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.

Procedure-related musculoskeletal symptoms in gastrointestinal endoscopists in Korea

AIM: To determine the prevalence and risk factors of work-related musculoskeletal disorders in gastrointestinal endoscopists in Korea. METHODS: A survey of musculoskeletal symptoms, using a self-administered questionnaire, was conducted on 55 endoscopists practicing in general hospitals or health promotion centers. RESULTS: Forty-nine (89.1%) endoscopists reported musculoskeletal pain on at least one anatomic location and 37 (67.3%) endoscopists complained of pain at rest. Twenty-six (47.3%) endoscopists had severe musculoskeletal pain defined as a visual analogue score greater than 5.5. Factors related to the development of severe pain were (1) standing position during upper endoscopy, (2) specific posture/ habit during endoscopic procedures, and (3) multiple symptomatic areas. Finger pain was more common in beginners, whereas shoulder pain was more common in experienced endoscopists. Sixteen percent of symptomatic endoscopists have modified their practice or reduced the number of endoscopic examinations. Only a few symptomatic endoscopists had sought professional consultation with related specialists. CONCLUSION: The prevalence of musculoskeletal pain in endoscopists is very high. The location of pain was different between beginners and experienced endoscopists. Measures for the prevention and adequate management of endoscopy-related musculoskeletal symptoms are necessary.

Is burnout a mediating factor between sharps injury and workrelated factors or musculoskeletal pain?

BACKGROUND Burnout,musculoskeletal pain,and sharps injuries(SIs)affect medical workers.AIM To establish a model between SIs,burnout,and the risk factors to assess the extent to which burnout affects SIs.METHODS This questionnaire was used for an observational and cross-sectional study,which was based on members at a hospital affiliated with a medical university in Taichung,Taiwan,in 2020.The valid responses constituted 68.5%(1734 of 2531).The items were drawn from the Nordic Musculoskeletal Questionnaire and Copenhagen burnout inventory and concerned work experience,occupational category,presence of chronic diseases,sleep duration,overtime work,and work schedule.Factor analysis,chi-square test,Fisher exact test,Multiple linear,logistic regression and Sobel test were conducted.The present analyses were performed using SAS Enterprise Guide 6.1 software(SAS Institute Inc.,Cary,NC,United States),and significance was set at P<0.05.RESULTS Personal and work-related burnout ranks, sex, work experience ranks, occupationalgroups, drinking in the past month, sleep duration per day, presence ofchronic diseases, overtime work ranks, and work schedule were associated withSIs. Frequent upper limb and lower limb pain (pain occurring every day or once aweek) determined to be related to SIs. High personal burnout (> Q3) and highwork-related burnout (> Q3) mediated the relationship between SIs and frequentlower limb pain. Similarly, frequent lower limb pain mediated the relationship ofSIs with high personal and high work-related burnout. High personal and highwork-related burnout mediated the relationships of SIs with overtime work andirregular shift work. The mediating model provides strong evidence of anassociation between mental health and SIs.CONCLUSIONBurnout was determined to contribute to SIs occurrence;specifically, it mediatedthe relationships of SIs with frequent musculoskeletal pain, overtime work, andirregular shift work.

Chinese Medicine Yishen Jiangu Granules(益肾健骨颗粒)on Aromatase Inhibitor-Associated Musculoskeletal Symptoms

Objective： To assess the effectiveness of Yishen Jiangu Granules（益肾健骨颗粒, YSJGG） on aromatase inhibitor-associated musculoskeletal symptoms（AIMSS）. Methods： A single-arm, open-label study was conducted in 34 postmenopausal women with breast cancer who experienced AIMSS. Patients were treated with YSJGG for 12 weeks（12.4 g orally twice daily）. The primary outcome was a change in the mean worst pain score of Brief Pain Inventory-Short Form（BPI-SF） over 12 weeks, and the second outcomes included changes in pain severity and pain-related interference of BPI-SF and Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）, Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands（M-SACRAH）, the Functional Assessment of Cancer Therapy-Breast（FACT-B）, bone mineral density（BMD） and blood indices such as calcium（Ca）, phosphate（P）, and alkaline phosphatase（ALP）. Results： Of 37 women recruited, 30 initiated the therapy and 24 were evaluable at 12 weeks. The primary outcome（BPI-SF worst pain scores） achieved a 2.17-point reduction compared with baseline（5.75±1.87 vs 3.58±2.15, P〈0.01）. There were reductions in pain severity（decreased 1.65, P〈0.01） and pain-related interference（decreased 2.55, P〈0.01）. The changes in WOMAC and M-SACRAH scores were similar to BPI-SF（P〈0.05）. In the FACT-B, only physical wel-being and functional wel-being were improved compared with baseline（P〈0.05）. No clinical differences were found in BMD, Ca, P and ALP. Conclusion： YSJGG is an effective and wel-tolerated agent to reduce AIMSS.

乳腺癌患者药物相关性肌肉骨骼关节疼痛管理指南的质量评价

目的 对乳腺癌患者药物相关性肌肉骨骼关节疼痛管理相关循证指南和专家共识进行质量评价和内容分析,为制订国内相关护理干预方案提供依据。方法 系统检索2013年6月—2023年6月中英文数据库、指南网站中发布或更新的关于乳腺癌患者药物相关性肌肉骨骼关节疼痛管理的循证指南和专家共识,并采用对应的质量评价工具对纳入的循证指南和专家共识进行质量评价,分析其中相关的推荐意见。结果 共纳入4篇循证指南和5篇专家共识。经评价,1篇循证指南获评A级推荐、3篇获评B级推荐;5篇专家共识的真实性均较高。共汇总32条推荐意见,主要包括:疼痛的发生率、疼痛的症状、疼痛的病因、疼痛的评估与监测、疼痛的管理和疼痛的干预5个方面。结论 本研究纳入的循证指南和专家共识质量不高,汇总的推荐意见应用于临床护理实践前需进一步研究、细化内容,并进行患者意愿调查。

不同中医证候类风湿关节炎患者28关节肌肉骨骼超声表现差异分析

背景既往研究表明,不同中医证候类风湿关节炎(RA)患者实验室检查、影像学检查等临床指标具有一定的差异,同时临床指标能够为中医辨证提供依据。而探究不同中医证候RA患者28关节肌肉骨骼超声表现的差异,可为客观化RA的辨证论治提供依据。目的分析不同中医证候RA患者28关节肌肉骨骼超声表现差异,为进一步将肌肉骨骼超声纳入RA中医辨证体系提供依据。方法选取2017年4月-2018年4月在中日友好医院中医风湿病科住院及于门诊就诊的RA患者120例为研究对象。参照《中药新药临床研究指导原则》将患者分为湿热痹阻证、肝肾亏虚证、寒湿痹阻证、痰瘀痹阻证4大临床常见证候类型。收集患者性别、年龄、病程、C反应蛋白(CRP)、红细胞沉降率(ESR)、抗环瓜氨酸多肽抗体(ACPA)、类风湿因子(RF)[由于ACPA与RF是呈指数级进行增加的,为处理数据方便本研究使用ln(ACPA+1)及ln(RF+1)进行数据统计],记录28关节压痛关节数目(TJC28)、28关节肿胀关节数目(SJC28)及一般情况(GH)自我评估得分,计算28关节疾病活动度(DAS28)。对患者行28关节肌肉骨骼超声检查,记录其滑膜炎关节数、滑膜炎积分、多普勒血流信号(PD)关节数、PD积分、骨侵蚀关节数。结果 120例患者中医证候辨证分型:湿热痹阻证42例、肝肾亏虚证32例、寒湿痹阻证25例、痰瘀痹阻证21例。肝肾亏虚证患者病程长于湿热痹阻证、痰瘀痹阻证患者(P<0.05);肝肾亏虚证、寒湿痹阻证、痰瘀痹阻证患者CRP、ESR、ln(RF+1)、SJC28、GH自我评估得分、DAS28低于湿热痹阻证患者(P<0.05);寒湿痹阻证、痰瘀痹阻证患者TJC28低于湿热痹阻证患者(P<0.05)。湿热痹阻证、肝肾亏虚证患者滑膜炎关节数、滑膜炎积分大于寒湿痹阻证、痰瘀痹阻证患者(P<0.05);湿热痹阻证患者PD关节数、PD积分大于肝肾亏虚证、寒湿痹阻证、痰瘀痹阻证患者(P<0.05);湿热痹阻证患者骨侵蚀关节数小于肝肾亏虚证患者,大于寒湿痹阻证患者(P<0.05);肝肾亏虚证患者骨侵蚀关节数大于寒湿痹阻证、痰瘀痹阻证患者(P<0.05)。结论 RA的临床指标与中医证候具有密切关联,其中湿热痹阻证患者处于较高的疾病活动状态。同时中医证候与RA患者28关节肌肉骨骼超声下表现亦有一定的关联,湿热痹阻证与滑膜炎及PD密切相关,而肝肾亏虚证伴随着较多的骨侵蚀关节数。

芳香化酶抑制剂相关骨关节症状的研究进展

第三代芳香化酶抑制剂(aromatase inhibitors,AIs)是绝经后激素受体阳性乳腺癌患者内分泌治疗的标准药物。芳香化酶抑制剂相关骨关节症状(aromatase inhibitor-associated musculoskeletal symptoms,AIMSS)是AIs常见的不良反应之一,严重影响患者的生活质量和对内分泌治疗的依从性。目前AIMSS的发病机制和有效的治疗方法尚处于研究探索阶段。本文主要针对AIMSS的发病情况、临床特征、发病机制和治疗进展进行综述。

芳香化酶抑制剂相关骨关节症状的免疫调节机制研究

目的探讨乳腺癌患者应用芳香化酶抑制剂（AIs）所致骨关节症状的免疫调节机制。方法选择Ⅰ~Ⅲ期绝经后乳腺癌患者51例,33例应用AIs治疗,分为有较严重骨关节症状组16例（BPI-SF疼痛评分〉7）和未出现骨关节症状组17例,另18例为未进行AIs治疗受体阴性组。同时设对照组（健康人）16例。取各组研究对象的外周血,检测血中雌激素（E2）水平;应用ELISA方法检测血清中IFN-γ、IL-4浓度以及骨钙素（BGP）、骨碱性磷酸酶（BALP）和Ⅰ型胶原羧基端前肽（CICP）的浓度;应用流式细胞仪检测CD4＋CD25＋调节性T细胞表达率。结果有症状组的E2水平为（72.8±58.9）pmol/L,无症状组为（67.4±57.6）pmol/L,均低于对照组的（206.9±119.4）pmol/L（P〈0.01）,但有症状组与无症状组之间差异无统计学意义（P〉0.05）。有症状组的IFN-γ浓度为（82.83±5.53）pg/ml,明显高于无症状组和受体阴性组（P〈0.05）;有症状组的IL-4浓度为（22.83±1.09）pg/ml,低于无症状组和受体阴性组（P〈0.05）。流式细胞仪检测结果显示,有症状组外周血CD4＋CD25＋T细胞的表达率为（5.6±1.1）%,低于无症状组的（12.1±2.3）%和受体阴性组的（14.9±3.5）%,差异均有统计学意义（P〈0.01）。有症状组的骨代谢指标BALP和CICP水平分别为（62.1±5.5）U/L和（156.8±41.1）ng/ml,均高于无症状组的（45.2±4.6）U/L和（137.5±36.9）ng/ml,差异有统计学意义（P〈0.05）,但有症状组的BGP水平与无症状组无明显差异（P〉0.05）。结论应用AIs产生的相关骨关节症状可能与患者机体的免疫功能调节异常密切相关,其确切机制有待进一步的研究阐明。

月经状况对社区妇女肌肉骨骼疼痛的影响

目的探讨月经状况对社区女性肌肉骨骼疼痛的影响。方法采用统一的调查问卷,对北京市某社区697名35~64岁常住妇女进行面对面调查。问卷内容包括主要的社会人口学特征、月经状况、近2周内的肌肉骨骼疼痛发生情况,包括颈部、腰背部、膝部和其他部位,各部位疼痛发生频率用无、偶尔和经常表示。本研究将经常性的肌肉骨骼疼痛视为严重症状,分析其影响因素。结果腰背部疼痛是社区35~64岁妇女最常见的肌肉骨骼症状（33.4%）,其次为膝部疼痛（31.0%）、颈部疼痛（29.7%）、其他部位肌肉骨骼疼痛（25.6%）。绝经后妇女肌肉骨骼疼痛发生率显著高于绝经前妇女（P〈0.01）,绝经后期早期为肌肉骨骼疼痛发生的高峰阶段,到绝经后期晚期明显下降。颈部疼痛、腰背部疼痛发生率在绝经过渡期开始增加,与增龄不相关;膝部疼痛发生率随体重指数（body mass index,BMI）增加、年龄增长而增加（OR=1.085,1.050）。超重和肥胖是妇女膝部疼痛发生的危险因素。Logistic回归分析显示,肥胖妇女（BMI≥28 kg/m2）与正常体重妇女（BMI〈24 kg/m2）相比,膝部疼痛发生的危险度显著增加（OR=2.256）。结论绝经是女性肌肉骨骼疼痛发生的重要影响因素,增龄和超重与肌肉骨骼疼痛的相关性也不能被忽视。

医院护理人员肌肉骨骼疾患与三班制之间的相关性研究

目的:了解护士职业性肌肉骨骼损伤(OMD)的状况,为护士职业性肌肉骨骼损伤干预措施提供依据,为护理管理者人性化管理提供参考。方法:应用护士职业性肌肉骨骼损伤症状自评量表对浙江地区一所三级甲等综合医院的400名护士进行问卷调查。结果:护士腰部、膝部及背部OMD症状发生率分别为57.4%、48.4%、47.0%,其中腰部是最常见的OMD症状部位;白班护士与夜班护士之间腰部及踝部症状比较有差异(P<0.05),护士腰部症状与护龄及长期强迫姿势有关(P<0.05)。结论:护理管理者应重视护士职业性肌肉骨骼损伤的发生情况,合理安排临床护士轮科轮岗。

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.

乳腺癌芳香化酶抑制剂相关骨关节症状的中西医诊疗现状

芳香化酶抑制剂为激素受体阳性乳腺癌患者内分泌治疗的常用药物,但可能导致骨关节症状,影响患者生活质量及用药依从性,本文从中西医角度对芳香化酶抑制剂相关骨关节症状的定义、病因及治疗现状进行综述,并探索其研究新思路。

抑郁症状在石化企业员工职业紧张与工作相关肌肉骨骼疾患间中介效应

目的探讨抑郁症状在石化企业员工职业紧张与工作相关肌肉骨骼疾患(WMSDs)间的中介效应,为制定WMSDs的干预措施提供科学依据。方法采用整群抽样方法于2021年7-10月在江苏省某石油化工企业抽取4066名员工进行问卷调查,采用Spearman秩相关分析其职业紧张、抑郁症状与WMSDs的关系,并采用分层回归分析和Bootstrap法验证抑郁症状在职业紧张与WMSDs间的中介效应。结果最终纳入分析的3763名石化企业员工中,检出WMSDs者2934例,WMSDs检出率为77.97%。石化企业员工WMSDs得分为(3.47±3.17)分,抑郁症状得分为(10.04±5.99)分;职业紧张得分为(45.79±9.48)分,其中社会支持、组织与回报、要求与付出和自主性维度得分分别为(19.81±3.75)、(15.85±4.94)、(12.35±3.39)和(4.62±1.80)分。Spearman秩相关分析结果显示,石化企业员工WMSDs得分与职业紧张、组织与回报、要求与付出和抑郁症状得分均呈正相关(r=0.334、0.284、0.202和0.463,均P<0.01),与社会支持和自主性得分均呈负相关(r=–0.256和–0.141,均P<0.01);石化企业员工抑郁症状得分与职业紧张、组织与回报和要求与付出得分均呈正相关(r=0.621、0.540和0.410,均P<0.01),与社会支持和自主性得分均呈负相关(r=–0.419和–0.196,均P<0.01);石化企业员工职业紧张得分与组织与回报和要求与付出得分均呈正相关(r=0.848和0.639,均P<0.01),与社会支持和自主性得分均呈负相关(r=–0.648和–0.310,均P<0.01)。中介效应分析结果显示,抑郁症状在石化企业员工职业紧张的社会支持和要求与付出维度与WMSDs间具有部分中介效应,中介效应值分别为–0.137(–0.155~–0.120)和0.177(0.159~0.196),中介效应百分比分别为72.87%和78.67%;抑郁症状在石化企业员工职业紧张的组织与回报和自主性维度与WMSDs间具有完全中介效应,中介效应值分别为0.146(0.131~0.160)和–0.126(–0.158~–0.094),中介效应百分比分别为90.12%和98.44%。结论石化企业员工WMSDs检出率较高,抑郁症状在其职业紧张与WMSDs间具有中介效应,可通过缓解员工的抑郁症状来预防或减少部分WMSDs的发生。

乳腺癌患者芳香化酶抑制剂诱导的骨关节症状预防和管理的证据总结

目的系统检索、评价并总结国内外关于乳腺癌患者芳香化酶抑制剂诱导的骨关节症状预防和管理的最佳证据。方法系统检索国内外相关指南网站及专业协会网站、Cochrane Library、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、PubMed、Web of Science核心集、Embase、CINAHL、中国知网、维普数据库、万方数据库、中国生物医学文献数据库中所有关于乳腺癌患者芳香化酶抑制剂诱导的骨关节症状预防及管理的指南、专家共识、系统评价、Meta分析、最佳实践、推荐实践,检索时限为建库至2022年7月12日。由2名研究者独立进行文献质量评价和资料提取。结果共纳入21篇文献,其中循证指南1篇、共识指南3篇、系统评价或Meta分析17篇,从骨关节症状的发病率、临床表现、症状评估、风险评估、预防措施、药物干预、非药物干预、管理策略8个方面总结出37条最佳证据,其中有17条1级证据。结论乳腺癌患者芳香化酶抑制剂诱导的骨关节症状预防和管理的最佳证据可以为临床医护人员制订相关症状管理方案和开展临床实践提供参考,但仍需结合临床情境和患者意愿选择适宜的证据应用于临床实践。

职业紧张对城市职业人群颈、肩、腰部症状的影响

目的 探讨职业紧张对城市职业人群颈、肩、腰痛症状的影响。方法 采用横断面研究方法,在2012年1—7月调查上海城区7种职业2 458名20~63岁职员。采用中文北欧肌肉骨骼问卷调查颈、肩、腰部症状,职业紧张评估采用中文版工作内容问卷（JDC）和工作付出-回报（ERI）问卷,同时调查社会人口和工作特征因素,采用多因素非条件logistic回归方法分析职业紧张对颈、肩、腰症状的影响。结果 控制潜在混杂因素后,职业紧张可能是颈、肩、腰部症状的危险因素,OR值分别为1.44、1.27和1.60。工作付出-回报不平衡同样也是颈、肩、腰部症状的危险因素,OR值分别为1.31、1.34和1.33;工作满足度低则可能是肩、腰部症状患病的危险因素,OR值分别为1.33、1.32;抑郁能预测腰痛症状,OR值为1.37。结论 职业紧张可能对城市职业人群颈、肩、腰部的患病产生一定的影响。

新疆某煤矿工人职业倦怠及抑郁症状与工作相关肌肉骨骼疾患的关系

[背景]工作相关骨骼肌肉疾患(WMSDs)是损害劳动者工作能力的主要疾患之一。社会心理因素可以通过影响机体生理机制,改变工作姿势或扰乱情绪及认知能力,导致WMSDs发生。[目的]探究煤矿工人职业倦怠、抑郁症状水平及WMSDs现状,并分析三者间关系。[方法]本研究为横断面调查,采用整群随机抽样法,抽取新疆5家煤矿企业的1700名在岗煤矿工人。采用职业倦怠问卷、抑郁自评量表及中国肌肉骨骼疾患问卷对煤矿工人的一般情况、职业倦怠情况、抑郁状况和WMSDs发生情况进行调查。比较不同人口统计学特征煤矿工人WMSDs症状发生率、职业倦怠与抑郁症状评分。指标相关性分析采用Spearman相关分析。建立结构方程模型,分析抑郁症状在职业倦怠与WMSDs关系间的中介作用。[结果]回收有效问卷1528份,有效率为89.9%,其中男性1335名(87.4%)、女性193名(12.6%),年龄M(P_(0)~P_(100))为41(19~59)岁,工龄M(P_(0)~P_(100))为25(1~42)年。煤矿工人WMSDs症状发生率为57.7%,职业倦怠得分M(P_(25),P_(75))为54.0(45.0,61.0)分,抑郁症状得分M(P_(25),P_(75))为48.8(43.8,53.8)分。不同性别、年龄、工龄、倒班情况、文化程度组间WMSDs症状发生率、职业倦怠得分及抑郁症状得分差异均具有统计学意义(P<0.05)。职业倦怠、抑郁症状与WMSDs均呈现正相关关系(r_(s)=0.172、0.098,P<0.01),职业倦怠与抑郁症状呈正相关关系(r_(s)=0.138,P<0.01)。结构方程模型结果显示:职业倦怠和抑郁症状可直接影响WMSDs,标准化路径系数(β)分别为0.10和0.09;职业倦怠也可以直接影响抑郁症状,β为0.19。职业倦怠对WMSDs的总效应为0.120,直接效应为0.102。以抑郁症状为中介的间接效应为0.018,占总效应的15.0%(均P<0.05)。

类风湿关节炎患者倦怠乏力症状与临床指标的关系

目的探究类风湿关节炎(RA)出现倦怠乏力症状患者与未出现倦怠乏力患者之间临床指标的差异。方法类风湿关节炎患者74人,依据问诊症状将其分为倦怠乏力组(46人)和非倦怠乏力组(28人),观察患者一般临床资料、体格检查、实验室指标、肌肉骨骼超声指标,探究2组之间差异。结果倦怠乏力组28关节肿胀数目、患者健康状况评分、血沉、C反应蛋白、超声下28关节滑膜炎数、超声下28关节滑膜炎积分、超声下28关节PD数、超声下28关节多普勒血流信号(PD)积分及28关节疾病活动度(DAS 28)较之于非倦怠乏力组均显著升高,差异具有统计学意义(P<0.05或P<0.01);年龄、28关节压痛关节数、Ln(CCP+1)、Ln(RF+1)差异没有统计学意义(P>0.05)。结论倦怠乏力症状与RA患者炎症指标、疾病活动度及超声下关节表现具有一定的关联,其与疾病活动度之间的关系值得进一步探讨。

眼部和骨骼肌肉症状与使用不同视频显示终端的相关性研究

目的研究成人使用不同视频显示终端对其躯体症状的影响。方法选取浙江省杭州市、嘉兴市、湖州市、金华市和衢州市5个城市,采用Mitofsky-Waksberg二阶段抽样方法,拨打住宅电话对≥18岁居民进行电话调查,内容包括人口学特征、眼部和骨骼肌肉症状及使用各种视频显示终端的情况。采用多因素Logistic回归模型分析使用不同视频显示终端对眼部和骨骼肌肉症状的影响。结果共拨打固定电话号码3 464个,收集350份电话调查问卷,应答率为48.54%,拒访率为26.07%;对最终纳入的333份调查问卷进行统计分析。120名调查对象自述存在眼干、视物模糊、眼酸痛和流泪等眼部症状,占36.04%;71人自述存在骨骼肌肉症状,占21.32%。多因素Logistic回归分析结果显示,每天长时间使用电脑办公(0.5~4 h:OR=2.006,95%CI:1.021~3.943;4~6 h:OR=3.578,95%CI:1.751~7.315;>6 h:OR=4.874,95%CI:1.897~12.521),近视、老花和白内障等视力障碍疾病(OR=4.361,95%CI:2.465~7.714)是出现眼部症状的影响因素。长时间使用电脑办公(0.5~4 h:OR=3.815,95%CI:1.809~8.045;4~6 h:OR=4.974,95%CI:2.281~10.845;>6 h:OR=5.934,95%CI:2.347~15.005)、长时间使用电视机娱乐(>2 h:OR=2.051,95%CI:1.068~3.939)和女性(OR=1.884,95%CI:1.052~3.372)均是出现骨骼肌肉症状的影响因素。结论长时间使用电脑办公是出现眼部症状的危险因素,尤其是视力障碍疾病患者;长时间使用电脑办公、长时间使用电视机娱乐和女性是骨骼肌肉症状的危险因素。

职业紧张对制酸工人颈肩腰部疾患的影响

目的探讨职业紧张对硫酸制造工人颈肩腰部疾患的影响。方法采用职业紧张量表(OSI-R),调查498名制酸工人的职业任务、职业紧张反应、应对资源,参考北欧肌肉骨骼疾患标准问卷,调查制酸工作过去12个月内颈肩腰部出现的疼痛、不适、麻木症状。结果制酸工人颈、肩、腰部疾患患病率分别为56.2%、52.9%、61.2%,单因素分析结果提示,除年龄大、患其他疾病、弯腰30 min及以上、重度及以上劳动是影响制酸工人颈肩腰疾患因素外,较高职业紧张反应同样具有较大OR值,增加颈肩腰部疾患患病风险。logistic回归分析,除患其他疾病外,职业紧张反应也可增加颈肩腰部疾患的患病风险,OR值分别为3.32、3.33、2.47。结论职业紧张反应是颈肩腰部疾患患病的危险因素,消除紧张反应、增加应对资源可能会减轻制酸工人颈肩部疾患发生。

绝经后乳腺癌患者辅助AIs治疗骨折及骨关节症状危险因素分析

目的芳香化酶抑制剂(aromatase inhibitors,AIs)是一类通过抑制芳香化酶活性,阻断内源性雌激素生成,抑制乳腺癌细胞生长,从而治疗肿瘤的药物。本研究旨在分析绝经后乳腺癌患者使用AIs治疗后致骨质疏松性骨折及骨关节症状危险因素。方法回顾性分析2004-02-04-2019-01-31南京医科大学第一附属医院乳腺外科行乳腺癌手术及综合治疗的患者368例,其中AIs治疗191例,选择性雌激素受体调节剂治疗(selective estrogen receptor modulators,SERMs)85例以及未行内分泌治疗(继续服用与内分泌治疗无关的化疗药)92例。比较AIs组、SERMs组和未行内分泌治疗组之间骨质疏松性骨折发生率、关节痛、肌肉痛和晨僵等骨关节症状发生率及风险比,进一步分析骨折及骨关节症状发生的影响因素。结果AIs组、SERMs组、未行内分泌治疗组患者经不同方案治疗后,新发骨折发生率分别为12.6%、2.4%和4.3%;骨折的人年发生率分别为23.2/1000、4.1/1000、10.8/1000,差异均有统计学意义,P<0.05;而3组间二次骨折发生率相比,差异无统计学意义,P>0.05。AIs组、SERMs组、未行内分泌治疗组关节痛的发生率分别为67.0%、51.8%和44.6%;肌肉痛的发生率分别为38.2%、28.2%和28.3%;关节晨僵的发生率分别为50.8%、25.9%和29.3%,差异均有统计学意义,P<0.05;而3组间在关节痛评分、肌肉疼痛评分方面,差异无统计学意义,P>0.05;进一步分析显示,AIs组的关节痛风险是未行内分泌治疗组的2.252倍(OR=2.252,95%CI:1.518~4.208,P<0.001),AIs组肌肉痛风险是未行内分泌治疗组的2.484倍(OR=2.484,95%CI:1.461~4.224,P=0.001),差异均有统计学意义。二元Logistic回归分析显示,AIs治疗(OR=1.399,95%CI:1.098~3.211,P=0.041)可增加骨折发生的风险;补充维生素D及衍生物(OR=0.267,95%CI:0.160~0.916,P=0.030),补充钙剂(OR=0.210,95%CI:0.107~0.635,P=0.002)可降低骨折发生的风险。结论AIs治疗可增加绝经后乳腺癌患者发生骨折及骨关节症状的机会,而补充维生素D及钙剂则对患者具有保护作用。因此,在临床应用AIs过程中,可适当补充维生素D及钙剂,延缓骨折及骨关节症状的发生。