Effects of workplace upper extremity resistance exercises on function and symptoms of workers at a tertiary hospital: a randomized controlled trial protocol.

BACKGROUND: Work-related musculoskeletal disorders (WRMDs) are often caused by inadequate use of the musculoskeletal system during work. Evidence suggests that multimodal intervention through exercises, massage, education, and ergonomic guidelines reduces pain and symptoms in the neck and upper extremities and help to prevent musculoskeletal disorders. The purpose of this study will be to assess the additive effectiveness of a specific and individualized workplace strengthening exercise program to an ergonomic guidance in reducing fatigue, pain and discomfort in the upper extremities and neck perceived by workers. METHODS: This trial was designed according to the Consolidated Standards of Reporting Trials - CONSORT guidelines. Participants will be employees of a tertiary hospital, with any complaints of pain or discomfort in the upper extremities during the past 12 months, without clinical musculoskeletal diagnosis. 166 participants will be randomized into parallels groups as control and workplace exercises. The primary outcomes will be Numerical Pain Scale, isokinetic muscle strength of abduction and isometric handgrip strength. Secondary outcomes on discomfort, fatigue, work capacity and dysfunction will be assessed by QuickDASH, Patient Specific Functional Scale, Neck Disability Index, Need for recovery, Work Ability Index self-report questionnaires and FIT-HANSA performance test. The Ergonomic Work Analysis will be done by Quick Expose Check, RULA, REBA, RARME, ROSA and HARM risk assessment ergonomic tools. We will analyze the difference between baseline and 12 weeks of intervention by T test of independent samples (95% confidence interval, p < 0.05). Clinical significance will be analyzed by the minimum clinically important difference and effect size by Cohen index. The association between the variables will be analyzed by construct validity with the hypothesis of correlations between pain and muscle strength, strength and functionality and strength and fatigue. DISCUSSION: Although studies have shown promise outcomes for workplace exercises as an available therapeutic resource used to minimize complaints of pain and discomfort related to work, the results of this study aim to bring evidence about the benefit of a specific resistance exercise as an effective modality to facilitate mechanisms of neuromuscular adaptations, with gradual and posterior hypertrophy in the later phases. TRIAL REGISTRATION: (NCT04047056, https://clinicaltrials.gov/ct2/show/NCT04047056?term=NCT04047056&draw=2&rank=1 ) on Dec 03, 2020.

Association between muscle strength, upper extremity fatigue resistance, work ability and upper extremity dysfunction in a sample of workers at a tertiary hospital.

BACKGROUND: Upper extremity musculoskeletal disorders negatively affect ability to perform activities of daily living, self-care and work. Therefore, outcome measurements that address muscle strength, fatigue resistance, functionality and work physical capacity must be defined to assess and plan specific actions to minimize them. OBJECTIVE: To investigate the association of upper extremity muscle strength with upper extremity fatigue resistance, work ability and upper extremity dysfunction in a sample of workers from a tertiary hospital. METHODS: Shoulder and elbow isokinetic strength were assessed by Biodex System 4™, isometric hand grip by JAMAR™, upper extremity fatigue resistance by Functional Impairment Test Hand and Neck/Shoulder/Arm (FIT-HaNSA), ability to work by the Work Ability Index and upper extremity dysfunction by the Quick-Disabilities of the Arm, Shoulder and Hand QuickDASH-Br questionnaire. The Nordic questionnaire and Numeric Pain Rating Scale (NPRS) were used for pain description. The associations were analysed by Spearman's correlation coefficient (rho) (p < 0.05). RESULTS: Twenty-seven participants: 59.2% women; mean age 46 years old; 70.3% obese/overweight; 62.9% active with predominantly dynamic muscle contraction work. Besides predominance of good to moderate work ability (81.4%) and comorbidities (37%), all participants had symptoms of the upper extremities for at least 12 months, with a predominance of low-intensity in the shoulder (55.5%). In addition, 88.8% reported pain in other segments. Muscle strength of abduction (rho = 0.49), adduction (rho = 0.40), internal rotation (rho = 0.44) and hand grip (rho = 0.68) presented moderate correlation with FIT-HaNSA. Hand grip (rho = - 0.52) showed moderate correlation with upper extremity dysfunction. CONCLUSIONS: The results of this preliminary study suggested the association of shoulder strength with fatigue resistance. Also, hand grip strength was associated with upper extremity dysfunction and fatigue resistance. No association was found with the Work Ability Index in this sample. So, it is suggested that hand grip and shoulder strength could be outcome measurements used for future interventions focused on upper extremity preventive exercises to improve strength and fatigue resistance of workers at risk for the development of musculoskeletal disorders. Other individual, psychosocial and organizational risk factors must also be considered as influences on upper extremity function.

Generic health literacy measurement instruments for children and adolescents: a systematic review of the literature.

BACKGROUND: Health literacy is an important health promotion concern and recently children and adolescents have been the focus of increased academic attention. To assess the health literacy of this population, researchers have been focussing on developing instruments to measure their health literacy. Compared to the wider availability of instruments for adults, only a few tools are known for younger age groups. The objective of this study is to systematically review the field of generic child and adolescent health literacy measurement instruments that are currently available. METHOD: A systematic literature search was undertaken in five databases (PubMed, CINAHL, PsycNET, ERIC, and FIS) on articles published between January 1990 and July 2015, addressing children and adolescents ≤18 years old. Eligible articles were analysed, data was extracted, and synthesised according to review objectives. RESULTS: Fifteen generic health literacy measurement instruments for children and adolescents were identified. All, except two, are self-administered instruments. Seven are objective measures (performance-based tests), seven are subjective measures (self-reporting), and one uses a mixed-method measurement. Most instruments applied a broad and multidimensional understanding of health literacy. The instruments were developed in eight different countries, with most tools originating in the United States (n = 6). Among the instruments, 31 different components related to health literacy were identified. Accordingly, the studies exhibit a variety of implicit or explicit conceptual and operational definitions, and most instruments have been used in schools and other educational contexts. While the youngest age group studied was 7-year-old children within a parent-child study, there is only one instrument specifically designed for primary school children and none for early years. CONCLUSIONS: Despite the reported paucity of health literacy research involving children and adolescents, an unexpected number of health literacy measurement studies in children's populations was found. Most instruments tend to measure their own specific understanding of health literacy and not all provide sufficient conceptual information. To advance health literacy instruments, a much more standardised approach is necessary including improved reporting on the development and validation processes. Further research is required to improve health literacy instruments for children and adolescents and to provide knowledge to inform effective interventions.

Physical, functional and personal variables affecting shoulder complaints in healthcare workers.

BACKGROUND: Work-related shoulder disorders adversely affect the quality of life and lead to increased costs related to decreased productivity and injury treatment. Therefore, understanding the relationship between strength, upper extremity function and work ability contributes to the development of interventions aimed to improve the well-being of healthcare workers. OBJECTIVE: Correlate shoulder abduction and handgrip strength with upper extremity function and work ability in healthcare workers with shoulder complaints. METHODS: 67 workers with shoulder pain in the last year were assessed by Disability of Arm, Shoulder and Hand (QuickDASH), Work Ability Index (WAI), isokinetic shoulder strength and isometric handgrip strength dynamometers. Data were analysed with Spearman's Correlation Coefficient (ρ= 0.05), SPSS 20.0®. RESULTS: 52% males, mean age 48.4 years, 42% physically active, most administrative and general services workers. Low correlation between handgrip strength and QuickDASH (r=-0.359; p = 0.004); low correlation between handgrip strength and WAI (r = 0.359; p = 0.003) and between shoulder abduction strength and the QuickDASH (r = -0.267; p = 0.049); no significant correlation between shoulder abduction strength and WAI (r = 0.001; p = 0.997). CONCLUSIONS: Handgrip and shoulder abduction strength were inversely associated with upper extremity dysfunction. Shoulder abduction strength was associated with work ability. The inclusion of strength assessment in workers is important to guide strategies to prevent musculoskeletal disorders.

Tradução e adaptação cultural da ferramenta de avaliação de riscos ergonômicos de membros superiores ­ Hand Arm Risk Assessment Method ­ HARM-BR / Translation with cultural adaptation of the risk assessment tool for upper limbs ­ Hand Arm Risk Assessment Method HARM-BR

Lesões musculoesqueléticas nos membros superiores estão intimamente ligadas a limitações funcionais e incapacidades. Estas lesões podem estar relacionadas ao trabalho e são conhecidas como Lesões por Esforços Repetitivos (LER) ou Distúrbios Osteomusculares Relacionados ao Trabalho (DORT). A avaliação ergonômica visa detectar os fatores de riscos para o desenvolvimento das LER/DORT e assim, intervenções e/ou ações preventivas possam ser implementadas. Para isso, são necessárias ferramentas observacionais de avaliação traduzidas e validadas para que resultados fidedignos sejam alcançados. O questionário HARM 2.0 é uma ferramenta de avaliação específica que indica se há risco de lesão em diversas tarefas que utilizam majoritariamente os membros superiores durante sua jornada de trabalho. Objetivo: Conduzir a tradução e adaptação transcultural do questionário HARM 2.0 para ser usado para avaliação e prevenção de riscos de lesões relacionadas ao trabalho. Métodos: A tradução e adaptação transcultural seguiu um protocolo composto por quatro estágios: tradução, síntese, retrotradução, revisão pelo comitê de especialistas e aprovação do conteúdo pelas autoras da versão original. Resultados: O estágio inicial (Estágio I) de tradução do questionário HARM 2.0 transcorreu sem intercorrências. Com relação ao grau de dificuldade, o tradutor expert referiu facilidade ao traduzir os itens e instruções do instrumento, enquanto a tradutora leiga considerou a dificuldade como moderada. Conclusão: O instrumento HARM-BR 2.0 apresentou resultados satisfatórios no processo de tradução e adaptação transcultural, estando sua versão disponível para uso. Futuros estudos são necessários para analisar as suas propriedades de medidas para a população brasileira de trabalhadores.

Musculoskeletal injuries in the upper limbs are closely associated with limitations and disabilities. These injuries can be work-related and are known as Repetitive Strain Injuries (RSI) or Work-Related Musculoskeletal Disorders (WRMD). The ergonomic evaluation aims to detect the risk factors for the development of RSI/WRMD and, therefore, preventive or intervention strategies can be implemented. Translated and validated observational assessments are required to achieve reliable results. The HARM 2.0 questionnaire is a specific assessment tool that indicates the risk of injury in several tasks that use the upper limbs in the work environment. Objective:The objective of this study is to conduct the translation and cross-cultural adaptation of the HARM 2.0 questionnaire for the assessment and prevention of work-related injuries. Methods:Translation and cross-cultural adaptation protocol consisting of four stages: translation, synthesis, back-translation, review by the Expert Committee, and approval by the authors of the original version. Results:The initial stage (Stage I) of translation of the HARM 2.0 questionnaire was regular and had no significant issues. Regarding the difficulty, the expert translator referred that translating the HARM items and instructions was easy, whereas the lay translator considered the scale moderate. Conclusion:The scale HARM-BR 2.0 presents satisfactory results in the process of translation and cross-cultural adaptation and its version available to use. Future studies should be conducted to establish its measurement properties for the Brazilian population.

Validade de construto do Functional Impairment Test-Hand and Neck/Shoulder and Arm (FIT-HANSA) para trabalhadores com queixas no membro superior de um hospital terciário / Construct validity of the Functional Impairment Test-Hand and Neck/Shoulder and Arm (FIT-HANSA) for workers with upper limb complaints of a tertiary hospital

O Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) é um instrumento que avalia a resistência à fadiga e o desempenho do membro superior por meio de funções motoras grossas comumente utilizadas no dia a dia. Objetivo: Analisar a validade de construto do FIT-HaNSA em trabalhadores com sintomas no membro superior, por meio da correlação entre a resistência à fadiga do segmento com os escores de força muscular do ombro, cotovelo e mão, com a capacidade para o trabalho (ICT) e com a disfunção do membro superior (QUICK DASH-Br). Métodos: Trinta e nove trabalhadores de um hospital terciário com idade média de 42,9 anos (DP13,29) foram recrutados. Os instrumentos de medida Isocinético Biodex System 4 Pro™, dinamômetro de preensão palmar JAMAR®, QuickDASH-Br e ICT foram aplicados e correlacionados com o FIT-HaNSA. O Coeficiente de Correlação de Pearson (r) foi utilizado para quantificar a associação entre os instrumentos. Resultados: O FIT-HaNSA apresentou de fraca a moderada correlação entre a força muscular do ombro, cotovelo e mão (r= 0,18 ­ 0,58), porém significativas para ombro e mão. A associação entre o FIT-HaNSA com o QuickDASH-Br e ICT se mostraram fracas (r= -0,38 e 0,21). Conclusão: Nosso estudo forneceu evidências preliminares com relação às relações esperadas e validade do FIT-HaNSA como instrumento de medida para a avaliação da fadiga e desconforto em trabalhadores com queixas no membro superior

The Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) is an instrument that assesses fatigue resistance and upper limb performance through thick motor functions commonly used in everyday life. Objective: To analyze the construct validity of the FIT-HaNSA in workers with symptoms in the upper limb, through the correlation between the fatigue resistance of the segment with the muscle strength scores of the shoulder, elbow and hand, with the ability to work (ICT) and with upper limb dysfunction (QUICK DASH-Br). Methods: Thirty-nine workers from a tertiary hospital with an average age of 42.9 years (SD13.29) were recruited. The Biodex System 4 Pro ™ isokinetic measurement instruments, JAMAR® handgrip dynamometer, QuickDASH-Br and ICT were applied and correlated with FIT-HaNSA. Pearson's correlation coefficient (r) was used to quantify the association between the instruments. Results: FIT-HaNSA showed a weak to moderate correlation between the muscular strength of the shoulder, elbow and hand (r= 0.18 - 0.58), but significant for the shoulder and hand. The association between FIT-HaNSA with QuickDASH-Br and ICT was weak (r= -0.38 and 0.21). Conclusion: Our study provided preliminary evidence regarding the expected relationships and validity of FIT-HaNSA as a measurement tool for the assessment of fatigue and discomfort in workers with complaints in the upper limb

Sanitary quality, occurrence and identification of Staphylococcus sp. in food services.

Sanitary conditions are essential for the production of meals and control of the presence of pathogensis important to guarantee the health of customers. The aim of this study was to evaluate the sanitary quality of food services by checking the presence of thermotolerant coliforms, Staphylococcus sp. and evaluate the toxigenic potential from the latter. The analysis was performed on water, surfaces, equipment, ready-to-eat foods, hands and nasal cavity of handlers in seven food services. The water used in food services proved to be suitable for the production of meals. Most food, equipment and surfaces showed poor sanitary conditions due to the presence of thermotolerant coliforms (60.6%). Twenty-six Staphylococcus species were identified from the 121 Staphylococcus isolates tested. Staphylococci coagulase-negative species were predominant in the foods, equipment and surfaces. In food handlers and foods, the predominant species was Staphylococcus epidermidis. Twelve different genotypes were found after PCR for the classical enterotoxin genes. The seb gene (19.8%) was the most prevalent among all Staphylococcus sp. Both coagulase-positive and coagulase-negative Staphylococci showed some of the genes of the enterotoxins tested. We conclude that there are hygienic and sanitary deficiencies in the food services analyzed. Although coagulase-positive Staphylococci have not been present in foods there is a wide dispersion of enterotoxigenic coagulase-negative Staphylococci in the environment and in the foods analyzed, indicating a risk to consumer health.

Sanitary quality, occurrence and identification of Staphylococcus sp: in food services

Sanitary conditions are essential for the production of meals and control of the presence of pathogensis important to guarantee the health of customers. The aim of this study was to evaluate the sanitary quality of food services by checking the presence of thermotolerant coliforms, Staphylococcus sp. and evaluate the toxigenic potential from the latter. The analysis was performed on water, surfaces, equipment, ready-to-eat foods, hands and nasal cavity of handlers in seven food services. The water used in food services proved to be suitable for the production of meals. Most food, equipment and surfaces showed poor sanitary conditions due to the presence of thermotolerant coliforms (60.6%). Twenty-six Staphylococcus species were identified from the 121 Staphylococcus isolates tested. Staphylococci coagulase-negative species were predominant in the foods, equipment and surfaces. In food handlers and foods, the predominant species was Staphylococcus epidermidis. Twelve different genotypes were found after PCR for the classical enterotoxin genes. The seb gene (19.8%) was the most prevalent among all Staphylococcus sp. Both coagulase-positive and coagulase-negative Staphylococci showed some of the genes of the enterotoxins tested. We conclude that there are hygienic and sanitary deficiencies in the food services analyzed. Although coagulase-positive Staphylococci have not been present in foods there is a wide dispersion of enterotoxigenic coagulase-negative Staphylococci in the environment and in the foods analyzed, indicating a risk to consumer health.