Is self-reported pain an appropriate outcome measure in ergonomic-epidemiologic studies of work-related musculoskeletal disorders?

Of the various overlapping approaches used to define outcome in ergonomic-epidemiologic studies of work-related musculoskeletal disorders, the most widely used are clinical diagnostic entities, whose criteria derive either from clinical examination (consisting of clinical tests in conjunction with symptoms and clinical history) or from findings of special investigations, such as nerve conduction testing. Problems with the use of clinical diagnostic entities as surveillance tools relate to their high definitional variability, to the unknown test attributes and performance in worker populations, and to their lack of field utility. Other approaches to define outcome such as impairment and disability evaluations are seldom used; there are problems with existing instruments in disentangling multiple determinants. The use of subjective measures (self-reported pain) may be the most valuable approach to measuring outcome in population-based surveys. This approach has high capacity (can be used in large populations) and good field utility, has been supported by evidence of construct validity in some ergonomic-epidemiologic studies, and is able to assimilate the diverse and overlapping symptom patterns characteristic of some work-related musculoskeletal disorders. Traditional biases against subjective measures are evident in the literature, but these measures have also been badly used in many studies, with insufficient attention being paid to potential confounders and effect modifiers. Measurement of factors that influence pain perception and reporting need to be incorporated in ergonomic-epidemiologic studies and controlled for in analysis. Outcome definitions should be made more explicit. © 1996 Wiley-Liss, Inc.     

The Meaning of Annoyance in Relation to the Quality of Acoustic Environments

A supportive environment should take care of health. It is an environment that provides complete physical, mental and social well-being. It is not suffiently characterized by infirmity or the absence of disease. It should trigger good feelings and safety (WHO, 2000). Interdisciplinary procedures are needed that include acoustics, physics, psychology, and sociology when a survey on perception of acoustic environments is carried out under the aspect of comfort. It is necessary to combine methods with different sensibilities in order to measure the subjective perception of noise in such an environment. The context, the focus of attention, and the knowledge of past experiences must be taken into account. (Ipsen, 2001) These three conditions are required to implement an adequate measurement. Subject-centred methodological procedures should be used to develop a suitable measurement procedure. Such procedures will be presented with the aim to improve social surveys that especially address the meaning of annoyance in an acoustic environment and the contribution of a soundscape.     

Methodological and biological factors explaining the reduction in dental caries in Jamaican school children between 1984 and 1995.

OBJECTIVE: To assess the methods used and results found in two surveys, one conducted in 1984 and the other in 1995, that indicated a large reduction in the prevalence and severity of dental caries among children in Jamaica, with special attention focused on methodological differences between the two surveys and the biological factors that may explain the large reduction in caries. METHODS: In 1984 a modified "pathfinder" methodology was used to measure the prevalence and severity of dental caries in 6-, 12-, and 15-year-old children in Jamaica. A similar survey was conducted in 1995. A comparison of the two surveys showed an 84% reduction in the severity of dental caries at age 12. Both surveys used the same diagnostic criteria and clinical procedures, but the 1984 survey included a higher proportion of rural residents than did the 1995 one. RESULTS: The data show an epidemiological transition between 1984, when dental caries was highly prevalent and severe, and 1995, when the disease was less prevalent and was concentrated in a smaller proportion of the population. CONCLUSIONS: Most of the reduction in dental caries between 1984 and 1995 is attributable to the introduction, in 1987, of salt fluoridation. While the 1995 survey included fewer rural areas than the 1984 survey did, that does not invalidate the observed reduction in dental caries. The use of fluoride toothpaste and dietary fluoride supplements as well as access to dental health promotion and preventive and curative services do not seem to be major contributors to the reductions observed.     

Grading of sensorineural disturbances according to a modified Stockholm workshop scale using self-reports and QST

Objective The objective of the study was to apply, on a group of vibration exposed individuals, a proposed modification of the Stockholm Workshop scale for grading of sensorineural disorders by using self-reports and data from objective testing and to compare grading obtained through the two approaches. Methods The study group consisted of 126 young persons with different individual levels of hand-transmitted vibration exposures. Effect measurements included a self-administered questionnaire and vibrotactile perception measurements and Purdue Pegboard testing. For grading using self reports three specific questions, believed to be good markers for complaints of intermittent numbness, sensory deficiency, and reduced performance in fine motor tasks, was picked out from the questionnaire. Results from vibrotactile perception and Purdue Pegboard testing were used for grading based on quantitative sensory testing. The sensorineural grading obtained by the two methods was then compared. Results The outcome showed that about 60% of all individuals within the study group are graded equally by the two methods for grading. The frequency of individuals graded at advanced SN stages were however higher when using QST, predominantly due to more positive cases for the Purdue pegboard test compared with the corresponding outcome from the self reports. Conclusion The proposed modification of the grading scale reduces the in-built progressiveness and allows different combinations of sensorineural symptoms. The two grading methods seem to be somewhat correlated, something which may be considered as encouraging and promising for those who prefer to use, or must use one of the methods for grading. The proposed model for grading using self-reports should, however, be considered more as a conceptual idea for how this may be done. The models should be applied on a larger, more vibration exposed and more symptomatic study group, compared with the present study group, before any far-reaching conclusions can be drawn.     

The certification of smallpox eradication and implications for guinea worm, poliomyelitis, and other diseases: confirming and maintaining a negative

Rigorous, independent, confirmation of disease eradication is necessary to assure credibility of the claimed accomplishment. The criteria and procedures for formal certification of global disease freedom are based on the biological and epidemiological features of the pathogen and its manifestations. Certification activities by previously endemic and at-risk countries include comprehensive documentation focusing on surveillance, reports of national independent review groups, and special field surveys. National and regional results are reviewed by authoritative International Commissions (ICs) which verify the findings by field visits. The ICs present their results to an independent WHO-convened group ("Global Commission" for smallpox), members of which participate in field visits. When fully satisfied, the Global Commission makes conclusions and recommendations to the World Health Assembly (WHA). Smallpox was confirmed eradicated in 1980 by the WHA less than three years after the last naturally occurring case was detected. Dracunculiasis (guinea worm) freedom has been certified in 187 countries. Regional commissions have certified the Americas, Asia, and Europe polio-free; however, re-establishment of endemic foci in countries previously declared disease-free has created special challenges for completing this program. Post-eradication activities require attention to surveillance, maximum security of the microbial agent, and essential research to assure maintenance of disease freedom.     

Eating disorders

At the present time, research into Eating Disorders is being carried out in very different areas: clinical and diagnostic, epidemiological, comorbidity, aetiopathogeny, treatment and forms of care. This paper reviews this type of pathology, and aims to update the most important data in the different fields. The epidemiological studies of recent decades would indicate a considerable increase in the rates of incidence and prevalence of both Nervous Anorexia and Nervous Bulimia. On the other hand, there is increasing confirmation of an early appearance of these disorders. Similarly, the discovery of certain physiopathological appetite markers and/or regulators opens a new path for understanding this phenomenon. Research into these problems has reached a certain consensus in aspects such as: a multidimensional consideration of the ethiopathogeny, increasingly purified diagnostic criteria, care and therapeutic procedures and resources to be used in treatment.     

Lower back disorders among forklift operators: An emerging occupational health problem?

BACKGROUND: Most studies focusing on the occupational hazards associated with forklift operation have examined risks of fatalities and traumatic injuries. Few studies have examined the magnitude of risk of musculoskeletal disorders (MSDs). We review and critically appraise the epidemiological studies conducted on forklift operators in relation to MSDs, such as lower back pain and neck problems. METHODS: A comprehensive search of databases resulted in the identification of seven epidemiological studies that addressed MSDs. A critical appraisal of these studies was conducted using epidemiological principles and a meta-analysis approach that involved the use of the confidence limit method to determine an overall "meta-odds ratio." RESULTS: The methodological quality of these studies ranged from "marginal" to "average" with the exception of one study, which was considered "good." The meta-odds ratio for lower back pain among forklift operators was 2.13 (95% CI: 1.57, 2.87). CONCLUSIONS: Our results suggest that forklift operators are at increased risk of lower back pain. Additional high quality epidemiological studies are needed in the US, however, to determine the magnitude of risk for MSDs. In this regard, studies should address not only lower back pain among forklifts operators, but also neck pain. A full exposure assessment of physical and non-physical factors in these studies is needed.     

Risikokommunikation zu Arzneimitteln in Gewässern: Ein Balanceakt

Background

Pharmaceutical users can contribute to reducing the input of pharmaceuticals into the water cycle. The purpose of the literature study was to gain insight on how risk communication should be designed in terms of content to motivate to make this contribution. Focus was on risk perception research from which conclusions were drawn about intuitive risk perception around pharmaceuticals in the water cycle.

Results

The risk source “pharmaceuticals in the water cycle” has attributes that induce people to perceive a risk as negligible as well as attributes which promote the perception that a risk is high. The latter are main elements of the risk pattern “risk as an early indication of insidious danger”. It is likely that part of the addressees have little knowledge and low motivation to deal more intensively with the offered information.

Conclusion

Risk communication on pharmaceuticals in the water cycle requires balancing between awakening and reassuring. “It’s worth taking precautionary measures” should be the main message. Heuristic cues are of particular importance, special attention is required with respect to emotional cues in relation to drinking water. The broader frame of “Dealing responsibly with pharmaceuticals” could serve as an attention cue.     

Data splitting as a countermeasure against hypothesis fishing: with a case study of predictors for low back pain

There is growing concern in the scientific community that many published scientific findings may represent spurious patterns that are not reproducible in independent data sets. A reason for this is that significance levels or confidence intervals are often applied to secondary variables or sub-samples within the trial, in addition to the primary hypotheses (multiple hypotheses). This problem is likely to be extensive for population-based surveys, in which epidemiological hypotheses are derived after seeing the data set (hypothesis fishing). We recommend a data-splitting procedure to counteract this methodological problem, in which one part of the data set is used for identifying hypotheses, and the other is used for hypothesis testing. The procedure is similar to two-stage analysis of microarray data. We illustrate the process using a real data set related to predictors of low back pain at 14-year follow-up in a population initially free of low back pain. "Widespreadness" of pain (pain reported in several other places than the low back) was a statistically significant predictor, while smoking was not, despite its strong association with low back pain in the first half of the data set. We argue that the application of data splitting, in which an independent party handles the data set, will achieve for epidemiological surveys what pre-registration has done for clinical studies.     

Reliability of physical examination of the upper extremity among keyboard operators

BACKGROUND: Physical examination is a traditional outcome measure in epidemiological research. Its value as a reliable measure depends, in part, on the prevalence of positive findings. The purpose of this paper is to determine the empirical reliability of physical examination and anthropometry in a field study of upper extremity disorders among keyboard operators. METHODS: Two experienced examiners independently performed common provocative tests and procedures in physical examinations of the neck and upper extremity among 160 keyboard operators. Two additional examiners conducted anthropometric surveys among 137 workers. Inter-examiner reliability was assessed with observed agreement, kappa statistics, and intra-class correlations (ICC). RESULTS: Observed agreement was between 96% and 100% for neck and upper extremity signs, muscle stretch reflexes, and muscle strength, however, with the exception of provocative tests, reliability statistics were unstable. Among the provocative tests, Phalen and Tinel tests had modest agreement after adjusting for chance (kappa range: 0.20-0.43). The carpal compression test had the best reliability (kappa=0.60 and kappa=0.67, left and right side, respectively). The ICCs for anthropometry ranged from 0.36-0.91. CONCLUSIONS: Results from the study showed that statistically, except for the carpal compression test, physical examination contributed minimal reliable information. This was attributed mainly to the low prevalence of positive findings, and generally mild nature of upper extremity disorders in this population. The results are the best estimate of what would be found in a field study with experienced examiners. While it may reduce bias, separating physical examination from medical history may contribute to the poor reliability of findings. With a shift toward reliable measures, resources can be allocated to more effective tools, like questionnaires, in epidemiological research of upper extremity disorders among keyboard operators.     

Psychological effects of dietary components of tea: caffeine and L-theanine

This review summarizes the literature on the association between two dietary components of tea, caffeine and L-theanine, and the psychological outcomes of consumption; it also identifies areas for future research. The studies reviewed suggest that caffeinated tea, when ingested at regular intervals, may maintain alertness, focused attention, and accuracy and may modulate the more acute effects of higher doses of caffeine. These findings concur with the neurochemical effects of L-theanine on the brain. L-theanine may interact with caffeine to enhance performance in terms of attention switching and the ability to ignore distraction; this is likely to be reflective of higher-level cognitive activity and may be sensitive to the detrimental effects of overstimulation. Further research should investigate the interactive effects of caffeine, L-theanine, and task complexity, utilize a range of ecologically valid psychological outcomes, and assess the neuroprotective effects of L-theanine using epidemiological or longer-term intervention studies among individuals at risk of neurodegenerative disease.     

Safety of gastrointestinal endoscopy during pregnancy

There are only few data of gastrointestinal endoscopy in pregnant patients. Only 0.4% of all procedures are carried out during pregnancy. Case reports and some small retrospective studies are available. Because of physiological changes in pregnancy there might be special risks of endoscopy. There might be complaints which can be physiologic during pregnancy, but can be signs of gastrointestinal disorders, too. Therefore, indications for endoscopy are not always clear and easy. Safety of the procedures is also not well studied. Besides the risks of endoscopy, medication given to the mother, electrocoagulation and radiation exposure from fluoroscopy during endoscopic retrograde cholangiopancreatography might be harmful to the fetus. Endoscopy should only be done when indication is unquestionable and strong. Only FDA "A" and "B" category medication is allowed. Gastroscopy is necessary for bleeding and for patients with pyrosis going together with alarm signs. Nausea, vomiting, abdominal pain and fecal occult blood test positivity are not indications for endoscopy, only for gastroenterogical consultation. Sigmoidoscopy is recommended for indication of lower gastrointestinal bleeding and sigmoid or rectal mass. Only therapeutic endoscopic retrograde cholangiopancreatography should be performed. Obstructive jaundice and biliary pancreatitis need immediate endoscopic intervention. The fetus must be shielded from radiation exposure.     

老年髋部骨折围手术期疼痛控制对骶尾部压疮的影响

目的探究疼痛控制治疗对老年髋部骨折患者围手术期骶尾部压疮发生率和压疮病变严重程度的影响。 方法连续纳入2011年10月至2014年10月解放军第一八○医院骨科收治的214例老年髋部骨折患者(男性84例,女性130例;年龄61～90岁)进行前瞻性随机对照研究。将患者按随机表分为治疗组(121例)和对照组(93例)。对照组采用标准治疗方法,未进行特别疼痛治疗;治疗组除标准治疗方法外,还接受不同方法的疼痛控制治疗。治疗组患者根据镇痛方式不同,进一步按确诊顺序根据随机表分为4个亚组：静脉泵镇痛组(30例,地左辛注射液、高乌甲素注射液、哌替啶注射液,个体化用药,持续静脉泵入)、规律肌肉注射镇痛药组(24例,双氯芬酸钠利多卡因2 mL,肌注,2次/d)、口服中枢镇痛药组(33例,镇痛药物为氨酚羟考酮片5 mg,口服,3次/d)和口服非甾体类镇痛药组(34例,双氯芬酸钠释片,75 mg,口服,1次/d)。观察各组患者骶尾部压疮的发生率;入院时、术前和术后1周Braden压疮评分,术后1周压疮严重程度分级,药物镇痛的不良反应情况。 结果治疗组和对照组患者入院时和术前的Braden压疮评分差异均无统计学意义(P均>0.05);疼痛控制治疗组患者在术后1周的Braden压疮评分为(12.6±3.3)分,低于对照组的(14.8±3.4)分,差异有统计学意义(P<0.01)。各疼痛控制治疗亚组在入院时、术前和术后1周时Braden压疮评分间的差异均无统计学意义(P均>0.05)。对照组患者压疮发生率为23.66%(22/93),高于疼痛控制治疗组的10.74%(13/121),差异有统计学意义(P<0.05),但各疼痛控制亚组压疮发生率间的差异无统计学意义(P>0.05)。治疗组和对照组压疮的等级差异均有统计学意义(P<0.01),而四个疼痛亚组间的压疮等级比较差异无统计学意义(P>0.05)。静脉泵镇痛组和口服中枢镇痛药组出现呕吐和神经系统不良反应较明显;肌肉注射镇痛药组和口服非甾体类镇痛药主要产生胃肠道不良反应,通过制酸和保护胃粘膜等治疗后症状缓解或消除。 结论合适的疼痛控制可减少老年髋部骨折围手术期压疮的发生。在镇痛方法的选择上,肌注和口服非甾体类镇痛药使用方便、耐受性好、效果确切,但应注意预防胃肠道反应。     

Patient satisfaction studies: methodology, management and consumer evaluation

Discusses how consumer evaluation studies of health-care services might be undertaken to provide valid assessments of consumer opinions and priorities, amenable to subsequent, effective management action. To do so, provides an account of the history of patient satisfaction surveys, presents a detailed examination of key examples, and discusses the well-documented strengths and weaknesses of this approach. Draws attention to recent critiques of survey methods and growing interest in qualitative research focusing on the rationale that the latter provides more useful data for managers. Argues that the search for a "best" consumer evaluation method is misplaced since appropriate methods should be determined by research objectives which themselves may vary. Points to existing analyses of relevant research which offer sound methodological guidelines and concludes by offering explicit suggestions for the future conduct of consumer evaluation research.     

精神障碍患者危险行为影响因素分析

目的:通过分析可能影响精神障碍患者危险行为的因素,为防控社区精神障碍患者所致的危险性事件发生提供科学依据.方法:收集上海市某区2020年5月31日前管理的精神障碍患者信息,采用描述性流行病学以及多因素分析方法进行分析.结果:共有精神障碍患者6687例,纳入调查6144例.发生高危险行为308例,高危险行为发生率为5.0...     

Children's Behavior During Immunization Injections: A Principle Components Analysis

Observational assessment is an important component of a comprehensive evaluation of children's procedural pain. An understanding of children's behavior during painful procedures can inform the structure of these measures and is important in the development of effective interventions. This study used principle components analyses to evaluate the structure of children's behavior during routine immunizations. Videotapes of 159 children undergoing routine immunizations were coded using the Child-Adult Medical Procedure Interaction Scale (Blount et al., 1989). Results indicated a 4-component solution was the most appropriate categorization and accounted for 61.2% of the variance in children's behavior. The first 3 components represented “verbal fear” (seeking emotional support, verbal fear, information seeking), “vocal pain” (cry, verbal resistance, verbal pain), and “escape behavior” (need for restraint, flail). The final component, “other verbal behavior” consisted of nonprocedural talk and negative verbal emotion. Taken together, the preliminary results of the correlational analyses and the subsequent principal components analyses support the assertion that children's distress is a multidimensional experience and should be evaluated as such. Attention to multiple dimensions of distress is important in the evaluation of interventions as they may differentially target these dimensions.     

The informed consent procedure in epidemiological research

After a brief introduction on the beginning and subsequent developments of informed consent (IC), this paper analyses its ethical, legal, medical and scientific implications and its specific applications to epidemiological research. The aim is to highlight how IC principles should be fulfilled through different procedures responding to the ethical and scientific requirements of epidemiological research. At least two improper applications, in fact, can deprive IC of its meaning: referring to ethical principles without discernment, or following IC guidelines without critical evaluation. Attempts to improve IC procedures adapting them to specific needs and scientific developments should be evaluated carefully and without preconceptions.