ICU admission is associated with decreased physical function for years after discharge. The underlying mechanisms responsible for this muscle function impairment are undescribed. The aim of this study was to describe the biomechanical properties of the quadriceps muscle in ICU survivors 12 months after ICU discharge.
Case-control study with consecutive inclusion of ICU survivors and age- and sex-matched controls.
Patients were treated at a mixed 18-bed ICU at a tertiary care university hospital and tested at a biomechanical university laboratory.
We included 16 male ICU patients (Acute Physiology and Chronic Health Evaluation II score 20 ± 7, mean ± SD), who had stayed in the ICU >72 hrs and survived to 12 months and 15 age- and sex-matched controls.
An extensive battery of biomechanical tests, including maximum, fast, and endurance contractions, was administered during isometric knee extensions while simultaneously recording surface electromyography (quadriceps and hamstrings). Compared to controls, ICU survivors had reduced maximal voluntary torque (22%, 179 ± 64 Nm vs. 230 ± 57 Nm, p = 0.03), absolute rate of force development (50%, 868 ± 372 Nm/sec vs. 1739 ± 470 Nm/sec, p
Comment In: Crit Care Med. 2013 Jan;41(1):345-623269143
The lack of complete occupational histories causes underestimates or overestimates of occupational mortality and morbidity. The problem is emphasized in cohorts with high turnover and in cross-sectional study designs. In the study of the effect of selective turnover on occupational mortality and morbidity complete occupational histories were acquired via questionnaire. The sample comprised 1 200 current and 1 800 alive former workers and the closest relatives of 450 deceased workers and was formed from three exposure-level cohorts (defined primarily according to the physical demands of the work) of 15 714 metal workers hired in 1950-1976. The occupational histories reported in the questionnaires were compared with those collected from employers' personnel records. The coverage of occupational histories was the most accurate for current and former workers with the longest duration of exposure and the least accurate for dead workers and the oldest age groups. The use of complete occupational histories and the combining of the similar levels of exposure through the lifetime produced clear differences in the occurrences of musculoskeletal, respiratory, and cardiovascular diseases between the three levels of exposure. The errors in person-years were smaller than the errors in the duration of exposure; the coverage varied from 51 to 94%. However, misclassification clearly caused cancer cases to be located in classes with too short a period of latency. About 30% of the deceased workers had reportedly entered the industry before the first follow-up year.
The character of upper limb disorder in computer operators is subject to debate. A peripheral nerve-involvement is suggested from the common presence of a triad of symptoms consisting of pain, paraestesiae and subjective weakness, and from physical findings suggesting neuropathy. This study aimed to examine the outcome of a detailed neurological examination in computer operators and to compare findings with the presence of symptoms.
96 graphical computer operators answered a modified Nordic Questionnaire including information on perceived pain in the shoulder, elbow, and wrist/hand scored for each region on a VAS-scale 0-9. In addition, they underwent a physical examination including the subjective assessment of the individual function of 11 upper limb muscles, of algesia in five and vibratory threshold in three territories, respectively, and of mechanosensitivity of nerves at seven locations. In order to reflect an involvement of the brachial plexus (chord level), the posterior interosseous nerve and the median nerve at elbow level we defined three patterns of neurological findings illustrating the course of nerves and their innervation. The pain scores summarized for the three upper limb regions (min. = 0, max = 27) in the mouse-operating and contralateral limbs were compared by a Wilcoxon test and the relation to each physical item analyzed by Kendall's rank correlation. The relation of summarized pain to each pattern was studied by application of a test of the trend across ordered groups (patterns).
Pain, paraestesiae and subjective weakness was reported for 67, 23, and 7 mouse-operating limbs, respectively, with the summarized pain scores exceeding 4 in 33 limbs. Abnormal physical findings were prevalent. The summarized pain was significantly related to a reduced function in five muscles, to mechanical allodynia at one location and to elevated threshold to vibration in two territories. Brachial plexopathy was diagnosed in 9/2, median neuropathy in 13/5 and posterior interosseous neuropathy in 13/8 mouse operating/contralateral limbs, respectively. The summarized pain was significantly higher in the mouse-operating limbs and in limbs with any of the defined patterns. There was a significant trend between the summarized pain and the summarized scores for the items contained in each pattern.
This small-scale study of a group of computer-operators currently in work and with no or minor upper limb symptoms has indicated in symptomatic subjects the presence of peripheral nerve-afflictions with specific locations.
Cites: J Bone Joint Surg Am. 1999 Nov;81(11):1600-1010565653
Diastasis recti abdominis (DRA) is defined as a separation of the 2 muscle bellies of rectus abdominis. To date there is scant knowledge on prevalence, risk factors, and consequences of the condition. The present study aimed to investigate the prevalence of DRA during pregnancy and post partum, presence of possible risk factors, and the occurrence of lumbopelvic pain among women with and without DRA.
This prospective cohort study followed 300 first-time pregnant women from pregnancy till 12 months post partum. Data were collected by electronic questionnaire and clinical examinations. DRA was defined as a palpated separation of =2 fingerbreadths either 4.5 cm above, at or 4.5 cm below the umbilicus. Women with and without DRA were compared with independent samples Student's t-test and ?(2)/Fisher exact test, and OR with significance level >0.05.
Prevalence of DRA was 33.1%, 60.0%, 45.4%, and 32.6% at gestation week 21, 6 weeks, 6 months and 12 months post partum, respectively. No difference in risk factors was found when comparing women with and without DRA. OR showed a greater likelihood for DRA among women reporting heavy lifting =20 times weekly (OR 2.18 95% CI 1.05 to 4.52). There was no difference in reported lumbopelvic pain (p=0.10) in women with and without DRA.
Prevalence of mild DRA was high both during pregnancy and after childbirth. Women with and without DRA reported the same amount of lumbopelvic pain 12 months post partum.
An indicator of permanent disability was used to measure the chronic health problems associated with garment work. The study population comprised 800 female sewing-machine operators employed in the Quebec garment industry between 1976 and 1985. The workers were identified from public agency records. Their disability status was obtained in a personal interview. The disability prevalence of these workers was compared to national disability data of women employed in clerical work, services, and manufacturing industries. The garment workers who had left employment had an increased prevalence of severe disability (in comparison with that of workers who had left other types of employment) and an increased prevalence of moderate and slight disability. Currently employed garment workers had an increased prevalence of moderate and slight disability when compared with workers currently employed in other occupations. The risk ratios remained similarly elevated when the data were adjusted for age and smoking status.
In Oslo there are significant differences in the incidence and prevalence of medically determined disability pensions. In regions with a population characterized by low level of education and low annual income the prevalence of disability pensions is high in relation to regions with a highly educated and high income population. The main reasons for a disability pension are mental complaints, mainly anxiety and depressive states, and musculo-skeletal disorders (chronic states of muscular pain). In recent years subjective symptoms have become an increasingly more important reason for disability pensions. Social and economic factors, possibility of employment, and other non-medical factors seem to play a more determining role than ill health in the process leading to disability.
This study measured the association between duration of employment in piecework and the prevalence of severe disability among 533 Quebec female garment workers who left employment between 1976 and 1985. Yearly information regarding occupational characteristics was available from a public agency for the 30-year period 1956-1985. Information on disability status was collected in a personal interview. Duration of employment in piecework was associated with the prevalence of severe disability. A multivariate analysis found that the association was independent of age, smoking habits, education, type of task and total length of employment. Workers who spent 5-9, 10-14, 15-19, and greater than or equal to 20 years in piecework had an increased prevalence of severe disability in comparison with the base-line category of 0-4 years. The adjusted risk ratios were 2.2 [95% confidence interval (95% CI) 1.0-4.6], 3.3 (95% CI 1.5-6.9), 3.6 (95% CI 1.5-8.4), and 2.3 (95% CI 0.8-6.6), respectively. The association was particularly strong for disability due to musculoskeletal problems and disability due to cardiovascular disorders although small numbers were involved.