The Risk of Awkward Posture with the Incidence of Work-related Musculoskeletal Disorders (WMSDs) in Massage Therapist

Many massage therapists experience work-related skeletal muscle disorders (WMSDs). This study aimed to determine the proportion of the incidence of WMSDs and the relationship with the incident of posture WMSDs in massage therapists. The type of research was quantitative analytic observational with cross sectional design. The type of massage under study was traditional massage. Population and sample were massage therapist in Pekanbaru City 2017 with sample size 77 people taken by consecutive sampling technique. Data collection and processing used interviews with quesonnaires, documentation and Rapid Upper Limb Assesment (RULA). Level of risk of WMSDs incident used semi-qualitave analysis and nordic body map. WMSDs incidence rate in massage therapist was high enough that was 61%. The results showed that the variables significantly correlated with incidence of WMSDs were odd posture (POR: 8,30, 95% CI: 2,401-8,753), length of work (POR: 10,109; 95% CI:2,567-39,811) and age (POR: 7,649 95% CI: 2,567-39,811). The most WMSDs complaints on both hands were 57 people (74%), left shoulder and right shoulder were 27 people (35.1%) and lower back were 19 (24,7%). It is advisable in massage therapists to avoid awkward posture while massaging clients by improving work posture, posion while massaging and placing the equipment used within the reach of the hand.&nbsp

Combinations of bleeding and ischemic risk and their association with clinical outcomes in acute coronary syndrome.

Background: Clinical predictors of future ischemic events in patients with acute coronary syndrome (ACS) are also risk factors for bleeding, with patients often at high-risk of both outcomes. We aimed to define the clinical outcomes and provision of guideline-recommended care in ACS management for different combinations of ischemic and bleeding risk defined using a combined GRACE and CRUSADE score.Methods: A retrospective observational analysis of a national ACS database was performed for patients with ACS admitted to three tertiary centres from January 2010 to March 2016. Patients were stratified into 9 groups based on possible CRUSADE-GRACE risk combinations. Multiple logistic regression was used to estimate adjusted odds ratios (ORs [95% CI]) for outcomes (in-hospital net adverse cardiac events (NACE), in-hospital all-cause mortality, 30-day mortality and treatment strategy).Results: A total of 17,701 patients were included in the analysis. We observed a graded risk of mortality and adverse events in the high-risk GRACE strata (Groups 3, 6 and 9). Almost a third of patients with ACS were at a ‘dual high-risk’ (Group 9, 32%) and were independently associated with higher in-hospital NACE (composite of cardiac mortality, all-cause bleeding and re-infarction): aOR 6.33 [3.55, 11.29], all-cause mortality: aOR 14.17 [5.27, 38.1], all-cause bleeding: aOR 4.82 [1.96, 11.86], and 30-day mortality: aOR 10.79 [5.33, 21.81]. This group was also the least likely to be offered coronary angiography (aOR 0.24 [0.20, 0.29]) and dual anti-platelet therapy (aOR 0.26 [0.20, 0.34]). Conclusions: One in five patients presenting with an ACS are high ischemic and high bleeding risk, and these patients are more likely to experience poor clinical outcomes and reduced odds of receiving guideline-recommended therapy. <br/

Determinants of increasing trends of self-medication: physicians, perspectives

The objective of study was to take and evaluate opinions of the physicians about various aspects of self-medication. A self-fabricated questionnaire of 38 questions was distributed among 292 physicians. Prominent involvement of females in self-medication was suggested by 176 (60 %) physicians. The self-medication trend is more common in financially lower class as reported by 146 (50 %) physicians and in uneducated community as suggested by 165 (57 %) physicians. Family habits and easy to remember brand names were considered as a major source of drug information reported by 155 (53 %) and 187 (64 %) physicians, respectively. Both over the counter (OTC) and prescription only medicines (POM) drugs are used for self-medication as agreed by 131 (49 %) physicians. Medical stores were considered as the major source of drug provider for this purpose suggested by 264 (90 %) practitioners. The extensive use of analgesics for self-medication was reported by 52 % of the respondents. Presence of pharmacist at the points of drug dispensing and a comprehensive health care policy from Government were important suggestions to reduce the self-medication.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Sposol: 5 In 1 Smart Portable Solar Light

Smart Portable Solar Light is a project based on a circuit obtained through the internet connection.A few modifications have been done to the original circuit; original circuit uses eight LEDs while this project only uses one main LED.The main source of this system is harvest form the sun.The sun’s radiation is converted to electrical energy that is supplied to a battery,which acts as a power storage for the system.Another set of batteries is used as the structure of the lamp is design to be portable

Effi cacy of a Russian-backbone live attenuated infl uenza vaccine among young children in Bangladesh: a randomised, double-blind, placebo-controlled trial

Background The rates of infl uenza illness and associated complications are high among children in Bangladesh. We assessed the clinical effi cacy and safety of a Russian-backbone live attenuated infl uenza vaccine (LAIV) at two fi eld sites in Bangladesh. Methods Between Feb 27 and April 9, 2013, children aged 2–4 years in urban Kamalapur and rural Matlab, Bangladesh, were randomly assigned in a 2:1 ratio, according to a computer-generated schedule, to receive one intranasal dose of LAIV or placebo. After vaccination, we monitored children in weekly home visits until Dec 31, 2013, with study clinic surveillance for infl uenza illness. The primary outcome was symptomatic, laboratory-confi rmed infl uenza illness due to vaccine-matched strains. Analysis was per protocol. The trial is registered with ClinicalTrials.gov, number NCT01797029. Findings Of 1761 children enrolled, 1174 received LAIV and 587 received placebo. Laboratory-confi rmed infl uenza illness due to vaccine-matched strains was seen in 93 (15·8%) children in the placebo group and 79 (6·7%) in the LAIV group. Vaccine effi cacy of LAIV for vaccine-matched strains was 57·5% (95% CI 43·6–68·0). The vaccine was well tolerated, and adverse events were balanced between the groups. The most frequent adverse events were tachypnoea (n=86 in the LAIV group and n=54 in the placebo group), cough (n=73 and n=43), and runny nose (n=68 and n=39), most of which were mild. Interpretation This single-dose Russian-backbone LAIV was safe and effi cacious at preventing symptomatic laboratory-confi rmed infl uenza illness due to vaccine-matched strains. LAIV programmes might reduce the burden of infl uenza illness in Bangladesh

A Prospective Study of Arsenic Exposure, Arsenic Methylation Capacity, and Risk of Cardiovascular Disease in Bangladesh

Millions of persons worldwide, including 13 million Americans (U.S. Environmental Protection Agency 2009) and over 50 million in Bangladesh (British Geological Survey 2007), have been chronically exposed to arsenic, a group 1 human carcinogen (International Agency for Research on Cancer 2004), through contaminated drinking water. Arsenic exposure from drinking water has been associated with cardiovascular disease (CVD) (Chen CJ et al. 1996; Chen Y et al. 2011; Chiou et al. 1997; Liao et al. 2012; Tseng et al. 2003; Yuan et al. 2007). However, prospective studies assessing susceptibility to CVD due to arsenic exposure are rare. Arsenic in drinking water is present as inorganic arsenic (iAS). Once ingested, iAs is methylated to monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA). The relative distribution of urinary arsenic metabolites varies from person to person and has been interpreted to reflect arsenic methylation capacity (Hopenhayn-Rich et al. 1996; Vahter 1999). Mechanistic studies have shown that MMAIII is more toxic than iAs or any of the pentavalent metabolites (Petrick et al. 2000; Styblo et al. 2000). Incomplete methylation, indicated by a high percentage of urinary MMA (MMA%), has been consistently related to cancers (Chen YC et al. 2003; Pu et al. 2007; Steinmaus et al. 2006; Yu et al. 2000), and there is some evidence of stronger associations among smokers than nonsmokers (Pu et al. 2007; Steinmaus et al. 2006). However, the association between urinary MMA% and CVD risk is unknown, and research on the combined effects of arsenic and biomarkers of arsenic susceptibility on CVD risk is needed. We conducted a prospective case–cohort study nested in a large prospective cohort to assess associations of arsenic exposure from drinking water and arsenic methylation capacity, indicated using relative distribution of urinary arsenic metabolites, with CVD risk

Genome-Wide Association Study Identifies Chromosome 10q24.32 Variants Associated with Arsenic Metabolism and Toxicity Phenotypes in Bangladesh

Arsenic contamination of drinking water is a major public health issue in many countries, increasing risk for a wide array of diseases, including cancer. There is inter-individual variation in arsenic metabolism efficiency and susceptibility to arsenic toxicity; however, the basis of this variation is not well understood. Here, we have performed the first genome-wide association study (GWAS) of arsenic-related metabolism and toxicity phenotypes to improve our understanding of the mechanisms by which arsenic affects health. Using data on urinary arsenic metabolite concentrations and approximately 300,000 genome-wide single nucleotide polymorphisms (SNPs) for 1,313 arsenic-exposed Bangladeshi individuals, we identified genome-wide significant association signals (P<5×10−8) for percentages of both monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA) near the AS3MT gene (arsenite methyltransferase; 10q24.32), with five genetic variants showing independent associations. In a follow-up analysis of 1,085 individuals with arsenic-induced premalignant skin lesions (the classical sign of arsenic toxicity) and 1,794 controls, we show that one of these five variants (rs9527) is also associated with skin lesion risk (P = 0.0005). Using a subset of individuals with prospectively measured arsenic (n = 769), we show that rs9527 interacts with arsenic to influence incident skin lesion risk (P = 0.01). Expression quantitative trait locus (eQTL) analyses of genome-wide expression data from 950 individual's lymphocyte RNA suggest that several of our lead SNPs represent cis-eQTLs for AS3MT (P = 10−12) and neighboring gene C10orf32 (P = 10−44), which are involved in C10orf32-AS3MT read-through transcription. This is the largest and most comprehensive genomic investigation of arsenic metabolism and toxicity to date, the only GWAS of any arsenic-related trait, and the first study to implicate 10q24.32 variants in both arsenic metabolism and arsenical skin lesion risk. The observed patterns of associations suggest that MMA% and DMA% have distinct genetic determinants and support the hypothesis that DMA is the less toxic of these two methylated arsenic species. These results have potential translational implications for the prevention and treatment of arsenic-associated toxicities worldwide

Heart Failure Readmission in Patients With ST-Segment Elevation Myocardial Infarction and Active Cancer

BackgroundAlthough numerous studies have examined readmission with heart failure (HF) after acute myocardial infarction (AMI), limited data are available on HF readmission in cancer patients post-AMI. ObjectivesThis study aimed to assess the rates and factors associated with HF readmission in cancer patients presenting with ST-segment elevation myocardial infarction (STEMI). MethodsA nationally linked cohort of STEMI patients between January 2005 and March 2019 were obtained from the UK Myocardial Infarction National Audit Project registry and the UK national Hospital Episode Statistics Admitted Patient Care registry. Multivariable Fine-Gray competing risk models were used to evaluate HF readmission at 30 days and 1 year. ResultsA total of 326,551 STEMI indexed admissions were included, with 7,090 (2.2%) patients having active cancer. The cancer group was less likely to be admitted under the care of a cardiologist (74.5% vs 81.9%) and had lower rates of invasive coronary angiography (62.2% vs 72.7%; P < 0.001) and percutaneous coronary intervention (58.4% vs. 69.5%). There was a significant prescription gap in the administration of post-AMI medications upon discharge such as an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (49.5% vs 71.1%) and beta-blockers (58.4% vs 68.0%) in cancer patients. The cancer group had a higher rate of HF readmission at 30 days (3.2% vs 2.3%) and 1 year (9.4% vs 7.3%). However, after adjustment, cancer was not independently associated with HF readmission at 30 days (subdistribution HR: 1.05; 95% CI: 0.86-1.28) or 1 year (subdistribution HR: 1.03; 95% CI: 0.92-1.16). The opportunity-based quality indicator was associated with higher rates of HF readmission independent of cancer diagnosis. ConclusionsCancer patients receive care that differs in important ways from patients without cancer. Greater implementation of evidence-based care may reduce HF readmissions, including in cancer patients

Pathways to Care: Duration of Untreated Psychosis from Karachi, Pakistan

Background: Substantial amount of time is lost before initiation of treatment in Schizophrenia. The delay in treatment is labelled as Duration of Untreated Psychosis (DUP). Most of these estimates come from western countries, where health systems are relatively better developed. There is dearth of information on pathway to care from developing countries. Methods And Results: Patients with ICD-10 based diagnosis of Schizophrenia were enrolled by convenient method of sampling. The pathway to care was explored through a semi-structured questionnaire. Onset, course and symptoms of psychosis were assessed using Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS). Ethical approval of the project was taken from The Aga Khan University, Ethics Review Committee. Of the enrolled 93 subjects, 55 (59%) were males and 38 (41%) were females. In our sample, 1.56 mean (median, 2) attempts were made prior to successful help seeking. The duration of untreated psychosis was 14.8 months (St. Deviation, 29.4). DUP was 16.8 months (St. Deviation, 34.9) for males and 11.8 months (St. Deviation, 18.9) for females. In the pathway to care, psychiatrists featured prominently as initial care providers. In the first attempt at help-seeking, 43% Patients were initially taken to psychiatrists. After the initial consultation, 45% were prescribed psychotropic medication while 7% were hospitalized. Only 9% subjects were given the diagnosis of schizophrenia initially. When participants were inquired about the reasons for delay, 29% reported financial difficulties as the barrier to care. Positive symptoms of psychosis were present in 57% subjects while negative symptoms were present in 30% subjects. There was a statistically significant difference (Chi-square, 7.928, df: 1, Sig 0.005) between DUP and the positive and negative symptoms category. Conclusion: In the absence of well developed primary care health system in Pakistan, majority of Patients present to psychiatrists as a first contact. DUP, as a measurement of help seeking behaviour, tends to be shorter with positive symptoms of Schizophrenia. Substantial amount of time is lost due to non recognition of disease and subsequently, inadequate treatment. Secondary prevention strategies should focus on families, which play an important role in the treatment-seeking process of psychotic Patients