Musculoskeletal symptoms among energy distribution network linemen

BACKGROUND: Linemen should be evaluated regarding the presence of musculoskeletal symptoms to guide the identification of risk factors for development of work-related musculoskeletal disorders (WMSD) and to allow the implementation of preventive measures. OBJECTIVE: To assess the occurrence of WMSD symptoms among linemen working at a regional branch of an electricity distribution company, to investigate whether there were differences in the proportions of symptomatic workers among the functions performed, and to perform a preliminary survey of the main risk factors present. METHODS: Thirty male linemen (mean age 38.1±5.5 years) were evaluated, divided into three teams according to their job function (Live Line Linemen, LLL; Maintenance/Emergency Linemen, MEL; Commercial Linemen, CL). Musculoskeletal symptoms were identified on a body map, qualified using the McGill questionnaire and quantified using a numerical scale. The DASH questionnaire was also applied to evaluate the impact of the shoulder symptoms on the workers' performance. RESULTS: Seventy percent of the linemen presented at least one musculoskeletal symptom in the shoulders, back or knees. All of the LLL team presented musculoskeletal symptoms and these workers had the highest scores in the DASH questionnaire (28±15). Sixty-seven percent of the MEL team presented symptoms, and their DASH score was 8±11. Fifty percent of the CL team presented symptoms, but none of them had shoulder symptoms. The proportion of workers with shoulder symptoms was related to their job function (p=0.02). CONCLUSIONS: A high proportion of the linemen presented symptoms which varied according to the occupational activity. Interventions are needed to reduce the risk of WMSD among the linemen evaluated.CONTEXTUALIZAÇÃO: A presença de sintomas musculoesqueléticos em eletricistas deve ser caracterizada para auxiliar na identificação de fatores de riscos para os distúrbios osteomusculares relacionados ao trabalho (DORT) e para possibilitar implementação de medidas preventivas. OBJETIVO: Avaliar a ocorrência de sintomas de DORT em eletricistas de uma regional de uma empresa de distribuição de energia elétrica, verificar se existiam diferenças entre as funções exercidas quanto à proporção de trabalhadores sintomáticos, e realizar um levantamento preliminar dos principais fatores de riscos presentes. MÉTODOS: Foram avaliados 30 eletricistas do sexo masculino (38,1±5,5 anos), divididos em três equipes conforme a função exercida (ELV=Eletricistas Linha Viva; EEM=Eletricistas Emergência/Manutenção; EC=Eletricistas Comerciais). Sintomas musculoesqueléticos foram identificados em mapa corporal, qualificados pelo Questionário McGill e quantificados por escala numérica. O questionário DASH também foi aplicado para avaliar impacto dos sintomas nos ombros na performance dos trabalhadores. RESULTADOS: 70% dos eletricistas apresentaram ao menos um sintoma musculoesquelético nos ombros, coluna ou joelhos. A equipe ELV apresentou sintomas musculoesqueléticos em 100% dos trabalhadores e maior pontuação no questionário DASH (28±15). A equipe EEM apresentou sintomas em 67% dos trabalhadores e pontuação DASH de 8±11, e a equipe EC apresentou sintomas em 50%, mas sem sintomas nos ombros. A proporção de trabalhadores sintomáticos nos ombros estava associada à função exercida (p=0.02). CONCLUSÕES: Eletricistas avaliados apresentaram alta proporção de trabalhadores sintomáticos, que variou conforme a atividade ocupacional. Intervenções são necessárias para reduzir os riscos de DORT dentre os eletricistas avaliados.12312

Assessment of cognitive status in patients with type 2 diabetes through the mini-mental status examination: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Diabetes is considered an independent risk factor for cognitive impairment and some studies observed through neuropsychological tests that cognitive disfunction affects both elderly and younger patients with diabetes. The aims of this study were to evaluate the cognitive status of outpatients with type 2 diabetes and to evaluate factors associated with impaired function.</p> <p>Methods</p> <p>A cross-sectional study was conducted in a group of type 2 diabetic outpatients. They were asked to undergo the Mini-Mental State Examination (MMSE) during routine ambulatory visits between April 2006 and January 2007, with the highest pontuation of the test being 30 points. Patients were classified as having possible dementia according to years of study. Exclusion criteria were blindness, illiterately, stroke, Alzheimer disease and psychiatric disorder. Results are presented as median (interquartile range) or mean ± SD.</p> <p>Results</p> <p>The study group was composed of 346 type 2 diabetic outpatients (216 females), aged 58,6 ± 12,1 years and with duration of diabetes of 12,3 ± 9,1 years. Hypertension was present in 77,2%. The total MMSE score achieved was 26 points (16 - 30) and was correlated with years of study (R²= 0,39, p < 0,001) and 'per capita' income (R²= 0,22, p < 0,0001) and duration of diabetes (R2 = - 0,13, p = 0,01). Patients who needed help to take their medications obtained worst performance in the MMSE (23,16 ± 3,55 <it>vs </it>25,7 ± 2,84, p < 0,01) and were more likely to present possible dementia (p < 0,01). Forty two subjects (12.1%) had diagnosis of possible dementia and this was also associated with years of study (p = 0,045). No association was observed between possible dementia and total MMSE scores with A1C levels.</p> <p>Conclusions</p> <p>We conclude that patients with type 2 diabetes should be regularly evaluated for their cognitive function, because duration of disease could be associated with decline in cognition. The early implementation of mini mental which is a simple method of execution can be done to detect early stages of dementia. This test could be an important tool to access the ability of patient to understand their disease and treatment.</p

Maternal LAMP/p55gagHIV-1 DNA Immunization Induces In Utero Priming and a Long-Lasting Immune Response in Vaccinated Neonates

Infants born to HIV-infected mothers are at high risk of becoming infected during gestation or the breastfeeding period. A search is thus warranted for vaccine formulations that will prevent mother-to-child HIV transmission. The LAMP/gag DNA chimeric vaccine encodes the HIV-1 p55gag fused to the lysosome-associated membrane protein-1 (LAMP-1) and has been shown to enhance anti-Gag antibody (Ab) and cellular immune responses in adult and neonatal mice; such a vaccine represents a new concept in antigen presentation. In this study, we evaluated the effect of LAMP/gag DNA immunization on neonates either before conception or during pregnancy. LAMP/gag immunization of BALB/c mice before conception by the intradermal route led to the transfer of anti-Gag IgG1 Ab through the placenta and via breastfeeding. Furthermore, there were an increased percentage of CD4+CD25+Foxp3+T cells in the spleens of neonates. When offspring were immunized with LAMP/gag DNA, the anti-Gag Ab response and the Gag-specific IFN-γ-secreting cells were decreased. Inhibition of anti-Gag Ab production and cellular responses were not observed six months after immunization, indicating that maternal immunization did not interfere with the long-lasting memory response in offspring. Injection of purified IgG in conjunction with LAMP/gag DNA immunization decreased humoral and cytotoxic T-cell responses. LAMP/gag DNA immunization by intradermal injection prior to conception promoted the transfer of Ab, leading to a diminished response to Gag without interfering with the development of anti-Gag T- and B-cell memory. Finally, we assessed responses after one intravenous injection of LAMP/gag DNA during the last five days of pregnancy. The intravenous injection led to in utero immunization. In conclusion, DNA vaccine enconding LAMP-1 with Gag and other HIV-1 antigens should be considered in the development of a protective vaccine for the maternal/fetal and newborn periods

Subdominant/Cryptic CD8 T Cell Epitopes Contribute to Resistance against Experimental Infection with a Human Protozoan Parasite

During adaptive immune response, pathogen-specific CD8+ T cells recognize preferentially a small number of epitopes, a phenomenon known as immunodominance. Its biological implications during natural or vaccine-induced immune responses are still unclear. Earlier, we have shown that during experimental infection, the human intracellular pathogen Trypanosoma cruzi restricts the repertoire of CD8+ T cells generating strong immunodominance. We hypothesized that this phenomenon could be a mechanism used by the parasite to reduce the breath and magnitude of the immune response, favoring parasitism, and thus that artificially broadening the T cell repertoire could favor the host. Here, we confirmed our previous observation by showing that CD8+ T cells of H-2a infected mice recognized a single epitope of an immunodominant antigen of the trans-sialidase super-family. In sharp contrast, CD8+ T cells from mice immunized with recombinant genetic vaccines (plasmid DNA and adenovirus) expressing this same T. cruzi antigen recognized, in addition to the immunodominant epitope, two other subdominant epitopes. This unexpected observation allowed us to test the protective role of the immune response to subdominant epitopes. This was accomplished by genetic vaccination of mice with mutated genes that did not express a functional immunodominant epitope. We found that these mice developed immune responses directed solely to the subdominant/cryptic CD8 T cell epitopes and a significant degree of protective immunity against infection mediated by CD8+ T cells. We concluded that artificially broadening the T cell repertoire contributes to host resistance against infection, a finding that has implications for the host-parasite relationship and vaccine development

Pathogen-Induced Proapoptotic Phenotype and High CD95 (Fas) Expression Accompany a Suboptimal CD8+ T-Cell Response: Reversal by Adenoviral Vaccine

MHC class Ia-restricted CD8+ T cells are important mediators of the adaptive immune response against infections caused by intracellular microorganisms. Whereas antigen-specific effector CD8+ T cells can clear infection caused by intracellular pathogens, in some circumstances, the immune response is suboptimal and the microorganisms survive, causing host death or chronic infection. Here, we explored the cellular and molecular mechanisms that could explain why CD8+ T cell-mediated immunity during infection with the human protozoan parasite Trypanosoma cruzi is not optimal. For that purpose, we compared the CD8+ T-cell mediated immune responses in mice infected with T. cruzi or vaccinated with a recombinant adenovirus expressing an immunodominant parasite antigen. Several functional and phenotypic characteristics of specific CD8+ T cells overlapped. Among few exceptions was an accelerated expansion of the immune response in adenoviral vaccinated mice when compared to infected ones. Also, there was an upregulated expression of the apoptotic-signaling receptor CD95 on the surface of specific T cells from infected mice, which was not observed in the case of adenoviral-vaccinated mice. Most importantly, adenoviral vaccine provided at the time of infection significantly reduced the upregulation of CD95 expression and the proapoptotic phenotype of pathogen-specific CD8+ cells expanded during infection. In parallel, infected adenovirus-vaccinated mice had a stronger CD8 T-cell mediated immune response and survived an otherwise lethal infection. We concluded that a suboptimal CD8+ T-cell response is associated with an upregulation of CD95 expression and a proapoptotic phenotype. Both can be blocked by adenoviral vaccination

CD8+ T-Cells Expressing Interferon Gamma or Perforin Play Antagonistic Roles in Heart Injury in Experimental Trypanosoma Cruzi-Elicited Cardiomyopathy

In Chagas disease, CD8+ T-cells are critical for the control of Trypanosoma cruzi during acute infection. Conversely, CD8+ T-cell accumulation in the myocardium during chronic infection may cause tissue injury leading to chronic chagasic cardiomyopathy (CCC). Here we explored the role of CD8+ T-cells in T. cruzi-elicited heart injury in C57BL/6 mice infected with the Colombian strain. Cardiomyocyte lesion evaluated by creatine kinase-MB isoenzyme activity levels in the serum and electrical abnormalities revealed by electrocardiogram were not associated with the intensity of heart parasitism and myocarditis in the chronic infection. Further, there was no association between heart injury and systemic anti-T. cruzi CD8+ T-cell capacity to produce interferon-gamma (IFNγ) and to perform specific cytotoxicity. Heart injury, however, paralleled accumulation of anti-T. cruzi cells in the cardiac tissue. In T. cruzi infection, most of the CD8+ T-cells segregated into IFNγ+ perforin (Pfn)neg or IFNγnegPfn+ cell populations. Colonization of the cardiac tissue by anti-T. cruzi CD8+Pfn+ cells paralleled the worsening of CCC. The adoptive cell transfer to T. cruzi-infected cd8−/− recipients showed that the CD8+ cells from infected ifnγ−/−pfn+/+ donors migrate towards the cardiac tissue to a greater extent and caused a more severe cardiomyocyte lesion than CD8+ cells from ifnγ+/+pfn−/− donors. Moreover, the reconstitution of naïve cd8−/− mice with CD8+ cells from naïve ifnγ+/+pfn−/− donors ameliorated T. cruzi-elicited heart injury paralleled IFNγ+ cells accumulation, whereas reconstitution with CD8+ cells from naïve ifnγ−/−pfn+/+ donors led to an aggravation of the cardiomyocyte lesion, which was associated with the accumulation of Pfn+ cells in the cardiac tissue. Our data support a possible antagonist effect of CD8+Pfn+ and CD8+IFNγ+ cells during CCC. CD8+IFNγ+ cells may exert a beneficial role, whereas CD8+Pfn+ may play a detrimental role in T. cruzi-elicited heart injury