Reduction of headache intensity and frequency with maxillary stabilization splint therapy in patients with temporomandibular disorders-headache comorbidity: a systematic review and meta-analysis.

This systematic review and meta-analysis aimed to analyze the effectiveness of maxillary stabilization splint (SS) therapy to reduce headache (HA) intensity and HA frequency in patients with temporomandibular disorders (TMD)-HA comorbidity. Randomized controlled trials (RCTs) using full-arch coverage, hard resin, and maxillary SS therapy were included. Electronic databases, including Cochrane Library, MEDLINE through PubMed, Web of Science, and EMBASE, were searched. The risk of bias was analyzed based on Cochrane's handbook. The search yielded 247 references up to January 28, 2020. Nine RCTs were included at a high risk of bias. The comparison groups included other splints, counseling, jaw exercises, medications, neurologic treatment, and occlusal equilibration. Four studies reported a statistically significant reduction in HA intensity, and five studies reported significant improvement in HA frequency from baseline at 2-12 months in patients with TMD-HA comorbidity treated with a full-arch hard maxillary SS. HA frequency in tension-type HA (TTH) comorbid with TMD diagnoses of myofascial pain (MFP) or capsulitis/synovitis improved significantly with SS than that with full-arch maxillary non-occluding splint (NOS) in two studies. Comparison groups receiving hard partial-arch maxillary splint nociceptive trigeminal inhibition (NTI) showed statistically significant improvements in HA intensity in patients with mixed TMD phenotypes of MFP and disc displacement comorbid with "general HA." Comparison groups receiving partial-arch maxillary resilient/soft splint (Relax) showed significant improvements in both HA intensity and frequency in patients with HA concomitant with MFP. The meta-analysis showed no statistically significant difference in the improvement of pain intensity at 2-3 months with comparison of the splints (partial-arch soft [Relax], hard [NTI], and full-arch NOS) or splint use compliance at 6-12 months with comparison of the splints (partial-arch Relax and full-arch NOS) versus the SS groups in patients with various TMD-HA comorbidities. In conclusion, although SS therapy showed a statistically significant decrease in HA intensity and HA frequency when reported, the evidence quality was low due to the high bias risk and small sample size. Therefore, further studies are required.

Work-related musculoskeletal problems and associated factors among office workers.

Purpose. The aim of this study was to investigate musculoskeletal disorders (MSDs) and associated factors among Iranian office personnel. Materials and methods. In this cross-sectional study, 359 Iranian office workers were included. Data were gathered using a demographic questionnaire, the Nordic musculoskeletal questionnaire, the numeric rating scale, rapid office strain assessment (ROSA) and the NASA task load index (NASA-TLX). Results. Our findings showed that the highest prevalence rate of MSDs within the last 12 months and the highest pain/discomfort severity were related to the participants' necks. The mean performance, mental demand and effort subscale scores of the NASA-TLX were higher than other subscales (physical demand, temporal demand and frustration level). ROSA scores showed that 53.8% of the participants were in action level 1 (low MSD risk) and the rest (46.2%) were in action level 2 (high MSD risk). The pain/discomfort severity in the shoulders, elbows, wrists/hands, thighs and ankles/feet was correlated to the final ROSA score. Age, gender, body mass index and some NASA-TLX subscales (effort, mental demand and performance) were associated with symptoms of MSDs in different body regions. Conclusions. Improving workplace conditions (both mentally and physically) is suggested for reducing and eliminating musculoskeletal problems among office workers.

Occupational Health Problems and Safety Conditions among Small and Medium-Sized Enterprises: A Cross-sectional Study in Shiraz, Iran.

BACKGROUND: Small and medium-sized enterprises (SMEs) include a large part of manufacturing jobs and play an important role in developing national economics and employment. OBJECTIVES: The present study aimed to investigate occupational health problems and safety conditions among SMEs in Shiraz, Iran. METHODS: This cross-sectional study was carried out on 711 SMEs, including 371 small enterprises (fewer than 25 workers) and 340 medium enterprises (25-99 workers), in Shiraz, Iran. The participants were selected randomly among the workplaces under the coverage of social security insurance. The researcher-made questionnaire, which consisted of demographic characteristics, the frequency rate of occupational accidents, and exposure to workplace harmful agents, were distributed among participants. FINDINGS: The results showed there were significantly more physical and chemical harmful agents in medium enterprises compared to small ones (P < 0.001). However, the frequency rate of accidents in small enterprises was significantly higher than in medium enterprises (P < 0.001). Also, there was no significant difference between the studied enterprises in ergonomic hazards, except for awkward posture, whose frequency rate was significantly higher in small enterprises (P < 0.05). Finally, among the reported symptoms, the prevalence of eye, skin, ear, and respiratory symptoms was significantly higher in medium enterprises compared to small enterprises (P < 0.05). CONCLUSIONS: Occupational health and safety (OHS) regulations in medium enterprises have led to improved OHS conditions compared to small enterprises. Therefore, small enterprises should be included in OHS regulations.