics of a number of important musculoskeletal conditions, and of exercise-induced pulmonary haemorrhage, in two different Thoroughbred populations. Multivariable regression analyses were performed to identify important environmental risk factors for each condition in each population, and heritability analyses were conducted. Genetic correlations between disease conditions were also investigated. Fracture, tendon injury, suspensory ligament injury, osteoarthritis and EIPH/epistaxis were found to be heritable traits in the Hong Kong population. Distal limb fracture, SDFT injury and epistaxis were also found to be heritable in the UK Thoroughbred population. Most heritability estimates were small or moderate in magnitude. Selective breeding strategies that identify those animals with low genetic risk could play a part in future efforts to reduce the incidence of these conditions, in conjunction with favourable environmental manipulations based on research evidence. Due to low heritability, most of the conditions studied here would reduce in incidence slowly if selective breeding were implemented, thus strategic environmental manipulations would be warranted alongside such longer-term efforts to provide effective incidence reductions. A number of conditions were found to be positively genetically correlated, suggesting that risk reduction through breeding could reduce the risk of multiple diseases concurrently. For example, fracture and osteoarthritis were found to be positively genetically correlated (0.85 – 0.89) in the Hong Kong racehorse population. However, using the Hong Kong Thoroughbred population dataset, EIPH/epistaxis and tendon injury were negatively genetically correlated, which suggests that reduction in genetic risk of one of these may lead to increased genetic risk of the other. iii Measures of the durability and performance of racehorses were investigated to assess whether they were heritable traits in the UK and Hong Kong racehorse populations, and to assess their relationship to the disease conditions studied. Selection based on more holistic measures of horse health and longevity such as ‘career length’ could be a more attractive prospect for stakeholders, as this could forego the need to select for many different traits individually. Career length, number of starts over the career, and the level of earnings were all heritable traits in both populations. These holistic traits were found to have variable relationships with the disease conditions studied in each population. These analyses are the first to assess the genetic contribution to risk for many important diseases in the Thoroughbred. They provide a starting point from which further investigations into the applicability of genetic manipulations could yield realistic and achievable tools for racing stakeholders to use to ‘improve’ the breed in future.
3
Thomson, Colin E. "Interventions for the management musculoskeletal conditions of the foot : towards an evidence based approach." Thesis, University of York, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.428414.
Full text
4
Dawson, Lesley J. "Recommending core outcome measures for adults with musculoskeletal knee conditions : a consensus development conference." Thesis, Glasgow Caledonian University, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.601667.
Full textAbstract:
Musculoskeletal knee conditions present a growing burden for community based rehabilitation. Outcome measures profile current health status, detect change and evaluate response to interventions. There is, however, an abundance of outcome measures but no recommendation on which to use or what data to collect, leading to widespread variation in practice. The purpose of this study was to identify those outcome measures with robust scientific evidence for adults undergoing conservative treatment of musculoskeletal knee conditions and establish, through consensus with clinicians, researchers and patients, which are acceptable and feasible for use in community based settings. An investigation of current clinical practice in NHS Scotland profiled data collection and outcome measure use in community rehabilitation. Evidenced based, validated patient vignettes were developed to establish the scope of the study. The literature reporting and testing the clinimetric properties of outcome measures was systematically reviewed and the OMERACT filters of 'truth' and 'discrimination' applied to the data for each outcome measure by an expert panel. Those measures meeting predefined quality thresholds were presented to a national Consensus Development Conference where delegates voted on their acceptability and feasibility, followed by wider public consultation. None of the 37 outcome measures identified had been fully tested or were fully supported with sufficient quality and breadth of evidence for all components of the OMERACT filter, only ten met the preset criteria for 'truth' and 'discrimination' . Five were presented to Conference and two (Lysholm and WOMAC) were subsequently recommended for use in clinical practice. Barriers to implementation included time, administration and cost. This thesis reports on a study to recommend a core set of outcome measures that could facilitate standardisation of data collection and demonstrate effectiveness of interventions for adults with musculoskeletal conditions of the knee. It captures thoughts and concerns of clinicians on the introduction of a minimum core set of outcome measures.
5
Ndlovu, Mehluli. "Modelling factors associated with long-term prescription patterns of analgesia for musculoskeletal conditions in primary care." Thesis, Keele University, 2014. http://eprints.keele.ac.uk/2254/.
Full textAbstract:
Musculoskeletal (MSK) pain is a major reason why people consult their general practitioner. Analgesia plays a central role in its treatment but do not always work, resulting in the need to switch amongst analgesia potency levels. Stronger analgesia is however associated with increased adverse effects. The aim was to investigate the use of robust statistical approaches to determine socio-demographic and clinical factors associated with receiving and switching, prescribed analgesia in primary care management of MSK pain. The first phase reviewed statistical methods previously used in modelling medication switching, and established that Cox proportional hazards and logistic regression models were predominantly used. The second phase investigated the prevalence of prescribed analgesia, factors associated with being prescribed analgesia, and prescription patterns in the management of new MSK conditions using a general practice database. In 3236 incident consulters, 42% were prescribed analgesia, NSAIDs being most prescribed. In a 5 year follow-up period, three prescription patterns were identified: no analgesia or basic analgesia only, use of NSAIDs, and multiple-potency analgesia combinations. The main baseline factors associated with being prescribed analgesia, and stronger analgesia were increasing age and having been previously prescribed analgesia. The third phase used Cox and Weibull frailty models to identify factors associated with switching analgesia and switching to stronger analgesia. The main factors identified were age, gender and initially prescribed analgesia. The fourth phase used a prevalent cohort of 1610 patients aged 50+ with linked self-reported and medical record data. Patient-reported factors such as level of physical function and pain interference were also associated with switching of analgesia. Using a propensity score approach to modelling outcomes suggested those who switched analgesia did not have better three year outcomes, but further research is required to establish if switching analgesia is beneficial in reducing pain and improving function.
6
DARAISEH, NANCY M. "A COMPREHENSIVE ASSESSMENT OF UNSAFE WORKING CONDITIONS, MUSCULOSKELETAL SYMPTOMS, AND SUBJECTIVE HEALTH COMPLAINTS AMONG NURSING PERSONNEL." University of Cincinnati / OhioLINK, 2004. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1085423245.
Full text
7
Sabariego, Carla. "Assessment and determinants of health care utilization among patients with musculoskeletal conditions undergoing outpatient rehabilitation in Germany." Diss., lmu, 2011. http://nbn-resolving.de/urn:nbn:de:bvb:19-126382.
Full text
8
Metcalfe, Caroline Jane. "An investigation of patients' expectations of outpatient physiotherapy for peripheral musculoskeletal conditions and their effect on treatment outcome." Thesis, University of Hull, 2003. http://hydra.hull.ac.uk/resources/hull:8473.
Full textAbstract:
Little or no research has been conducted to explore patients' expectations of physiotherapy, or the effect that pre-conceived expectations might have on the outcome of treatment. This thesis aimed to fill that void. Stage one involved a review of the literature to develop a conceptual framework and understanding of expectations and how they may affect outcome. Stage two explored the evidence regarding the role of patients' expectations of physiotherapy and the impact that such expectations may have on the outcome of treatment. Three studies were carried out (1) a Delphi study with physiotherapists; (2) exploratory interviews with patients; and (3) the development and testing of a questionnaire. Stage three examined the relationship between patients' expectations of benefit and the outcome of physiotherapy using a postal survey of patients, with upper or lower limb musculoskeletal problems. Stage four consisted of a randomised-controlled trial aimed at determining whether manipulation of patients' expectations of benefit could influence treatment outcome in patients with non-traumatic knee problems. The results from stage one suggested that patient expectations were likely to be associated with patients' previous experiences of physiotherapy, anecdotal knowledge, preferences, expectation of benefit, time related issues, such as duration of condition (chronicity), educational level and work status. In stage two, the Delphi study with thirteen physiotherapists, resulted in a list of factors, ranked in order of importance, that they believed may influence the outcome of physiotherapy. The list concurred with the literature. Twelve patients were then interviewed. They generally had a positive view of physiotherapy, understood why they needed to have physiotherapy, but had limited knowledge of what physiotherapy is, what physiotherapists do or what level of involvement that they would have in their treatment. Their knowledge came mainly from first-hand or anecdotal experience of physiotherapy. Finally, a questionnaire was developed to gather information on patients' expectations and tested on 18 patients. The survey in stage three (n=289) found statistically significant positive relationships (p<0.002) between expectations of benefit before treatment and trauma, upper limb problems, locus of control and satisfaction with the health care received so far. Furthermore, negative relationships were found between the expectations variable and duration of condition and previous experience of physiotherapy. A statistically significant positive relationship (p<0.004) was also found between expectations of benefit and treatment outcome in terms of change in functional disability, perceived improvement, change in health status and satisfaction. Finally, 95 patients with nontraumatic knee problems participated in the randomised controlled trial in stage four. However, the results found no evidence that the intervention, through changes In expectations or locus of control, improved the outcome of physiotherapy. The research carried out in this thesis appears to support the notion that the characteristics that patients demonstrate in terms of their beliefs, perceptions and cognitions appear to have some influence on the course of their physiotherapy. The findings suggest that physiotherapists need to be more aware of the psychological attributes of their patients as well as the effect that their intervention (communication, handling and therapeutic) has on their patients' beliefs, perceptions and cognitions. However, further research is needed to determine whether, and by what means, patients' expectations can be influenced to improve the outcome of physiotherapy.
9
Hills, Rosemary Eleanor. "Patient satisfaction with outpatient physiotherapy : an examination of needs and expectations of patients with acute and chronic musculoskeletal conditions." Thesis, King's College London (University of London), 2003. https://kclpure.kcl.ac.uk/portal/en/theses/patient-satisfaction-with-outpatient-physiotherapy--an-examination-of-needs-and-expectations-of-patients-with-acute-and-chronic-musculoskeletal-conditions(c9f0dd3b-12a0-4947-834b-4a3ad235b675).html.
Full text
10
Lumpkins, Logan, and Craig Wassinger. "Effects of Lower Extremity Aerobic Exercise and Conditioned Pain Modulation on Evoked Shoulder Pain." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/honors/434.
Full textAbstract:
Background: Emerging evidence suggests that aerobic exercise and conditioned pain modulation may be advocated in treating patients with musculoskeletal pain. The effects of lower extremity aerobic exercise and conditioned pain modulation on evoked shoulder pain are not known.
Purpose: To determine the acute effects of lower extremity aerobic exercise and conditioned pain modulation on outcomes of evoked shoulder pain from pain pressure threshold measurements.
Study Design: Repeated measures.
Methods: Thirty (30) healthy volunteers were tested over the course of two sessions. Session 1 consisted of collecting pain pressure threshold measurements over the infraspinatus before and immediately following a conditioned pain modulation with cool water. Session 2 consisted of collecting pain pressure threshold measurements over the infraspinatus before and immediately following a bout of lower extremity aerobic exercise on a recumbent stepper apparatus.
Results: Pain pressure threshold was not significantly influenced by the conditioned pain modulation using cool water (p=0.725). Pain pressure threshold was significantly increased immediately following the lower extremity exercise session (P<0.001).
Conclusion: Conditioned pain modulation with cool water did not produce any significant changes in pain pressure threshold. Lower extremity aerobic exercise acutely increased pain pressure threshold in participants with experimentally induced shoulder pain. Physical therapists may consider lower extremity aerobic exercise to produce short-term hypoalgesic effects and facilitate the application of more active interventions.
11
Pinzke, Stefan. "Towards the good work : methods for studying working postures to prevent musculoskeletal disorders with farming as refererence work /." Alnarp : Swedish Univ. of Agricultural Sciences (Sveriges lantbruksuniv.), 1999. http://epsilon.slu.se/avh/1999/91-576-5471-9.pdf.
Full text
12
Fjell, Ylva. "Working conditions and musculoskeletal pain in public sector employees : a study of female dominated workplaces in health care and educational services /." Stockholm : Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-256-9/.
Full text
13
Rolander, Bo. "Work conditions, musculoskeletal disorders and productivity of dentists in public dental care in Sweden : Are dentists working smarter instead of harder?" Doctoral thesis, Linköpings universitet, Arbetslivsinriktad rehabilitering, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-65428.
Full textAbstract:
Introduction: During the last 20 years, Sweden and other countries have been adjusting their models of welfare to a changed economic environment. Rationalization, influenced by New Public Management, has been implemented in public dentistry in order to improve efficiency and to streamline activities. This has involved transferring some of dentists’ tasks to dental hygienists and dental nurses. The goal is to achieve a more efficient mix of skills and more interaction between professional groups, in order to utilize all skills better in a more efficient work organization. Organizational changes may have an effect on the work environment both with regard to physical and to psychosocial work conditions and affect health and well-being. In many cases these changes have a profound negative effect on musculoskeletal and mental health, and corresponding risk factors, by reducing the number of natural breaks and thus reducing the efficacy of targeted ergonomic interventions. Dentists in Jönköping County in Sweden perceive high precision demands and poor working postures in their work. The five studies in this thesis describe organizational changes and analyse the risk of illness among dentists in the public sector in Jönköping County. Aim: The main aim is to study dentists’ physical and psychosocial work conditions and investigate associations with musculoskeletal disorders, work ability and sick leave during a period of extensive rationalizations; secondly, to assess the risk of illness as a basis for recommending preventive measures. Methods: The present thesis was designed with four cross-sectional studies (Paper I-IV) and one prospective longitudinal study (Paper V). In Paper I, a questionnaire concerning physical and psychosocial work conditions and health was sent out to all employees working in public dental care in Jönköping County in Sweden. To obtain more information on the difficult physical work situation for dentists (Paper I), an observation study with Portable Ergonomic Observation (Paper II) and an sEMG study (Paper III) was then conducted. Paper IV deals with psychosocial issues (using the same survey as in Paper I) and questions in the Eysenk Personality Questionnaire (EPQ) and the Marlowe-Crown scale SD (MCSD), to analyse their impact on perceived physical load. In Paper V, data about physical and psychosocial conditions and health from a survey, as well as production data (number of adult treatments per year per dentist) from computerized patient records (T4), are analysed with regard to changes and associations during a period of extensive rationalizations (2003 – 2008). Results: In Paper I, dentists reported the poorest physical work conditions of all occupational groups and high prevalence of musculoskeletal disorders. However, relatively low intensity of pain was reported and only a small proportion thought that work was affected. Paper II and Paper III confirmed that dentists’ work is physically demanding, with sitting postures and head bent forward, as well as prolonged low muscle loading. Paper IV shows that physical load is mainly influenced by psychosocial demands and to some extent by loss of work control. The results in Paper V show that during the period of extensive rationalizations between 2003 and 2008, dentists perceive improved precision demands and fewer uncomfortable work postures, but still a high level of physical load. The number of adults treated per dentist also improved, but there was a slight deterioration in work control and leadership. Conclusions: The results in this thesis show a consistent picture of high perceived physical load due to high precision demands and uncomfortable work postures, supported by observation of body movements (Portable Ergonomic Observation) and sEMG signs during psychosocially demanding circumstances. The rationalizations implemented in Jönköping County during the period 2003-2008 have not resulted in a deterioration of the physical environment, in spite of the fact that dentists produce more treatments of adult patients than before. This result may indicate that rationalizations do not always lead to increased health risks; it depends how they are implemented. Dentists may have changed the way they work for the better, and due to task delegation and SMS reminders a smoother patient flow has probably resulting in a reduction of workload and perceived stress regarding financial loss.
14
Partlow, Adam. "A knowledge based engineering system for the prescription and manufacture of custom contoured seating for clients with severe musculoskeletal and postural conditions." Thesis, University of South Wales, 2014. https://pure.southwales.ac.uk/en/studentthesis/a-knowledge-based-engineering-system-for-the-prescription-and-manufacture-of-custom-contoured-seating-for-clients-with-severe-musculoskeletal-and-postural-conditions(d6dbc8e7-3874-4f1a-a824-1583b0250f52).html.
Full textAbstract:
This thesis presents a study into the feasibility of applying a Knowledge Based Engineering System to the manufacture and prescription of custom contoured seating. The custom contoured seats are designed to meet the needs of clients of Cardiff and Vale University Health Board’s Rehabilitation Engineering Unit who have neurological, musculoskeletal and/or other conditions that result in limited movement, complex body shapes and poor posture. The custom contoured seats provide accommodation or correction for poor posture whilst improving the client’s function and comfort level, minimising risk to the client and in some cases providing therapeutic benefits such as improving the client’s unsupported posture. The literature review showed that there is not currently a technique in development or envisaged that would perform the task of the system being investigated in this thesis. Three techniques were identified, two for the prescription of wheelchairs based on a series of extensive questions, the output of which is a wheelchair with no custom contoured seating. The third technique converts pressure readings of clients with low complexity conditions sitting on a flat surface into a custom contoured seat. The client group being investigated in this study are unable to sit unsupported and would not be able to provide a meaningful pressure reading when held in position due to the shape of most of the clients’ bodies. Algorithms were developed to extract useful features from Cardiff and Vale University Health Board’s Rehabilitation Engineering Unit’s mechanical shape sensor; which is called the Cardiff Body Match. The features extracted from the measurements were designed to reduce the dimensionality of the data and inform a clinical engineer as to the anthropometry of the client seated in the Cardiff Body Match mechanical shape sensor. The algorithms developed were able to correct errors in measurements, estimate the location of pelvic landmarks and provide a classification of the curvature of the back. Engineering rules were elicited from clinical engineers at Cardiff and Vale University Health Board’s Rehabilitation Engineering Unit and from the literature. The engineering rules were described in plain English and represented using a novel approach based on notations used in predicate calculus. The engineering rules’ application was tested and the shape of a custom contoured seat that could be produced with the Knowledge Based Engineering System was demonstrated. This study has shown that through further research a Knowledge Based Engineering System for the manufacture and prescription of custom contoured seating for clients of Cardiff and Vale University Health Board’s Rehabilitation Engineering Unit is possible. This thesis contributes to the knowledge by demonstrating the feasibility of the Knowledge Based Engineering System, developing the bespoke algorithms and the novel collection of knowledge through elicitation.
15
Larsman, Pernilla. "On the relation between psychosocial work environment and musculoskeletal symptoms : a structural equation modeling approach /." Stockholm : Arbetslivsinstitutet, förlagstjänst, 2006. http://ebib.arbetslivsinstitutet.se/ah/2006/ah2006_02.pdf.
Full text
16
Dahlberg, Raymond. "Health and working conditions among low-educated women /." Stockholm : Arbetslivsinstitutet, 2005. http://diss.kib.ki.se/2005/91-7045-758-1/.
Full text
17
de, Alwis Pahansen. "On Evaluation of Working Conditions aboard High-Performance Marine Craft." Licentiate thesis, KTH, Marina system, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-223903.
Full textAbstract:
High-Performance Marine Craft (HPMC) is a complex system confronted by the stochastic nature of the waves challenging the safety of life at sea. The personnel aboard these craft are vulnerable to detrimental conditions, in fact, limiting the system’s performance evoking the significance of the Human Factors Integration (HFI) in the design and operation of these craft. The risks related to the work environments at sea have inadequately been investigated. A consistently identified fact is that the exposure to work environments containing vibration and repeated shock elevates the risk of adverse effects on human health and performance. In the event that the exposure risk is known, the situation can be managed by the operators and the legislated health and safety demands can be achieved by the employer. Moreover, when quantification of the exposure-effect relationships is potential, human factors, in terms of health and performance, can be integrated into HPMC design and operation. However, the knowledge is limited about the adverse health and performance effects among the High-Performance Marine Craft Personnel (HPMCP), the factors causing theses effects and their relationships. The thesis presents a holistic approach for the integration of human factors, in terms of health and performance, into HPMC design and operation. A research program has been designed branching the design and operational requirements of HPMC concerning HFI. A method is introduced for a real-time crew feedback system, which monitors and characterizes vibration and shock conditions aboard HPMC, enabling determination of the risk of acute injuries due to the high-intensity instantaneous impact exposure and the acquired risk of adverse health and performance effects due to the accumulated vibration exposure. This brings forth the requirement of epidemiological studies in order to strengthen the exposure-effect relationships. Therefore, web-based questionnaire tools are developed, validated and pilot tested for cross-sectional and longitudinal investigation of health and performance in HPMCP. The work exposure is measured aboard HPMC in terms of vibration and investigated in relation to the adverse health and performance event onsets, and the ride perception of the personnel aboard. The introduced method for the real-time crew feedback is capable of informing the exposure risk in terms of human health and performance. The questionnaire tools are feasible for epidemiologically surveying HPMCP and similar populations providing data for investigating adverse health and performance effects, risk factors and their relationships. Promising trends are observed between the quantified work exposure and the health and performance onsets, and the human perception. The work will be continued to identify the exposure-effect relationships facilitating better use of the existing standards, supporting ongoing development of the existing standards and providing information to draw appropriate design and operational limits in rules and regulations.Högprestandafartyg (HPMC) utgör komplexa tekniska system där sjösäkerheten i den stokastiska vågmiljön är en utmaning. Besättningen ombord utgör många gånger den begränsande faktorn för systemets prestanda vilket betonar betydelsen av att integrera olika aspekter av människan som systemkomponent (Human factors integration, HFI), vid så väl projektering, konstruktion som under driftsfasen. Riskerna vid arbete till sjöss är inte fullt ut kartlagda. Vad som står klart är dock att exponering för vibrationer och upprepade stötar ökar risken för att hälsan såväl som arbetets kvalité påverkas menligt. Om riskerna med exponeringen var kända skulle besättning i sitt handhavande kunna agera så att riskerna hålls på acceptabla nivåer och att arbetsgivaren uppfyller kraven i arbetsmiljö- och säkerhetslagstiftning. Dessutom, om riskrelationen mellan exponering och följder för hälsan och arbetsförmågan kan kvantifieras så öppnas en reell möjlighet att integrera human factors i både konstruktions- och driftsfasen. För närvarande är dock kunskapen begränsad om vilka negativa effekter på hälsa och arbetsförmågan som förekommer hos besättningar till HSMC, vilka faktorer som leder till dessa effekter och hur relationen mellan dessa ser ut. Avhandlingen presenterar ett holistiskt angreppsätt för att integrera human factors, i termer av hälsa och arbetsförmåga, vid konstruktion och drift av högprestandafartyg. Ett forskningsprogram har utformats för att klargöra konstruktions- och driftskrav för HPMC avseende HFI. En metod för att övervaka och i realtid karaktärisera stöt- och vibrationsförhållandena ombord introduceras för att möjliggöra bedömning av risken för akuta skador till följd av enstaka kraftiga genomslag, risken för nedsatt arbetsförmåga under pågående verksamhet samt risken för negativa hälsoeffekter till följd av ackumulerad stöt- och vibrationsexponering. Behovet av epidemiologiska studier för att klargöra exponeringens relation till hälsa och arbetsprestation blir i det här sammanhanget tydligt. Därför har nätbaserade enkätverktyg utvecklas, valideras och pilottestas för tvärsnitts- och longitudinella studier av besättningars hälsa och arbetsprestation. Exponeringen mäts med accelerometrar och studeras i relation till besättningarnas hälso- och prestandastatus samt den upplevelse av exponeringen som de rapporterar via enkäterna. Metoden för realtidsåterkoppling av exponeringsnivån kan informera besättningen om hälsorisker och prestationsnedsättning. Enkätverktygen kan användas för datainsamling till epidemiologiska studier i populationer, som t.ex. besättningar till högprestanda fartyg, för att undersöka arbetssituationens inverkan på hälsa och arbetsprestation, riskfaktorer samt relationen dem emellan. Inledande studier påvisar trender mellan kvantitativa mått på exponering och besättningars hälsostatus såväl som mellan uppmätt och upplevd exponering. Det fortsatta arbetet siktar mot att identifiera och kvantifiera relationerna mellan exponeringen och dess påverkan på hälsa och prestation. Därmed kan man bättre utnyttja befintlig standard, stödja den pågående utvecklingen av befintlig standard och bidra till att sätta relevanta gränser i regelverk och lagstiftning som styr konstruktion och handhavande av högprestandafartyg.
QC 20180305
18
Barnes, Roline Yvette. "An investigation into the nature and prevalence of musculoskeletal conditions among women attending a community clinic, and the effectiveness of an intervention programme for these patients." Doctoral thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/23424.
Full textAbstract:
The thesis set out to document the process of developing and testing a non-pharmacological biopsychosocial intervention programme which included exercise and health education for women with musculoskeletal conditions attending a clinic in a poorly resourced area of the Free State Province in South Africa. To inform the development of an appropriate intervention, several sub-studies were undertaken. Systematic reviews on the use of exercise and health education in adults were undertaken, one on the impact of these interventions on adults with chronic diseases of lifestyle (diabetes mellitus type II, hypertension) and the risk factor obesity, and the other on the impact on adults with musculoskeletal conditions. The selected research tools, which were chosen based on the framework of the International Classification of Functioning, Disability and Health (ICF) were subjected to a rigorous translation process. A facility-based descriptive observational cross-sectional study was undertaken to determine the prevalence and nature of musculoskeletal conditions amongst women between the ages of 40 and 64 years attending a community clinic. The gathered information was then used to modify and adapt existing non-pharmacological programmes and develop an intervention programme tailor made for these patients. Finally, an experimental randomised controlled trial was undertaken to determine the effectiveness of usual care against a non-pharmacological intervention utilising a workbook for the women identified in the survey.
19
Tängerstad, Louise, and Maria Källskog. "Finns det arbetsmiljöfaktorer på Arbetsförmedlingen Kundtjänst som förklarar korttidssjukfrånvaron? - En studie med MTO-perspektiv." Thesis, KTH, Ergonomi, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-153739.
Full textAbstract:
Bakgrund Callcenter- verksamhet har vuxit fram snabbt och utvecklats mycket under de senaste årtionden, både internationellt och i Sverige. Det är en verksamhet som innebär många utmaningar i en ofta komplex arbetsmiljö med höga krav på samverkan inom systemperspektivet Människa - Teknik - Organisation. Arbetsförmedlingen tillhandahåller handläggning per telefon via kundtjänster på sju olika orter i Sverige. Korttidssjukfrånvaron ansågs högre i denna verksamhet än i övriga organisationen och målet var att minska den. Syfte Huvudsyftet med denna uppsats var att undersöka om det fanns arbetsmiljöfaktorer på Arbetsförmedlingen Kundtjänst som förklarade korttidssjukfrånvaron. Detta genom att tillämpa ett MTO- perspektiv (Människa - Teknik - Organisation). Metod För att få svar på vår frågeställning tillämpades metodtriangulering genom kvalitativ och kvantitativ datainsamling. En halvdags observation och 16 semistrukturerade intervjuer utfördes på Arbetsförmedlingens kundtjänst i Södertälje och 76 enkäter utfördes på kundtjänsterna i Södertälje och Söderhamn. Resultat Utifrån resultaten i vår studie gick det inte att se samband mellan fysisk arbetsmiljö, höga krav eller låg kontroll och korttidssjukfrånvaro på grund av arbetet. Det fanns dock en statistiskt signifikant skillnad beträffande vissa frågor om arbetsförhållanden och korttidssjukfrånvaro på grund av arbetet. Slutsats På de flesta frågor kunde sambandet mellan korttidssjukfrånvaro och fysisk och psykosocial arbetsmiljö inte påvisas. Däremot fanns en statistisk signifikans i några frågor gällande arbetsförhållanden i denna studie. Det fanns således flera faktorer i arbetsmiljön som skulle kunna förbättras och därmed individens upplevelse av arbetsmiljön. Detta kanske kunde bidra till minskad korttidssjukfrånvaro. Trots att det fanns vissa frågor som påvisade en signifikant skillnad mellan arbetsförhållanden och korttidssjukfrånvaro var det svårt att dra slutsatser på grund av studiens design samt att underlaget var litet. Interventioner i systemkomponenterna Människa – Teknik - Organisation kan vara av värde för att minska korttidssjukfrånvaron.
20
Källskog, Maria, and Louise Tängerstad. "Finns det arbetsmiljöfaktorer på Arbetsförmedlingen Kundtjänst som förklarar korttidssjukfrånvaron -en Studie med MTO-perspektiv." Thesis, KTH, Ergonomi, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-154039.
Full textAbstract:
Sammanfattning Bakgrund Callcenter- verksamhet har vuxit fram snabbt och utvecklats mycket under de senaste årtionden, både internationellt och i Sverige. Det är en verksamhet som innebär många utmaningar i en ofta komplex arbetsmiljö med höga krav på samverkan inom systemperspektivet Människa - Teknik - Organisation. Arbetsförmedlingen tillhandahåller handläggning per telefon via kundtjänster på sju olika orter i Sverige. Korttidssjukfrånvaron ansågs högre i denna verksamhet än i övriga organisationen och målet var att minska den. Syfte Huvudsyftet med denna uppsats var att undersöka om det fanns arbetsmiljöfaktorer på Arbetsförmedlingen Kundtjänst som förklarade korttidssjukfrånvaron. Detta genom att tillämpa ett MTO- perspektiv (Människa - Teknik - Organisation). Metod För att få svar på vår frågeställning tillämpades metodtriangulering genom kvalitativ och kvantitativ datainsamling. En halvdags observation och 16 semistrukturerade intervjuer utfördes på Arbetsförmedlingens kundtjänst i Södertälje och 76 enkäter utfördes på kundtjänsterna i Södertälje och Söderhamn. Resultat Utifrån resultaten i vår studie gick det inte att se samband mellan fysisk arbetsmiljö, höga krav eller låg kontroll och korttidssjukfrånvaro på grund av arbetet. Det fanns dock en statistiskt signifikant skillnad beträffande vissa frågor om arbetsförhållanden och korttidssjukfrånvaro på grund av arbetet. Slutsats På de flesta frågor kunde sambandet mellan korttidssjukfrånvaro och fysisk och psykosocial arbetsmiljö inte påvisas. Däremot fanns en statistisk signifikans i några frågor gällande arbetsförhållanden i denna studie. Det fanns således flera faktorer i arbetsmiljön som skulle kunna förbättras och därmed individens upplevelse av arbetsmiljön. Detta kanske kunde bidra till minskad korttidssjukfrånvaro. Trots att det fanns vissa frågor som påvisade en signifikant skillnad mellan arbetsförhållanden och korttidssjukfrånvaro var det svårt att dra slutsatser på grund av studiens design samt att underlaget var litet. Interventioner i systemkomponenterna Människa – Teknik - Organisation kan vara av värde för att minska korttidssjukfrånvaron.
21
Kjellsson, Sara. "Sick of Work? : Questions of Class, Gender and Self-Rated Health." Doctoral thesis, Stockholms universitet, Sociologiska institutionen, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-148744.
Full textAbstract:
This thesis examines two aspects of social inequalities in health with three empirical studies that are based on the Swedish Level of Living survey (LNU): The relationship between accumulated occupational class positions during adulthood and health and the class-specific nature of gender differences in health. Previous research continuously finds that there are health differences by class and gender, but less is known about the extent to which accumulated class experiences in adulthood are related to health or how gender differences vary by class. The overall conclusion in this thesis is that occupational class experiences matters for health, both as historical and current experiences. Furthermore, the results highlight the importance of taking class into consideration when examining health differences between men and women, as the mechanisms that underlie the gender gaps in health are not necessarily the same for all classes. The studies can be outlined as: Study I: Class differences in working conditions is a mechanism that underlies class inequalities in health. The working class is generally more exposed to adverse working environments than non-manual employees, and when the wear and tear of these conditions accumulate over time, the length of this exposure may contribute to class inequalities in health. Thereby, accumulated time in the working class is studied as a partial explanation for class differences in health. The results suggest that the duration of time in the working class is related to a higher probability of less than good self-rated general health (SRH), given current class position. This association was also found among individuals who were no longer in working class positions and thus show that duration of experience matters, both as current and past experience. Study II: The study addresses the research gap of class-specificity in gender health inequality and seeks to further disentangle class and gender by studying gender gaps separately by class. The results show that there are class-specific gender gaps for both SRH and musculoskeletal pain, while the gender gap in psychiatric distress appears to be more general across class. Working conditions do not explain the between-class differences in gender gaps but contribute to specific gender differences in health within classes. Study III: The labour market has changed over time and has “upgraded” the class structure while at the same time the share of women in paid employment has increased. Therefore, female health may be increasingly influenced by occupational factors, such as working conditions. This study explores the class-specific nature of gender differences and investigates musculoskeletal pain and working conditions among employed men and women within classes during a time-period that spanned more than 30 years. There were class-specific gender gaps in health throughout the period. The gender gap has increased more, and is wider, among non-manual employees compared to the working classes. This development could not be explained by changes in working conditions.At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: Manuscript. Paper 3: Manuscript.
22
Coupaud, Marine. "Mondialisation, conditions de travail et santé." Thesis, Bordeaux, 2016. http://www.theses.fr/2016BORD0139/document.
Full textAbstract:
Cette thèse s’applique à explorer dans quelle mesure et par quels mécanismes lamondialisation, au travers de ses différentes composantes, impacte la santé des travailleurseuropéens. Dans une première partie, nous exposons les conséquences socio-économiques de cephénomène. Dans une deuxième partie, nous montrons que l’exposition concurrentielleinternationale constitue un facteur de risque pour la santé des travailleurs non qualifiés. Lesfacteurs individuels et organisationnels sont néanmoins les plus à même d’expliquer la prévalencede troubles physiques et mentaux chez l’ensemble des travailleurs. La mondialisation impliqueaussi de nouvelles pratiques organisationnelles liées à l’internationalisation des firmes, une autrefacette de la mondialisation. Nous soulignons que les travailleurs doivent ainsi trouver lesressources nécessaires pour rester attractifs dans ce monde en perpétuelle évolution. Dans unetroisième partie, nous exposons que la mondialisation favorise le développement des activités deservices dans les pays industrialisés. En parallèle, l'organisation de type "lean" est mise en placedans ces secteurs et la pression concurrentielle s’accroit. Ces changements impactent les conditionsde réalisation du travail. Dans ce contexte, la santé se trouve dégradée par des facteurs de risqueen évolution, parmi eux l’intensité du travail liées aux relations interpersonnelles. Enfin, nousmontrons que la Responsabilité Sociale de l’Entreprise apparait comme une solution dont lesentreprises peuvent s’emparer pour améliorer la santé de leurs travailleurs et par conséquent, leurperformance sociale et financièreThis thesis aims at exploring to what extent globalization, through its diversecomponents, impacts the health of European workers. In a first part, we expose the socio-economicconsequences of this multi-faceted phenomenon. In a second part, we show that internationalcompetition, one of the essential components of globalization, is a risk factor for non-skilledworkers. Nevertheless, individual and organizational factors are the most likely to explain mentaland physical disorders prevalence in the population as a whole. Globalization also implies newpractices linked to firms’ internationalization strategy, another component of globalization. Weunderline that workers must acquire the skills to stay attractive in a constantly changing worldand they do not find much support in their companies. In a third part, we show that globalizationenhances the surge of the service sector in industrialized countries. In addition, the leanmanagement is implemented in those sectors and competitive pressure increases. These changesimpact the way the work is performed. Within this context, the health of workers deterioratesbecause they are exposed to changing risk factors, among them: intense of work related tointerpersonal relationships. Finally, we find that the Corporate Social Responsibility comes as ananswer to improve workers’ health and as a consequence, firms’ social and financial performance
23
Mandelli, Marcia Cristina Castanhari. "Condições de trabalho e morbidade referida para distúrbios osteomusculares em catadores de materiais recicláveis." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-25082017-095724/.
Full textAbstract:
INTRODUÇÃO: A urbanização tem sido acompanhada por um crescente aumento no volume e na diversidade de resíduos sólidos produzidos. O reaproveitamento desses resíduos vem sendo feito desde o início do século XX, inicialmente pela figura do \"velho garrafeiro\", até que em 2003 ocorre o reconhecimento da profissão do \"catador de materiais recicláveis\" na Classificação Brasileira de Ocupações. O problema ambiental decorrente da geração e do descarte de resíduos fez com que fosse instituída a Política Nacional de Resíduos Sólidos, sendo que entre suas diretrizes há o estimulo à participação do catador na cadeia produtiva da reciclagem. Não obstante a ocorrência de avanços nas condições de trabalho dos catadores persistem exposições penosas às cargas biomecânicas, tais como esforços físicos, posições viciosas e movimentos repetitivos. Adicionalmente, a organização do processo produtivo e o modo com que os catadores desenvolvem suas tarefas, são situações que predispõem a riscos e danos à saúde. OBJETIVO: Identificar a ocorrência de dor/desconforto osteomusculares relacionados ao trabalho em catadores que atuam em cooperativas de triagem na Região Metropolitana de São Paulo. MÉTODO: Estudo transversal, com amostra constituída por 250 catadores distribuídos em quatro cooperativas, com entrevista dirigida por um instrumento de coleta de dados padronizado. RESULTADOS: Entre os catadores predominou o gênero feminino (62%), a idade entre 41-59 anos (53%), a raça negra/parda (66,4%) e abaixa escolaridade (77% com menos de oito anos de estudo). A dor/desconforto osteomuscular foi referida por 163 (65%) dos catadores, entre esses, a localização na coluna foi a mais frequente (50%), seguida dos membros superiores (45%) e membros inferiores (31%). Os resultados encontrados na análise multivariada mostraram que dor/desconforto estava associado aos meios de produção da cooperativa (p<0.000), ao fato de ter tido outra ocupação (p=0.007) e ter tido acidente de trabalho (p=0.043). CONCLUSÕES: As condições de trabalho observadas eram extremamente precárias e constituíam importante fator de risco para distúrbios osteomusculares. Catadores estão expostos à mesma posição de trabalho por longo período, posturas inadequadas, monotonia, esforço físico, repetitividade e manuseio de materiais cortantes. As condições em que desempenham suas tarefas são prováveis fatores a problemas osteomuscularesINTRODUCTION: Urbanization has been accompanied by a growing increase in the volume and diversity of solid waste produced. The practice of reusing these wastes has been carried out since the beginning of the XX century, initially by the figure of the \"bottle dealer\", up to 2003 when we had the recognition of the profession of \"recyclable materials collector\" in the Brazilian Classification of Occupations. The environmental problem caused by the production and disposal of waste led to the establishment of the National Solid Waste Policy, and among its guidelines there is an stimulus to the participation of the waste collector in the recycling chain. Despite the improvements in the working conditions of the waste collector, exposures to biomechanical loads, such as physical stresses, vicious positions and repetitive movements persist. In addition, the organization of the production process and the way in which the collectors perform their tasks are situations that predispose to risks and damages to health. OBJECTIVE: To identify the occurrence of musculoskeletal pain / discomfort related to the work of recyclable materials collector working in sorting cooperatives in the Metropolitan Region of São Paulo. METHOD: A cross-sectional study with a sample of 250 collectors distributed in four cooperatives, with an interview conducted by a standardized data collection instrument. RESULTS: Among the recyclable materials collector, the majority were women (62%), with age between 41-59 years (53%), of black / brown race (66.4%) and low education (77% with less than 8 years of schooling). Musculoskeletal pain / discomfort was reported by 163 (65%) of the recyclable materials collector, among them, the location in the spine was the most frequent (50%), followed by upper limbs (45%) and lower limbs (31%). The results found in the multivariate analysis showed that pain/discomfort was associated with the means of production of the cooperative (p < 0.000), having had another occupation (p=0.007) and having had a work accident previously (p = 0.043). CONCLUSIONS: The working conditions observed are extremely precarious and constitute an important risk factor for musculoskeletal disorders. Waste pickers are exposed to the same work position for long periods, inadequate postures, monotony, physical effort, repetitiveness and handling of sharp materials. The conditions under which they perform their tasks are likely factors to musculoskeletal problems
24
Dybeck, Axel, and Julia Persson. "Användning av transkutan elektrisk nervstimulering i smärtstillande syfte vid muskuloskeletala tillstånd : En litteraturstudie." Thesis, Högskolan i Halmstad, Akademin för hälsa och välfärd, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-43782.
Full textAbstract:
Bakgrund: Vid smärtsamma muskuloskeletalatillstånd är patienten beroende av sjuksköterskans omvårdnadsåtgärder och stöd till smärtlindring. Transkutan elektrisk nervstimulering (TENS) är en icke farmakologisk smärtlindringsmetod som med fördel kan kombineras med analgetiska läkemedel vid både akuta och långvariga smärttillstånd. För att optimera smärtlindringen i vardagen vid långvarig smärta kan patienten utbildas i att använda TENS i sin egenvård. Syfte: Syftet var att beskriva effekten av transkutan elektrisk nervstimulering som en del av smärtbehandlingen för personer med muskuloskeletala smärttillstånd. Metod: Allmän litteraturstudie med induktiv ansats där två kvalitativa artiklar samt sju kvantitativa artiklar granskats. Resultat: I resultatet framkom två teman: TENS effekt vid akut smärtaoch TENS effekt vid långvarig smärta. Resultatet visade att behandling med TENS kunde ge adekvat smärtlindring och var en säker metod med få negativa konsekvenser för patienten. Det framkom även att behandlingen medförde en reducering av intag av analgetiska preparat för patienterna. Patienter som behandlades med TENS visade även på en högre grad av fysisk funktion och psykiskt välbefinnande. Konklusion: För sjuksköterskans omvårdnad av patienter med muskuloskeletala tillstånd ter sig TENS vara en effektiv och säker omvårdnadsåtgärd med fler fördelar än enbart smärtlindrande effekt. Kunskap och utbildning för sjuksköterskan av denna behandlingsmetod kan ge sjuksköterskan ytterligare verktyg för multimodal omvårdnad av både akut och långvarig smärta. Sjuksköterskans kunskap om TENS ger även möjlighet till patientutbildning och kan stärka patientgruppens möjlighet till egenvård vid smärta.Background: In painful musculoskeletal conditions, the patient is dependent on the nurse's nursing measures and support for pain relief. Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological pain relief method that can be advantageously combined with analgesic drugs for both acute and long-term pain conditions. To optimize the pain relief in everyday life in the event of long-term pain, the patient can be trained in using TENS in their self-care. Aim: The aim was to describe the effect of transcutaneous electrical nerve stimulation as part of the pain treatment for people with musculoskeletal pain conditions. Method: A General literature study with inductive approach, where two qualitative articles and seven quantitative articles were examined. Results: The results revealed two themes: TENS effect in acute pain and TENS effect in long lasting pain. The results showed that treatment with TENS could provide adequate pain relief and was a safe method with few negative consequences for the patient. Itwas also found that the treatment resulted in a reduction in the intake of analgesic pharmaceuticals for the patients. Patients treated with TENS also showed a higher degree of physical function and mental well-being. Conclusion: For the nurse's nursing of patients with musculoskeletal conditions, TENS appears to be an effective and safe nursing measure with more benefits than just a pain-relieving effect. Knowledge and training for the nurse of this treatment method can provide the nurse with additional tools for multimodal care of both acute and long lasting pain. The nurse's knowledge of TENS also provides opportunities for patient education and can strengthen the patient group's opportunities for self-care in case of pain.
25
Matzelle, Melissa M. "Inflammation Inhibits Osteoblast-Mediated Bone Formation in Rheumatoid Arthritis and Regulates the Wnt and BMP Signaling Pathways: A Dissertation." eScholarship@UMMS, 2012. https://escholarship.umassmed.edu/gsbs_diss/596.
Full textAbstract:
Osteoclast-mediated focal articular bone erosion is a hallmark of rheumatoid arthritis, a disease of inflammation-induced bone loss. Inflammation in the bone microenvironment enhances osteoclast differentiation leading to bone erosion. Simultaneously, inflammation also inhibits osteoblast-mediated bone formation, further contributing to the net loss of bone. Previous studies have shown a paucity of mature osteoblasts at eroded bone surfaces correlating with suppression of bone formation and upregulation of antagonists of the Wnt pathway, a signaling cascade essential for osteoblast lineage commitment. Despite these observations, the exact pathogenesis of impaired bone formation in the setting of inflammation is not clearly understood.
This dissertation aims to delineate the mechanisms by which inflammation suppresses osteoblast differentiation and activity in inflammatory arthritis. Specifically, this research elucidates how inflammation-induced alterations in the Wnt and bone morphogenetic protein (BMP) osteogenic signaling pathways contribute to bone loss and formation at distinct inflammatory microenvironments within the bone. Secondly, the means by which cellular mediators, including lymphocytes and macrophages, facilitate bone erosion and formation was addressed.
Taken together, the research in this dissertation underscores the relationship between inflammation-induced bone loss and alterations in osteogenic signaling. Using an innovative murine inflammatory arthritis model, this study definitively demonstrates that resolving inflammation promotes osteoblast-mediated bone formation. Repair of erosions correlates with upregulation of synovial expression of Wnt10b, a Wnt agonist, and downregulation of sFRP1 and sFRP2, Wnt antagonists. This work also directly evaluates the contribution of sFRP1 to inflammation-induced bone destruction. Furthermore, this research demonstrates that expression of BMP3, a negative regulator of BMP signaling, is upregulated in osteoblasts by IL-17, a pro-inflammatory cytokine. BMP3-expressing osteoblasts are also observed at erosion sites in murine arthritis. Lastly, evaluation of the mediators of inflammation-induced periosteal bone formation implicates BMP2 as a means by which inflammation may positively regulate osteoblast function.
This dissertation further elucidates the role of T cells and macrophages in the erosion and formation processes, respectively. In the absence of lymphocytes, bone erosion occurred normally, demonstrating that RANKL-expressing lymphocytes are not absolutely required for the bone erosion. Preliminary studies also suggest that M2 macrophages are potential mediators of bone formation via the expression of BMP2.
In conclusion, this dissertation explores the ability of inflammation to act as a rheostat, which controls the fate of bone by modulating not only osteoclast differentiation, but also osteogenic signaling pathways and cellular mediators in the bone microenvironment. The soluble mediators and cell types identified in this research highlight novel mechanisms by which inflammation may regulate osteoblast activity within the bone microenvironment. Collectively, these data imply that strict control of inflammation may be necessary in order to create an anabolic environment that preserves bone architecture in diseases of inflammation-induced bone loss.
26
Himalowa, Simon. "The effect of occupational-related low back pain on functional activities among male manual workers in a construction company in Cape Town, South Africa." Thesis, University of the Western Cape, 2010. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_9770_1361367868.
Full textAbstract:
Construction manual workers are at a high risk of suffering from occupational related low back pain because of high-risk activities involved and the nomadic nature of the workforce. Low back pain and its associated disability continue to plague the construction industry. The prevalence of occupational related low back pain among manual workers in construction companies is believed to be due to high exposure to awkward postures for long hours, heavy manual work and exposure to whole-body vibration in the work environment. As a result of these risky exposures, low back pain has consistently been the leading cause of both occupational disability and absenteeism in the construction industry. The purpose of this study was to determine the effect of occupationalrelated low back pain on the functional activities of the manual workers in a construction company in Cape Town. The prevalence and the predisposing factors of low back pain among construction manual workers were established as well as the effect of occupational-related low back pain on the functional activities of the manual workers was also determined. A crosssectional descriptive study using quantitative method was utilized. A convenient sampling method was employed and all the 212 available participants at two construction settings were recruited for the study. The population was categorised into four main occupational groups
masons, handymen, labourers and foremen. Data was collected using a structured questionnaire as a closed ended interview guide. The questionnaire comprised of four parts. Part one was used to determine the demographic data while parts two, three and four utilised three standardizedclose-ended validated questionnaires. These are
the Nordic Musculoskeletal Disorder Questionnaire, the Profile Fitness Mapping questionnaire and the Pain and Disability Questionnaire. Data was captured and analyzed using the statistical package for social sciences (SPSS) version 17.0 spreadsheet for statistical analysis. The study was conducted under the adherence of the ethical considerations. Descriptive and inferential statistical analyses describe the association between the investigated independent variables with the occurrence of occupational related low back pain in the study. Results are presented using tables, charts and graphs. The results revealed a 25% prevalence of low back pain while the one month and one week prevalence rates were 69% and 54% respectively. Masons recorded the highest low back pain prevalence rate (58%). Initial onset of low back pain was mainly attributed to bending (48%) and load lifting (28%). The chi-square test at p<
0.05 was done. The results revealed a lack of association between low back pain and the socio-demographic characteristics. Participants confirmed suffering physical, emotional, financial and functional problems with 41.5% reporting sickness absence and a mean of 4 days being lost during the past year. Further chi-square test for proportion revealed an association between low back pain and participants âability to
lift (p=0.006), bend back forwards (p=0.001) and ability to bend back backwards (p=0.014). To prevent impairment, activity limitation and participation restriction among construction manual workers, a number of factors must be addressed at epidemiological level as highlighted in the recommendations of this study.
27
Pélissier, Carole. "Conditions de travail et état de santé physique et psychique du personnel non médical des établissements d'hébergements pour personnes âgées dépendantes (EHPAD)." Thesis, Lyon 1, 2015. http://www.theses.fr/2015LYO10265.
Full textAbstract:
Contexte : Le personnel non médical des Etablissements d’Hébergements pour Personnes Agées Dépendantes (EHPAD) est exposé à des contraintes physiques et psychiques élevées du fait de la prise en charge de résidents de plus en plus dépendants et polypathologiques. Notre démarche de recherche s’appuie sur le modèle de santé publique de Green et Kreuter. Il s’agit de préciser l’état de santé physique et psychique du personnel (diagnostic épidémiologique) et d’explorer les conditions de travail perçues par les salariés (diagnostic comportemental et environnemental). Matériels et Méthode : Une étude transversale a été menée par 78 médecins du travail auprès 2649 salariés (706 agents de service, 1565 agents de soins et 378 infirmiers) provenant de 105 maisons de retraite de la Région Rhône Alpes. Plusieurs questionnaires standardisés validés ont été utilisés pour recueillir des informations auprès des salariés. Les analyses statistiques ont été réalisées à partir du logiciel SAS, version 9.3. Résultats : Le personnel interrogé exprime un fort niveau de pénibilité et souhaite recevoir plus fréquemment une formation continue aux soins palliatifs. Il est fortement exposé aux contraintes psychosociales (efforts élevés, récompenses faibles, déséquilibre effort/récompense et surinvestissement). Les plaintes musculo-squelettiques du cou et des membres supérieurs et les signes de détresse psychique de ce personnel sont significativement liées à l’exposition aux contraintes psychosociales. Conclusions : La prochaine étape de recherche consisterait à établir le diagnostic éducationnel en précisant les facteurs organisationnels associés aux contraintes psychosociales de ce personnelBackground: Non-medical staff in nursing homes for the elderly are exposed to high levels of physical and psychological stress related to managing increasingly dependent residents with multiple pathologies. Our research approach is based on Green and Kreuter's public health model. This is intended to describe the physical and mental health (epidemiological diagnosis) and to explore working conditions as experienced by nursing home staff (behavioral and environmental diagnosis). Methods: A cross-sectional descriptive survey was conducted by 78 occupational physicians on 2,649 employees (706 housekeepers, 1,565 nursing assistants and 378 nurses) in 105 nursing homes for the elderly in the Rhône-Alpes Region of France. Employee data were collected on several validated questionnaires. All statistical analyses were performed on SAS software, version 9.3. Results: Respondents related elevated hardship and desired more continuous training in palliative care. They were highly exposed to psychosocial stress (strong effort, low reward, effort/reward imbalance, overcommitment). Neck and upper limb musculoskeletal complaints and signs of psychological distress were significantly associated with exposure to psychosocial stress. Conclusions: The next phase of the research plan should consist in establishing an educational diagnosis by assessing the organizational factors associated with psychosocial stress in nursing home staff
28
Briggs, Virginia G. "Injection Treatment for Lower Back Pain in Older Adults with Lumbar Spinal Stenosis: A Dissertation." eScholarship@UMMS, 2009. https://escholarship.umassmed.edu/gsbs_diss/439.
Full textAbstract:
Background:Lower back pain is one of the most common health-related complaints in the adult population. Thirty percent of Americans 65 years and older reported symptoms of lower back pain in 2004. With an aging population, the proportion of people over the age of 65 is expected to reach 20% by the year 2030. Because of this increase in older adults, lumbar spinal stenosis (LSS) associated with arthritic changes will also likely increase. In older adults, lower back pain is most often caused by degenerative lumbar spinal stenosis. Stenosis is the narrowing ofthe spinal canal, causing pressure on the nerve roots and is frequently treated surgically. Lumbar spinal stenosis is one of the most common reasons for back surgery in patients 65 years and older 2. However, risks associated with surgery increase with age 3-5 and older patients may choose non-surgical treatment for their lower back pain, including injection treatment.
Injection treatment, usually consisting of anti-inflammatory medications and analgesics, has improved since the mid-1990's when fluoroscopic guidance was developed. Information about injection treatment for lower back pain is limited, especially in the older population. An extensive review of published literature regarding injection treatment revealed a paucity of information about older adults diagnosed with lumbar spinal stenosis. In this study, three aims were designed to gain more information about the effectiveness of injection treatment in older patients with lumbar spinal stenosis. In the first (retrospective) study, information about receipt of second injections and time between injections was collected to examine injection usage. In the second and third (prospective) studies, information about pain relief and functional return following injection treatment was collected to examine the effectiveness of injection treatment in patients age 60 and older diagnosed with lumbar spinal stenosis. To our knowledge, such results have not been repolted for this population in the literature.
Objective:Injection treatment is a commonly used non-surgical procedure to alleviate lower back pain in older adults. However, older patients do not have enough information about how long pain relief will last after treatment or the amount of pain relief and functional return they will experience. These studies focused on three topics: 1) usage of injection treatment; 2) effectiveness of injection treatment on pain relief; 3) effectiveness of injection treatment on functional return. In addition, the variations of the effectiveness were examined by selected patient attributes.
Methods:In a retrospective study, medical records of patients aged 60 years or older from a high volume dedicated spine center at the University of Massachusetts Memorial Hospital were retrospectively reviewed. This study included those diagnosed with degenerative LSS, who had not received an injection for lower back pain within six months, and whom were treated between June I, 2006 and May 31, 2007.
In two prospective studies, patients scheduled for lumbar injection treatment between January 1 and June 30, 2008 were selected from the University of Massachusetts Memorial Hospital Spine Center. Selection criteria included patients age 60 and over, diagnosed with degenerative lumbar spinal stenosis and no previous lumbar injection within 6 months or lumbar surgery within 2 years. The Pain sub-score of the SF-36 questionnaire was used to measure pain at baseline and at one and three months post injection. The Physical Component Score (PCS) of the SF-36 questionnaire and the Oswestry Disability Index (ODI) were used to measure function at baseline and at one and three months post injection. Variations in longitudinal changes in scores by patient characteristics were analyzed in both unadjusted (univariate) analyses using one-way analysis of variance (ANOVA), and adjusted (multiple regression) analyses using linear mixed effects models.
Results: In the retrospective cohort, the mean age of the cohort was 68, 64% were female, 59% were married, with a mean Body Mass index of 32 kg/m2. Of 92 eligible patients, 57% returned for a second injection within six months of the first. The mean number of months between injections was 4.8 for all patients, ranging from 1 to 22 months. When patient characteristics were examined, the only variable that showed a statistically significant difference was age. Patients aged 70 years and older were found to be 67% less likely to return for a second injection when compared to patients age 60-69 (OR=0.33 (0.12 - 0.94)p In the prospective cohort, information was collected on 62 patients. Mean Pain scores improved significantly from baseline to one month (14.1 points), and from baseline to three months (8.3 points). Post injection changes in Pain scores varied by Body Mass Index (BMI) and baseline emotional health. Based on a linear mixed effects model analysis, higher baseline emotional health, as measured by the SF-36 Mental Component Score (MCS>50), was associated with greater reduction in pain over three months when compared to lower emotional health (MCS Conclusion: Patients over age 70 do not return for repeat injection as frequently as patients age 60-69. In addition, each year a patient ages over age 60, they are 10% less likely to return for a repeat injection. Lower back pain in older adults with LSS is clinically significantly alleviated after injection treatment. In addition, injection treatment for LSS is associated with return of lost function needed for daily living activities in older adults. Pain relief and functional return varies by patient personal and clinical characteristics. Higher emotional health was associated with more pain relief and more functional return experienced over three months following injection treatment. Additional information is needed about why older patients do not return for second injections at the same rate as younger patients and how emotional health affects response to injection treatment in older adults.
29
Melzer, Adriana Cristina de Souza. "Trabalho e dor osteomuscular : um estudo em industrias ceramicas do municipio de Pedreira, SP." [s.n.], 2008. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308418.
Full textAbstract:
Orientador: Aparecida Mari IgutiTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-11T21:10:35Z (GMT). No. of bitstreams: 1 Melzer_AdrianaCristinadeSouza_D.pdf: 4010646 bytes, checksum: f789104f16ca57bf824ef9a5515ddd51 (MD5) Previous issue date: 2008
Resumo: Introdução: Este estudo foi realizado no município de Pedreira, SP, cuja principal atividade industrial é a produção cerâmica. Grande número de trabalhadores destas indústrias tem se afastado do trabalho em conseqüência de Distúrbios Osteomusculares Relacionados ao Trabalho (DORT). Objetivos: Os principais objetivos foram descrever aspectos relacionados às condições e organização do trabalho nas indústrias cerâmicas, determinar a prevalência de dor osteomuscular em trabalhadores em atividade e identificar as associações entre dor e variáveis organizacionais, biomecânicas, psicossociais e individuais. Métodos: O estudo desenvolveu-se em duas fases complementares. Entre os anos de 2003 e 2005 foi realizado um estudo exploratório composto por duas partes: a descrição das atividades de produção de uma indústria cerâmica do município, por meio de uma abordagem ergonômica e a descrição da trajetória de trabalho e adoecimento de trabalhadores portadores de DORT, por meio de entrevistas. Entre os anos de 2006 e 2007, foi realizado um estudo sistemático de desenho transversal-descritivo. Nove indústrias cerâmicas participaram desta fase. As atividades de trabalho de 18 indivíduos, dois de cada empresa, foram descritas e analisadas através do método de observação direta. Todos os trabalhadores das empresas participantes responderam a um questionário sobre trabalho e saúde (n=235). Um outro questionário complementar para avaliação de sintomas psicológicos comuns foi aplicado a 57 indivíduos. Resultados: No geral, as condições de trabalho nas indústrias cerâmicas eram ruins. O ambiente físico era insalubre, expondo os trabalhadores a variados riscos à saúde, incluindo-se os provenientes da poeira de sílica, das altas temperaturas e ruído, da pouca ventilação, de problemas nos pisos e da ausência de proteção nas máquinas. A organização do trabalho estava baseada na divisão e no parcelamento das tarefas e no controle sobre o ritmo a fim de atingir as metas de produção. Homens e mulheres não executavam os mesmos tipos de atividades, revelando-se uma clara divisão sexual do trabalho. Aos trabalhadores da produção cabia a execução de atividades repetitivas, em ritmo elevado e com a utilização de posturas estáticas e inadequadas. A prevalência de dor nos últimos 12 meses foi de 38,5%. As principais localizações foram membros inferiores, coluna lombar e pescoço. Foi identificada uma associação positiva entre dor osteomuscular e sexo feminino. Entre as variáveis biomecânicas e psicossociais, repetitividade de movimentos, utilização de ferramentas de trabalho, ausência de participação nas decisões, preocupação com a produção, problemas de relacionamento com supervisores, insatisfação no trabalho e desejo de mudar de função foram associadas à dor. Conclusões: A dor osteomuscular é uma das expressões do elevado custo humano e social derivado das condições e da organização do trabalho nas indústrias cerâmicas. O ambiente e os equipamentos de trabalho precários, a divisão do trabalho, o parcelamento e a repetitividade das atividades, a mecanização seletiva e o ritmo acelerado são determinantes do desencadear da dor. A maior prevalência de dor entre as mulheres relaciona-se aos diferentes setores e atividades de trabalho em que estão concentradas, submetendo-as a um trabalho mais repetitivo e estático, em ritmo mais acelerado, com pouca autonomia para grandes decisões e sujeitas a menores salários. As pessoas estão trabalhando com dor. A procura por serviço médico é adiada até quando a incapacidade para o trabalho se instala, pela impossibilidade de manter a produção. O uso de medicamentos acaba sendo a única alternativa encontrada pelos trabalhadores para continuarem no trabalho. Palavras-chave: distúrbios osteomusculares relacionados ao trabalho; condições de trabalho; fatores de risco; indústria cerâmica; aparelho locomotor
Abstract: Background: This study was developed in the municipality of Pedreira, SP, Brazil, where the main industrial activity is the ceramic production. A large number of workers from these industry have left their jobs because of Work Related Musculoskeletal Disorders (WRMD). Objectives: To describe work conditions and organization pertaining to the ceramic industry, to determine the prevalence of pain among active workers and to identify the associations between symptoms and organizational, biomechanical, psychosocial and individual variables. Methods: The study was developed in two complementary stages. In the years 2003 and 2005 an exploratory study was carried out, divided in two steps: the description of the production activities developed in one ceramic manufacturer in Pedreira, by means of an ergonomic approach, and a description of the job and illness progression of workers with WRMD, using interviews. In the years 2006 and 2007, a systematic, descriptive and cross-sectional study was carried out. Nine ceramic manufacturers participated in this stage. The activities of 18 individuals, two in each company, were described and analyzed through the direct observation method. All workers answered a questionnaire about work and health (n=235). An additional questionnaire for the assessment of minor psychological disorders was applied to 57 subjects. Results: In general, the work conditions in the ceramic industry were found to be poor. The physical environment was unhealthy, as workers are exposed to several health risks, including those originated from silica dust, high temperatures and noise, low ventilation, inadequate flooring conditions and absence of safety gear. The work organization is based in the division of tasks and pace control in order to achieve the production demands. Men and women do not perform activities with the same characteristics, indicating a clear work division according to gender. Production workers are assigned repetitive activities, executed in a fast pace, using static and awkward postures. A 38.5% prevalence of musculoskeletal pain over the past 12 months was found, mostly localized in the lower limbs, back and neck. A relationship was identified between musculoskeletal pain and the female gender. Among the biomechanical and psychosocial variables, repetitiveness, tool using, lack of control over decisions, worries regarding work demands, relationship issues with supervisors, work dissatisfaction and wish to move on to another function, were associated with pain. Conclusions: Musculoskeletal pain is one of the outcomes of elevated social and human requirements resulting from work conditions and organization in the ceramic industry. The work environment and use of outdated equipment, the work division, repetitiveness of the activities, selective mechanization and fast pace are components in the development of pain. The higher prevalence of pain among women is related to their allocation in different sectors and activities, submitting them to a more repetitive and static work, executed in more accelerated pace, with less autonomy and low salaries. People are working with pain. Seeking medical service is delayed until the worker's capacity has compromised their ability to maintain the work schedules. Medication ends up as the only alternative found by workers to carry on with their duties
Doutorado
Epidemiologia
Doutor em Saude Coletiva
30
Moura, Neto Alvaro Braga de. "Nível de atividade física em trabalhadores do transporte coletivo urbano da cidade de Pelotas/RS." Universidade Federal de Pelotas, 2012. http://repositorio.ufpel.edu.br/handle/ri/1765.
Full textAbstract:
Made available in DSpace on 2014-08-20T13:49:05Z (GMT). No. of bitstreams: 1
Alvaro Braga de Moura Neto.pdf: 794476 bytes, checksum: e95db4d51b255980101fd944d5e7b24c (MD5)
Previous issue date: 2012-05-24Physical inactivity (IF) appears associated with a number of chronic diseases, affecting people in all age groups and different social groups. When we focus on the working class, lack of information regarding the specificity of their work difficult to recognize risk factors for certain diseases or health hazards, especially when the outcome it is the level of IF in the fields of leisure and work. The recognition of the level of physical inactivity, particularly those working in urban public transport, is of great value in order to provide information to help governing bodies to create public policy measures that include improvements in both the workplace and health this population. Objective: To determine the level of IF and associated factors among drivers and conductors of public transport of the city of Pelotas / RS. Methodology: Cross-sectional study of character in the census the urban area of Pelotas. All drivers and collectors working in the transportation of the city of Pelotas / RS for study. Data collection will be made through pre-tested questionnaires and coded, with questions on socioeconomic, demographic, labor conditions and health (musculoskeletal problems, level of IF and minor psychiatric disorders). The instrument used to determine the level of IF is the long version of the International Physical Activity Questionnaire (IPAQ), leisure and travel sections in the application interview on the previous week, including questions regarding the frequency and duration of performing activities moderate physical, vigorous and walking. Minor psychiatric problems or minor mental illnesses will be identified by the SRQ-Self-Report Questionnaire, an instrument consisting of 20 questions (SRQ-20) that can be answered through self-report or interview. The identification of musculoskeletal problems is through the reference of pain or discomfort located in different physical locations, as recommended by Kuorinka et al. (1987).
A inatividade física (IF) apresenta-se associada a uma série de doenças crônicas, atingindo pessoas em todas faixas etárias e de diferentes grupos sociais. Quando focamos a classe trabalhadora, escassez de informações referentes à specificidade de seu trabalho dificultam o reconhecimento de fatores de risco para determinadas doenças ou agravos a saúde, principalmente quando o desfecho trata-se do nível de IF nos domínios de lazer e trabalho. O reconhecimento do nível de inatividade física, em especial daqueles que trabalham no transporte coletivo urbano, é de grande valia no sentido de fornecer informações que auxiliem órgãos gestores de políticas públicas a criarem medidas que contemplem melhorias, tanto no ambiente de trabalho como para a saúde dessa população. Objetivo: Determinar o nível de IF e fatores associados em motoristas e cobradores do transporte coletivo urbano da cidade de Pelotas/RS. Metodologia: Estudo transversal de caráter censitário na zona urbana da cidade de Pelotas-RS. Todos os motoristas e cobradores que trabalham no transporte coletivo urbano da cidade de Pelotas/RS participarão do estudo. A coleta de dados será realizada através de questionários pré-testados e codificados, contendo questões sobre variáveis socioeconômicas, demográficas, condições de trabalho e saúde (problemas musculoesqueléticos, nível de IF e transtornos psiquiátricos menores). O instrumento utilizado para determinar o nível de IF será a versão longa do Questionário Internacional de Atividade Física (IPAQ), nas seções lazer e deslocamento com a aplicação de entrevista referente à semana anterior, contendo perguntas em relação à frequência e duração da realização de atividades físicas moderadas, vigorosas e da caminhada. Os problemas psiquiátricos menores ou doenças psíquicas menores serão identificados por meio do SRQ- Self-Report Questionnaire, instrumento constituído de 20 perguntas (SRQ-20) que podem ser respondidas através de autopreenchimento ou de entrevista. A identificação dos problemas musculoesqueléticos será através da referência de dor ou mal-estar localizado nas diversas localizações corporais, conforme recomendação de Kuorinka et al. (1987).
31
Encarnação, José Manuel Passeira. "Sintomas músculo-esqueléticos, compatibilidade homem-trabalho e qualidade de vida no trabalho em empresa industrial." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Ciências Empresariais, 2015. http://hdl.handle.net/10400.26/10660.
Full textAbstract:
Dissertação apresentada para cumprimento dos requisitos necessários à obtenção do grau de
Mestre em Segurança e Higiene no TrabalhoO trabalho desenvolvido, realizado numa empresa multinacional do setor industrial, teve como objetivos principais: Avaliar a incidência de queixas músculo-esqueléticas relacionadas com o trabalho; Avaliar a compatibilidade homem-trabalho na empresa em estudo; Avaliar a qualidade de vida no trabalho na organização em estudo. Para o efeito, foi aplicado um inquérito por questionário a uma amostra de 49 trabalhadores afetos à área operacional da empresa em estudo. O questionário aplicado encontra-se dividido em 4 instrumentos: 1.ª parte: Caraterização sociodemográfica; 2.ª parte: Inventário da Qualidade de Vida no Trabalho (IQVT); 3.ª parte: Compatibilidade do Trabalho (CT) e 4.ª parte: Questionário Nórdico Músculo-Esquelético (QNME). Pretendeu-se, com a aplicação destes instrumentos, avaliar a importância e a frequência da qualidade de vida no trabalho na empresa, avaliar a compatibilidade homem-trabalho e ainda aferir a presença de sintomas músculo-esqueléticos. Além disso, foram efetuadas diversas correlações entre as variáveis dos diferentes instrumentos aplicados (IQVT, CT e QNME) e entre estas e as variáveis sociodemográficas, no sentido de se perceber de que forma as mesmas influenciam a QVT e a CT. Os resultados obtidos permitem verificar que relativamente à QVT, a média global da escala de “Importância” (4,44-grau de importante) é superior à da “Frequência” (3,56-grau de frequente) em todas as dimensões. No que se refere à CT, os resultados obtidos com a aplicação do instrumento demonstram que o grau de exigência do trabalho é de nível moderado (3,00) para os trabalhadores. Quanto aos resultados alcançados com a aplicação do QNME, é possível verificar que, cerca de 80% da amostra em estudo apresenta queixas relacionadas com as LMERT. Quanto às possíveis correlações entre os instrumentos aplicados e variáveis sociodemográficas, não se verificou qualquer correlação. Através dos resultados alcançados, foi ainda possível elencar algumas recomendações de melhoria, com o intuito de apoiar a organização na implementação de medidas que visem a melhoria das condições de trabalho e de saúde dos trabalhadores.
Abstract: The work, carried out in a multinational company in the industrial sector, had as main objectives, to evaluate the presence of musculoskeletal symptoms at work, the worker-job compatibility and the working life quality. To achieve these objectives, a questionnaire was used on a sample of 49 employees affects to the operational area of the company. The questionnaire is divided into four sections: Part 1: Socio-demographic characterization; Part 2: Quality of Life at Work Inventory (QLWI); 3rd part: Labor Compatibility (LC) and 4th part: Nordic Musculoskeletal (NM). It was intended, with the application of this questionnaire, to evaluate the importance and frequency of worker’s QLW, assess the Worker-Labor Compatibility and still measure the presence of musculoskeletal symptoms. In addition, different correlations have been made between the different sections used (QLWI, WLC and NM) and between sociodemographic variables, in order to understand how they influence QLW and LC of the workers. The results, show that in relation to QLW, the global average of the range of "Importance" (4,44-importance level) is superior to the "Frequency" one (3,56-frequecy level), in all dimensions. Regarding the LC, the results with the application of the section, demonstrate that the degree of labor requirement is moderate (3,00) for the workers. As for the results achieved with the application of QNME it can see that about 80% of the sample under study have complaints related to MSDs. As for possible correlations between sections applied and sociodemographic variables, there was no correlation. Through the results achieved, it was also possible to list some recommendations for improvement, in order to support the organization in implementing measures to improve working conditions and workers health.
32
Daerga, Laila. "Att leva i två världar : hälsoaspekter bland renskötande samer." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-138405.
Full textAbstract:
Introduction: There is a gap of knowledge of the health situation among the reindeer herding Sami in Sweden. The Swedish government has also got criticism for not taking responsibility for the Sami health. The aim of this thesis was to get more knowledge to understand the health situation of the reindeer herding Sami in Sweden. Furthermore, gender specific risk factors in the working environment among reindeer herders and their perception of healthcare and social services were investigated. Method: Cross–sectional questionnaires covering different aspects of health such as musculoskeletal disorders, trust for different healthcare providers and work related psychosocial factors was distributed to reindeer herding Sami and non-Sami populations. Interviews with nine reindeer herding Sami about trust in healthcare and social services were carried out and analyzed with thematic analysis. Sixteen discussion meetings with 80 reindeer herders focusing on psychosocial perspectives of working conditions in Sami communities were performed. Result: The prevalence of musculoskeletal symptoms from elbow, hand/wrist and lower back from male reindeer herders were higher compared to blue-collar worker. Psychosocial risk factors for health were identified such as high workload on a few herders, difficulties to get relief and support as well as to get appreciation in work and lack of participation in decisionmaking among women were common in the organization of reindeer husbandry. The trust in healthcare and social services was lower among reindeer herding Sami compared to non-Sami majority population. A hypothesis is that healthcare professionals do not know that the "Reindeer cloud" (metaphor to iCloud) affects all parts in the reindeer herders life. The distrust are influenced by historically traumas, reindeer herding Sami experiences from healthcare professionals and healthcare organization and culturally generated norms. Conclusio: The thesis hypothesized that health disorders, attitude towards healthcare and psychosocial environment are important aspects when trying to understand the health situation among the reindeer herding Sami. There is a need to introduce long-term public health work for all Sami people, to establish ethical guidelines for Sami health research and develop healthcare services that provides access to healthcare for the reindeer herding Sami, on equal terms.
33
Mitra, Ganguli Tora. "Modulation of Voltage-Gated N-Type Calcium Channels by G Protein-Coupled Receptors Involves Lipids and Proteins: A Dissertation." eScholarship@UMMS, 2008. https://escholarship.umassmed.edu/gsbs_diss/389.
Full textAbstract:
Pain signaling involves transmission of nociceptive stimuli in the spinal cord where a critical balance between excitatory and inhibitory inputs determines the response to noxious stimuli. The neuropeptide, substance P (SP), mediates transmission of pain in part by binding to the tachykinin receptor (NK-1R) in the dorsal horn (DH) of the spinal cord. One of SP’s downstream effects is to modulate N-type Ca2+(N-) channels. While phospholipid breakdown is a part of the inflammatory process that accompanies tissue damage, the role of this metabolic pathway has not been completely described with respect to N-channel modulation during pain signaling. Despite the incomplete understanding of this modulation, pharmacological antagonists of both NK-1R and N-channels have been used to treat pain.
In Chapter II, using whole-cell patch clamp recording techniques, the SP signaling cascade that mediates inhibition of recombinant N-channel activity was characterized. By adopting a pharmacological approach, I show that this pathway resembles the slow pathway that was earlier described for modulation of N-current by the M1 muscarinic receptor (M1R). M1R couples to Gq to stimulate phospholipid breakdown. Together with previous observations, the data presented in this chapter provide evidence for involvement of the extracellular receptor kinase (ERK1/2), phospholipase A2 and release of phospholipid metabolites in the modulation of N-current by SP. Overall, this chapter shows that phospholipid metabolism involved in modulation of N-currents is not specific to M1Rs but that other Gq-coupled receptors may also modulate N-currents via the same signal transduction pathway.
In Chapter III, enhancement of N-current by SP was studied as part of a collaborative project to understand current enhancement that occurs when a palmitoylated accessory CaVβ2a subunit is co-expressed with the pore-forming subunit CaV2.2 and the accessory subunit α2δ-1. When CaVβ3 is present, SP inhibits N-current as described in Chapter II. However, when palmitoylated CaVβ2a is co-expressed with CaV2.2 (and α2δ-1), current enhancement is observed at negative test potentials, demonstrating that both M1Rs and NK-1Rs exhibit the same profile of N-current modulation. This change in modulation by muscarinic agonists is not observed in the presence of a depalmitoylated CaVβ2a. However a chimeric CaVβ2aβ1b subunit that contains the palmitoylated N-terminus from CaVβ2a confers enhancement. Normally expression of the β1b subunit resulted in current inhibition. These findings indicated that the palmitoylated CaVβ2a participates in enhancement of current. Our data support a model where inhibition dominates over enhancement; when inhibition is blocked, enhancement may be observed. Lastly, we show that N-current inhibition by SP is minimized when exogenous palmitic acid is applied to cells co-expressing CaVβ3 subunits with N-channels. These results indicate that the presence of palmitic acid can prevent N-current inhibition when SP is applied most likely by interacting with CaV2.2. We propose a model where palmitic acid occupies the inhibitory site and serves to antagonize inhibition by a lipid metabolite, which is most likely arachidonic acid. The CaVβ2a protein seems to have a role in positioning the palmitoyl groups near CaV2.2. This chapter provides a new role for protein palmitoylation where the palmitoyl groups of CaVβ2a are both necessary and sufficient to block inhibition of another protein: CaV2.2.
In Chapter IV, I probe the role of the relative orientation of CaVβ2a and the pore-forming subunit of the N-channel in N-current modulation. Evidence is presented that shows that not just the presence of a palmitoylated CaVβ2a is necessary, but the relative orientation of CaVβ2a to CaV2.2 is critical for blocking inhibition. Using N-channel mutants that cause a change in the orientation of CaVβ2a relative to CaV2.2, I show that the block of inhibition is disrupted; inhibition by the slow pathway is rescued. These findings further support my model that the palmitoyl groups of CaVβ2a normally reside in a specific location that overlaps with the slow pathway inhibitory site on CaV2.2. Lastly I present data showing that the enhancement of N-current, observed when palmitoylated CaVβ2a is present, occurs via the slow pathway.
In Chapter V the effect of CaVβ’s orientation on N-channel modulation by the dopamine D2 receptor is tested. In this form of modulation, inhibition is rapid and voltage-dependent. The signaling pathway is membrane-delimited since Gβγ, released after receptor stimulation, directly interacts with the N-channel at a site that overlaps with a high affinity binding site for CaVβs. While N-currents are modulated by this pathway, the deletion mutants show aberrant membrane-delimited modulation. The findings in this chapter further underscore the importance of proper positioning of CaVβ to CaV2.2 for eliciting proper N-current modulation after GPCR stimulation.
Overall, the data presented in this dissertation provides a mechanistic approach into examining modulation of N-current by different GPCRs via two different signaling pathways as well as the role CaVβ subunits serve in each modulatory pathway.
34
Isosaki, Mitsue. "Intervenção nas situações de trabalho em um serviço de nutrição hospitalar de São Paulo e repercussões nos sintomas osteomusculares." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-13012009-115732/.
Full textAbstract:
INTRODUÇÃO: Os trabalhadores dos Serviços de Nutrição Hospitalar são submetidos às exigências físicas, cognitivas e psíquicas que levam à distúrbios osteomusculares relacionados ao trabalho. O objetivo deste estudo foi implantar ações de melhorias nas situações de trabalho de um serviço de nutrição hospitalar e avaliar a percepção dos trabalhadores e as repercussões sobre os sintomas osteomusculares. MÉTODO: Esta pesquisa foi desenvolvida em um hospital público especializado em cardiologia, localizado em São Paulo, Brasil, após aprovação pelo comitê de ética da instituição. A coleta de dados foi realizada por meio da aplicação de questionários e análise ergonômica do trabalho. Os questionários continham dados sócio-demográficos, história ocupacional, situação de trabalho atual, sintomas osteomusculares e satisfação no trabalho. Do total de 130 trabalhadores, 115 participaram voluntariamente. A análise ergonômica do trabalho foi efetuada de acordo com Guérin et al (2001), sendo realizadas entrevistas, medições do ambiente da cozinha e análises biomecânicas. A partir dos resultados foram implantadas ações de intervenção baseadas na ergonomia participativa durante um ano. Após esta fase, 89 (77%) trabalhadores responderam novamente ao questionário, sendo incluídas perguntas sobre a percepção das modificações. A análise dos dados incluiu testes estatísticos para verificar se houve mudança da prevalência de sintomas antes e após as intervenções, com nível de significância de 5%, por meio dos Programas SPSS 13.0 e Excel 2003. Além disso, foram analisados os dados de percepção dos trabalhadores e dos especialistas em ergonomia sobre o impacto das melhorias na saúde e no processo de trabalho. RESULTADOS: A população constitui-se, em sua maioria, por mulheres, na faixa etária de 25 a 34 anos, com grau médio de escolaridade, casadas, com filhos, e ocupavam o cargo de atendente de nutrição. A maioria trabalhava de 5 a 10 anos no hospital e em jornada de trabalho de 40 horas semanais. Os principais problemas observados foram espaço físico reduzido, equipamentos e materiais de trabalho inadequados, absenteísmo e déficit de pessoal, volume excessivo de trabalho com elevado esforço mental, alta prevalência de sintomas osteomusculares, principalmente nos membros inferiores e ombros. Após as intervenções realizadas, houve melhoria na situação de trabalho com redução nos sintomas osteomusculares e os trabalhadores perceberam as seguintes mudanças nas situações de trabalho: melhoria na iluminação e no controle do ar condicionado, aquisição de batedeira de tamanho médio, conserto de equipamentos, substituição dos pratos de vidro por descartáveis, aquisição de cadeiras, introdução de pausas durante a jornada de trabalho, ginástica laboral e treinamento em liderança para as chefias. Neste período houve ampliação no número de leitos do hospital com conseqüente aumento no volume de trabalho e diminuição da satisfação no trabalho associados à crise financeira da instituição com suspensão de contratações e da compra de materiais e equipamentos. CONCLUSÕES: As intervenções repercutiram em melhorias, principalmente quanto ao ambiente e equipamentos, e na redução dos sintomas osteomusculares nos membros inferiores, ombros, pescoço/região cervical, antebraço e região lombar, apesar desta redução não ter sido estatisticamente significativa.INTRODUCTION: Hospital food service workers have high level of physical, cognitive and mental demands that are associated with musculoskeletal disorders. The objective of this study was to introduce improvements in the working conditions in a hospital food service and to evaluate the workers perceptions and its effects on musculoskeletal symptoms. METHOD: this study was performed in a public cardiac hospital in São Paulo, Brazil, after its approval by the Ethics Committee. The data were collected by questionnaires and ergonomic analysis of the work. The questionnaire included: socio-demographic, workhistory, work conditions, musculoskeletal symptoms and job satisfaction. A hundred and fifteen questionnaries were applied from 130 workers. The work ergonomic analysis was carried out in accordance with Guérin et al (2001), by means of interviews, observations of kitchen working conditions and biomechanical analyses. Based on the results, interventions have been undertaken by means of a participatory ergonomic approach over one year. After this, another ergonomic analysis was carried out and 89 workers (77%) answered a new questionnaire that also included questions about their perception of the improvements. Data analysis was done by statistical tests to verify symptom prevalences before and after the interventions with a 5% level of significance. SPSS 13.0 and Excel 2003 software was used. RESULTS: The workers were women in the 25-34 age-group, had secondary education, were married, had children and occupied the position of nutrition attendants. They were in this hospital for from 5 to 10 years and on a 40 hour working week schedule. Most of problems observed were reduced space, inadequate equipment and work materials, absenteeism, insufficient number of workers, great volume of work with mental demands, high prevalence of musculoskeletal symptoms mainly in lower members and shoulders. After the improvements in working conditions, the symptoms of musculoskeletal disorders reduced and the workers perceived the following changes in the work process: better lighting and control of air conditioning, acquisition of low capacity mixer, repair of equipment, use of disposable utensils instead of glass plates, acquisition of more chairs, introduction of breaks during working hours, work related gymnastics, workshops for leadership training. In this period the number of hospital beds was increased with a corresponding intensification of the work load and a decline on job satisfaction. The hospital was in a financial crisis with consequences in terms of the hiring of personnel and the acquisition of equipment and materials. CONCLUSION: Interventions brought improvements mainly as regards the work environment and equipment and in the reduction of musculoskeletal symptoms in the lower members, shoulders, neck/cervical region, forearm and lumbar region, though this reduction has not been statistically significant.
35
Silva, Luciane Goulart da. "Condições de trabalho e saúde de professores pré-escolares da cidade de Pelotas." Universidade Federal de Pelotas, 2011. http://repositorio.ufpel.edu.br/handle/ri/1852.
Full textAbstract:
Made available in DSpace on 2014-08-20T13:49:18Z (GMT). No. of bitstreams: 1
Luciane G da Silva.pdf: 886455 bytes, checksum: f38d456501fecb57ccf797bfdcb900c0 (MD5)
Previous issue date: 2011-03-25the workers in education, nowadays, face problems like the increase of the students matriculated, lack of equipments and essential material or lack of maintenance of the ones that exist, lack of infrastructure and material resources, and others. The knowledge of the work conditions and their reflection in the teacher´s health, especially at those who work with childhood education, is very important to give information that helps public politician s managers to create measures that comprehend improvements, to both work environment and population involved health. Objectives: To investigate the work and health conditions of preschool teachers from the public schools in Pelotas, RS. Methodology: Descriptive study. All the preschool teachers of the city and the state will be part of this study. The collect of the data will be performed using a pretested and codified questioner, comprehend socioeconomic, demographic, work conditions and health (musculoskeletal problems, the level of physical activity, the voice problems correlated and the minor psychological disorders) variables. The instrument used to determinate the level of physical activity will be the long version of the International Physical Activity Questionnaire (IPAQ), performing an interview regarding the previous week, including questions about the frequency and duration of the realization of moderated and intense physical activity and walking. The minor psychological problems or the minor psychiatric disease will be identified by the SRQ Self-Report Questionnaire, instrument comprising 20 questions (SRQ-20) that can be answered by self-report or interview. The identification of the musculoskeletal problems will be by the report of the presence of pain or uneasiness located at the body, according to Kuorinka et al. (1987). Problems related to the voice will be investigated by the Brazilian versions of the V-RQOL (Hogikyan & Sethuraman, 1999), which received the name Qualidade de Vida em Voz QVV (Behlau et al. 2009)
Os trabalhadores em educação, atualmente, encontram problemas como aumentos de alunos matriculados, ausência de equipamentos e materiais essenciais ou falta de manutenção dos existentes, insuficiência de infra-estrutura e de recursos materiais, entre outros. O conhecimento das condições de trabalho e suas repercussões na saúde dos professores, em especial dos que trabalham na educação infantil, é de grande valia no sentido de fornecer informações que auxiliem órgãos gestores de políticas públicas a criarem medidas que contemplem melhorias, tanto no ambiente de trabalho como para a saúde dessa população. Objetivo: investigar as condições de trabalho e saúde de professores pré-escolares da cidade de Pelotas/RS. Metodologia: Estudo descritivo no qual participarão todos os professores pré-escolares que atuam em escolas municipais e estaduais da zona urbana da cidade de Pelotas/RS. A coleta de dados será realizada através de questionário pré-testado e codificado contendo questões sobre variáveis socioeconômicas, demográficas, condições de trabalho e saúde (problemas musculoesqueléticos, nível de atividade física, problemas relacionados à voz e transtornos psiquiátricos menores). O instrumento utilizado para determinar o nível de atividade física será a versão do Questionário Internacional de Atividade Física (IPAQ) na forma longa, com a aplicação de entrevista referente à semana anterior, contendo perguntas em relação à freqüência e duração da realização de atividades físicas moderadas, vigorosas e da caminhada. Os problemas psiquiátricos menores ou doenças psíquicas menores serão identificados por meio do SRQ- Self-Report Questionnaire, instrumento constituído de 20 perguntas (SRQ-20) que podem ser respondidas através de autopreenchimento ou de entrevista. A identificação dos problemas musculoesqueléticos será através da referência de dor ou mal-estar localizado nas diversas localizações corporais, conforme recomendação de Kuorinka et al (1987). Problemas relacionados à voz serão mensuradas pelo Protocolo de Qualidade de Vida e Voz (QVV) (Behlau et al. 2009), versão brasileira do Voice- Related Quality of Life (V-RQOL) (Hogikyan & Sethuraman, 1999)
36
Torá, Rocamora Isabel 1979. "Historia natural y factores determinantes de la duración de las incapacidades temporales por contingencia común en trabajadores afiliados a la Seguridad Social." Doctoral thesis, Universitat Pompeu Fabra, 2013. http://hdl.handle.net/10803/283472.
Full textAbstract:
Esta tesis doctoral está basada en el estudio de los factores determinantes de la duración de la incapacidad temporal por contingencia común (ITcc). Se examina la variabilidad geográfica de la duración de la ITcc entre comarcas de Cataluña para episodios de ITcc en general y para dos patologías frecuentes, trastornos musculoesqueléticos (TME) y trastornos mentales. Se utilizan datos de cohortes de episodios de ITcc cedidos por el Institut Català d’Avaluacions Mèdiques i Sanitàries (ICAMS) de la Generalitat de Catalunya. Se analizaron todos los primeros episodios de ITcc finalizados en el año 2007 y 2010 estudiando factores individuales (sexo, edad, diagnóstico, entidad gestora del episodio, régimen de afiliación a la Seguridad Social y rama de actividad económica) y/o contextuales relacionados con recursos sanitarios (número de áreas básicas de salud) y socioeconómicos (cuota de mercado y tasa de desempleo) que podrían explicar la variabilidad observada. Se utilizaron modelos de regresión multinivel de riesgos proporcionales con episodios anidados en comarcas. También se propone un modelo de fragilidad condicional basado en un enfoque Poisson para analizar la duración de la ITcc (u otro evento de interés) en presencia de eventos repetidos para un mismo individuo, y se muestra la utilidad del modelo para analizar dicha duración en grandes bases de datos. Se utilizaron episodios de ITcc finalizados en el año 2007 por trastorno mental y por neoplasia, a partir de los cuales se comparó empíricamente el modelo de fragilidad condicional (CFM) y el enfoque propuesto basado en un modelo de fragilidad condicional Poisson (CFPM).This thesis is based on the study of the determinants of the duration of sickness absence (SA). We examined the geographic variability of the SA duration between comarcas of Catalonia for SA in general and for two common groups of disorders, musculoskeletal disorders (MSDs) and mental health disorders. Cohort data of SA episodes ceded by the Institut Català d’Avaluacions Mèdiques i Sanitàries (ICAMS) of the Generalitat of Catalunya were used. All first SA episodes ending in 2007 and 2010 were analyzed studying individual factors (sex, age, diagnosis, entity managing the sick leave, employment status, and economic activity branch) and contextual factors related to health resources (number of basic health areas) and socioeconomic indicators (market share and unemployment rate) that could explain the observed variability. Multilevel proportional hazard regression models with episodes nested in comarcas were used. This thesis also proposes using a conditional frailty model based on a Poisson approach for analyzing SA duration (or other event of interest) in the presence of repeated events in the same individual, and demonstrates the usefulness of such a model to analyze large datasets. SA episodes ending in 2007, caused by mental health disorders and neoplasms were used, from which the conditional frailty model (CFM) and a novel approach based on a conditional frailty Poisson model (CFPM) were compared empirically.
37
Jalkebo, Charlotte. "Placement of Controls in Construction Equipment Using Operators´Sitting Postures : Process and Recommendations." Thesis, Linköpings universitet, Maskinkonstruktion, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-108980.
Full textAbstract:
An ergonomically designed work environment may decrease work related musculoskeletal disorders, lead to less sick leaves and increase production time for operators and companies all around the world. Volvo Construction Equipment wants to deepen the knowledge and investigate more carefully how operators are actually sitting whilst operating the machines, how this affects placement of controls and furthermore optimize controls placements accordingly. The purpose is to enhance their product development process by suggesting guidelines for control placement with improved ergonomics based on operators’ sitting postures. The goal is to deliver a process which identifies and transfers sitting postures to RAMSIS and uses them for control placement recommendations in the cab and operator environments. Delimitations concerns: physical ergonomics, 80% usability of the resulted process on the machine types, and the level of detail for controls and their placements. Research, analysis, interviews, test driving of machines, video recordings of operators and the ergonomic software RAMSIS has served as base for analysis. The analysis led to (i) the conclusion that sitting postures affect optimal ergonomic placement of controls, though not ISO-standards, (ii) the conclusion that RAMSIS heavy truck postures does not seem to correspond to Volvo CE’s operators’ sitting postures and (iii) and to an advanced engineering project process suitable for all machine types and applicable in the product development process. The result can also be used for other machines than construction equipment. The resulted process consists of three independent sub-processes with step by step explanations and recommendations of; (i) what information that needs to be gathered, (ii) how to identify and transfer sitting postures into RAMSIS, (iii) how to use RAMSIS to create e design aid for recommended control placement. The thesis also contains additional enhancements to Volvo CE’s product development process with focus on ergonomics. A conclusion is that the use of motion capture could not be verified to work for Volvo Construction Equipment, though it was verified that if motion capture works, the process works. Another conclusion is that the suggested body landmarks not could be verified that they are all needed for this purpose except for those needed for control placement. Though they are based on previous sitting posture identification in vehicles and only those that also occur in RAMSIS are recommended, and therefore they can be used. This thesis also questions the most important parameters for interior vehicle design (hip- and eye locations) and suggests that shoulder locations are just as important. The thesis concluded five parameters for control categorization, and added seven categories in addition to those mentioned in the ISO-standards. Other contradictions and loopholes in the ISO-standards were identified, highlighted and discussed. Suggestions for improving the ergonomic analyses in RAMSIS can also be found in this report. More future research mentioned is more details on control placement as well as research regarding sitting postures are suggested. If the resulted process is delimited to concern upper body postures, other methods for posture identification may be used.
38
Wood, Sarah. "Efficacy of Myofascial Decompression for Musculoskeletal Conditions." Thesis, 2021. https://vuir.vu.edu.au/42510/.
Full textAbstract:
Musculoskeletal pain is highly prevalent and a significant contributor to global disability and disease, with most countries reporting neck and low back pain as a leading cause of disability. The use of the complementary therapy, dry cupping and its modified technique, myofascial decompression are becoming an increasingly popular modality utilised by manual and physical therapists in western clinical practice, aimed at reducing musculoskeletal pain and improving mobility. The aim of this thesis was to investigate the efficacy of dry cupping techniques in the treatment of musculoskeletal pain and improving range of motion.
Firstly, this research critically evaluated the evidence from randomised controlled trials through a systematic review and meta-analysis to determine the efficacy and safety of western dry cupping methods. A systematic literature search was performed from March until April 2018, for randomised controlled trials (RCT) pertaining to musculoskeletal pain or reduced range of motion, treated with dry cupping. Outcomes were pain, functional status, range of motion and adverse events. Risk of bias and quality of evidence was assessed using the modified Downs & Black checklist and GRADE. A total of 21 RCTs with 1049 participants were included. Overall, the quality of evidence was fair, with a mean Downs & Black score of 18/28. Low-quality evidence revealed that dry cupping had a significant effect on pain reduction for chronic neck pain (MD, -21.67; 95% CI, -36.55, to -6.80) and low back pain (MD, -19.38; 95%CI, -28.09, to -10.66). Moderate-quality evidence suggested that dry cupping improved functional status for chronic neck pain (MD, -4.65; 95%CI, -6.44, to -2.85). For range of motion, low quality evidence revealed a significant difference when compared to no treatment (SMD, -0.75; 95%CI, -0.75, to 0.32). Dry cupping was found to be effective for reducing pain in patients with chronic neck pain and non-specific low back pain. However, definitive conclusions regarding the effectiveness and safety of dry cupping for musculoskeletal pain and range of motion were unable to be reached due to the low to moderate quality of evidence.
Secondly, this research aimed to test the feasibility of a randomised controlled crossover trial comparing dry cupping techniques to provide recommendations for future research. The study compared myofascial decompression (dry cupping with active movement) with static dry cupping (dry cupping with no movement) and an active movement protocol (control) and assessed pressure pain threshold and range of motion. This study’s findings suggest that dry cupping techniques improve both pain threshold and range of motion; however, it is unknown whether myofascial decompression is superior to active movement only and could be investigated in future studies.
This thesis provides a critical review of the available evidence for the use of dry cupping therapy for musculoskeletal conditions. For definitive conclusions on the efficacy of dry cupping, further systematic reviews and meta-analyses are required as larger dry cupping randomised controlled trials are published. Furthermore, this thesis provides a basis for future research to be undertaken, specifically investigating the efficacy of myofascial decompression for the treatment of musculoskeletal pain and improving range of motion.
39
Bergsten, Eva L. "Working conditions and musculoskeletal disorders in flight baggage handling." Doctoral thesis, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-316468.
Full textAbstract:
Introduction: Baggage handling is considered to be a heavy manual handling job including biomechanical exposures suspected of increasing the risk for musculoskeletal disorders. Aims: To document low back pain (LBP), shoulder pain (SP), and physical and psychosocial factors in baggage handlers, and to evaluate the implementation of an ergonomic intervention aiming to increase the use of loading assist devices. Methods: A questionnaire was utilized to characterize pain and psychosocial work conditions in 525 baggage handlers. The postures of 55 baggage handlers during 114 shifts were measured using inclinometry, half shift video-recordings were made for subsequent task analysis, and the number of aircraft handled was registered. Associations for psychosocial and biomechanical exposures with pain were assessed using regression analyses. An ergonomic intervention was implemented and evaluated using questionnaires and repeated interviews. Feasibility, intermediate outcomes, barriers and facilitators were assessed. Results: The prevalence rates of reported LBP and SP were 70% and 60%, respectively. Pain interfering with work (LBP - 30% and SP - 18%) and high pain intensity (LBP - 34% and SP - 28%) were associated with poor psychosocial working conditions. Extreme postures with arms elevated >60° occurred for 6.4% of the total time, and in trunk flexion >60° for 2.1% total time. In contrast, 71% of the total time was spent in a neutral trunk posture. The 90th percentile trunk forward flexion was 34.1°. Daily shoulder pain increased in approximately one-third of all shifts and was positively associated with extreme work posture and the number of aircraft handled; this association was modified by influence and support. The intervention was delivered as planned, and dose received and satisfaction were rated as high. Motivated trainees facilitated implementation while lack of manager support, opportunities to observe and practice behaviors, follow-up activities, staff reduction, and job insecurity were barriers. Conclusion: The high prevalence rates of LBP and SP in baggage handlers were associated with psychosocial exposures, and daily shoulder pain was associated with higher biomechanical exposure. Barriers to implementation can be minimized by recruiting motivated trainees, securing strong organizational support, and carrying out follow-up activities.
40
Stanhope, Jessica Louise. "The preventable burden of musculoskeletal conditions in Australian musicians." Thesis, 2019. http://hdl.handle.net/2440/123109.
Full textAbstract:
Background: The prevalence of musculoskeletal symptoms (MSSs) among musicians is reportedly high, and may have a profound impact upon those affected. Most studies have been conducted on university classical music students and professional orchestral musicians, leaving other sub-groups, such as military band musicians and opera singers, under-investigated. Even for these most commonly researched groups, there have been relatively few studies investigating the impact of MSSs, or their preventability in terms of psychosocial and organisational factors potentially associated with MSS outcomes. The central research question in this thesis was: “is there a preventable burden of musculoskeletal conditions among Australian university music students and professional musicians?”. Methods: Data were obtained from two sources: the National Data Set for Compensation-based Statistics, and a targeted questionnaire survey developed specifically for this project. Questionnaire development was informed by a systematic search and narrative review of the types of outcomes and data collection tools used to assess musicians’ MSS outcomes. The questionnaire was distributed to university music students and professional musicians, as well as a reference group of university science students and non-music university staff. The utility of the questionnaire measures was examined using Rasch analysis. Data were analysed using standard statistical methods. Results: Musculoskeletal disorders accounted for the majority of workers’ compensation claims (WCCs) made by musicians (70%), and the majority of costs (78%). Of the musicians surveyed, 90% reported MSSs in the last 12 months, and 57% reported experiencing MSSs in the last 12 months that impaired musical activities. Musculoskeletal symptoms were most common in the upper limb and spinal regions. There was no significant difference in MSS prevalence overall between musicians and the reference groups, however music students reported a higher prevalence of wrist/hand MSSs specifically. Symptomatic music students also reported higher ratings of the emotional impact of MSSs than did science students. A higher proportion of symptomatic female professional musicians reported moderate-severe pain than their university staff counterparts. The majority (82%) of musculoskeletal WCCs made by musicians were attributed to body stressing. All symptomatic musicians surveyed provided at least one perceived cause (of up to three reported) of their MSSs that was likely modifiable or preventable. The most commonly reported such perceived causes were behavioural factors (94%). Psychological distress was identified as the most important modifiable personal factor to address, as it was associated with most MSS outcomes. The evidence for other factors was less consistent, however social support, musical activity time, sitting time, and perceived work effort were associated with specific MSS outcomes. Conclusion: Evidence from this research indicates that there is a preventable burden of musicians’ musculoskeletal conditions. To reduce this burden, interventions should be developed that are directed at psychological distress. The effectiveness of these interventions should be examined with particular reference to MSSs in the upper limb and spinal regions, and to the consequences of having MSSs. If found to be safe and effective, appropriate interventions could be implemented nationally, to reduce the burden of musicians’ musculoskeletal conditions.Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 2019
41
Batista, Paula Alexandra Gouveia. "Musculoskeletal pain among Workers in Portugal - the European Workimg Conditions Survey." Master's thesis, 2016. https://hdl.handle.net/10216/87554.
Full text
42
Batista, Paula Alexandra Gouveia. "Musculoskeletal pain among Workers in Portugal - the European Workimg Conditions Survey." Dissertação, 2016. https://hdl.handle.net/10216/87554.
Full text
43
Batista, Paula Alexandra Gouveia. "Musculoskeletal pain among Workers in Portugal - the European Workimg Conditions Survey." Dissertação, 2002. https://repositorio-aberto.up.pt/handle/10216/87554.
Full text
44
O'Brien, Kate Maree. "Telephone-based management for patients with osteoarthritis and other musculoskeletal conditions." Thesis, 2019. http://hdl.handle.net/1959.13/1405176.
Full textAbstract:
Research Doctorate - Doctor of Philosophy (PhD)Musculoskeletal conditions, including osteoarthritis of the knee or hip and spinal pain, are leading causes of global disability. Despite this, evidence suggests that the vast majority of patients with osteoarthritis and spinal pain do not receive care that is consistent with evidence-based clinical practice guidelines, including encouragement to engage in physical activity and support to lose weight. Two key barriers to the provision of guideline-recommended care are concerned with the accessibility of such care, and scalability of existing clinical models of care. Telephone-based models of care are a promising option to support patients with musculoskeletal conditions. While a number of trials investigating the use of telephone-based interventions for osteoarthritis and spinal pain have been published there remains uncertainty about the effectiveness and cost-effectiveness of telephone interventions for patients in this population group. In Chapter Two, a systematic review was conducted to assess the effectiveness of telephone-based interventions to support patients with osteoarthritis and spinal pain on pain intensity and disability. Seven electronic databases were searched for randomised controlled trials (RCTs) and non-randomised controlled trials that aimed to test the effectiveness of telephone-based interventions for patients with osteoarthritis and spinal pain. Twenty-three studies with a total of 4,994 participants were included. All included studies examined interventions focused on supporting self-management and providing education in addition to a range of intervention targets, for example, physical activity. The review found moderate-quality evidence that telephone-based interventions reduce pain intensity (n = 5 trials, n = 1,357 participants, standardised mean difference (SMD) -0.27, 95%CI:-0.53 -0.01, Tau2 = 0.06, I2 = 74%) and disability (n = 7 trials, n = 1,537 participants, SMD -0.21, 95%CI: -0.40 to -0.02, Tau2 = 0.03, I2 = 56%) compared to usual care. There was moderate-quality evidence that telephone plus face-to-face interventions are no more effective than face-to-face interventions alone. The results highlight the potential for telephone-based services to support osteoarthritis and spinal pain patients to access better quality care. All clinical practice guidelines for osteoarthritis recommend weight loss as a core treatment for patients with knee osteoarthritis. Despite these recommendations, few overweight patients with knee osteoarthritis receive care to support weight loss. There is evidence to support telephone-based approaches in achieving modest weight loss among overweight participants in the general population. Similarly, telephone-based interventions have been found to be effective in addressing behavioural determinants of weight, diet and physical activity in the general population. However, there are no previous studies primarily focused on the provision of weight loss care via telephone for patients with knee osteoarthritis. Chapters Three and Four presents an a priori protocol and statistical analysis plan for a high-quality pragmatic RCT testing the effectiveness of referring patients with knee osteoarthritis, who are overweight or obese, to an existing non-condition specific telephone-based weight loss intervention. Eligible patients (n=120) were randomly allocated to receive the weight loss intervention or usual care. Chapter Five presents the results of the trial and showed that there were no differences between groups for knee pain intensity over 6 months (area under the curve, mean difference 5.4, 95%CI: -13.7 to 24.5, p=0.58; equivalent to a 0.2 point difference on the pain intensity numerical rating scale 95%CI: -0.53 to 0.94) or weight change (the hypothesised mechanism to reduce pain intensity) at 6 months (self-reported weight; mean difference -0.4, 95%CI: -2.6 to 1.8, p=0.74). These results suggest that among patients with knee osteoarthritis who are overweight, telephone-based weight loss support, provided using an existing weight loss intervention might not adequately support patients with knee osteoarthritis to reduce knee pain intensity or weight. Given the scarce resources in healthcare, policy-makers are increasingly requiring evidence of economic value for healthcare interventions to make informed decisions about how to allocate resources. Therefore, undertaking economic evaluations of knee osteoarthritis management approaches is important. Chapter Six presents an economic evaluation of the RCT presented in Chapters Three, Four and Five. Quality-adjusted life years (QALYs) was the utility measure of effect and pain intensity, disability, weight, and BMI were the clinical measures of effect. Costs included intervention costs, healthcare utilisation costs (healthcare services and medication use) and absenteeism costs due to knee pain, collected using a patient self-reported inventory. The primary cost-effectiveness analysis was performed from the societal perspective, which accounted for a range of cost categories (intervention costs, healthcare utilisation costs and absenteeism costs due to knee pain). Mean cost differences between groups (intervention minus control) were $493 (95%CI: -3513 to 5363) for healthcare costs, $-32 (95%CI: -73 to 13) for medication costs, and $125 (95%CI: -151 to 486) for absenteeism costs. The total mean difference in societal costs was $1197 (95%CI: - 2887 to 6106). For QALYs and all clinical measures of effect, the probability of the intervention being cost-effective compared with usual care was less than 0.36 at all willingness-to-pay values. These findings suggest from a societal perspective referral to an existing non-condition specific telephone-based weight loss service was not a cost-effective relative to usual care for quality-adjusted life years (QALYs). Whilst the studies included in this thesis have advanced the evidence-base regarding the effectiveness of telephone-based interventions for the delivery of recommended care for patients with osteoarthritis and spinal pain, there remain a number of aspects that require further investigation. Specifically, although the systematic review found that telephone-based interventions should be considered for the management of osteoarthritis and spinal pain, the referral of patients with knee osteoarthritis patients who were overweight or obese to an existing telephone weight loss service was neither effective nor cost-effective despite offering a scalable, accessible option for the delivery of weight loss care. Given the high prevalence of osteoarthritis, and that excess weight is a key driver for the onset and progression of this condition; a dedicated line of research to understand how to best deliver weight loss support at scale is warranted. This research should focus on how to best integrate and optimise scalable, effective weight loss interventions into clinical practice; such that clinicians can embed this care into routine practice and improve outcomes for patients with osteoarthritis.
45
Gattie, Eric. "Dry needling provided by physical therapists for the management of musculoskeletal pain conditions." Thesis, 2021. http://hdl.handle.net/1959.13/1429178.
Full textAbstract:
Research Doctorate - Doctor of Philosophy (PhD)Background: Dry needling is utilized by a growing number of physical therapists to treat musculoskeletal conditions. However, current evidence for its effectiveness is mixed and lacking long-term outcomes. Little is known about physical therapy practice patterns and safety performing dry needling. Purpose: To investigate (1) the effectiveness of dry needling as applied by physical therapists (Systematic review), (2) physical therapy clinical practice patterns related to dry needling (Survey), and (3) the long-term effectiveness of dry needling in patients with neck pain when applied using a typical physical therapy clinical approach (Randomized clinical trial). Methods: A systematic review with meta-analysis determined the effectiveness of dry needling applied by physical therapists for patients with musculoskeletal pain. A survey of physical therapists assessed dry needling practice patterns and adverse events. A sham-controlled randomized clinical trial with 1-year follow-up investigated the effectiveness of dry needling when added to a multi-modal treatment program of manual therapy and exercise for improving pain and disability in patients with mechanical neck pain. Results: The review of 13 studies (8 meta-analyses) found low to moderate quality evidence for dry needling in the short-term when compared to control/sham/other treatment, but few other long-term effects were reported. Fifty-five percent of 865 physical therapists surveyed performed dry needling, with practices consistent with expert advice. Minor adverse events were common. Major adverse events were rare, but more common than anticipated (407 occurrences reported by 413 respondents), 8 requiring emergency medical attention. The randomized clinical trial found no group-by-time interactions at 4-weeks, 6-months or 1-year for any outcomes (p>0.5), indicating the addition of dry needling to an evidence-based treatment had no added benefit. However, both groups demonstrated significant improvement in all outcomes (p<0.5) that was maintained to the 1-year follow up. Conclusions: The review found low to moderate quality evidence that dry needling is more effective compared to sham, no treatment, and physical therapy treatments in the short/medium-term, but not in the long-term. Physical therapists commonly apply dry needling, consistent with expert opinion, with frequent minor and several major adverse events reported. Adding dry needling to evidence-based care for patients with mechanical neck pain does not improve outcomes. These findings suggest dry needling may benefit some patients with musculoskeletal pain, but does not provide additional benefits beyond current evidence-based care in patients with neck pain. Potential risks of major adverse events suggest caution when applying dry needling and a need for more standardized training.
46
Jenkins, Heather Theresa. "Work-related thumb disorders in South African physiotherapists treating musculoskeletal conditions using manual therapy techniques." Thesis, 2014.
Find full textAbstract:
Of all the structures in the hand, the thumb is the most vulnerable to biomechanical and work-related
injuries in physiotherapists using manual therapy techniques. The objectives of the current study were
to determine the prevalence and factors associated with work – related thumb problems (WRTP) in
South African physiotherapists and establish the strategies they used in the management of the thumb
problems. A cross-sectional, descriptive study design was used and data were collected using an
internet-based questionnaire.
The life-time prevalence of WRTP in South African physiotherapists using manual therapy techniques
was 65.3% in survey one and 67.5% in survey two. The factors that were significantly associated with
WRTP in all 395 respondents were hyperextension >10° of the knee on the non-dominant side
(p=0.02), passive F of the thumb to the anterior forearm (p=0.04), hyperextension >30°of the nondominant
IP joint of the thumb (p=0.02) and the treatment of more than six patients a day with
manual therapy to the cervical spine (p=0.02). The factors that were significantly associated with
WRTP in all 395 respondents in the univariate analysis were put in a regression analysis. The factors
that remained significantly associated with WRTP were the cervical treatment of up to six patients a
day (p=0.01) and hyperextension>30° of the non-dominant IP joint of the thumb (p=0.05).
The factors that were significantly associated with WRTP in the 258 respondents who had WRTP
were all grades of transverse glides applied to the spine (p<0.001), grade II-IV unilateral and central
posterior-anterior pressures to the spine (p< 0.001), Additional occupational factors significantly
associated with WRTP (p<0.001) included an increase in thumb use in the performance of manual
techniques, inadequate training in injury prevention, a high, repetitive workload, working with a
current injury, working in sustained, uncomfortable positions, inadequate rest periods, working at or
near your physical limits and manual chest physiotherapy (p=0.005).The strategies most commonly
used by the physiotherapists in the management of the WRTP were the modification of the technique
and the use of a different technique. Randomised control trials are recommended to investigate the
effectiveness of the preventative and management strategies of WRTP in physiotherapists.
47
Williams, Amanda Jayne. "The relationship between musculoskeletal conditions and chronic disease, and the management of lifestyle risk factors." Thesis, 2019. http://hdl.handle.net/1959.13/1397865.
Full textAbstract:
Research Doctorate - Doctor of Philosophy (PhD)Musculoskeletal conditions, such as spinal pain and osteoarthritis (OA) have a high global burden. Although evidence suggests that musculoskeletal conditions are linked with both chronic diseases and lifestyle risk factors, there are significant evidence gaps in our understanding of these relationships. This thesis attempts to explore the relationship between musculoskeletal conditions and chronic diseases and assess the management of lifestyle risk factors in patients with common musculoskeletal conditions including chronic low back pain and knee OA. Chronic diseases and musculoskeletal conditions have a significant global burden and frequently co-occur. Emerging evidence suggests musculoskeletal conditions may contribute to the development of chronic disease and several mechanisms have been proposed to explain these links. However, the available studies have not been systematically synthesised, and longitudinal relationships have not been assessed. In Chapter Two, a systematic review was performed to investigate whether the most common musculoskeletal conditions contribute to the development of non-communicable chronic diseases. Electronic databases were searched for cohort studies reporting adjusted estimates of the association between musculoskeletal conditions (neck or back pain or osteoarthritis of the knee or hip) and subsequent development of chronic disease (cardiovascular disease, cancer, diabetes, chronic respiratory disease or obesity). Thirteen eligible cohort studies following 3,086,612 people were identified. In the primary meta-analysis of adjusted estimates, osteoarthritis was the exposure in eight studies and back pain in two studies and cardiovascular disease was the outcome in eight studies, cancer in one study, and diabetes in one study. Pooled adjusted estimates from these ten studies showed that people with a musculoskeletal condition, have a 17% increase in the risk of developing a chronic disease, compared to people without a musculoskeletal condition (hazard ratio 1.17, 95%CI 1.13 to 1.22; I2 52%, total n=2,686,113). The meta-analysis found musculoskeletal conditions may increase the risk of chronic disease. The results highlight that musculoskeletal conditions could be important in the prevention of chronic disease. There is evidence to suggest that the persistence of low back pain is linked to lifestyle risk factors, such as overweight and obesity. Although there is widespread suggestion that managing lifestyle risks such as weight, should be part of management for patients with low back pain, there is currently no evidence about the effectiveness of lifestyle management to guide clinical practice. Chapter Three presents a study protocol (Part A) and statistical analysis plan (Part B) for the first high quality randomised controlled trial (RCT) testing whether targeting lifestyle risk factors could improve outcomes for patients with chronic low back pain. Eligible patients (n=160) were randomly allocated, using a central concealed random allocation process, to receive advice and education and referral to a 6-month telephone-based healthy lifestyle coaching service, or usual care. Chapter Four presents the results of the trial and showed that there were no differences between groups for pain intensity over six months (area under the curve, mean difference 6.5, 95%CI -8.0 to 21.0; p=0.38) or any secondary outcome. The lifestyle intervention did not reduce self-reported weight, the hypothesised mechanism to influence important patient outcomes such as pain and disability. The results suggest that clinical education and advice coupled with referral to generic, non-disease specific telephone-based healthy lifestyle coaching may not adequately support patients with chronic low back pain. Standard analyses of RCTs estimate whether an intervention is effective or not. However, these analyses cannot provide explanations for how an intervention works, or why it does not work. Causal mediation analysis of RCTs can be used to determine if intervention effects worked through the hypothesised targets or if they are explained by other mechanisms. When there are no intervention effects, causal mediation analysis can help to determine if changing the targets is likely to lead to the outcome of interest. Chapter Five and Six presents an a priori protocol and results of a causal mediation analysis, respectively, of aggregated data from two RCTs; one which included 160 patients with chronic low back pain (the RCT presented in Chapters Three and Four), and another which included 120 patients with knee OA. In both trials the intervention consisted of brief advice and referral to a 6-month telephone-based healthy lifestyle coaching service. In the back pain trial participants were also offered a single physiotherapy consultation. The hypothesised primary mediator was self-reported weight and alternative mediators were diet, physical activity and pain beliefs. Outcomes were pain, disability and quality of life (QoL). Data were analysed using causal mediation analysis with sensitivity analyses for sequential ignorability. The intervention had no effect on pain intensity, disability or physical QoL. The intervention significantly improved mental QoL however, the intervention effect was not channeled via the selected mediators. The intervention did not reduce weight, or the alternative mediators (diet, physical activity, pain beliefs), and these mediators were not associated with the outcomes (with one exception; poor diet was associated with lower mental QoL). Although clinical guidelines advocate focusing on lifestyle risk factors and erroneous pain beliefs in patients with chronic low back pain or knee OA, there is uncertainty about whether they are causes of pain, disability, and poor QoL. These findings suggest that addressing lifestyle risk factors and erroneous pain beliefs may not be appropriate targets to improve pain, disability and quality of life in these patients. Decision makers often have limited funds and are required to choose between health care interventions. Economic analysis of RCTs provide decision makers with information to help guide allocation of scarce resources. Chapter Six presents an economic evaluation of a healthy lifestyle intervention for patients with chronic low back pain, compared with usual care (the RCT presented in Chapters Three and Four). The primary outcome was quality-adjusted life years (QALYs). Secondary outcomes were pain intensity, disability, weight, and body mass index. Costs included intervention costs, healthcare utilisation costs and work absenteeism costs. The primary analysis was conducted from the societal perspective and included all of these cost categories. Mean total costs were lower in the intervention group than the control group (-$614, 95%CI -3133 to 255). For all outcomes, the intervention was on average less expensive and more effective than usual care and the probability of the intervention being cost-effective compared to usual care was relatively high (i.e. 0.81) at a willingness-to-pay of $0/unit of effect. For QALYs, this probability increased to 0.90 at a willingness-to-pay of $17,000/QALY and reached a maximum of 0.96 at $67,000/QALY. However, the probability of cost-effectiveness was not as favourable among sensitivity analyses. These findings suggest that the healthy lifestyle intervention seems to be cost-effective from the societal perspective. However, variability in the sensitivity analyses indicate caution is needed when interpreting these findings. Overall, the studies included in this thesis have advanced the evidence-base regarding the relationship between musculoskeletal conditions and chronic disease, and the management of lifestyle risk factors. A systematic review of the literature suggests that musculoskeletal conditions should be considered in the prevention of chronic disease. However, a better understanding of the relationships between musculoskeletal conditions and chronic diseases is required to support inclusion of musculoskeletal conditions in the current chronic disease prevention agenda. To improve understanding about causal relationships, use of contemporary analytical methods in the assessment of longitudinal data is needed. Other aspects of this thesis explore management of lifestyle risk factors in patients with musculoskeletal conditions. Using existing population health services might be a scalable and cost-effective model to support clinicians to provide lifestyle-focused care for patients with musculoskeletal conditions. However, in their generic form, they do appear to produce clinically meaningful benefit to patients. Given the high prevalence of musculoskeletal conditions, a dedicated line of research would be warranted to support adaptation of available services for patients with musculoskeletal conditions and concomitant health risks. To maximise knowledge gained from the investment in research, clinical trialists should routinely plan and use supplementary analyses, such as causal mediation analyses and economic evaluations, in addition to standard analyses of treatment effectiveness. These methods of analysis extend knowledge from RCTs to guide intervention refinement and can inform decisions about resource allocation for clinical or policy decision-makers.
48
Gylfadóttir, Halldóra Sif. "Application of the six-minute walk test in populations with neuromuscular and musculosketetal conditions : a methodologic perspective." Thesis, 2003. http://hdl.handle.net/2429/14599.
Full textAbstract:
Rationale: Over the past decade, the six-minute walk (SMW) test has been increasingly used as an assessment tool and treatment outcome measure in populations with neuromuscular and musculoskeletal conditions. Recently, the validity of the test has been called into question. Contamination of the test results with uncontrolled extraneous variables due to an apparent lack of standardization in the administration of the test, and lack of monitoring, recording, and reporting of these variables, may lead to major discrepancies in the test results, thereby limiting optimal clinical decision making, and the interpretability of the test results in research. Purposes: 1) To review systematically the application of the SMW test in research studies on individuals with neuromuscular and musculoskeletal conditions from a methodological perspective, 2) To examine common clinical measures that may influence walk performance in the SMW test in people with chronic poliomyelitis, and to examine the test-retest reliability of the SMW distance, lower extremity muscle strength, balance, and balance confidence on separate trials in the same cohort, and 3) To formulate guidelines for conducting the test to meet the special needs of patients with neuromuscular and musculoskeletal conditions. Results: 1) Sixty-five studies were included in the systematic review. Of these, 25 used the test as an assessment tool, and 40 as a treatment outcome measure. There was marked variability in the administration of the SMW test across studies. 2) The SMW distance correlated with physiological cost index (PCI), pre test pain, lower extremity muscle strength, balance, balance confidence, corrected leg length discrepancy, and lung function, but not with rate pressure product, ratings of perceived exertion, post test pain, pre and post test fatigue. The PCI correlated with balance confidence and lung function. About 68% of variance in SMW distance was accounted for by balance and pre-test pain. 3) Clinical practice guidelines for the SMW test were extended. Conclusion: Based on tightened guidelines of the SMW test for patients with chronic poliomyelitis, walking may be improved by optimizing balance and controlling pain. We propose that these guidelines be adopted universally and applied systematically across clinical and research applications for patients with neuromuscular/musculoskeletal, as well as cardiovascular/cardiopulmonary conditions.
49
Ribeiro, Hermínia. "Adaptação cultural, validade e fiabilidade da versão portuguesa do Musculoskeletal Health Questionnaire (MSK-HQ)." Master's thesis, 2022. http://hdl.handle.net/10400.26/39546.
Full textAbstract:
Introdução: As condições músculo-esqueléticas (CME) têm uma elevada prevalência na população mundial sendo uma das maiores causas de anos vividos com incapacidade. Desta forma, ter uma avaliação e resposta efetiva por parte dos serviços de saúde é primordial. Evidências recentes têm sugerido que é adequado e relevante considerar um conjunto de domínios comuns na gestão e avaliação de resultados nas várias CME. O Musculoskeletal Health Questionnaire (MSK-HQ) é um instrumento que avalia todos estes domínios. O objetivo deste estudo foi adaptar culturalmente o MSK-HQ para português europeu e analisar a sua validade e fiabilidade em indivíduos com CME.
Metodologia: Este estudo realizou-se em duas fases. A primeira fase foi constituída pela tradução e a adaptação cultural do MSK-HQ, e seguiu as atuais orientações internacionais.
A segunda fase foi composta por um estudo observacional, longitudinal e multicentro, integrando uma amostra de indivíduos com CME no contexto de tratamentos de fisioterapia. Na avaliação inicial todos os participantes preencheram a versão portuguesa do MSK-HQ, a escala numérica da dor (END) e a versão portuguesa do questionário europeu de qualidade de vida (EQ-5D-3L). Os participantes com dor lombar, cervical, no joelho e no ombro preencheram instrumentos específico da região do corpo, pois faziam parte de subgrupos específicos pré-definidos. Após 4 a 7 dias, os participantes preencheram o MSK-HQ e a versão portuguesa do Patient Global Impression of Change (PGIC). Os dados recolhidos na avaliação inicial foram utilizados para o estudo da consistência interna e da validade de construto. Os dados dos participantes clinicamente estáveis após 4 a 7 dias foram utilizados
para análise da fiabilidade teste-reteste e erro de medição.
Resultados:
O MSK-HQ foi traduzido e adaptado para Português Europeu com sucesso. A fase 2 do estudo contou com uma
Palavras-chave: Musculoskeletal Health Questionnaire; adaptação cultural; validade; fiabilidade; condições músculo-esqueléticas
amostra de 191 participantes. O MSK-HQ apresentou uma
elevada consistência interna (α de Cronbach=0,885) e uma excelente fiabilidade teste-reteste (CCI(2,1)=0,908). Observaram-se ainda correlações moderadas entre o MSK-HQ e o EQ-5D-
3L (rs=0,671) e entre o MSK-HQ e todos os instrumentos específicos de região do corpo. O
erro padrão de medida foi de 2,82 e a diferença mínima detetável de 7,81.
Conclusão: O MSK-HQ revelou adequada consistência interna e fiabilidade teste-reteste. A maioria das hipóteses pré-definidas para a validade de construto foram confirmadas. Estes resultados apontam para a utilização da MSK-HQ em contexto clínico e de investigação em
indivíduos com CME.Introduction: Musculoskeletal conditions (MSC) have high prevalence in world's population being one major cause of years lived with disability. In this way, having an effective assessment and response by the health services is essential. Recent evidence has suggested that it is appropriate and relevant to consider a set of common domains in the management and evaluation of health outcomes in the various MSCs. The Musculoskeletal Health Questionnaire (MSK-HQ) is an instrument that assesses all those domains. The aim of this study was to culturally adapt the MSK-HQ to European Portuguese, and to analyze its validity and reliability in individuals with MSC. Methodology: This study was conducted in two phases. The first phase consisted of the translation and cultural adaptation of the MSK-HQ and followed current international guidelines. The second phase consisted in an observational, longitudinal and multicenter study, integrating a sample of individuals with MSC in the context of physiotherapy care. In the initial assessment, all participants filled in the Portuguese version of the MSK-HQ, the Numerical Pain Scale (NPS), and the Portuguese version of the European Quality of Life Survey (EQ-5D-3L). Participants with low back, neck, knee and shoulder pain filled in instruments specific to the body region, as they belonged to specific predefined subgroups. After 4 to 7 days, participants filled the MSK-HQ and the Portuguese version of the Patient Global Impression of Change (PGIC). Data collected in the initial assessment were used to study the internal consistency and construct validity. Data from the patients clinically stable after 4 to 7 days were used for analysis of the test-retest reliability and measurement error. Results: MSK-HQ was successfully translated and adapted to European Portuguese. Phase 2 of the study had a sample of 191 participants. MSK-HQ showed high internal consistency (α de Cronbach=0,885), and an excellent test-retest reliability (ICC(2,1)=0,908). Moderate correlations were also observed between the MSK-HQ and the EQ-5D-3L (rs=0,671), and between the MSK-HQ and all body-region specific instruments. The standard error was 2,82 and the minimum detectable difference was 7,81. Conclusion: MSK-HQ revealed adequate internal consistency and test-retest reliability. Most of the hypothesis predefined for the validity of the construct were confirmed. These results point to the use MSK-HQ in a clinical and research context in individuals with MSC.
50
Balasukumaran, Tharani. "The implication of backward walking in the rehabilitation of neuro-musculoskeletal conditions: systematic reviews and a biomechanical movement analysis." Thesis, 2018. https://hdl.handle.net/10539/25223.
Full textAbstract:
A thesis submitted to the Faculty of Health Science, University of the Witwatersrand, in fulfilment of the requirements for the degree of
Doctor of Philosophy in Physiotherapy, Johannesburg, South Africa 2018The neuro-musculoskeletal gait impairments have an enormous and growing impact in the world. Estimation shows that one in four people suffer from gait impairments as a major limitation. It reduces the quality of life with poor balance, muscle fatigue, joint stiffness and deformity. To treat neuromuscular gait impairments proper rehabilitation training is crucial. Walking is one of the functional training used by therapist for rehabilitation. Though, walking refers a forward walking (FW) in our daily life backward walking (BW) was reported for an effective functional exercise in rehabilitation. The underlying biomechanical characteristics such kinetic and kinematic parameters of both FW and BW were studied to understand and predict the clinical benefits. Biomechanical characteristics of FW were studied extensively with respect to speed, inclination, and surface. Whereas, limited reports on BW were found with level and uphill walking with comfortable/fixed speed on both ground and treadmill. It is important to study biomechanical characteristics with respect to speed and inclination to understand neural control strategies and musculoskeletal activities during BW. This helps to evaluate their clinical worthiness before implementing on patients. The comparison of FW with BW as a systematic review is an optimum way to reveal their clinical benefits and unique changes in locomotion task. As there is no systematic review is available in the literature, the present thesis designed with two systematic reviews and an experimental study. In brief the methodologies followed in this thesis were as follow: The two systematic reviews identified existing literature based on a structured search strategy applied to various databases. The outcomes were statistically analysed by RevMan software. For experimental study, 3Dkinematic movements were tracked by reflective markers using Qualisys cameras. Force plate integrated treadmill was used to measure GRF and muscle activities were recorded by wireless EMG. These Qualisys camera, treadmill and EMG were synchronised with QTM software. The collected data were analysed and processed through Visual3D software. The processed data were used to simulate an anthropometric model via OpenSim software. This software was used to calculate the kinematic and kinetic parameters. The first systematic review in Chapter-3 explores the clinical effectiveness of BW as a functional training for neuro-musculoskeletal gait impairment condition. This review dealt with six types of comparison with BW as an experimental group. The systematic search strategy finalises the eight trials with three conditions such as knee osteoarthritis (OA), stroke, and diabetic peripheral neuropathy. The primary outcome measures were the pain, functional disability, muscle strength, gait parameters, balance and plantar pressure. The results show BW with CPT was significantly effective in reducing knee OA pain (total SMD: -0.87), lowering functional difficulties (total SMD: -1.39) and improving muscle strength (SMD: 1.51). In conclusion BW with CPT is an effective and clinically worthwhile training for rehabilitation of knee OA. The second systematic review in Chapter-4 deals with biomechanical characteristics BW through comparison of FW for healthy participants to understand neuromuscular contributions. Twenty trials were found through systematic search strategy for kinematic and kinetic outcomes. The results show that BW significantly different from FW with lower hip flexion, knee flexion, tibiofemoral joint reaction force, ankle joint power, hip joint power, GRF and temporal gait parameters. The muscles GM, BF, RF, and LGAS are more active in BW than FW. Hence, the modified neural control strategies were required to produce BW from FW. The absence of visual cues in BW improves the neuromuscular control, proprioception and protective reflexes. Among the trials, BW in water found to be safer and yields better results than ground and treadmill. The experimental study in Chapter-5 analysed biomechanical characteristics of FW and BW with controlled speed and inclination. Ten healthy participant were chosen for FW and BW in three inclinations (-5%, 0% and +5%) and speeds (0.28 m/s, 0.69 m/s and 1.11 m/s). The study concludes that, walking speed is directly related to energy requirements. Increasing the speed requires higher magnitudes of the joint moment, joint power and muscle activity irrespective of inclination and direction. In FW and BW, uphill and downhill task produces opposite joint moment with a variety of flexor and extensor muscles contributions. These indicate that the motor control task requires different control strategies for inclined walking. The anatomical constraint and visual cues give additional features in biomechanical parameters of BW. Hence, a simple time reversal is not sufficient to distinguish between BW and FW. Interestingly, the similarities were observed between FW uphill and BW downhill or FW downhill and BW uphill in hip/knee joint moment and muscle activities. Such as during FW uphill and BW downhill an extension moment was present at the hip joint and a flexion moment at the knee joint. Here, the biarticular muscles BF was active in both types of walking. But we cannot conclude both types of walking were controlled by the same neural network as power patterns were distinctly different. The distributions of total power flow among joints were found to be related to the posture associated with the inclination in both FW and BW. Ankle contribution is more in both FW uphill and BW downhill (leaned trunk) whereas hip contributes for FW downhill and BW uphill (erected trunk). In level walking ankle dominates in both FW and BW irrespective of speeds. The ankle joint had main propulsion at all inclination and speed during FW and BW except FW uphill.
XL2018