Identifying factors associated with physical therapy use versus non-use among injured workers with back pain in Washington State.

BACKGROUND: There is little information about predictors of physical therapy (PT) use among injured workers with back pain. The primary objective of this study is to investigate the associations between PT use and baseline factors not routinely captured in workers' compensation (WC) data. METHODS: We conducted a secondary analysis using the Washington State Workers' Compensation Disability Risk Identification Study Cohort, which combines self-reported surveys with claims data from the Washington State Department of Labor and Industries State Fund. Workers with an accepted or provisional WC claim for back injury between June 2002 and April 2004 were eligible. Baseline factors for PT use were selected from six domains (socio-demographic, pain and function, psychosocial, clinical, health behaviors, and employment-related). The outcome was a binary measure for PT use within 1 year of injury. Bivariate and multivariable logistic regression models were conducted to evaluate the associations between PT use and baseline factors. RESULTS: Among the 1370 eligible study participants, we identified 673 (49%) who received at least one PT service. Baseline factors from five of the six domains (all but health behaviors) were associated with PT use, including gender, income, pain and function measures, injury severity rating, catastrophizing, recovery expectations, fear avoidance, mental health score, body mass index, first provider seen for injury, previous injury, and several work-related factors. CONCLUSION: We identify baseline factors that are associated with PT use, which may be useful in addressing disparities in access to care for injured workers with back pain in a WC system.

Traumatic spinal cord injury in South Korea for 13 years (2008-2020).

Traumatic spinal cord injury (TSCI) has significant physical, psychological, and socioeconomic impacts. However, the epidemiological characteristics and treatment patterns of TSCI in South Korea remain unclear. This study aimed to investigate TSCI incidence and treatment behaviors in South Korea from 2008 to 2020. We included data from 30,979 newly diagnosed TSCI patients obtained from the Health Insurance Review and Assessment Service (HIRA). Treatment trends, location of surgery, surgical method, comorbidities, factors affecting hospital stay, and risk factors affecting readmission were analyzed. Patients were divided into the surgery group [n = 7719; (25%)] and the non-surgery group [n = 23,260; (75%)]. Surgical cases involved cervical (64%), thoracic (17%), and lumbar/sacral (19%) lesions. Anterior fusion (38%), posterior fusion (54%), and corpectomy (8%) were the surgical methods. Surgical treatments increased annually. Factors influencing hospital stay included male sex, older age, and higher Charlson comorbidity index (CCI). Female sex and higher CCI scores were associated with readmission. In conclusion, a quarter of all TSCI patients underwent surgery, with an upward trend. Risk factors for longer hospital stays were thoracic spine injury, older age, higher CCI, and male sex. Risk factors for readmission included age range of 40-59 years, lumbar/sacral spine injuries, CCI score of 2, and female sex.

The Burden of Back and Neck Strains and Sprains in Professional Baseball Players.

STUDY DESIGN: A retrospective case series study. OBJECTIVE: To analyze the epidemiology of diagnoses of back and neck strains and sprains among Major League (MLB) and Minor League (MiLB) Baseball players. BACKGROUND: Baseball players perform unique sets of repetitive movements that may predispose to neck and back strains and sprains. Data are lacking concerning the epidemiology of these diagnoses in this population. MATERIALS AND METHODS: De-identified data on neck/back strains and sprains were collected from all MLB and MiLB teams from 2011 to 2016 using the MLB-commissioned Health and Injury Tracking System database. Diagnosis rates of conditions related to cervical, thoracic, and lumbar musculature and their impact on days missed due to injury, player participation, and season or career-ending status were assessed. Injury rates were reported as injuries per 1000 athlete exposures (AEs). RESULTS: There were 3447 cases of neck/back strains and sprains in professional baseball players from 2011 to 2016. Seven hundred twenty-one of these occurred in MLB versus 2726 in MiLB. Of injuries 136 were season-ending (26 in MLB, 110 in MiLB); 22 were career-ending (2 in MLB, 20 in MiLB). The total days missed were 39,118 (8838 from MLB and 30,280 from MiLB). Excluding season or career-ending injuries, the mean days missed were 11.8 (12.7 and 11.6 in MLB and MiLB, respectively). The median days missed were 4 (3 and 5 in MLB and MiLB, respectively). Combining MLB and MiLB, the pitcher injury rate was 1.893 per 1000 AEs versus 0.743 per 1000 Aes for other position players ( P < 0.0001). CONCLUSION: There was a high incidence of neck/back strains and sprains in MLB and MiLB players, with nearly 40,000 aggregate days missed in our 6-year study period. The median days missed were lower than the mean days missed, indicating rightward outliers. Pitchers had over double the rates of injuries compared with other position players. LEVEL OF EVIDENCE: Level III.

Is MRI screening for bone marrow oedema useful in predicting lumbar bone stress injuries in adult male professional cricketers? A New Zealand pilot study.

OBJECTIVES: The aims were to (1) prospectively observe the incidence of bone marrow oedema in asymptomatic adult male domestic professional cricketers during a season and evaluate its relationship to the development of lumbar bone stress injury and (2) further understand the practicalities of implementing a Magnetic Resonance Imaging-based screening program to prevent lumbar bone stress injury in New Zealand cricket. DESIGN: Prospective observational cohort. METHODS: Adult male pace bowlers received 6-weekly pre-planned Magnetic Resonance Imaging scans over a single season to determine the presence and intensity of bone marrow oedema in the posterior vertebral arches of the lumbar spine. The participants bowling volume and back pain levels were monitored prospectively. RESULTS: 22 participants (mean age 25.3 years (range 20-32 years)) completed all 4 scans. Ten participants had a prior history of lumbar bone stress injury. Ten participants (45 %, 95 % confidence interval 24-68 %) had bone marrow oedema evident on at least one scan, with 9 (41 %) participants recording a bone marrow oedema intensity ≥ 2 and 5 (23 %) participants demonstrated an intensity ≥ 3. During the study one participant was diagnosed with a lumbar bone stress reaction. No participants developed a lumbar bone stress fracture. CONCLUSIONS: Due to the lower incidence of lumbar bone stress injuries in adult bowlers coupled with uncertainty over appropriate threshold values for bone marrow oedema intensity, implementation of a resource intense screening program aimed at identifying adult domestic cricketers at risk of developing a lumbar bone stress injury is not currently supported.

Incidence and risk factors of lumbar plexus injury in patients undergoing oblique lumbar interbody fusion surgery.

PURPOSE: To investigate the incidence and risk factors of lumbar plexus injury (LPI) after oblique lumbar interbody fusion (OLIF) surgery. METHODS: A total of 110 patients who underwent OLIF surgery between January 2017 and January 2021 were retrospectively reviewed. Patients were divided into two groups: the group with LPI (LPI group) and the group without LPI (non-LPI group). The baseline demographic data, surgical variables and radiographic parameters were compared and analyzed between these two groups. RESULTS: Among all participants, 13 (8.5%) had LPI-related symptoms postoperatively (short-term), and 6 (5.5%) did not fully recover after one year (long-term). Statistically, there were no significant differences in the baseline demographic data, surgery duration, intraoperative blood loss, preoperative diagnosis, surgical procedures used and incision length. Compared with the non-LPI group, patients in the LPI group had a narrower OLIF channel space. In LPI group, the anterior edge of left psoas major muscle overpasses the anterior edge of surgical intervertebral disk (IVD) on axial MRI. Logistic regression analysis revealed that narrow OLIF channel space and the anterior edge of left psoas major muscle overpassing the anterior edge of surgical IVD on axial MRI were independently associated with both short-term and long-term LPI. CONCLUSION: Narrow OLIF channel space and the anterior edge of left psoas major muscle overpassing the anterior edge of surgical IVD are significant risk factors of OLIF surgery-related LPI. Surgeons should use preoperative imaging to adequately assess these risk factors to reduce the occurrence of LPI.

A Longitudinal Study of Prevalence Ratios for Musculoskeletal Back Injury Among U.S. Navy and Marine Corps Personnel, 2009-2015.

INTRODUCTION: Medical readiness to deploy is an increasingly important issue within the military. Musculoskeletal back pain is one of the most common medical problems that affects service members. This study demonstrates the associations between risk factors and the prevalence of musculoskeletal back pain among active duty sailors and Marines within the Department of the Navy (DoN). MATERIALS AND METHODS: Utilizing the Military Health System Data Repository, we conducted a retrospective cross-sectional review of administrative healthcare claim data for all active duty DoN personnel with at least one medical encounter during fiscal years 2009-2015. For each fiscal year, we identified all claims with an ICD-9 code for back pain and calculated prevalence. We compared those with and without back pain across all variables (age, gender, rank, race, body mass index, tobacco use, occupation, and branch of service) using chi-square analysis. Unadjusted and adjusted log-binomial regressions were used to calculate prevalence ratios and examine associated risk factors for back pain. RESULTS: The number of active duty subjects per fiscal year ranged from 424,460 to 437,053. The prevalence of back pain showed an upward trend, ranging from 9.99% in 2009 to 12.09% in 2015. Personnel aged 35 years and older had the strongest adjusted prevalence ration (APR) for back pain (APR 2.59; 95% CI, 2.53-2.66). There were also strong associations with obese body mass index (APR 1.76; 95% CI, 1.66-1.86), overweight body mass index (APR 1.29; 95% CI, 1.27-1.32), and tobacco use (APR 1.39; 95% CI, 1.36-1.42). Females were more likely to have back pain than males (APR 1.43; 95% CI, 1.40-1.47) and Marines more likely than sailors (APR 1.39; 95% CI, 1.36-1.42). The occupation with the highest prevalence ratio was healthcare (APR 1.34; 95% CI, 1.29-1.40) when compared to the reference group of combat specialists. CONCLUSIONS: There was an increasing prevalence of back pain across the DoN from 2009 to 2015. Different occupational categories demonstrate different prevalence of back pain. Surprisingly, combat occupations and aviators were among the groups with the lowest prevalence. Lifestyle factors such as excess body weight and use of tobacco products are clearly associated with increased prevalence. These results could inform military leaders with regard to setting policies that could increase medical readiness.

Factors associated with asymptomatic vertebral fractures in patients with rheumatoid arthritis in a rheumatology service in Bogotá (Colombia)

Introduction: In patients with rheumatoid arthritis (RA), osteoporotic vertebral fractures (OVF) are of multifactorial etiology. The main mechanism is spontaneous and therefore most are asymptomatic. The presence of VF has an impact on the quality of life of patients, and consequently on morbidity and mortality, therefore it should be systematically evaluated in this population, especially when associated factors have been reported. The main objective of this study was to identify clinical characteristics for osteoporosis and poor prognosis in rheumatoid arthritis that could be associated with the development of osteoporotic vertebral fractures identified in the lateral chest X-ray of asymptomatic patients with RA. The secondary objectives were to present the frequency, location, and severity of the fractures, as well as the inter and intra-observer correlation, when analyzing the radiographs. Methodology: Patients with a diagnosis of RA were included, with a lateral chest X-ray and indication dissimilar to spinal symptoms. The mean age was 58 years (IQR 21-88). Three researchers evaluated 151 images in a sequenced and standardized manner using the Algorithm-Base Qualitative approach (ABQ) and Genant methods. Variables associated with the presence of osteoporosis and poor prognosis in RA were identified. Subsequently, a multivariate analysis was carried out to find an association with the presence of VF in this population. Results: We found 39 fractures in 32/151 patients. Identifying multiple fractures in 5 of them. The prevalence of osteoporotic vertebral fractures was 21.2%. The distribution of fractures was mainly at the level of T5, T8 and T9, with a predominance of Genant grade 1 in 46%. In the multivariate analysis, age, duration of RA (mainly greater than 10 years), rheumatoid factor, anti-citrullinated peptide antibodies, DAS28, HAQ, presence of antinuclear antibodies (ANA), smoking and being under treatment for osteoporosis showed a statistically significant association. The interobserver correlation for the ABQ and Genant methods presented a kappa index of .9 and .92, respectively. Conclusion: In patients with RA there is a significant association with the development of VF, independent of the presence of osteoporosis. Furthermore, this research suggests that the presence of some clinical and paraclinical characteristics could be associated with the prevalence of osteoporotic vertebral fractures. Age, duration of arthritis, poor prognostic markers for RA in terms of serology and functionality, as well as being in treatment for osteoporosis had statistical significance of association. This should guide the timely detection of fractures, independent of symptoms, with the respective targeted treatment in this population and thus avoid functional complications and a decrease in quality of life.

Introducción: En los pacientes con artritis reumatoide (AR) las fracturas vertebrales osteoporóticas (FVO) son de etiología multifactorial. El principal mecanismo es espontáneo y por ende la mayoría son asintomáticas. La presencia de FVO impacta en la calidad de vida de los pacientes y, en consecuencia, en la morbilidad y la mortalidad, por lo tanto, se debería evaluar de forma sistemática en esta población, más aún cuando se han reportado factores asociados. Objetivos: Los objetivos principales fueron identificar las características clínicas de osteoporosis y de mal pronóstico en AR, que podrían estar asociadas con el desarrollo de fracturas vertebrales osteoporóticas identificadas en la radiografía lateral de tórax en pacientes asintomáticos con AR, y los objetivos secundarios fueron presentar la frecuencia, la localización y la severidad de las fracturas, como también la correlación inter e intraobservador al analizar las radiografías. Metodología: Se incluyeron pacientes con diagnóstico de AR, con radiografía lateral de tórax e indicación disímil a síntomas en columna. La media de edad fue de 58 arios (RIC 21-88). Tres investigadores evaluaron 151 imágenes, de manera secuencial y estandarizada, utilizando los métodos Algorithm-Base Qualitative approach (ABQ) y de Genant. Se identificaron variables asociadas con la presencia de osteoporosis y de pobre pronóstico en AR. Posteriormente, se hizo un análisis multivariado orientado a encontrar asociación con la presencia de FVO en esta población. Resultados: Se encontraron 39 fracturas en 32/151 pacientes, en cinco de ellos se encontraron múltiples fracturas. La prevalencia de fracturas vertebrales osteoporóticas fue de 21,2%. La distribución de fracturas fue principalmente a nivel de T5, T8 y T9, con predominio de aquellas grado 1 de Genant (46%). En el análisis multivariado, la edad, la duración de la AR (principalmente mayor a 10 anos), el factor reumatoideo, los anticuerpos antipéptidos citrulinados, el Disease Activity Score-28 (DAS28), el Health Assessment Questionnaire (HAQ), la presencia de anticuerpos antinucleares (ANA), el tabaquismo y estar en tratamiento para osteoporosis presentaron una asociación estadísticamente significativa. La correlación interobservador para los métodos ABQ y Genant presentó un índice kappa de 0,9 y 0,92, respectivamente. Conclusión: En pacientes con AR existe una asociación significativa con el desarrollo de FVO, con independencia de la presencia de osteoporosis. Además, esta investigación sugiere que la presencia de algunas características clínicas y paraclínicas podría estar asociada con la prevalencia de fracturas vertebrales osteoporóticas. La edad, la duración de la artritis, los marcadores de mal pronóstico de la AR en cuanto a serología como funcionalidad, así como estar en tratamiento para osteoporosis tuvieron significancia estadística de asociación. Esto debería guiar una detección oportuna de las fracturas, más allá de los síntomas, con el respectivo tratamiento dirigido a esta población y así evitar complicaciones funcionales y una disminución en la calidad de vida.

The Impact of Adherence to Clinical Practice Guidelines on Medical Costs.

OBJECTIVE: To examine the association between non-adherence to clinical practice guidelines (CPGs) and medical and indemnity spending among back and shoulder injury patients. METHODS: Workers compensation claims data was used from a large, US insurer (1999 to 2010). Least square regression models were created to examine the association between spending and guideline-discordant care. RESULTS: Non-adherence to CPGs was associated with higher medical and indemnity spending for 11 of the 28 CPG indicators. Failure to adhere to the other CPGs did not increase medical or total spending. After covariate adjustment, non-adherence to these 11 CPGs was associated with spending increases that ranged from $16,000 for physical therapy (PT) to $114,000 for surgery. CONCLUSIONS: Our results demonstrate that failure to adhere to a subset of CPG indicators significantly predicts increased medical and indemnity spending for two important occupational injuries.

Orthopedic Injuries in Professional Surfers: A Retrospective Study at a Single Orthopedic Center.

BACKGROUND: Literature regarding surfing injuries is scarce and most studies report a high number of minor injuries. Recent literature suggests that musculoskeletal injuries are more common than previously reported. In the mid 2000s, competitive surfing has seen an increase in aerial maneuvers, as they have become more highly rewarded by the judging panel, which may be contributing to a change in injury patterns. Our goal was to evaluate orthopedic injuries in professional surfers. HYPOTHESIS: Orthopedic injuries in professional surfers are diverse and have evolved with skill and technology. STUDY DESIGN: Retrospective observational study. LEVEL OF EVIDENCE: Level 4 Case Series. METHODS: Medical records of professional surfers from a single orthopedic center between 1991 and 2016 were reviewed. Injuries sustained while surfing and chronic injuries related to surfing were included. Site of injury, diagnosis, and treatment were recorded along with demographic data. RESULTS: In total, 163 injuries in 86 athletes were recorded. The median injury age was 28.5 years (range 12-62 years) and 92.6% of patients were male. The most frequently injured body parts were the knee (28.2%), ankle (22.1%), and shoulder (19%). Most knee injuries were of the medial collateral ligament at 49%, with 75% of ankle injuries being sprains, and in shoulder, 48% had instability, 42% had a rotator cuff tear, and 35% had a superior anterior-posterior labral tear. Lower extremity injuries primarily affected the surfers' back leg (72.5%). In all, 34.6% of all injuries required surgical intervention and involved shoulder injuries most the time. CONCLUSIONS: The most common orthopedic injuries in professional surfers involve the knee, ankle, shoulder, hip, and back. Surfers' rear extremities were preferentially injured which is the extremity responsible for power and torque. Shoulder injuries increased the probability of an operative intervention. Last, overuse injuries (femoral-acetabular impingement, rotator cuffs) occurred in the older surf population compared with more acute injuries (ankle sprains/fractures, anterior cruciate ligament tears) which is also consistent with time to surgery.

Increased overall and cause-specific mortality associated with disability among workers' compensation claimants with low back injuries.

BACKGROUND: Mortality tends to be higher among people who do not work than among workers, but the impact of work-related disability on mortality has not been well studied. METHODS: The vital status through 2015 was ascertained for 14 219 workers with an accepted workers' compensation claim in West Virginia for a low back injury in 1998 or 1999. Mortality among the cohort compared with the West Virginia general population was assessed using standard life table techniques. Associations of mortality and disability-related factors within the cohort were evaluated using Cox proportional hazards regression. RESULTS: Compared to the general population, mortality from accidental poisoning was significantly elevated among the overall cohort and lost-time claimants. Most deaths from accidental poisoning in the cohort were due to drug overdoses involving opioids. Mortality from intentional self-harm was also significantly elevated among lost-time claimants. In internal analyses, overall mortality and mortality from cancer, heart disease, intentional self-harm, and drug overdoses involving opioids was significantly associated with lost time. Overall mortality and mortality from drug overdoses involving opioids were also significantly associated with amount of lost time, permanent partial disability, and percent permanent disability. Heart disease mortality was also significantly associated with the amount of lost time. CONCLUSIONS: The results suggest that disability itself may impact mortality risks. If confirmed, these results reinforce the importance of return to work and other efforts to reduce disability.

MRI Bone Marrow Edema Signal Intensity: A Reliable and Valid Measure of Lumbar Bone Stress Injury in Elite Junior Fast Bowlers.

STUDY DESIGN: Comparative reliability and prospective validity. OBJECTIVE: First, to evaluate the reliability of four methods of assessing magnetic resonance imaging (MRI) bone marrow edema (BMO) of the posterior vertebral arch of the lumbar vertebrae of elite junior fast bowlers. Second, to evaluate the validity of the most reliable method for the early detection of lumbar bone stress injury. SUMMARY OF BACKGROUND DATA: MRI has demonstrated utility in identifying BMO in lumbar vertebrae. Methods to grade the severity of BMO may provide valuable insight to inform clinical management, particularly in elite athletes where detection of early-stage bone stress may prevent progression to more severe and costly bone stress injury. METHODS: Sixty-five male elite junior fast bowlers had repeat MRI scans during a cricket season. A subset of 19 bowlers' images were reassessed by experienced musculoskeletal radiologists to determine intra- and inter-rater reliability. All images were aligned with independent medical records of lower back symptoms and diagnosed bone stress injuries to establish the relationship of BMO and lumbar bone stress injury. RESULTS: Clinical detection of abnormal BMO, whether the pars region of the vertebra was considered in its entirety or subdivided into regions, had fair-to-moderate inter-rater reliability, and fair-to-almost perfect intra-rater reliability. Measurement of BMO signal intensity using an imaging software tool had excellent intra-rater and inter-rater reliability (ICC = 0.848, 0.837). BMO signal intensity was positively associated with subsequent LBSI (P < 0.001), and differentiated between asymptomatic and symptomatic bowlers (P < 0.001). CONCLUSION: Measurement of BMO signal intensity using an imaging software tool proved a reliable and valid measure of the severity of lumbar bone stress injury in elite junior fast bowlers. LEVEL OF EVIDENCE: 2.

Air-fluidized therapy in the treatment of severe burns: A retrospective study from a burn intensive care unit in Austria.

INTRODUCTION: Air-fluidized therapy (AFT) has long been used in the treatment of severe burns. In patients with extensive burns involving the posterior trunk, we aim to keep affected posterior areas dry and to postpone their treatment, initially applying available split-thickness skin grafts in functionally more important regions. We retrospectively assessed the impact of AFT on the survival of patients treated in the burn intensive care unit (ICU) of the Medical University of Vienna, Austria, between 2003 and 2016. METHODS: This retrospective single-center study included patients aged ≥18 years with burned total body surface area (TBSA) ≥20% and IIb-III° thermal injuries on the posterior trunk who received AFT. Survival rates were compared with those predicted by the abbreviated burn severity index (ABSI). Demographic, clinical, and surgical data were analyzed. RESULTS: Seventy-five of 110 patients with posterior trunk burns received AFT. Their survival rate exceeded that predicted by the ABSI score (mean ABSI, 10.0 ± 2.0; 73.3% (95% CI: 62-83%) survival rate vs. 20-40% predicted; p < 0.0001); no such difference was observed in the non-AFT group (mean, 8.8 ± 1.9; 65.7% (95% CI: 48-81%) survival rate vs. 50-70% predicted). Patients receiving AFT had significantly greater TBSA (median, 50% (35-60) vs. 30% (25-45) and longer ICU stays (median, 63 (36-92) vs. 18 (9-52) days; both p < 0.0001). Fifty-one (68.0%) patients in the AFT group and 26 (74.3%) patients in the non-AFT group underwent posterior trunk surgery (p = 0.66) a median of 16 (10-26) and 5 (2.5-9.5) days, respectively, after admission (p < 0.0001). CONCLUSIONS: Patients receiving AFT had significantly better survival than predicted by ABSI score in contrast to patients not receiving AFT although burn injuries in this group were more severe (greater TBSA, higher ABSI). As intensive care was similar in these groups aside from AFT, the better survival could be attributed to this additional therapy.

Measuring Back Injury Risk in Mexican Workers of an Automotive Company / Medición del riesgo de lesión de espalda en trabajadores mexicanos de una empresa automotriz / Medição do risco de lesão de costas em trabalhadores mexicanos de uma empresa automotiva

Abstract Introduction : The Mexican manufacturing sector in the automotive industry employs an average of 8 million 850 thousand workers per year spread across the 32 states, of which Puebla contributes with 465106, developing, in a high percentage, the verification of new parts as part of the manufacture process. This activity is supported by the use of devices known as fixtures, whose equipment and tool forces operators to lift loads between 10 and 50 kilograms by performing manual operations to hold parts, presenting pain at the lumbar level, therefore, it is essential to measure the risks of back injuries in the study population. The objective was to identify and measure the risks of back injuries in the study population. Materials and Methods : The inspection process is analyzed by identifying the potential risk factors. Ergonomic methodologies and instruments are used, such as Quick Exposure Check (QEC), the National Institute for Occupational Safety and Health (NIOSH) equation, the REBA (Rapid Entire Body Assessment) method, Ovako's Work Posture Analysis System (OWAS), among others. Results : The QEC method shows that trunk/back and wrist/hand are the most sensitive parts to risk exposure, indicating that 18 % of the postures are rated 4 in the level of risk, with the back rotated and bent in over 32 % of time. The weight of the operation exceeds 20 kilograms in 71.4 %. Conclusion: Four ergonomic techniques are used to assess the risk of injury, the inspection process of manufactured parts is analyzed.

Resumen Introducción: la industria manufacturera mexicana del ramo automotor emplea en promedio 8 millones 850 mil trabajadores al año repartidos en los 32 estados, de los cuales Puebla contribuye con 465106, desarrollando, en un alto porcentaje, la verificación de piezas nuevas como parte de los procesos de manufactura. Esta actividad se apoya en el uso de dispositivos conocidos como fixtures, cuyo equipo y herramienta obliga a los operarios a levantar cargas entre los 10 y los 50 kilogramos, realizando operaciones manuales para la sujeción de piezas, presentándose dolores a nivel lumbar, por lo que es primordial medir los riesgos de lesiones en la espalda de la población en estudio. El objetivo fue identificar y medir los riesgos de lesiones en la espalda de la población en estudio. Materiales y métodos : se analiza el proceso de inspección identificando los factores de riesgo potencial. Se utilizan metodologías y herramientas ergonómicas, tales como Quick Exposure Check (QEC), la ecuación del National Institute for Occupational Safety and Health (NIOSH), el método REBA (Rapid Entire Body Assessment), el sistema de análisis de posturas de trabajo de Ovako (OWAS), entre otras. Resultados : el método QEC muestra que tronco/ espalda y muñeca/mano son las partes más sensibles a la exposición de riesgo, señalando el 18 % de las posturas en un nivel de riesgo 4, con la espalda rotada y flexionada en más del 32 % del tiempo. El peso que conlleva la operación supera los 20 kilogramos en el 71,4%. Conclusión : se utilizan cuatro técnicas ergonómicas para evaluar el riesgo de lesión y se analiza el proceso de inspección de piezas fabricadas.

Resumo Introdução : a indústria manufatureira mexicana do ramo automotivo emprega em média 8 milhões 850 mil trabalhadores ao ano repartidos nos 32 estados, dos quais Puebla contribui com 465106 deles, desenvolvendo, em uma alta porcentagem a verificação de peças novas como parte dos processos de manufatura. Esta atividade apoia-se no uso de dispositivos conhecidos como fixtures, cuja equipe e ferramentas abriga aos operários a levantar cargas entre os 10 e 50 quilogramas realizando operações manuais para a fixação de peças, se apresentando dores no nível lombar, pelo que é primordial medir os riscos de lesões nas costas da população em estudo. Materiais e métodos : se analisa o processo de inspeção identificando os fatores de risco potencial. Se utilizam metodologias e ferramentas ergonómicas, tais como Quick Exposure Check (QEC), a equação do National Institute for Occupational Safety and Health (NIOSH), o método REBA (Rapid Entire Body Assessment), o sistema de análise de posturas de trabalho de Ovako (OWAS), entre outras. Resultados : o método QEC mostra que o torso/costas e o pulso/mão são as partes mais sensíveis à exposição de risco, assinalando o 18 % das posturas em um nível de risco 4, com as costas rotadas e curvadas em mais do 32 % do tempo. O peso que leva a operação supera os 20 quilogramas no 71.4 %. Conclusão : utilizam-se quatro técnicas ergonómicas para avaliar o risco de lesão e se analisa o processo de inspeção de peças fabricadas.

Role of computed tomography tractography in evaluation of back/flank stab wounds.

BACKGROUND: The clinical approach to back/flank wounds has evolved over the years. The aim of this study was to discuss the potential of computed tomography tractography in patients with a stab wound to the back or flank. METHODS: A total of 25 stable patients with stab wounds confined to the back/flank region were enrolled in this retrospective study. After initial resuscitation and physical examination, tractography was performed at the site of the stab wound. The patients subsequently underwent computed tomography with intravenous contrast. RESULTS: Computed tomography tractography helped avoid a laparotomy in 15 (60%) patients and accurately revealed a peritoneal breach in 10 (40%) patients. No missed injuries were reported in the conservatively followed patients. CONCLUSION: The addition of tractography to computed tomography is a safe, fast, and cost- and time-effective technique to evaluate back/flank stab wounds.

MRI bone marrow oedema precedes lumbar bone stress injury diagnosis in junior elite cricket fast bowlers.

OBJECTIVES: Lumbar bone stress injury ('bone stress injury') is common in junior fast bowlers. The repetitive loading of cricket fast bowling may cause bone marrow oedema (BMO), detectable on MRI, before the bowler suffers from symptomatic bone stress injury. We investigated the temporal relationship between BMO, bone stress injury, along with bowling workload correlates, in elite junior fast bowlers throughout a cricket season. METHODS: 65 junior fast bowlers were prospectively monitored for one 8-month cricket season. For research purposes, participants had up to six MRI scans at set times in the season; findings were withheld from them and their clinicians. Standard practices for bowling workload monitoring and injury diagnosis were followed. RESULTS: 15 (23%) participants developed bone stress injury during the study. All 15 of these participants had BMO detected on at least one of the preceding MRI scans, including the scan immediately prior to diagnosis. The risk of BMO progressing to bone stress injury during the season was greatest for participants with BMO present 2 weeks prior to the national championship tournament (period of high load) (RR=18.9, OR=44.8). Both bone stress injury and BMO were associated with bowling a higher percentage of days in training and having a shorter bowling break during the season. The number of balls bowled and acute-to-chronic workload were not associated with imaging abnormalities or injury. CONCLUSION: The presence of BMO on MRI in asymptomatic junior cricket fast bowlers confers a very high risk for bone stress injury. The risk may be managed by MRI screening and monitoring bowling frequency.

The Effect of the Histone Deacetylase Inhibitor Suberoylanilide Hydroxamic Acid and Paclitaxel Treatment on Full-Thickness Wound Healing in Mice.

INTRODUCTION: Neoadjuvant chemotherapy prior to lumpectomy or mastectomy for breast cancer challenges wound healing. Suberoylanilide hydroxamic acid (SAHA), a histone deacetylase inhibitor, has been shown to work synergistically with paclitaxel in vitro and in preclinical studies. In addition, our laboratory has demonstrated that SAHA treatment decreases paclitaxel-associated stem cell toxicity, modulates inflammatory response, and promotes wound healing in injured fibroblast cells. Our goal was to determine if combined SAHA and paclitaxel treatment would improve wound healing in an in vivo full-thickness murine model, without altering antitumor effect. METHODS: Thirty-two nude athymic mice received intraperitoneal injections of paclitaxel (20 mg/kg), SAHA (25 mg/kg), paclitaxel + SAHA (20 mg/kg + 25 mg/kg), or no treatment for 2 weeks prior to surgery. Under general anesthesia, 8-mm full-thickness dorsal wounds were created in all animals, and a silicone splint was attached to minimize wound contraction. The wounds were measured twice a week with a surgical caliper until healing was complete. To evaluate the in vivo effect of drug treatment, 16 athymic nude mice with MDA-MB-231 xenografts received the treatments described previously, following which tumor volumes were compared between groups. RESULTS: Average wound healing time was prolonged in mice treated with paclitaxel (20 ± 1.9 days), and combination SAHA + paclitaxel therapy improved average wound healing time (17.0 ± 1.8 days). In the xenograft model, the antitumor effect of SAHA and paclitaxel (average tumor volume 43.9 ± 34.1 mm) was greater than paclitaxel alone (105.8 ± 73.8 mm). CONCLUSIONS: The addition of SAHA to taxane chemotherapy improves the therapeutic effect on triple-negative breast cancer while decreasing the detrimental effect of paclitaxel on wound healing. This may have substantial implications on improving outcomes in breast reconstruction following chemotherapy.

Musculoskeletal pain and its associated risk factors among medical students of a public sector University in Karachi, Pakistan.

OBJECTIVE: To assess the frequency and anatomical distribution of musculoskeletal pain and its related risk factors. METHODS: This cross-sectional study was conducted at the Dow Medical College, Karachi, from September to November 2016, and comprised medical students. A self-administered questionnaire was filled out by the participants. Data was analysed using SPSS 17. RESULTS: Of the 360 participants, 268(74.4%)and 140(38.9%)students reported having musculoskeletal pain in at least one of the body sites in the past 12 months and in the past seven days, respectively. Self-reported mental stress (p=0.01) and history of trauma in the neck, shoulder or lower back (p=0.002) were the most significant predictors of musculoskeletal pain during the past seven days. Age, body mass index, gender, academic year, family history of musculoskeletal disorders, hours of clinical practice per day, hours of study per day, smoking and exercise had no significant relation with musculoskeletal pain in neck, shoulder or lower back (p>0.05 each). The use of computer/laptop for more than three hours per day had an increased occurrence of neck pain (p=0.03).. CONCLUSIONS: There was a significant risk of musculoskeletal pain for medical students.

No difference in prevalence of spine and hip pain in young Elite skiers.

PURPOSE: To investigate the prevalence between back and hip pain in young Elite skiers. METHODS: Sample group (n = 102), consisted of young Elite skiers (n = 75) and age-matched non-athletes (n = 27), all completed a three-part back and hip pain questionnaire, Oswestry Disability Index and EuroQoL to evaluate general health, activity level, back and hip pain prevalence. RESULTS: No significant differences were shown for lifetime prevalence of back pain in the skiers (50%) compared with controls (44%) (n.s.). Duration of back pain for the skiers showed (30%) > 1 year, whilst (46%) > 5 years. A significant difference was shown with increased Visual Analogue Scale back pain levels for skiers 5.3 (SD 3.1) compared with controls 2.4 (SD 1.9, p = 0.025). No significant differences were shown for lifetime prevalence of hip pain in skiers (21%) compared with controls (8%) (n.s.). CONCLUSION: Young Elite skiers are shown not to have increased lifetime prevalence for back and hip pain compared with a non-athletic control group. LEVEL OF EVIDENCE: II.