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Comparative development of antitrochanteric disease in male and female turkeys of a traditional line and a contemporary sire-line fed ad libitum or with restricted quantities of food.

The prevalence of musculoskeletal disease at eight, 16, 24, 34, 44 and 54 weeks of age in male and female turkeys was determined by dissecting 688 limbs from traditional lines and sire-line turkeys fed to achieve different bodyweights. Traditional turkeys were fed ad libitum and sire-line turkeys were fed ad libitum or restricted to 0.5 during rearing and subsequently to 0.8 of ad libitum-fed bodyweight of birds of the same strain and sex. A group of male sire-line turkeys was also fed ad libitum to 18 weeks and 0.8 of ad libitum thereafter. Lameness during the rearing period was usually associated with joint infection. Ruptured ligaments were an occasional finding in sire-line turkeys before sexual maturity. The major finding at 34, 44 and 54 weeks of age was degeneration of the antitrochanter in both sexes of the sire-line. The prevalence and severity of disease increased with age but was not generally associated with lameness. Antitrochanteric degeneration in the sire-line was diminished by decreasing bodyweight through food restriction. Antitrochanteric degeneration did not occur in traditional turkeys.

Animals↗

Computer-aided generation of stimulation data and model identification for functional electrical stimulation (FES) control of lower extremities.

Standard stimulation data for unassisted standing up of paraplegic patients was generated by dynamic optimization linked with model simulation, to overcome the difficulties in the present electromyogram (EMG)-based method. The generated stimulation data were roughly in agreement with the normal subjects' EMG. From these, it is suggested that the 'model-based' method is useful as an alternative of the 'EMG-based method'. The same technique can be applied to generation of patient-specific stimulation data once the musculoskeletal system of a patient is properly identified. The musculoskeletal system must be identified from data taken from simple and noninvasive experiments for the identification method to be practically acceptable. We developed a musculoskeletal model and systematic identification protocols for this purpose. They were validated for the vastus lateralis muscle at the knee joint. The identification was successful and the predicted joint angle trajectories closely matched the experimental data. This implies that the model-based generation of patient-specific stimulation data is possible.

Computer Simulation↗

The ergonomics of caring for children: an exploratory study.

BACKGROUND: Caring for one's children is among the most ubiquitous of occupations. However, few studies have examined the ergonomic risks involved in parents caring for children at home. PURPOSE: The purpose of this study was to identify the frequency, type, and severity of musculoskeletal symptoms in parents of children less than 4 years old. The study further examined the factors that contribute to musculoskeletal pain in this sample. METHODS: A convenience sample of 130 parents with children younger than 4 years old completed a seven-page survey that included questions related to the parents' demographics, their musculoskeletal discomfort, their performance of child-care tasks with high biomechanical risks (such as carrying a child in a car seat), and parents' perceived psychological strain related to caring for their children. RESULTS: Ninety-two percent (92%) of the providers were mothers. Sixty-six percent (66%) of the sample reported the presence of musculoskeletal pain. The parts of the body most affected were the low back (48%), neck (17%), upper back (16%), and shoulders (11.5%). Factors associated with musculoskeletal pain were performing child-care tasks defined as having high biomechanical risks (p = .001), the perception that caring for children is highly demanding (p = .003), and performing hobbies less than 1 hour per week (p = .04). Parents' working status, age, and participation in other daily activities were not significantly related to musculoskeletal discomfort. CONCLUSION: This study demonstrates the high prevalence of musculoskeletal pain in parents of children under the age of 4 years. It underscores the association between physical and psychological factors in the development of musculoskeletal discomfort. It suggests the need for occupational therapy wellness programs that focus on preventing musculoskeletal discomfort and providing support for the parenting role.

Adult↗

Lyme disease associated with fibromyalgia.

OBJECTIVE: To describe the clinical and laboratory findings as well as results of treatment in patients with Lyme disease associated with fibromyalgia. DESIGN: Observational cohort study. The mean duration of observation was 2.5 years (range, 1 to 4 years). SETTING: Diagnostic Lyme disease clinic in a university hospital. PATIENTS: Of 287 patients seen with Lyme disease during a 3.5-year period, 22 (8%) had fibromyalgia associated with this illness, and 15 (5%) participated in the observational study. MEASUREMENTS: Symptoms and signs of fibromyalgia, immunodiagnostic tests for Lyme disease, and tests of neurologic function. RESULTS: Of the 15 patients, 9 developed widespread musculoskeletal pain, tender points, dysesthesias, memory difficulties, and debilitating fatigue a mean duration of 1.7 months after early Lyme disease; the remaining six patients developed those symptoms during the course of Lyme arthritis. At the time of our evaluation, late in the course of their illness, 11 patients had positive immunoglobulin (Ig) G antibody responses to Borrelia burgdorferi by enzyme-linked immunosorbent assay (ELISA), one had a positive Western blot, and the three seronegative patients had positive cellular immune responses to borrelial antigens. Four patients had abnormal cerebrospinal fluid analyses that showed an elevated protein level, a slight pleocytosis, or intrathecal antibody production to the spirochete. The signs of Lyme disease resolved with antibiotic therapy, usually intravenous ceftriaxone, 2 g/d for 2 to 4 weeks, except in one patient with persistent knee swelling. However, 14 of the 15 patients continued to have symptoms of fibromyalgia. Currently, only one patient is completely asymptomatic. CONCLUSIONS: Lyme disease may trigger fibromyalgia, but antibiotics do not seem to be effective in the treatment of the fibromyalgia.

Adult↗

[Occupational and individual risk factors of muscular pain].

It is suggested that occupational exposure to muscle load should be described by three factors to indicate health risks: level, repetitiveness and duration. A reduction in level is beneficial if the level is high (> 10-15% MVC). However, even a low level involves risk of musculoskeletal complaints if the exposure is repetitive. A reduction of the occupational exposure from 7-8 hours to 4-5 hours per day delays the development of musculoskeletal complaints, but does not provide long-term reduction of risk with frequent repetitions. When interventions are carried out to reduce the risk of occupational musculoskeletal complaints, it is necessary to consider psychosocial and individual constitutional factors in addition to the three factors constituting the occupational exposure to muscle load.

Biomechanical Phenomena↗

Local knowledge and attitudes about onchocerciasis in Oji-River local government area of Enugu State, Nigeria.

A total of 556 individuals in Agbalenyi Community of Oji-River local government area of Enugu State, Nigeria were studied using questionnaires, focus group discussions and key informant interviews to determine the socio-cultural factors affecting the transmission of onchocerciasis. The result revealed a low level of knowledge about the cause, prevention and complications of onchocerciasis. Respondents have developed a cultural system around the disease due to long exposure. The majority are aware of the disease which they recognize once their body starts itching or musculoskeletal pain develops but only 64.4, 34.0, 1.4 and 3.6%, respectively attributed chronic itching, nodules, bad vision and leopard skin to blackfly bite. Other perceived causes mentioned include ageing, the type of food eaten, farm work and 'bad blood'. Only 0.8% knew diagnosis could be made through skin snips. Neither Oji-River nor any of the river systems were associated with any of the complications of onchocerciasis. Significant differences in most socio-demographic characteristics were associated with differences in the level of knowledge about the disease.

Adolescent↗

Definition and assessment of specific occupational demands concerning lifting, pushing, and pulling based on a systematic literature search.

AIMS: (1) To find a universal strategy for the identification of specific demands of a job or task, focusing on occupations in which there may be an increased risk for health complaints owing to these specific demands. (2) To select reliable and valid tests concerning lifting, pushing, and pulling, which consider the relation between occupational work demands and the assessment of the maximally acceptable load on an individual level. METHODS: Literature search was performed using Medline (1988 to May 2001), Embase (1966 to May 2001), and NIOSHTIC (1971-98). RESULTS: No universal strategy was found for the definition of specific occupational demands. Therefore a "three step strategy" was formulated for defining specific occupational demands in a job or a task in order to prevent health complaints on an individual level. Many tests were found in the literature concerning lifting, but only a few concerning pushing and pulling. None of the tests concerning pushing, pulling, or lifting considered the relation between work demands and the assessment of the maximally acceptable load on an individual level. Furthermore, none of the tests met the criteria of reliability and prognostic value for musculoskeletal complaints completely. Only for the prognostic value of relative strength capacity tests concerning pushing pulling and lifting, did there appear to be limited proof for the development of musculoskeletal complaints. CONCLUSIONS: In general, for the prevention of work related health complaints, it can be suggested that more attention should be paid to: (1) the definition of specific occupational demands; (2) the assessment of specific occupational demands; and (3) the quality of tests for specific occupational demands.

Humans↗

Musculoskeletal involvement in systemic lupus erythematosus.

Involvement of the musculoskeletal system is common if not universal in the clinical course of systemic lupus erythematosus (SLE). Joint involvement on the whole does not cause major erosive disease, however, recent developments in musculoskeletal imaging show clearly the presence of significant bony and soft tissue involvement. It might well explain the frequently observed discordance between the clinical signs and the articular symptoms assuming that fibromyalgia has been excluded. The clear demonstration of tendon involvement in SLE by MRI would merit considering tendonitis and tenosynovitis as candidates for inclusion in the diagnostic criteria.

Humans↗

Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art.

In an attempt to explain how and why some individuals with musculoskeletal pain develop a chronic pain syndrome, Lethem et al. (Lethem J, Slade PD, Troup JDG, Bentley G. Outline of fear-avoidance model of exaggerated pain perceptions. Behav Res Ther 1983; 21: 401-408).ntroduced a so-called 'fear-avoidance' model. The central concept of their model is fear of pain. 'Confrontation' and 'avoidance' are postulated as the two extreme responses to this fear, of which the former leads to the reduction of fear over time. The latter, however, leads to the maintenance or exacerbation of fear, possibly generating a phobic state. In the last decade, an increasing number of investigations have corroborated and refined the fear-avoidance model. The aim of this paper is to review the existing evidence for the mediating role of pain-related fear, and its immediate and long-term consequences in the initiation and maintenance of chronic pain disability. We first highlight possible precursors of pain-related fear including the role negative appraisal of internal and external stimuli, negative affectivity and anxiety sensitivity may play. Subsequently, a number of fear-related processes will be discussed including escape and avoidance behaviors resulting in poor behavioral performance, hypervigilance to internal and external illness information, muscular reactivity, and physical disuse in terms of deconditioning and guarded movement. We also review the available assessment methods for the quantification of pain-related fear and avoidance. Finally, we discuss the implications of the recent findings for the prevention and treatment of chronic musculoskeletal pain. Although there are still a number of unresolved issues which merit future research attention, pain-related fear and avoidance appear to be an essential feature of the development of a chronic problem for a substantial number of patients with musculoskeletal pain.

Chronic Disease↗

Inflammation reduces physiological tissue tolerance in the development of work-related musculoskeletal disorders.

Work-related musculoskeletal disorders (MSDs) cause substantial worker discomfort, disability and loss of productivity. Due to the difficulty in analyzing the tissues of patients in the early stages of work-related MSD, there is controversy concerning the pathomechanisms of the development of these disorders. The pathophysiology of work-related MSD can be studied more easily in animal models. The purpose of this review is to relate theories of the development of tissue injury due to repeated motion to findings of recent investigations in animals that address the role of the inflammatory response in propagating tissue injury and contributing to chronic or recurring tissue injury. These tissue effects are related to behavioral indicators of discomfort and movement dysfunction with the aim of clarifying key time points for specific intervention approaches. The results from animal models of MSD are discussed in the light of findings in patients, whose tissues are examined at a much later phase of MSD development. Finally, a conceptual model of the potentially negative impact of inflammation on tissue tolerance is proposed along with suggestions for future research directions.

Animals↗

Lower quarter screening for skeletal malalignment--suggestions for orthotics and shoewear.

Skeletal malalignments of the lower quarter, deformities within a bone or at a joint, may be the primary cause of musculoskeletal patient problems. Skeletal malalignments also may sustain the presence of a musculoskeletal patient problem that has some other causal mechanism. A screening exam for skeletal alignment of the lower quarter may assist clinicians in identifying skeletal malalignments that are associated with a musculoskeletal complaint. The purposes of this paper are to: 1) describe components for a skeletal alignment screening exam, 2) analyze how lower quarter malalignments may influence lower quarter function and contribute to the development of musculoskeletal pathology, and 3) suggest general characteristics of foot orthoses and shoes that may assist in the management of musculoskeletal patient problems of the lower quarter.

Biomechanical Phenomena↗

Permeability of musculoskeletal tissues and scaffolding materials: experimental results and theoretical predictions.

Fluid movement produces a wide range of phenomena in musculoskeletal tissues, including streaming potentials, hydrodynamic lubrication, nutrient transport, and mechanical signaling, all of which are governed by tissue permeability. Permeability is a measurement of the ease with which a fluid passes through a material and is described by Darcy's law. An appreciation of the flow-related structure-function relationships that have been found for musculoskeletal tissues as well as the materials used to engineer substitutes is important for clinicians and engineers alike. In addition, fluid transport phenomena is one of the most often neglected, but important, aspects of developing functional musculoskeletal tissue replacements. Mathematical models provide the means to relate permeability to microstructure and enable one to span multiple hierarchical length scales. In this article, we have summarized the experimentally determined permeability for a range of musculoskeletal tissues. In addition, we have included a summary of the microstructural models that are available to relate bulk permeability to microstructural flow profiles. These models have the potential to predict cellular level fluid shear stresses, nutrient and drug transport, degradation kinetics, and the fluid-solid interactions that govern mechanical response.

Animals↗

Mechanical exposure concepts using force as the agent.

This paper presents a model that addresses mechanical exposure with regard to the development of musculoskeletal disorders, defines exposure concepts, unifies a variety of exposures, and includes the concept of human activity. When force is used as an agent, concepts related to the measurement, transformation, and interaction of the agent with tissues can be developed for use in epidemiologic exposure assessment and hazard assessment. The importance of tissue response in the exposure modeling process and in the creation of exposure indices is highlighted. Unfortunately, the response of tissue to forces of varying amplitudes and time variation patterns are largely unknown and thus reduce the possibility to develop optimal exposure assessment metrics. Although the paper argues that an exposure index at the tissue level may be the most powerful, considerations of resources and current knowledge make exposure indices based on external exposure or internal exposure preferable choices.

Biomechanical Phenomena↗

Evidence for and mechanisms of exercise modulation of growth--an overview.

This symposium was organized to highlight new information regarding the mechanisms through which physical activity and exercise may affect the process of growth. Exercise associated anabolic effects (i.e., constructive or biosynthetic metabolic processes involved in tissue adaptation to physical activity) are varied and modulated by maturational and nutritional factors. Nonetheless, identifying common processes responsible for the many anabolic effects of physical activity may improve the ways exercise can be used in rehabilitation programs and to promote health. Thus, the overall aim of this symposium is to explore the diverse mechanisms that link physical activity with growth at both the cellular and somatic level. A conceptual model is presented that includes the interaction of central and local components of exercise modulation of growth. Central components encompass the mechanisms through which exercise of skeletal muscle groups can seemingly affect cellular growth and function throughout the body. Local components encompass those mechanisms that stimulate growth, hypertrophy, and the appearance of new mitochondria and capillaries in the muscle, bone, vascular and connective tissues involved in the specific exercise. The physiology of these putative mechanisms and their clinical applications are developed from six different perspectives.

Animals↗

Occupational musculoskeletal disorders in the neck and upper limbs of forestry workers exposed to hand-arm vibration.

An epidemiologic and clinical study of neck and upper limb musculoskeletal disorders was carried out on 65 vibration-exposed forestry operators using chain-saws and 31 comparable control subjects (maintenance workers) performing manual activity and not exposed to vibration. Upper limb function was evaluated by measuring finger and wrist circumference size, maximal hand grip strength and range of motion manoeuvres in both the controls and the exposed workers. Vibration from two chain-saws was measured, and vibration exposure for each forestry worker was assessed in terms of 4 h energy-equivalent frequency-weighted acceleration according to ISO 5349. Job analysis indicated a slight excess risk of upper extremity cumulative trauma disorders (CTDs) in the forestry operators compared with the control workers. After adjustment for age and body constitution, significantly higher prevalence rates of persistent upper limb pain, muscle-tendon syndromes and carpal tunnel syndrome were observed among the forestry workers than among the controls. In the forestry operators, the occurrence of upper limb musculoskeletal disorders increased with increasing vibration exposure. Upper limb function was found to be impaired in the forestry workers compared with the controls. Vibration exposure was significantly related to increased finger circumference size, diminished muscle force and reduced joint function. Even though it is difficult to establish the relative importance of vibration and ergonomic factors in the aetiology of CTDs, nevertheless the results of this study indicate that musculoskeletal impairment to the upper limbs was more severe in the forestry operators than in the controls who did solely manual work. This finding and the observed dose-effect relationships suggest that vibration stress is an important contributor to the development of musculoskeletal disorders in workers using hand-held vibrating tools.

Adult↗

Clinical significance of antinuclear antibodies in malignant diseases: association with rheumatic and connective tissue paraneoplastic syndromes.

Our objective was to determine the prevalence of antinuclear antibodies (ANAs) in patients with malignancies and to investigate if their presence might be related with development of musculoskeletal symptoms or paraneoplastic rheumatic syndromes. Antinuclear antibodies were determined by indirect immunofluorescence on Hep-2 cells in 274 neoplastic patients and in a control group of 140 age-adjusted healthy subjects. Antinuclear antibody specificities (anti-DNA and anti-ENA) were investigated in patients with rheumatological symptoms and positive ANA. Antinuclear antibodies were detected in 76 of 274 (27.7%) patients with malignancies and in nine of 140 (6.4%) healthy subjects. Twenty patients reported paraneoplastic rheumatic symptoms or syndromes. Two of them developed clinical symptoms mimicking rheumatoid arthritis (rheumatoid-like arthropathy), one systemic lupus erythematosus (lupus-like syndrome), one dermatomyositis and four cutaneous vasculitides. Musculoskeletal symptoms and paraneoplastic rheumatic symptoms and syndromes were both more frequently observed in patients with positive ANA. Antinuclear antibody specificities were found in only two cases. We can conclude that there is an increased incidence of antinuclear antibodies in malignant conditions. Musculoskeletal symptoms and rheumatic paraneoplastic symptoms and syndromes seem to be more frequent in patients with cancer-related positive ANAs. The failure to find ANA specificities (anti-ENA, anti-DNA) in patients with malignancies and positive ANAs in our study may simply reflect molecular differences between the autoantigens involved in cancer and those characteristically involved in the systemic autoimmune diseases.

Adult↗