Muscle Learning Therapy—Efficacy of a Biofeedback Based Protocol in Treating Work-Related Upper Extremity Disorders

Work-related upper extremity disorders (WRUEDs) continue to present significant treatment and financial challenges to providers, employers, and insurers. This retrospective study reviews outcomes for 309 subjects who, between 1995 and 1999, were referred through the workers' compensation system for treatment of computer keyboard- and mouse-related WRUED injuries. The mean length of time from the recorded date of injury to the date of intake was 12.9 months. Subjects were offered a 12-visit course in muscle learning therapy (MLT). MLT is an operant conditioning program which uses surface electromyography (sEMG) to train injured workers to control their muscles during work activities. Patient response to therapy was obtained by a therapist-administered questionnaire during Visit 8 of 12. A group of 309 subjects, who had failed to respond to a previous course of therapy (typically physical therapy), reported significant improvements of pain in the neck, thorax, and upper extremities. Ninety six percent reported that they felt more in control, 86% reported feeling better overall, and 81% reported either working the same and feeling better or working and accomplishing more. This study provides preliminary support for this approach and provides justification for controlled clinical trials in the future.     

Study of endemic scrapie in a flock of ≪ ile de France≫ sheep

An Ile de France flock was studied over a period of 5 years. The authors found similar results concerning incidence and age of onset of scrapie to those found in the English literature. A close relationship was established between the age of the dam at parturition and the age of the progeny at onset of scrapie. In the later years of our study, scrapie was detected in younger animals than in the earlier years, suggesting a phenomenon of genetic anticipation . Increased fecundity in this endemically affected flock might represent a form of selection which favorises the occurrence and maintenance of the disease within the flock.Corresponding author.     

Comprehensive pediatric primary care vs traditional care in an israeli population: Their influence on pediatric emergency room use and hospitalization

Emergency room (ER) utilization and hospitalization were studied as indicators of the impact of improvements in pediatric primary care services in an Israeli development town, Ofakim, population 12,000. One of the two pediatric services was upgraded in 1976 through the introduction of pediatric faculty, integration of preventive and curative services and conversion of the medical records to a problem-oriented format ( experimental clinic B ). The primary care system remained unchanged in the second clinic ( traditional clinic A ). During 1980, ER utilization by the B clinic population was 9.3/100 compared with 17.6/100 for the A clinic population. Fifty two percent of the B clinic population patients reaching the ER were hospitalized compared with 25% of A clinic patients.The lower ER utilization rate represents a significant saving for the health services, and educational interventions are suggested from the study. Analysis of ER utilization data seems to offer useful information for overall planning and monitoring of ambulatory services for a community.Corresponding author.     

Biological effects of epidermal growth factor and 2,3,7,8-tetrachlorodibenzo-p-dioxin on developmental parameters of neonatal Mink

Newborn mink (Mustela vison) kits were administered 0.1 g 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)/kg body weight, 1g TCDD/kg body weight, 10g epidermal growth factor (EGF)/ kg body weight, or 50 (g EGF/kg body weight by intraperitoneal (i.p.) injection (10 ml/kg body weight) for 12 consecutive days to compare the effects of TCDD and EGF on body weight gains, time of eyelid opening, tooth eruption, and pelage development. A 19 acetone-corn oil mixture and 0.85 NaCl served as vehicle controls for the TCDD and EGF groups, respectively. Mortality exceeded 50% at the higher doses of both TCDD and EGF, while at the lower doses, TCDD and EGF resulted in significant reduction of body weight gains. Additionally, EGF caused a significant decrease in the time of eyelid opening and retarded growth and development of the fur of the treated kits. TCDD had no discernible effects on the time of eyelid opening or hair growth. The time of tooth eruption was not significantly affected by either compound.Published with the approval of the Michigan Agricultural Experiment Station as Journal Article No. 12216.     

Dietary cadmium intake in polluted and non-polluted areas in Japan in the past and in the present

Objective The purpose of this data compilation is to overview past and current dietary exposure (primarily via rice) of general populations to cadmium (Cd) in environmentally polluted and non-polluted areas in Japan, and to compare the levels with counterpart levels in other areas in Asia.Methods A literature survey was conducted for publications on this subject, in either Japanese or international languages, since the early 1970s. Most of the studies identified employed the food-duplicate method in combination with atomic absorption spectrometry for Cd determination, although a few studies utilized other methods, such as the market basket method and dithizon-colorimetry.Results The highest estimate of dietary Cd intake (Cd-D), 600 g Cd/day, was reported in the late 1960s for the local population in the Jinzu river basin, where Itai-itai disease had been endemic, and the Cd-D levels were 300 g/day or higher in other polluted areas. Cd-D dropped to well below 100 g/day when the polluted soil was replaced in the late 1970s and thereafter. In non-polluted areas, the Cd-D was reported to be approximately 100 g/day in 1969, followed by a gradual decrease to approximately 40 g/day in the late 1970s, to reach the current level of less than 30 g/day. There is a trend of gradual reduction at the rate of 0.3 to 0.6 g/day per year. Cd from rice accounted for 30 to 40% of the Cd-D in non-polluted areas, but a higher contribution was observed in some polluted areas. Nevertheless, the current Cd-D is still higher than the levels in other rice-dependent populations in east and south-east Asia.Conclusion The Cd-D levels reported for polluted areas were in excess of 300 g Cd/day. Substantial reduction in Cd-D to the level below 100 g/day was observed after remediation, such as replacement of polluted paddy soil. In non-polluted areas, there has been a gradual decrease in Cd-D in the past 25 years. Nevertheless, the levels in the current intake of the general population in Japan (25 to 30 g/day, or <1/10 of the levels in polluted areas in the past) is still higher than the levels in other rice-dependent areas in Asia.     

Making sense of illness: late-in-life migration as point of departure for elderly Iranian immigrants' explanatory models of illness

This article is based on data gathered through 60 qualitative interviews conducted within the realm of three research projects that have used culture-appropriate lenses to study the postmigration situation of late-in-life Iranian immigrants to Sweden. The findings gathered through these studies were interpreted against the backdrop that culturally appropriate nursing theories provide. This meant that it was, at times, these elders backgrounds as cultural others that were implicitly used to make sense of the various issues that were brought to the fore by these studies. The particular issue with which this article is concerned is the unusualness of these elders explanatory models of illness. Inspired by the concept definition of situation in the symbolic interactionist perspective and by the feeling that this perspective might bring about a different interpretation of the original findings regarding their understandings of illness and disease, we set out to conduct a secondary analysis of these elders explanatory models of illness. The findings presented in this article will show how the elderly Iranian immigrants interviewed in these three studies utilize the process of late in life migration as a point of reference for their understandings of what has caused the illnesses from which they suffered. Hereby we will suggest that the unusualness of their explanatory models of illness might be best understood if we focus on what they shared as immigrants (i.e., the fact that the process of late-in-life migration has made their culture obsolete) as opposed to what they shared as Iranians (i.e., their culture of origin).     

Correlation between vibration-induced white finger and symptoms of upper and lower extremities in vibration syndrome

Summary The correlation was investigated between the frequency of attacks of vibration-induced white finger (VWF) and numbness or coldness of the fingers and legs in patients with vibration syndrome. Some 1687 patients with vibration syndrome were examined and of these 342 chain-saw operators and 277 rock-drill operators had no disease other than vibration snydrome. Then subjects were matched by age and period of treatment within three years. In the last analysis, 20 in the VWF almost everyday group or in the never group, and 40 in the occasionally group were selected from the chain-saw operators, and from the rock-drill operators 32 in the VWF everyday or the never group and 64 in the occasionally group. The present study showed that, with the frequency of VWF attacks, patients had a higher prevalence of coldness not only in the fingers but also in the legs. These findings suggest a correlation between the severity of circulatory disturbances of the upper extremities and that of the lower ones in patients with vibration syndrome. Further studies on circulatory disturbances in the leg are required.     

Psychosocial stressors associated with Mexican migrant farmworkers in the midwest United States

Although estimates suggest that there are upwards of 5 million migrant farmworkers in the United States, scant research has explored the stressors associated with their lifestyle. Contrary to previous work, the present study directly explored migrant farmworkers' own perceptions of what is difficult in their lives. The purposes of the present study were to qualitatively explore, from a phenomenological standpoint, the stressors associated with living as a migrant farmworker in the Midwest United States; and to determine the stressors that were most strongly related to symptoms of anxiety and depression. The findings indicated that 18 stressors were commonly experienced by the migrant farmworkers and that the farmworkers experienced overall elevated levels of anxiety and depression. A number of stressors that were not previously reported in the literature were identified. The stressors of rigid work demands and poor housing conditions were significantly associated with higher levels of anxiety and low family income/living in poverty and rigid work demands were significantly associated with depression. Implications of findings and prevention strategies are discussed.     

Levels of β-HCH,HCB, p,p′-DDE,p,p′-DDT and PCBs in human milk from a continental town in Croatia,Yugoslavia

Summary Concentrations of -HCH, HCB, p,p-DDE, p,p-DDT and PCBs were determined by gas chromatography in 50 human milk samples collected from the general population during 1981/1982 in a continental town in Croatia (Yugoslavia). The samples were collected between one and 22 weeks after delivery from mothers breast-feeding one child only. The mothers' age was 18 to 31 years, and they were nursing their first or second child. All 50 samples contained -HCH, HCB, p,p-DDE and PCBs, whereas p,p-DDT was present in 37 samples. The concentrations of -HCH, HCB, p,p-DDE, p,p-DDT and PCBs expressed on a whole milk basis were (median in g/kg): 11, 7.1, 67, 7.3 and 22 respectively, and expressed on a fat basis (median in mg/kg): 0.28, 0.21, 1.9, 0.18 and 0.62 respectively. The fat content was 3.7% (median). PCBs were present in a mixture containing penta-, hexa- and heptachlorobiphenyls.     

Human exposure to volatile halogenated hydrocarbons from the general environment

Summary The objective of this study was to assess individual human exposure to volatile halogenated hydrocarbons (VHH) under normal environmental conditions by means of biological monitoring, i.e. by the measurement of these compounds or their metabolites in body fluids, such as blood, serum, and urine. Blood samples of 39 normal subjects without known occupational exposure to these agents were examined for the occurrence of VHH. The following compounds were present in quantifiable concentrations in 60 to 95% of the blood samples examined: chloroform (median 0.2 g/l; range < 0.1–1.7 g/l), 1,1,1-trichloroethane (median 0.2 g/l; range < 0.1–3.4 g/l), tetrachloroethylene (median 0.4 g/l; range < 0.1–3.7 g/l). Trichloroethylene could be detected in 31% of all blood samples (median < 0.1 g/l; range < 0.1–1.3 g/l). In addition, the levels of trichloroacetic acid (TCA) were determined in serum and 24-h urine samples of 43 and 94, respectively, normal subjects. TCA was present in measurable concentrations in all serum and urine samples examined. The median of the TCA levels in serum was 21.4 g/l (range 4.8–221.2 g/l) and in urine 6.0 g/24 h (range 0.6–261.4 g/24 h). The results are discussed in relation to data from the literature on human exposure to VHH from the general environment, i.e. via air, food, and water. The upper normal limits calculated from the results of this investigation can be used to detect even minor excessive exposures to VHH.     

Pilotprojekt Rauchfrei am Arbeitsplatz

Summary In 1991 SAN had acquired wide experience with firms which had introduced rules about smoking, governing where and when smoking is permitted at the workplace. A dossier was produced, based on this expertise, with the title: Smoke-free Workplaces. A pilot projekt, taking Zurich as a model, was intended to demonstrate how health-promoting measures could be sucessfully put into effect in the context of smoking.The results of experimentation with six different, interlocking measures were collated, and evaluated with a view to their implementation throughout the whole of Switzerland. The basic components covered the three areas of Information, Raising Awareness, and Motivation, and focussed particularly on the following six points: Information materials; text/cartoons for internal company PR use; bids to wean people off smoking; the 5-day-campaign (a communication game, 5 min. a day); an information event raising the interest of the personnel on to a wide range of possibilities: Information, experience the reactions of your body on tobacco-smoke, expositions, opinion-walls. And sixth: advice on strategy for employers and personnel managers.     

Going up river with Sue Scholar and John D. Dollarsense

Going upstream to find out and do something about drowning children one finds Knowledge and Research Land and Public Policy Land separated by a widening river. Our fearless hero, Tom Swift, explores with Sue Scholar what is known about prevention and then with John Dollarsense what those in power and control of resources would support. For example one must weigh the increasing research on what makes early childhood experiences helpful to children with the now needs of children on alcohol and drugs, children living in abusive homes and teenage pregnancy. Several specific courses of action are suggested as possible ways of building a bridge between knowledge producers and public policy makers.     

Media reviews

Of the three films reviewed in this issue, only the first, All Women Have Periods, deals with both areas of sexuality and disability. The second film, A Masturbatory Story, deals with sexuality but not disability. The third film, A Different Approach, deals with disability but not sexuality. The reason I have included the last two films are that A Masturbatory Story is one of the best, most permission giving films I have seen on the subject of masturbation and A Different Approach while focusing on employment of the disabled, is one of the most entertaining and effective films I have seen dealing with attitudes.     

Forestry workers involved in aerial application of 2,4-dichlorophenoxyacetic acid (2,4-D): Exposure and urinary excretion

Urinalysis was conducted on six volunteer workers involved in mixing and loading 2,4-D ester solutions into aircraft and in guiding the spray aircraft in two conifer release programs during 1981 and 1982. Exposures were reduced by wearing a full line of protective clothing. Two females and one male were involved in mixing the spray for 109 aircraft loads over an 11-day period in 1981. During the 1981 operation, the highest daily excretion of 2,4-D in the urine was 0.30, 0.94 and 9.59 g/kg body weight for the three workers. In 1982, three male workers were involved, one diluting the concentrated solution and loading the aircraft, and two marking the swaths for aerial application over an 18 day period. The highest daily excretion of 2,4-D in the urine was 7.73, 8.37, 22.2 g/kg body weight for the three workers. One of the authors, acting as a bystander, was directly sprayed in the 1982 season and 0.44% was absorbed based on urine analysis. The highest daily excretion of 2,4-D in his urine was 4.75 g/kg body weight. For all seven people, the calculated exposure was less than the no-effect level of 10 mg/kg of body weight/day by a large margin of safety. The presence of 2,4-D in urine samples in the pre-spray period and its slow disappearance during the post spray period prompted further investigation. Swabs of internal surfaces of living quarters revealed deposits of 2,4-D from 0.7 to 288 g/0.1m² and on spray equipment from 0.7 to 184 g/0.1m².     

Polychlorobiphenyls, ΣDDT,and hexachlorocyclohexane isomers in the western North Pacific ecosystem

Polychlorobiphenyls (PCBs), DDT (p,p-DDT,p,p-DDD, andp,p-DDE and HCH isomers (hexachlorocyclohexanes including , , and isomers) were determined in a marine food chain, including seawater, zooplankton, myctophid, squid and striped dolphin collected from the western North Pacific waters. The concentrations of these pollutants increased in higher trophic levels, where the highest bioconcentration factors (concentration ratio in organisms to water), as much as 10⁷, were obtained from both PCBs and DDT in striped dolphin. The proportions of highly chlorinated biphenyls,p,p-DDE and -HCH increased in higher-ranking predators. These observations suggest that the bioaccumulation mechanisms in lower trophic levels depend primarily on the physicochemical properties of pollutants, whereas those in higher trophic levels are affected by the biodegradability of the pollutants and the metabolic capacity and life-span of the organisms.     

The Intendedness of Pregnancy: A Concept in Transition

Background: Although interest in the intendedness or the planning status of a pregnancy goes back many centuries, it is only since 1941 that questions about these issues have been asked systematically in large-scale surveys. More recently, questions about intendedness have become standard features of the National Survey of Family Growth and of the Pregnancy Risk Assessment Monitoring System (PRAMS). Interest in and concern about the large numbers of unintended pregnancies reported in those surveys resulted in an Institute of Medicine report on the subject and the inclusion of a national health objective for increasing the proportion of pregnancies that are intended in Healthy People 2000 and Healthy People 2010. Needs: The terms, intended, unintended, mistimed, wanted, unwanted, and planned are often used without significant attention being paid to their meaning or how they are derived from survey questions. There is a particular need to distinguish between terms that define attitudes and those that define behaviors. In addition, research has revealed that women are often happy despite experiencing an unintended pregnancy and that contraceptive failures do not always result in a report of an unintended pregnancy. Objectives: Researchers have begun to ask questions about the meaning of the intendedness concept and its relationship to what women express as their feelings about pregnancies and births. This article, and this entire issue, is an attempt to make the reader aware of the current issues in this area and to suggest additional research that is needed to enable policy makers and program planners to design programs that will better assist couples in meeting their fertility goals.     

The Politics of Primary Prevention

Primary prevention is the only effective strategy for reducing the future incidence of mental/emotional problems. But arguments about methods of reducing the rate of future problems have begun to raise questions that are more political, ideological and ethical than they are methodological. Prevention efforts may focus on safe strategies like individual behavioral change programs or alternatively on stronger non-voluntary group-mandated programs. Another dimension currently under debate is whether programs should be aimed at reducing risks for specific mental diseases or at efforts at fostering social competence to resist susceptibility to stress generally. Still another more general issue is the relevance of early childhood trauma like abuse and neglect in producing later emotional problems. Political conservatives favor the organic (biological, genetic) approaches to prevention that do not require social change while radicals argue for reducing social class inequalities and reducing poverty, exploitation and injustice.     

Heterosexual copulatory patterns in stumptail macaques (Macaca arctoides) and in other macaque species

A comparison of the mating behavior patterns of several macaque species reveals that the mating behavior of Macaca arctoidesexhibits several unique features. The laboratory groups of stumptail monkeys observed had exceptionally long single-mount copulations characterized by a large number of pelvic thrusts, a slow thrusting rate, and an unusually salient male orgasmic pattern (characterized by body rigidity followed by body spasms and a typical facial expression and vocalization). The frequency with which the copulation culminates in ejaculation is unusually high, and copulating stumptails generally manifest tieing in a genital lock after ejaculation. This research was supported in part by the Interdisciplinary Training Program, Langley Porter Neuropsychiatric Institute, University of California, San Francisco; by United States Public Health Service Training Grant No. 5-T1-MH-7082 from the National Institute of Public Health; and by Grant No. GS-31943X from the National Science Foundation to Dr. S. L. Washburn of the University of California at Berkeley, given for Primate Studies and Human Evolution.This paper was given as one part of the presentation prepared for the symposium Male and Female Sexual Behavior in Primate Societies, Fourth International Congress of Primatology, Portland, Oregon, August 1972. The first part was published as Male-Female, Female-Female, and Male-Male Sexual Behavior in the Stumptail Monkey, with Special Attention to the Female Orgasm,Archives of Sexual Behavior 3: 95–116, 1974.     

Retailing Policies for Generic Medicines

As there is general disagreement about the way generic medicines should be commercialized, two retailing policies are analyzed, taking into account their effects on the welfare of patients, government, pharmacies and physicians. In the first policy scenario, pharmacies are allowed to substitute generic medicines for branded ones, while in the second, substitution is forbidden. In both cases a pharmacies association is allowed to have a share in the production of generic medicines. The model predicts that under some conditions patients may prefer substitution by pharmacies but when doctors decisions are binding, they are never excessively bad. However, the policy choice belongs to the government, which prefers to allow for substitution more often than patients would like.     

The evaluation of pornography: Effects of attitude and perceived physiological reaction

Twenty-three medical and 28 nonmedical male student Ss read four erotic prose passages and then rated each on obscenity, censorship, and four semantic differential evaluation scales. Ss were given varying levels of false (experimenter-controlled) GSR feedback for each stimulus passage, as well as different explanations of the significance of this arousal feedback. Four-way analyses of variance showed that low Stolerance of erotica, pedophelic passage content, and GSR feedback indicating physiological arousal resulted in passages being labeled as more obscene and unfavorable. Explanations to Ss that GSR feed-back indicated sexual arousal resulted in more favorable ratings by the medical Ss and interacted with passage type for the nonmedical Ss. Concurrently monitored heart rate was not significantly influenced by any of the experimental variables and was (with one marginal exception) uncorrelated with any of the dependent labeling variables. An earlier version of this article was presented at the XVIIth International Congress of Applied Psychology, Liege, Belgium, July 1971.