Functional activities versus work hardening in the rehabilitation of the injured worker.

A correlational study was carried out to consider whether a program based on a work-hardening paradigm would result in objective improvements in return-to-work rates relative to a functional-activities approach. Subjects, 165 nurses, were obtained from the Alberta Workers' Compensation Board Rehabilitation Centre client files. The clients were described relative to their age, accident-to-admission times, length of stay, and other relevant measures. A logistic regression was carried out to ascertain whether a work-hardening program versus a functional-activities program would be more effective in facilitating return-to-work rates. The logistic regression was carried out controlling for other relevant predictor variables. The results indicated that clients who received a work-hardening program were statistically more likely to return to work.

From endothelial dysfunction to atherosclerosis.

It has recently emerged that endothelial dysfunction is an early step in the development of atherosclerosis and is mainly characterised by a reduction in the bioavailability of nitric oxide. All of the traditional cardiovascular (CV) risk factors (dyslipidemia, arterial hypertension, hyperglycemia and diabetes) are associated with endothelial dysfunction, and oxidised low-density lipoproteins, the renin-angiotensin axis and insulin resistance play important roles in the pathogenesis of impaired endothelial function. The increased expression of adhesion molecules and pro-inflammatory cytokines leads to abnormal endothelium-dependent vasodilation which could be investigated using vasoreactivity tests such as flow-mediated dilation in the brachial artery. Recently, new evidences showed that the immune system plays an important role in the pathogenesis of endothelial dysfunction and atherosclerosis with a particular regard towards autoimmunity. The high prevalence of the atherosclerotic process in systemic autoimmune diseases supports the hypothesis of the immune pathogenesis. Evaluating coronary microvascular dysfunction by means of transthoracic echocardiography with non-invasive coronary flow reserve assessment is particularly interesting as it could detect preclinical impairment of coronary microvascular function. The discovery that the mechanisms responsible for endothelial damage have a genetic basis could improve the approach to CV diseases. This review summarises the most important aspects of the pathogenesis and development of endothelial dysfunction, with particular attention to the role of traditional CV risk factors, the usefulness of vasoreactivity tests, and the future perspectives opened by genetic studies.