Epidemiological Patterns of Work-Related Musculoskeletal Disorders among Healthcare Workers in Five Reference Hospitals in the City of Douala, Cameroon

Introduction: Work-related musculoskeletal disorders (WRMSDs) are a public health problem and have forced many workers to quit their jobs prematurely. This study investigated the prevalence and risk factors of WRMSDs among Healthcare workers in five reference hospitals in the City of Douala-Cameroon. Methods: A cross-sectional study was conducted in 2022 among 561 healthcare workers working in five reference hospitals in the city of Douala, Cameroon. Participants were selected using a convenient sampling technique. Data were collected with structured questionnaires;data on the demographics and risk factors were collected using a well-designed questionnaire, while estimation of the prevalence of WRMSDs was done using the Modified Nordic questionnaire. Results: The overall prevalence rate of WRMSDs among healthcare workers in Douala hospitals was 83.4% (468/561). The prevalence per professional groups was as follows: 88.8% (71) for Medical Laboratory Scientists (MLS), 81.9% (289) for nurses, 21 (80.8%) for Physiotherapists (PTs) and 78.8% (41) for Medical Doctors (MDs). There was a significant difference (p = 0.001) in the prevalence of WRMSDs with respect to place of work where healthcare workers from HLD recorded the highest prevalence 89.9%, while Healthcare workers from NBDH were 2.91 times at risk (AOR = 2.91;95% CI: 1.32 - 6.41;p = 0.001) to develop WRMSDs than healthcare workers in the other hospitals. With respect to body region, the highest prevalence of WRMSDs was recorded on the lower back, 58.8% with the lowest at the elbows 11.2%. The age group 30 to 39 years was significantly associated with WRMSDs at level of the shoulder (p = 0.002), upper back (p = 0.019), elbows (p Conclusion: The overall prevalence rate of WRMSDs among healthcare workers in Douala hospitals was high. The prevalence of WRMSDs is highest among MLS and nurses and the most affected body parts are;lower back, neck and upper back. Working on the same posture, stressful job, and repetitive tasks were the major risk factors associated to WRMSDs among healthcare workers in Douala hospitals.

High Prevalence of Musculoskeletal Disorders and Self-Medication among Street Vendors in Bangui, Central African Republic (CAR)

Introduction: Musculoskeletal disorders (MSDs) are a set of peri-articular conditions that result mainly in pain and functional discomfort. They represent a major occupational health problem in all areas of activity. The objective of this work was to determine the prevalence of MSDs among street vendors in the city of Bangui in the Central African Republic (CAR). Methods: A cross-sectional study was conducted from September 01 to October 31, 2021 in Bangui, the capital of CAR. The study population consisted of street vendors which were included at the entrance of 4 large markets of Bangui after giving informed consent. The sample size, calculated according to the Schwartz formula, was 384. Sociodemographic data (age, gender, level of education, marital status), professional data (the duration of sale in hours, the distance traveled per day);and health data (the health problems suffered by itinerant sellers and the means of dealing with them) were collected using a pre-established self-questionnaire. This collected data was processed using Microsoft Excel 2013 and Epi-Info version 7 software. Results: Among 384 street vendors included, women represented a quarter (24.9%). The average age was 27 years;the 25-34 age group was the most represented (50%). About two-thirds (64.8%) sold for at least 12 hours and traveled more than 10 km (69.3%) per day. The main health problems reported by street vendors were musculoskeletal disorders (95.8%). Their locations concerned the upper limbs shoulder 65.36% (251), elbow 24.22% (93). Non-ergonomic postures that stress the back and joints all day long, causing pain are risk factors for MSDs. These MSDs were treated by self-medication with non-steroidal anti-inflammatory drugs (22.0%), mainly sold on the street. Conclusion: MSDs dominated the health problems of street vendors. These problems raise the need for recognition and support for these workers to optimize their performance while preserving their health through awareness and good management of MSDs whose chronicity generates a disability.

Prevalence and factors of work-related musculoskeletal disorders among hand surgeons

BACKGROUND The nature of tasks required by hand surgeons require both forceful and repetitive maneuvers,thus subjecting these surgeons to the risk of musculoskeletal(MSK)injuries during their years in practice.AIM To assess the prevalence,characteristics and impact of MSK disorders among hand surgeons.METHODS A modified version of the physical discomfort survey was sent to surgeons who were members of the American Society for Surgery of the Hand via e-mail.The collected data were analyzed using descriptive statistics,one-way analysis of variance,and Fisher’s exact test.P values of<0.05 were considered statistically significant.RESULTS Of the 578 respondents,60.4%reported that they had sustained a work-related MSK injury,of which the most common diagnoses were lateral elbow epicondylitis(18.7%),low back pain(17.1%)and carpal tunnel syndrome(15.6%).Among those that reported an injury,73.1%required treatment and 29.2%needed time off work as a direct result of their injury.The number of work-related injuries incurred by a surgeon increased significantly with increasing age(P<0.003),increasing years in practice(P<0.001)and higher case load(P<0.05).CONCLUSION To our knowledge this study is the first of its kind to assess MSK injuries sustained by Hand surgeons with a high incidence.These results should increase awareness on this aspect and fuel future studies directed at preventing these types of work-related injuries,thus minimizing the financial and psychological burden on these surgeons and the healthcare system.

A Study on the Prevalence of Musculoskeletal Disorders among Ageing Workforce of Indian Construction Industry

Ageing work force is one of the leading causes behind the depletion in the growth rate of the labor force in construction industries.Construction industry is a paramount source of employment worldwide after agricul­tural industry explicitly in urban areas.Manual material handling in con­struction industries causes musculoskeletal disorders affecting both upper and lower extremities of the body.Studies on lower limb problems due to dynamic work like handling of heavy loads in construction industries are scanty.To analyze the level of exertion,ergonomics risk factors and the prevalence of work-related lower limb disorders among the young and elderly construction workforce.20 male construction workers in the age group of i)20 to 30 years(golden age group);ii)50 years and above were selected from a local construction site in Mumbai.Demographic data like age,height,weight,BMI,body fat,waist hip ratio and risk assessment by questionnaires study comprising QEC,NMQ,VAS,and LEFS were collected.Compared to the golden age group,the elderly subjects were found to feel more discomfort in their lower back,knee and calf regions of lower limb due to immoderate forces and motions tolerated by their lower limbs during their daily work.Muscle pliability and proper coor­dination diminishes with age and it is appearing to be the most probable reason behind the pain experienced in their lower limbs might be due to improper techniques and postures.For elderly workers,age related limita­tions become an additional factor to maintain their normal work-life.

A Pragmatic Observational Feasibility Study on Integrated Treatment for Musculoskeletal Disorders：Design and Protocol

Background：Musculoskeletal disorders（MSD） comprise a wide range of conditions,associated with an enormous pain and impaired mobility,and are affecting people＇s lives and work.Management of musculoskeletal disorders typically involves a multidisciplinary team approach.Positive findings have been found in previous studies evaluating the effectiveness of complementary therapies,though little attention has been paid to evaluating of the effectiveness of integrated packages of care combining conventional and complementary approaches for musculoskeletal conditions in a National Health Service（NHS） setting.Objective：To determine the feasibility of all aspects of a pragmatic observational study designed：（1） to evaluate the effectiveness and cost effectiveness of integrated treatments for MSDs in an integrated NHS hospital in the UK;（2） to determine the acceptability of the study design and research process to patients;（3） to explore patients＇ expectation and experience of receiving integrated treatments.Methods：This is an observational feasibility study,with 1-year recruitment and 1-year follow-up,conducted in Royal London Hospital for Integrated Medicine,University College London Hospital Trust,UK.All eligible patients with MSDs newly referred to the hospital were included in the study.Interventions are integrated packages of care（conventional and complementary） as currently provided in the hospital.SF-36 Health Survey,short form Brief Pain Inventory,Visual Analogue Scale,and modified Client Service Receipt Inventory will be assessed at 4/5 time points.Semi-structured interview/focus group will be carried out before treatment,and 1 year after commence of treatment.Discussion：We intend to conduct a pragmatic observational study of integrated medical treatment of MSDs at a public sector hospital.It will inform the design of a future trial including recruitment,retention,suitability of the outcome measures and patients experiences.

Effects of self-administered exercises based on Tuina techniques on musculoskeletal disorders of professional orchestra musicians: a randomized controlled trial

BACKGROUND： Musicians are frequently affected by playing-related musculoskeletal disorders （PRMD）. Common solutions used by Western medicine to treat musculoskeletal pain include rehabilitation programs and drugs, but their results are sometimes disappointing. OBJECTIVE： To study the effects of self-administered exercises based on Tuina techniques on the pain intensity caused by PRMD of professional orchestra musicians, using numeric visual scale （NVS）. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： We performed a prospective, controlled single-blinded, randomized study with musicians suffering from PRMD. Participating musicians were randomly distributed into the experimental （n = 39） and the control （n = 30） groups. After an individual diagnostic assessment, specific Tuina self-administered exercises were developed and taught to the participants. Musicians were instructed to repeat the exercises every day for 3 weeks. MAIN OUTCOME MEASURES： Pain intensity was measured by NVS before the intervention and after 1, 3, 5, 10, 15 and 20 d of treatment. The procedure was the same for the control group, however the Tuina exercises were executed in points away from the commonly-used acupuncture points. RESULTS： In the treatment group, but not the control group, pain intensity was significantly reduced on days 1, 3, 5, 10, 15 and 20. CONCLUSION： The results obtained are consistent with the hypothesis that self-administered exercises based on Tuina techniques could help professional musicians controlling the pain caused by PRMD. Although our results are very promising, further studies are needed employing a larger sample size and double blinding designs.

A comprehensive musculoskeletal and peripheral nervous system assessment of war-related bilateral upper extremity amputees

Background: Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation.Methods: The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees(206 amputations) from the IranIraq war were evaluated, and a detailed questionnaire was also administered.Results: The most common level of amputation was the finger or wrist level(108, 52.4%). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis(65, 31.6%), rotator cuff injury(24, 11.7%), bicipital tendonitis(69, 33.5%), shoulder drop(42, 20.4%) and muscle atrophy(19, 9.2%). Peripheral nerve disorders included carpal tunnel syndrome in 13(6.3%) and unilateral brachial plexus injury in 1(1%). Fifty-three(51.5%) were diagnosed with facet joint syndrome at the level of the cervical spine(the most frequent site). Using a prosthesis was reported by 65(63.1%), both left and right sides. The back was the most common site of pain(71.8%).Conclusion: The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.

The Protocol of Ultrasonic Backscatter Measurements of Musculoskeletal Properties

This study aims to introduce the protocol for ultrasonic backscatter measurements of musculoskeletal properties based on a novel ultrasonic backscatter bone diagnostic(UBBD)instrument.Dual-energy X-ray absorptiometry(DXA)can be adopted to measure bone mineral density(BMD)in the hip,spine,legs and the whole body.The muscle and fat mass in the legs and the whole body can be also calculated by DXA body composition analysis.Based on the proposed protocol for backscatter measurements by UBBD,ultrasonic backscatter signals can be measured in vivo,deriving three backscatter parameters[apparent integral backscatter(AIB),backscatter signal peak amplitude(BSPA)and the corresponding arrival time(BSPT)].AIB may provide important diagnostic information about bone properties.BSPA and BSPT may be important indicators of muscle and fat properties.The standardized backscatter measurement protocol of the UBBD instrument may have the potential to evaluate musculoskeletal characteristics,providing help for promoting the application of the backscatter technique in the clinical diagnosis of musculoskeletal disorders(MSDs),such as osteoporosis and muscular atrophy.

Understanding the eff ect of recreational drug use on bone health and musculoskeletal disease in the establishment of pain regimens

BACKGROUND:The widespread use of recreational drugs has raised concerns regarding their eff ects on various organ systems.The use of cannabis and opioids in chronic pain management increases their prevalence among patients with musculoskeletal conditions whose bone health may already be compromised.This article aims to review the pathophysiology and toxic eff ects of recreational drug use on musculoskeletal health to establish appropriate pain regimens for patients with substance use.METHODS:Medical literature published from 1970 until 2022 was identifi ed utilizing MEDLINE/PubMed and the Cochrane Library.In addition to the databases,references were obtained through the use of reference lists of published articles identifi ed by the aforementioned databases.The initial search terms included opioids,inhalants,hallucinogens,cannabis,stimulants,and bone health.There were no methodological limitations in relation to the initial acquisition and analysis of data.RESULTS:A total of 55 research articles were included in this review.Cannabis,stimulants,opioids,and inhalants impact bone maintenance,specifically osteoblast and osteoclast activity,as well as impede hormone production.These substances inhibit bone remodeling and development,manifesting as lower bone mineral density and increased fracture risk in chronic users.CONCLUSION:Although the current literature suggests a deleterious effect of recreational drugs on bone health and musculoskeletal disease,further research is warranted to evaluate the clinical effects of long-term substance use.The evaluation of such effects will aid in establishing appropriate pain regimens,as well as appropriate screening and treatment plans for recreational drug users.

Biofat grafts as an orthobiologic tool in osteoarthritis:An update and classification proposal

Among degenerative musculoskeletal disorders,osteoarthritis remains one of the main causes of pain and disability in the adult population.Current available alternatives to alleviate symptoms include conservative treatments such as physical therapy,anti-inflammatory drugs and an educational approach to lifestyle modification.The use of certain analgesics,such as opiates and corticosteroids offer short-term results but does not address the etiological source of pain and disability.In addition,prolonged use of such medications can cause additional complications.Therefore,the demand for regeneration of joint cartilage has led to an alternative approach called"orthobiologics".This alternative is based on cellular and molecular components capable of inducing and promoting tissue repair.Products derived from adipose tissue have been studied as an excellent source of orthobiologics in an attempt to promote joint cartilage repair.However,the lack of standardization regarding collection and processing protocols presents a challenge for the generalization of study results and determination of effectiveness.To the best of our knowledge,orthobiologics derived from fat have not yet been classified.Therefore,this manuscript proposes the HGS classification system which aims to describe certain parameters that are relevant to the quality of organic products regarding harvesting techniques(H),graft type(G),and number of centrifugations(S).The more parameters used would imply greater characterization and complexity of the evaluation of the biological product used.The HGS classification may provide a valuable contribution to the understanding of clinical procedures and research results,aiming to ultimately usher in a standardization of optimal practice.

Bone marrow-derived products: A classification proposal – bone marrow aspirate, bone marrow aspirate concentrate or hybrid?

Degenerative musculoskeletal disorders are one of the top causes of pain and disability in the adult population.Current available alternatives to mitigate symptoms include conservative treatments such as the administration of pharmacological agents and an educative approach towards lifestyle modification.The use of certain analgesics,such as opiates and corticosteroids,delivers short term results but do not address the etiological source of pain and disability.Also,prolonged use of such medications may cause additional complications.Therefore,the demand for musculoskeletal tissue regeneration has led to an alternative approach referred to as“orthobiologics”.This alternative is based on cellular and molecular components capable of inducing and promoting tissue repair.Bone marrow(BM)aspirate(BMA)and concentrate are well-known orthobiologics used to treat musculoskeletal conditions.Orthobiologics derived from the BM have been discussed in the literature;however,the lack of standardization regarding collection and processing protocols presents a challenge for generalization of study outcomes and determination of efficacy.Since BM-derived orthobiologics have not yet been classified,to our knowledge,this manuscript proposes the ACH classification system,which speaks to BMA(A),BMA and concentrate(C)and hybrid(H),which combines A and C.This classification proposes and describes 8 parameters that are relevant for the quality of biological products.The more parameters used would imply greater characterization and complexity of the evaluation of the biological product used.The ACH classification envisages a necessary contribution to the comprehension of both clinical procedures and research outcomes,ultimately ushering in a standardization of best practice.

Risk of Upper Extremity Biomechanical Overload in Automotive Facility

Objective To assess the risk factors for upper extremity-work-related musculoskeletal disorders（UE-WMSD） on 13 prod ucti on lines in an airbag factory using the threshold limit values-American conference of industrial hygienists-hand activity level（TLV-ACGIH-HAL） method and introduce the ergonomic improvement to reduce the repe titi veness and the peak force（Pf）.Methods Professional exposure level on 13 production lines in a automobile factory was measured using the TLV-ACGIH-HAL method and a further risk was assessed according to the ergonomic improvement.Results The first assessment of 9 produc tion lines showed that the professional exposure level was above the TLV or HAL limit.The second assessment showed that the professional exposure level was below the AL limit on all production lines except 1,in which the professional exposure level was between TLV and HAL.Conclusion The assessment of UE-WMSD-related risk can ide ntif y the riskiest emplacements and evaluate the reduc tion of risk in professional exposure through interventi ons of structuralorganizati onal type.

Painful Symptomatology Reported by Dentistry Students at a Brazilian University

Objectives: Identification of the level of knowledge on ergonomics principles, and application of these by dentistry students to investigate whether painful symptomatology was experienced. An-other objective is the expansion of discussions on occupational health in academic settings. Study Design and Settings: Dentistry students of the Federal University of Rio Grande do Norte, Brazil (n = 148) were surveyed using the Nordic Musculoskeletal Questionnaire to determine the severity of musculoskeletal symptoms experienced. Data were analyzed through EpiInfo 7.0 to measure central trends and variability 5for quantitative variables, absolute and relative frequencies for categorical variables, and significance between groups (confidence intervals and chisquare). Association analysis (Pearson) was also carried out. Results: Ergonomic measures were not reported by students. Within the musculoskeletal symptoms described, females were the most affected, independent of academic level. Conclusions: Positive correlations were verified between all categories and all anatomic regions (e.g., neck, lower back, wrists, hands, and shoulders). Data suggest progressive worsening of symptoms, which will eventually result in leaves of absence.

High-resolution,three-dimensional magnetic resonance imaging axial load dynamic study improves diagnostics of the lumbar spine in clinical practice

BACKGROUND The response to axial physiological pressure due to load transfer to the lumbar spine structures is among the various back pain mechanisms.Understanding the spine adaptation to cumulative compressive forces can influence the choice of personalized treatment strategies.AIM To analyze the impact of axial load on the spinal canal’s size,intervertebral foramina,ligamenta flava and lumbosacral alignment.METHODS We assessed 90 patients using three-dimensional isotropic magnetic resonance imaging acquisition in a supine position with or without applying an axial compression load.Anatomical structures were measured in the lumbosacral region from L1 to S1 in lying and axially-loaded magnetic resonance images.A paired t test atα=0.05 was used to calculate the observed differences.RESULTS After axial loading,the dural sac area decreased significantly,by 5.2%on average(4.1%,6.2%,P<0.001).The intervertebral foramina decreased by 3.4%(2.7%,4.1%,P<0.001),except for L5-S1.Ligamenta flava increased by 3.8%(2.5%,5.2%,P<0.001),and the lumbosacral angle increased.CONCLUSION Axial load exacerbates the narrowing of the spinal canal and intervertebral foramina from L1-L2 to L4-L5.Cumulative compressive forces thicken ligamenta flava and exaggerate lumbar lordosis.

Design and Structural Analysis of Flexible Wearable Chair Using Finite Element Method

The flexible wearable chair is like a light weight mobile exoskeleton that allows people to sit any-where in any working position. The traditional chair is difficult to move to different working locations due to its large size, heavy weight (~5 - 7 kg) and rigid structure and thus, they are inappropriate for workplaces where enough space is not available. Flexible wearable chair has a gross weight of 3 kg as it utilizes light-weight aluminium alloy members. Unlike the traditional chair, it consists of kinematic pairs which enable taking halts between continuous movements at any working position and thus, it is capable of reducing the risk of the physical musculoskeletal disorder substantially among workers. The objective of this paper is to focus on the mechanical design and finite element analysis (FEA) of the mechanism using ANSYS® software. In the present work, all the parts of the mechanism are designed under static load condition. The results of the analysis indicate that flexible wearable chair satisfies equilibrium and stability criterion and is capable of reducing fatigue during working in an assembly line/factory.

Immediate effects of Tuina techniques on working-related musculoskeletal disorder of professional orchestra musicians

BACKGROUND：Musicians are a prone group to suffer from working-related musculoskeletal disorder（WRMD）.Conventional solutions to control musculoskeletal pain include pharmacological treatment and rehabilitation programs but their effi ciency is sometimes disappointing.OBJECTIVE：The aim of this research is to study the immediate effects of Tuina techniques on WRMD of professional orchestra musicians from the north of Portugal.DESIGN,SETTING,PARTICIPANTS AND INTERVENTIONS：We performed a prospective,controlled,single-blinded,randomized study.Professional orchestra musicians with a diagnosis of WRMD were randomly distributed into the experimental group（n=39）and the control group（n=30）.During an individual interview,Chinese diagnosis took place and treatment points were chosen.Real acupoints were treated by Tuina techniques into the experimental group and non-specifi c skin points were treated into the control group.Pain was measured by verbal numerical scale before and immediately after intervention.RESULTS：After one treatment session,pain was reduced in 91.8%of the cases for the experimental group and 7.9%for the control group.CONCLUSION：Although results showed that Tuina techniques are effectively reducing WRMD in professional orchestra musicians of the north of Portugal,further investigations with stronger measurements,double-blinding designs and bigger simple sizes are needed.