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2.
BMC Public Health ; 19(1): 1502, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711455

RESUMO

BACKGROUND: Musculoskeletal impairments (MSI) are a major global contributor to disability. Evidence suggests entrenched cyclical links between disability and poverty, although few data are available on the link of poverty with MSI specifically. More data are needed on the association of MSI with functioning, socio-economic status and quality of life, particularly in resource-poor settings where MSI is common. METHODS: We undertook a case-control study of the association between MSI and poverty, time use and quality of life in post-conflict Myanmar. Cases were recruited from two physical rehabilitation service-centres, prior to the receipt of any services. One age- (+/- 5 years of case's age) and sex- matched control was recruited per case, from their home community. 108 cases and 104 controls were recruited between July - December 2015. Cases and controls underwent in-depth structured interviews and functional performance tests at multiple time points over a twelve-month period. The baseline characteristics of cases and controls are reported in this manuscript, using multivariate logistic regression analysis and various tests of association. RESULTS: 89% of cases were male, 93% were lower limb amputees, and the vast majority had acquired MSI in adulthood. 69% were not working compared with 6% of controls (Odds Ratio 27.4, 95% Confidence Interval 10.6-70.7). Overall income, expenditure and assets were similar between cases and controls, with three-quarters of both living below the international LMIC poverty line. However, cases' health expenditure was significantly higher than controls' and associated with catastrophic health expenditure and an income gap for one fifth and two thirds of cases respectively. Quality of life scores were lower for cases than controls overall and in each sub-category of quality of life, and cases were far less likely to have participated in productive work the previous day than controls. CONCLUSION: Adults with MSI in Myanmar who are not in receipt of rehabilitative services may be at increased risk of poverty and lower quality of life in relation to increased health needs and limited opportunities to participate in productive work. This study highlights the need for more comprehensive and appropriate support to persons with physical impairments in Myanmar.


Assuntos
Pessoas com Deficiência/reabilitação , Doenças Musculoesqueléticas/reabilitação , Qualidade de Vida , Ferimentos e Lesões/epidemiologia , Adulto , Estudos de Casos e Controles , Status Econômico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico , Mianmar , Razão de Chances , Modalidades de Fisioterapia/estatística & dados numéricos , Classe Social , Ferimentos e Lesões/reabilitação
3.
J Med Life ; 12(3): 247-252, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31666826

RESUMO

Musculoskeletal disorders (MSDs) caused by incorrect working positions among dentists is a serious health issue and one that leads to decreased productivity and quality of life. Muscle activity and strain is correlated with higher surface temperatures due to increased metabolic activity [2]. The main objective of this study is to evaluate, using thermal imaging, the muscular strain experienced by oral healthcare professionals during work depending on their position, and to assess whether periodic stretching exercises have an impact on preventing MSDs. The study included four subjects and used thermal imaging to evaluate the heat pattern produced by muscle strain in two different states, one while working in incorrect postures and the other after performing stretching exercises. We used a FLIRB200 thermal imaging camera to measure skin surface temperature changes of the underlining muscles in the cervical, right arm triceps, and lumbar areas. According to the imaging, all four subjects recorded a drop in temperature in evaluated muscle regions after performing stretching exercises, corresponding to a decrease in muscle strain. Thermal imaging can be effectively used to evaluate muscle strain and MSDs. Stretching exercises could be viewed as effective preventive measures to avoid MSDs caused by erroneous work postures, however, more subjects are required to draw a definite conclusion.


Assuntos
Odontólogos , Diagnóstico por Imagem , Doenças Musculoesqueléticas/diagnóstico , Doenças Profissionais/diagnóstico , Temperatura Ambiente , Humanos
4.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi ; 37(10): 768-772, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31726509

RESUMO

Objective: To investigate the visual application of the CiteSpace software in the field of work-related musculoskeletal disorders (WMSDs) . Methods: The literature on WMSDs research, published from 1991 to 2017, was retrieved in Web of Science database. The CiteSpace 5.2 was used to make visualization analysis on the hotspots and tendency of the keywords, authors, countries (regions) and research institutes in relevant literature. Results: A total of 3224 literatures were included in the analysis. The amount of the literatures published was increasing annually. The key word co-occurrence network showed that the research hotspots mainly focused on the study of epidemiology, risk factors, symptoms, and other aspects of WMSDs. The cooperation network and time network of counties and regions showed that America and Europe were at the leading position in the field of WMSD, and the top three were America, Canada and Sweden. The developing countries, like Brazil and China, had also begun to make relative research since 2000. In research cooperation, the collaboration among countries, research institutions was relatively close, and multiple leading core authors and teams were formed in the international arena. Conclusion: The CiteSpace software can directly demonstrate the hotspots and tendency in the area of WMSDs.


Assuntos
Diagnóstico por Computador , Doenças Musculoesqueléticas/diagnóstico , Doenças Profissionais/diagnóstico , Software , Humanos
5.
J Hand Ther ; 32(3): 361-367, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31533909

RESUMO

INTRODUCTION: Productive outcomes for the hand therapy patient involve many components. Understanding whether therapists agree with the recommendations they receive, or find these informative, is a first step into understanding how shared decision-making on a treatment plan can be optimized. PURPOSE OF THE STUDY: The purposes of this study include (1) the extent which therapists see variable presentations of primary surgical/management in some indicator exemplars where practices vary from accepted/evidence-based practice; (2) hand therapists' level of agreement with the interventions prescribed on referrals, (3) describe the undocumented complications observed by hand therapists, and (4) report the therapists' perceptions as to the reasons for these complications METHODS: A survey was designed and pilot tested. Multiple-choice questions and free text allowed further explanation. The survey was administered through an electronic mailing to all American Society of Hand Therapy members with available e-mail addresses. Raw survey data were extracted and processed. Descriptive statistics were used to analyze therapists' demographic information. Frequencies of therapists' responses were calculated. RESULTS: Ninety percent of all who responded have been in practice 10 years or more. The mean of the "often and always" ordered interventions was 20%. The mean of therapist perceptions as to whether these ordered interventions are best practice was 14%. Sixty percent reported that they had found an undocumented condition, and 60% reported to have found a postoperative complication. Perceived reasons for complications included the lack of communication and therapy intervention. DISCUSSION: Hand therapists can play an important role in improving patient outcomes. Therapists can provide the health care team information regarding best practice. Additionally, the hand therapist may be who first identifies a postsurgical complication or an undocumented issue. Communication between the hand therapist and referral source is vital in optimizing patient outcomes. CONCLUSION: Hand therapists can play an important role in improving overall outcomes for patients. The inter-professional working relationship between the referral source, hand therapist, and the patient is a complex phenomenon and communication between the hand therapist and referral source is vital.


Assuntos
Fisioterapeutas , Encaminhamento e Consulta , Comunicação , Humanos , Doenças Musculoesqueléticas/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Inquéritos e Questionários , /diagnóstico
6.
Bull Hosp Jt Dis (2013) ; 77(3): 171-177, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31487481

RESUMO

INTRODUCTION: Medical vocabulary that conveys different meanings to different groups of readers can lead to confusion and potential misinterpretation of diagnoses. This article reviews words used by radiologists that convey information to the orthopedic surgeon and patient that is different from what the radiologist intended. These terms include meniscal tears, ligament sprains, partial tendon tears, bone bruises, bone contusions, articular cartilage injury, disc bulges, disc herniations, and joint subluxation. These words can, for example, suggest a traumatic etiology when in fact the condition is atraumatic, and they can imply a surgical treatment where none is indicated. This problem is further magnified in the arena of personal injury litigation. MATERIALS AND METHODS: The terms tear, bruise, contusion, injury, sprain, bulge, herniation, and subluxation are defined and analyzed for their ambiguous use, i.e., their actual versus intended meaning or other interpretation. RESULTS: Abnormalities and variations observed on musculoskeletal magnetic resonance (MR) images are often multi-factorial and may not be the source of any given patient's symptoms. The same MR image findings can have a congenital, traumatic, or degenerative source. CONCLUSIONS: Radiology vocabulary that invokes a singular traumatic event as a cause of an MRI finding can significantly mislead patients (as well as judges and juries). We propose that some terms be either avoided entirely when the findings are of uncertain etiology. At the very least, the various meanings of the terms need to be spelled out. Greater cooperation between orthopedic surgeons and radiologists on this matter would be beneficial to patient care.


Assuntos
Current Procedural Terminology , Erros de Diagnóstico/prevenção & controle , Imagem por Ressonância Magnética , Doenças Musculoesqueléticas/diagnóstico , Cirurgiões Ortopédicos/normas , Radiologistas/normas , Terminologia como Assunto , Ferimentos e Lesões/diagnóstico , Competência Clínica , Humanos , Colaboração Intersetorial , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/normas , Melhoria de Qualidade , Estados Unidos
7.
Med Lav ; 110(4): 278-284, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31475689

RESUMO

BACKGROUND: Under-reporting and recognition of occupational diseases is a problem in countries with workers' compensation schemes. OBJECTIVE: To describe the role of a public hospital Occupational Disease Unit (ODU) in Barcelona that resulted in improved reporting and official recognition of occupational diseases from 2010 to 2017. METHODS: Hospital physicians referred possible cases of work-related disease to the ODU, where in-depth medical evaluations were then performed, and a detailed report addressing causation was generated. Patients with confirmed cases of occupational disease were counselled and followed while pursuing official recognition and benefits claims by the Spanish Social Security System. RESULTS: Between 2010 and 2017, 149 cases were referred to the ODU for evaluation. Of these, 80 (53.7%) were confirmed to have an occupational disease, 54 (67.5%) patients pursued official recognition, and to date 26 (48.1%) have been recognized by the Social Security System. The recognition rate varied by diagnosis group (p=0.003), and was highest for skin diseases (71.4%) and cancer (66.7%), and lowest for hearing loss (29.4%) and musculoskeletal disorders (16.7%). CONCLUSIONS: A hospital ODU can improve reporting and official recognition of occupational diseases that otherwise might not have been recognized. Expanding this experience to other Spanish and European hospitals could improve the efficiency of workers' compensation schemes and better support preventive policies.


Assuntos
Doenças Musculoesqueléticas , Doenças Profissionais , Unidades Hospitalares , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Profissionais/diagnóstico , Indenização aos Trabalhadores
8.
Yonsei Med J ; 60(9): 870-875, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31433585

RESUMO

PURPOSE: The aim of this study was to examine the prevalence of upper extremity musculoskeletal (MSK) diseases and to identify factors influencing disability among fruit tree farmers in Korea. MATERIALS AND METHODS: Of the 1150 subjects of the Namgaram study, 460 fruit tree farmers completed a questionnaire and underwent clinical evaluations, including physical assessments, laboratory tests, simple radiographic examinations, and magnetic resonance imaging studies of the upper extremities. Disability was assessed using the Disabilities of the Arm, Shoulder, and Hand outcome measure. Data were analyzed with descriptive statistics and regression analyses using SPSS Win 24.0. RESULTS: The prevalences of upper extremity MSK diseases were 60.4% for rotator cuff tear, 20.9% for golf elbow, 40.9% for tennis elbow, and 58.0% for hand osteoarthritis. Disability in fruit farmers was associated with female sex (B=-4.47, p<0.001), smoking (B=-4.00, p=0.026), depression (B=2.83, p<0.001), working hours (B=0.96, p=0.001), injuries of the arms (B=10.78, p<0.001) and shoulders (B=6.75, p<0.001), and numbers of upper extremity MSK diseases (B=2.02, p=0.001), with 26.5% of the variance explained (R²=0.265, Durbin-Watson test=1.81, p<0.001). CONCLUSION: Fruit tree farmers remain at risk for MSK diseases of the upper extremities. Disability tended to worsen with more MSK diseases. It is necessary to not only educate farmers about prevention strategies, but also to develop an effective management system for agricultural work-related MSK diseases and a surveillance system at the government level for the health problems of farmers.


Assuntos
Doenças dos Trabalhadores Agrícolas/epidemiologia , Fazendeiros , Doenças Musculoesqueléticas/epidemiologia , Extremidade Superior/fisiopatologia , Adulto , Doenças dos Trabalhadores Agrícolas/etiologia , Estudos Transversais , Avaliação da Deficiência , Feminino , Frutas , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico , Osteoartrite/epidemiologia , Prevalência , República da Coreia/epidemiologia , Lesões do Manguito Rotador/epidemiologia , Inquéritos e Questionários , Cotovelo de Tenista/epidemiologia , Árvores
9.
Z Rheumatol ; 78(8): 722-742, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31468170

RESUMO

In order to reduce the prognostically relevant time interval between the initial manifestation of a rheumatic and musculoskeletal disease and diagnosis as well as the consecutive initiation of an appropriate treatment, several rheumatological centers in Germany have improved the access to initial rheumatologic evaluation by establishing early recognition/screening clinics at their respective sites. Corresponding models located at Altoetting·Burghausen, Bad Pyrmont, Berlin Buch, Duesseldorf, Heidelberg, Herne, Mannheim as well as supraregional/multicenter initiatives Rheuma Rapid, RhePort and Rheuma-VOR are presented in this overview along with the respective characteristics, potential advantages and disadvantages, but also first evaluation results of several models. The aim of this publication is to promote early detection of rheumatic and musculoskeletal diseases as one of the most important challenges in current rheumatology by encouraging further rheumatologic centers and practices to launch their own early recognition/screening consultation model on the basis of aspects presented herein.


Assuntos
Doenças Musculoesqueléticas , Doenças Reumáticas , Reumatologia , Diagnóstico Precoce , Alemanha , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/terapia , Encaminhamento e Consulta , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/terapia , Reumatologia/métodos
10.
Appl Ergon ; 80: 75-88, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31280813

RESUMO

Ensuring a healthier working environment is of utmost importance for companies and global health organizations. In manufacturing plants, the ergonomic assessment of adopted working postures is indispensable to avoid risk factors of work-related musculoskeletal disorders. This process receives high research interest and requires extracting plausible postural information as a preliminary step. This paper presents a semi-automated end-to-end ergonomic assessment system of adopted working postures. The proposed system analyzes the human posture holistically, does not rely on any attached markers, uses low cost depth technologies and leverages the state-of-the-art deep learning techniques. In particular, we train a deep convolutional neural network to analyze the articulated posture and predict body joint angles from a single depth image. The proposed method relies on learning from synthetic training images to allow simulating several physical tasks, different body shapes and rendering parameters and obtaining a highly generalizable model. The corresponding ground truth joint angles have been generated using a novel inverse kinematics modeling stage. We validated the proposed system in real environments and achieved a joint angle mean absolute error (MAE) of 3.19±1.57∘ and a rapid upper limb assessment (RULA) grand score prediction accuracy of 89% with Kappa index of 0.71 which means substantial agreement with reference scores. This work facilities evaluating several ergonomic assessment metrics as it provides direct access to necessary postural information overcoming the need for computationally expensive post-processing operations.


Assuntos
Ergonomia/métodos , Doenças Musculoesqueléticas/diagnóstico , Doenças Profissionais/diagnóstico , Postura/fisiologia , Trabalho/fisiologia , Adulto , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Instalações Industriais e de Manufatura , Doenças Musculoesqueléticas/etiologia , Doenças Profissionais/etiologia , Medição de Risco/métodos , Fatores de Risco
11.
Int J Mol Sci ; 20(12)2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31242644

RESUMO

Chronic musculoskeletal (MSK) pain is one of the most common medical complaints worldwide and musculoskeletal injuries have an enormous social and economical impact. Current pharmacological and surgical treatments aim to relief pain and restore function; however, unsatiscactory outcomes are commonly reported. In order to find an accurate treatment to such pathologies, over the last years, there has been a significantly increasing interest in cellular therapies, such as adipose-derived mesenchymal stem cells (AMSCs). These cells represent a relatively new strategy in regenerative medicine, with many potential applications, especially regarding MSK disorders, and preclinical and clinical studies have demonstrated their efficacy in muscle, tendon, bone and cartilage regeneration. Nevertheless, several worries about their safety and side effects at long-term remain unsolved. This article aims to review the current state of AMSCs therapy in the treatment of several MSK diseases and their clinical applications in veterinary and human medicine.


Assuntos
Tecido Adiposo/citologia , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Doenças Musculoesqueléticas/terapia , Animais , Humanos , Transplante de Células-Tronco Mesenquimais , Doenças Musculoesqueléticas/diagnóstico , Medicina Regenerativa , Resultado do Tratamento
13.
Medicina (Kaunas) ; 55(6)2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31207961

RESUMO

Background and Objectives: The participation of women in sports, including basketball, is becoming increasingly common, and this increased involvement raises concerns about the potential risk of sports injuries, but there is a lack of epidemiological studies about the incidence of sports injuries in women's basketball, especially in Europe. The aim of this study was to determine the prevalence and localizations of sport related injuries and illnesses in elite female basketball players. Materials and Methods: This was a retrospective study. The sample consisted of 358 elite female basketball players, with a mean age of 23.4 ± 5.93 years, participated in the study. The players were interviewed using a pre-participation health questionnaire during the 2013-2016 sport seasons in the pre-season preparation phase. Results: 155 health problems were reported in 358 athletes during the screening period. The most frequently injured body parts were lower limbs: more than 60%, representing an injury rate of 0.14 per athletes and a 0.2 pain rate per athlete during the study period. Conclusions: The main findings showed the importance of monitoring lower extremity injuries and pain to pay attention to the players, which are at risk. The occurrence of injuries and pain among female basketball players was high. The lower extremities are the most frequently injured body area in the Lithuanian Women's Basketball League.


Assuntos
Atletas/estatística & dados numéricos , Basquetebol/lesões , Doenças Musculoesqueléticas/diagnóstico , Adulto , Análise de Variância , Feminino , Humanos , Incidência , Lituânia/epidemiologia , Doenças Musculoesqueléticas/epidemiologia , Prevalência , Estudos Retrospectivos , Risco , Inquéritos e Questionários
14.
BMC Musculoskelet Disord ; 20(1): 279, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31170940

RESUMO

BACKGROUND: Musculoskeletal complaints of arm, neck, and shoulder (CANS) can lead to loss of work productivity. To assess the functional consequences of impairments in work, patient-reported outcomes can be important. The Hand Function Sort (HFS) is a 62-item pictorial questionnaire that focuses on work task performance. The aims of this study were the cross-cultural adaptation of HFS into HFS-Dutch Language Version (HFS-DLV) (Part I) and determining construct validity, internal consistency, test-retest reliability, responsiveness and floor/ceiling effects of HFS-DLV (Part II). METHODS: I: Translation into Dutch using international guidelines. II: Construct validity was assessed with Spearman's correlation coefficients between the HFS-DLV and the Dutch version of the QuickDASH, PRWHE, PDI, RAND-36, NRS-pain, and work ability score. Internal consistency was assessed using Cronbach's α and reliability by a test-retest procedure. A global rating scale of change was used after 4-8 weeks of hand therapy to determine responsiveness. RESULTS: I: Forty patients were included, and no items were changed. II: 126 patients with hand, wrist, and/or forearm disorders classified as specific or nonspecific CANS. Six predefined hypotheses (50%) were confirmed. Cronbach's α: 0.98. Test-retest reliability: ICC of 0.922. AUC of 0.752. There were no floor/ceiling effects. CONCLUSIONS: I: Translation process into the HFS-DLV went according to plan. II: For construct validity, the presumed direction of correlations was correct, but less than 75% of hypotheses were confirmed. Internal consistency was high, suggesting redundancy. Reliability and responsiveness of the HFS-DLV were good. HFS-DLV can be used in research or clinical practice for Dutch patients with CANS, to evaluate self-reported functional work ability.


Assuntos
Avaliação da Deficiência , Mãos/fisiopatologia , Doenças Musculoesqueléticas/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Punho/fisiopatologia , Atividades Cotidianas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/fisiopatologia , Países Baixos , Estudos Prospectivos , Psicometria , Reprodutibilidade dos Testes , Traduções
15.
Orthopade ; 48(6): 461-468, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31168737

RESUMO

BACKGROUND: Leg pain is a common reason for consultation in the children's orthopedic clinic. It can occur across all age groups, although most patients are of pre-school or elementary school age. As there are a series of possibly severe differential diagnoses that might cause such pains in children and adolescents apart from benign pains that occur in the context of growth, a thorough patient history and physical examination are essential. PATHOGENESIS: Despite extensive research, the cause of benign growing pains has not been elucidated so far. Several possible factors play a role on an anatomical, metabolic or functional basis, ; thus, various theories exist with regard to their origin. DIAGNOSIS: Growing pains constitute a diagnosis of exclusion. If a possible organic cause of the pains is suspected, an extended diagnosis of the person affected should be made. Growing pains primarily occur at night and are always self-resolving. THERAPY: With regard to treatment, mild pain medications can be employed in more severely affected patients. It is much more important to inform family members about the benign nature of the condition. Reassuring words and physical relaxation exercises, in addition to massaging and stretching of the leg muscles, can cause a significant reduction in pain without medication.


Assuntos
Doenças Musculoesqueléticas/diagnóstico , Adolescente , Criança , Pré-Escolar , Diagnóstico Diferencial , Humanos , Massagem , Doenças Musculoesqueléticas/terapia , Dor , Exame Físico
16.
Work ; 63(2): 261-268, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31156207

RESUMO

BACKGROUND: In the US, as the demands for rehabilitation services increase, work-related musculoskeletal disorders (WMSDs) have increased among rehabilitation practitioners. This trend has been noticed among physical therapists (PTs) in the State of Kuwait. OBJECTIVE: The purpose of this study was to determine the prevalence and risk factors associated with WMSDs among PTs in Kuwait over a 12-month period. In addition, the result compared across countries and health care professions. METHODS: A descriptive cross-sectional design was used in this study. A self-administered questionnaire was distributed to the PT departments at Kuwait government hospitals and schools. A total of 312 returned questionnaires (69.3% response rate) were received. RESULTS: Results showed that 149 (48%) PT respondents experienced WMSDs. The lower back and muscle spasm were the most common area of the body injured and type of injury, respectively. Manual therapy techniques and patient transfers were most common activities associated with injuries. CONCLUSIONS: The prevalence of PTs with WMSDs in Kuwait was high and similar to other studies of PTs with WMSDs working in other countries. The performance of work activities was the leading risk factor for WMSDs, and WMSDs were prevalent among industrialized, industrially developing, and underdeveloped countries. Education of PTs regarding ergonomic and biomechanical principles as well as hands-on training of patient handling are the key tools to help prevent WMSDs.


Assuntos
Traumatismos Ocupacionais/diagnóstico , Fisioterapeutas/estatística & dados numéricos , Trabalho/fisiologia , Adulto , Estudos Transversais , Feminino , Humanos , Kuweit/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/epidemiologia , Traumatismos Ocupacionais/epidemiologia , Fatores de Risco , Inquéritos e Questionários , Trabalho/normas
17.
Emerg Infect Dis ; 25(6): 1075-1083, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31107224

RESUMO

Nontuberculous mycobacteria represent an uncommon but important cause of infection of the musculoskeletal system. Such infections require aggressive medical and surgical treatment, and cases are often complicated by delayed diagnosis. We retrospectively reviewed all 14 nonspinal cases of nontuberculous mycobacterial musculoskeletal infections treated over 6 years by orthopedic surgeons at a university-affiliated tertiary referral center. All patients required multiple antimicrobial agents along with aggressive surgical treatment; 13 of 14 patients ultimately achieved cure. Four patients required amputation to control the infection. Half these patients were immunosuppressed by medications or other medical illness when they sought care at the referral center. Six cases involved joint prostheses; all ultimately required hardware removal and placement of an antimicrobial spacer for eradication of infection. Our findings highlight the importance of vigilance for nontuberculous mycobacterial musculoskeletal infection, particularly in patients who are immunosuppressed or have a history of musculoskeletal surgery.


Assuntos
Doenças Musculoesqueléticas/epidemiologia , Doenças Musculoesqueléticas/microbiologia , Infecções por Micobactéria não Tuberculosa/epidemiologia , Infecções por Micobactéria não Tuberculosa/microbiologia , Micobactérias não Tuberculosas , Centros de Atenção Terciária , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Colorado/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/tratamento farmacológico , Infecções por Micobactéria não Tuberculosa/diagnóstico , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Vigilância em Saúde Pública , Estudos Retrospectivos , Avaliação de Sintomas , Adulto Jovem
19.
BMC Musculoskelet Disord ; 20(1): 186, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31043169

RESUMO

BACKGROUND: A model for triaging patients in primary care to provide immediate contact with the most appropriate profession to treat the condition in question has been developed and implemented in parts of Sweden. Direct triaging of patients with musculoskeletal disorders (MSD) to physiotherapists at primary healthcare centres has been proposed as an alternative to initial assessment by general practitioners (GPs) and has been shown to have many positive effects. The aim of this study was to evaluate the cost-effectiveness from the societal perspective of this new care-pathway through primary care regarding triaging patients with MSD to initial assessment by physiotherapists compared to standard practice with initial GP assessment. METHODS: Nurse-assessed patients with MSD (N = 55) were randomised to initial assessment and treatment with either physiotherapists or GPs and were followed for 1 year regarding health-related quality of life, utilization of healthcare resources and absence from work for MSD. Quality-adjusted life-years (QALYs) were calculated based on EQ5D measured at 5 time-points. Costs for healthcare resources and production loss were compiled. Incremental cost-effectiveness ratios (ICERS) were calculated. Multiple imputation was used to compensate for missing values and bootstrapping to handle uncertainty. A cost-effectiveness plane and a cost-effectiveness acceptability curve were construed to describe the results. RESULTS: The group who were allocated to initial assessment by physiotherapists had slightly larger gains in QALYs at lower total costs. At a willingness-to-pay threshold of 20,000 €, the likelihood that the intervention was cost-effective from a societal perspective including production loss due to MSD was 85% increasing to 93% at higher thresholds. When only healthcare costs were considered, triaging to physiotherapists was still less costly in relation to health improvements than standard praxis. CONCLUSION: From the societal perspective, this small study indicated that triaging directly to physiotherapists in primary care has a high likelihood of being cost-effective. However, further larger randomised trials will be necessary to corroborate these findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT02218749 . Registered August 18, 2014.


Assuntos
Análise Custo-Benefício/estatística & dados numéricos , Doenças Musculoesqueléticas/terapia , Atenção Primária à Saúde/economia , Triagem/economia , Adolescente , Adulto , Idoso , Procedimentos Clínicos/economia , Procedimentos Clínicos/organização & administração , Feminino , Seguimentos , Clínicos Gerais/economia , Clínicos Gerais/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/psicologia , Enfermeiras e Enfermeiros/economia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fisioterapeutas/economia , Fisioterapeutas/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Suécia , Resultado do Tratamento , Triagem/estatística & dados numéricos , Adulto Jovem
20.
BMC Musculoskelet Disord ; 20(1): 187, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053119

RESUMO

BACKGROUND: Musculoskeletal (MSK) conditions are a common presentation in primary care. This study sought to determine the prevalence of MSK conditions in primary care in Ontario and to validate the extent to which health administrative date billing codes accurately represent MSK diagnoses. METHODS: De-identified electronic medical records (EMR) from the DELPHI database in southwestern Ontario, which contains 2493 patients (55.6% female, mean age 50.3 years (SD = 22.2)) and 21,964 encounters (July 1, 2006-June 30, 2010) were used for the analyses. Outcomes included: validation measures of agreement between International Classification of Diseases (ICD-9) diagnostic codes (health administrative data) and International Classification of Primary Care (ICPC) diagnoses defined as the reference standard, time to first ICD-9 code, prevalence, and healthcare utilization. RESULTS: There were 2940 true positive MSK encounters with primary care practitioners for 998 patients. Performance of the ICD-9 diagnostic codes included sensitivity = 76.5%, specificity = 95.2%, PPV = 94.6%, and NPV = 78.7%, compared to the ICPC reference standard. The majority of 998 patients were coded with both an ICPC and ICD-9 MSK code at their first or second encounter (67.4%). However, 23.5% of patients with the ICPC reference standard MSK were never coded with ICD-9. Four-year prevalence of MSK was 52.3% and varied by age (4.5% 0-17 years, 20.1% 18-44, 42.7% 45-64, and 32.7% 65+). Patients at MSK encounters had a higher number of: investigations (17.9% compared to 9.1%, p < .0001); referrals (17.6% compared to 14.3%, p < .0001); and prescriptions for opioids (17.2% compared to 5.3%, p < .0001). CONCLUSIONS: This study determined the prevalence of musculoskeletal conditions in primary care in Ontario using a reference standard definition. The study highlighted the value of using primary care ICPC codes to validate a definition for musculoskeletal conditions. Health administrative data can be used to ascertain the presence of musculoskeletal conditions; however, ICD-9 codes may underrepresent the prevalence of MSK conditions.


Assuntos
Bases de Dados Factuais/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Doenças Musculoesqueléticas/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Idoso , Algoritmos , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico , Ontário/epidemiologia , Prevalência , Estudos Retrospectivos , Adulto Jovem
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