Work Organization and Musculoskeletal Health: Clinical Findings From Immigrant Latino Poultry Processing and Other Manual Workers

OBJECTIVE:: To determine the potential role of differential exposure to work organization hazards in musculoskeletal disorders among immigrant Latino workers. METHOD:: Self-reported work organization data were obtained from immigrant Latino workers in poultry processing and nonpoultry, manual occupations (N = 742). Clinical evaluations for epicondylitis, rotator cuff syndrome, and back pain were obtained from a subsample (n = 518). RESULTS:: Several work organization hazards (eg, low job control, high psychological demands) were elevated among poultry processing workers. Job control predicted epicondylitis (odds ratio [OR] = 0.77) and rotator cuff syndrome (OR = 0.79); psychological demand predicted rotator cuff syndrome (OR = 1.30) and back pain (OR = 1.24); awkward posture and repeated movements predicted all three outcomes; and management safety commitment predicted rotator cuff syndrome (OR = 1.65) and back pain (OR = 1.81). DISCUSSION:: Immigrant poultry processing workers are exposed to greater work organization hazards that may contribute to occupational health disparities.     

The effects of work organization on the health of immigrant manual workers: A longitudinal analysis

This analysis uses a longitudinal design to examine the associations of work organization and health outcomes among Latino manual workers. Participants included 247 Latino workers who completed baseline and 1-year follow-up interviews and clinical examinations. Health outcome measures were epicondylitis, rotator cuff syndrome, back pain, and depressive symptoms. Independent measures were measures of job demand, job control, and job support. Workers commonly experienced rotator cuff syndrome (6.5%), back pain (8.9%), and depressive symptoms (11.2%); fewer experienced epicondylitis (2.4%). Psychological demand was associated with rotator cuff syndrome; awkward position and decision latitude were associated with back pain. Decreased skill variety but increased decision latitude was associated with elevated depressive symptoms. Work context factors are important for health outcomes among vulnerable workers. Further research is needed to expand upon this work, particularly cultural perspectives on job support.     

Minimally invasive pediatric cardiac surgery. Atrial septal defect closure through axillary and submammary approaches

Introduction and objectives

Minimally invasive approaches in less-complex cardiac procedures can avoid unpleasant cosmetic results. Moreover, surgery can be scheduled in younger patients. In previous papers, we compared submammary and midline sternotomy. We present our initial experience with an axillary, compared to submammary, approach to repair atrial septal defects under extracorporeal circulation.

Methods

20 patients are included: 10 in the submammary group (7 ostium secundum, 2 sinus venosus, 1 ostium primum) and 10 in the axillary group (7 ostium secundum, 3 sinus venosus). Mean age and weight are 6.4 ± 3.62 years (range 3-13) and 23.5 ± 8.74 Kg (range 12-38) in the submammary group, and 5.5 ± 2.04 years (range 3-9) and 19.7 ± 5.88 Kg (range 14-29) in the axillary one, respectively. Muscles are spared (pectoralis in submammary and latissimus in axillary). The whole procedure (cannulation and correction) is performed through a single incision, with no side ports.

Results

No residual defects were found at discharge. Surgical approach maneuvers are more cumbersome through the axillary than the submammary approach. In a peer comparison, extracorporeal circulation and cross-clamp time were similar in both groups (P > .05).

Conclusions

1. Axillary approach is as safe as submammary access in selected patients and for defects approached through the atrium. 2. Cosmetic result is excellent.Full English text available from: www.revespcardiol.org     

The management of gastrointestinal disease in Hermansky-Pudlak syndrome

Hermansky-Pudlak syndrome (HPS) was first described in 1959 by Hermansky and Pudlak. Clinically, HPS is characterized by oculocutaneous albinism, platelet storage pool deficiency, and ceroid tissue accumulation. It is a rare disorder that has been described globally but has the highest frequency in a cluster population in Puerto Rico. HPS patients also have major organ involvement that typically includes pulmonary fibrosis and granulomatous colitis. Rarely have cardiomyopathy and renal dysfunction been described. We report a case of the oldest historical patient with HPS type 6 and the associated gastrointestinal management.     

Use of gadolinium as contrast agent in endoscopic retrograde cholangiopancreatography in patients with iodine allergy

Introduction

Radiologic contrasts are required during endoscopic retrograde cholangiopancreatography (ERCP). The most frequently used are iodine-based contrast media. Controversy still surrounds the optimal strategy in patients with previous adverse reactions to iodine contrasts that need to undergo an ERCP.

Objective

To evaluate the safety and efficacy of a gadolinium-derived contrast medium in patients with previous reactions to iodine-derived agents during ERCP.

Material and methods

Thirteen ERCP were performed in 11 patients with well-established adverse reactions to iodine compounds. ERCP was carried out with gadobutrol, a non-ionic gadolinium compound and without prophylaxis.

Results

In all patients, ERCP were satisfactorily completed. Thirteen cholangiograms and one pancreatogram were obtained. All procedures were technically successful, allowing diagnosis and endotherapy. The quality of the images was good, similar to those obtained with standard contrast media, and did not represent a limitation. No contrast-related adverse events were observed, and there were no post-ERCP complications.

Conclusions

Gadolinium-derived agents are a safe and effective alternative in iodine-allergic patients.     

Heart transplantation in biventricular congenital heart disease: indications, techniques, and outcomes

Heart transplantation is an accepted therapeutic modality for end-stage congenital heart disease for both biventricular and univentricular anomalies. Many transplant centers have pushed the limits of transplantation to include patients with high pulmonary vascular resistance, high panel reactive antibodies, positive cross-matches, and ABO-incompatibility. Excellent results have been possible, particularly with the development of improved diagnostic and therapeutic algorithms to prevent and treat rejection, infection, and post-transplant lymphoproliferative disease. Late graft failure and chronic rejection remain vexing problems. The vast majority of patients with biventricular congenital heart disease have undergone prior cardiac surgical procedures. Indications for transplantation in this subgroup are primarily progressive refractory heart failure following prior cardiac surgical reconstructive procedures. Contraindications to transplantation mimic those for other forms of end-stage heart disease. A determination of pulmonary vascular resistance is important in listing patients with biventricular congenital heart disease for heart transplantation. Modifications in the implant technique are necessary and vary depending on underlying recipient anatomy. Risk factors for perioperative outcomes in patients with biventricular congenital heart disease include the need for reoperation, the degree of anatomic reconstruction necessary during the implant procedure, and the degree of antibody sensitization, in addition to a number of other recipient and donor factors. Postoperative outcomes and survival are very good but remain inferior to those with cardiomyopathy in most series. In conclusion, patients with end-stage biventricular congenital heart disease represent a complex group of patients for heart transplantation, and require careful evaluation and management to ensure optimal outcomes.     

Localized overexpression of FGF-2 and BDNF in hippocampus reduces mossy fiber sprouting and spontaneous seizures up to 4 weeks after pilocarpine-induced status epilepticus

Purpose: We have recently reported that viral vector–mediated supplementation of fibroblast growth factor‐2 (FGF‐2) and brain‐derived neurotrophic factor (BDNF) in a lesioned, epileptogenic rat hippocampus limits neuronal damage, favors neurogenesis, and reduces spontaneous recurrent seizures. To test if this treatment can also prevent hippocampal circuit reorganization, we examined here its effect on mossy fiber sprouting, the best studied form of axonal plasticity in epilepsy. Methods: A herpes‐based vector expressing FGF‐2 and BDNF was injected into the rat hippocampus 3 days after an epileptogenic insult (pilocarpine‐induced status epilepticus). Continuous video–electroencephalography (EEG) monitoring was initiated 7 days after status epilepticus, and animals were sacrificed at 28 days for analysis of cell loss (measured using NeuN immunofluorescence) and mossy fiber sprouting (measured using dynorphin A immunohistochemistry). Key Findings: The vector expressing FGF‐2 and BDNF decreased both mossy fiber sprouting and the frequency and severity of spontaneous seizures. The effect on sprouting correlated strictly with the cell loss in the terminal fields of physiologic mossy fiber innervation (mossy cells in the dentate gyrus hilus and CA3 pyramidal neurons). Significance: These data suggest that the supplementation of FGF‐2 and BDNF in an epileptogenic hippocampus may prevent epileptogenesis by decreasing neuronal loss and mossy fiber sprouting, that is, reducing some forms of circuit reorganization.     

Applicability of an on-site test for its use in post-mortem blood

The number of deaths related to drugs of abuse makes necessary the use of an on-site test for those cases in which a rapid detection of the consumed drug is required. Cozart® DDS test provides a simple, fast and reliable tool for the qualitative on-site analysis in post-mortem blood. Owing that this test is prepared for oral fluid samples, a validation becomes essential in order to use it for a different matrix than the established one. According to that, results obtained by Cozart® DDS test used in post-mortem blood samples have been compared with a qualitative gas chromatography–mass spectrometry (GC/MS/MS). Positive results for cocaine family compounds (COC-F) were 43.75%, for opiates family compounds (OPI-F) 25.78%, and for cannabis family compounds (THC-F) 2.34%. Negative results were 28.13%. No amphetamines (AMP) or methamphetamines (MA) were found. Sensitivity and specificity was available for cocaine and opiates but not for cannabis because only five cases were detected. Sensitivity, specificity, predictive positive value and predictive negative value for cocaine were 98%, 91%, 88% and 99%, respectively. Sensivilty, specificity, predictive positive value (PPV) and predictive negative value (NPV) for opiates were 93%, 92%, 76% and 98%, respectively. Likelihood positive ratios for cocaine and opiates have been 10.92 and 11.69, respectively, while likelihood negative ratios have been 0.02 and 0.08, respectively. Results show the suitability of Cozart® DDS test for the qualitative detection of cocaine and opiates in post-mortem blood.     

Association between self-monitoring of blood glucose and diet among minority patients with diabetes

Background: Self‐monitoring of blood glucose (SMBG) is used to regulate glucose control. It is unknown whether SMBG can motivate adherence to dietary recommendations. We predicted that participants who used more SMBG would also report lower fat and greater fruit and vegetable consumption. Methods: The present study was a cross‐sectional study of 401 primarily minority individuals living with diabetes in East Harlem, New York. Fat intake and fruit and vegetable consumption were measured with the Block Fruit/Vegetable/Fiber and Fat Screeners. Results: Greater frequency of SMBG was associated with lower fat intake (r_s = ?0.15; P < 0.01), but not fruit and vegetable consumption. The effects of SMBG were not moderated by insulin use; thus, the relationship was significant for those individuals both on and not on insulin. A significant interaction was found between frequency of SMBG and changing one’s diet in response to SMBG on total fat intake. The data suggest that participants who use SMBG to guide their diet do not have to monitor multiple times a day to benefit. Conclusion: The present study found that the frequency of SMBG was associated with lower fat intake. Patients are often taught to use SMBG to guide their self‐management. This is one of the first studies to examine whether SMBG is associated with better dietary intake.