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Query: UMLS:C0015672 (fatigue)
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The improvement of an irregular three-shift system with anti-clockwise rotation of workers of a disabled persons' facility covering 42 h a week was a subject for management-labour debate. Workers were complaining of physical fatigue, high prevalence of low back pain, sleep shortages associated with short inter-shift intervals, and irregular holidays. With the co-operation of trade union members, an educational and intervention programme was designed to analyse, plan, and implement improved shift rotation schemes. The programme consisted of (a) a group study on the existing system and effects on health and working life; (b) joint planning of potential schemes; (c) communication and feedback (d) testing and evaluation; and (e) agreement on an improved system. The group study was undertaken by means of time study, questionnaire and physiological methods, and the results were jointly discussed. This led to the planning of alternative shift schemes incorporating more regular, clockwise rotation. It was agreed to stage a trial period with a view to shorter working hours. This experience indicated the importance of a stepwise intervention strategy with frequent dialogues and a participatory process focusing on the broad range of working life and health issues.
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PMID:Educational and intervention strategies for improving a shift system: an experience in a disabled persons' facility. 844 Feb 17

More than 410,000 people participated in the National Marrow Donor Program (NMDP) as of October 1, 1991, and more than 850 volunteers had donated marrow. While the incidence of serious morbidity as a result of bone marrow donation is rare, the incidence of lesser complications and the long-term consequences of marrow donation are not known. To determine the incidence of donor complications and measure the recovery time of volunteer, unrelated marrow donors, we analyzed the results of surveys of the first 493 persons who donated marrow through the NMDP. The marrows were collected at 42 centers. The median age of the donors was 37.9 years (range 19.1 to 55.6 years). The median volume of marrow collected was 1,050 mL (range 180 to 2,983 mL). Autologous red blood cells were transfused to 89.8% (439) of donors but only 0.6% (3) of donors received allogeneic blood. Acute complications related to the collection procedure occurred in 5.9% of donors; but a serious complication, apnea during anesthesia, occurred in only one donor. When donors were questioned approximately 2 days following discharge from their hospitalization, most donors described symptoms related to the collection; 74.8% experienced tiredness, 67.8% experienced pain at the marrow collection site, and 51.6% of the donors experienced low back pain. Donors were surveyed repeatedly until they felt that they had recovered completely. Mean recovery time was 15.8 days; however, 42 (10%) donors felt that it took them > or = 30 days to recover fully. The duration of the marrow collection procedure and duration of anesthesia both positively correlated with donor pain and/or fatigue following the collection; but the duration of the collection procedure had the highest correlation with post-collection pain and fatigue. The volume of marrow collected per unit of donor weight was more weakly correlated with donor pain and/or fatigue than the anesthesia and collection times. When multivariate analysis was used to analyze the correlation between donor recovery time and these variables, only the duration of the collection was found to correlate significantly with donor recovery time (P = .001). This analysis demonstrates that marrow donation is well tolerated with few complications. To decrease further the incidence of donor discomfort and recovery time following donation, the duration of the collection procedure, and probably the duration of anesthesia, and the volume of marrow collected, should be kept to a minimum.
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PMID:Experiences of the first 493 unrelated marrow donors in the National Marrow Donor Program. 846 78

In low back pain patients the paraspinal muscles demonstrate excess fatigability. Whether the cause is "central" as could result from impaired motor unit recruitment due to poor motivation or fear of pain, or "peripheral", and caused by defects in the contractile apparatus, is unknown. Using surface electromyography in conjunction with a standardized isometric fatigue test, this study investigates the mechanisms causing paraspinal muscle dysfunction in patients with both nonsurgical and postsurgical chronic low back pain. During the fatigue test normal subjects and both patient groups exhibited electromyographic increases. These were significantly greater in both patient groups, indicating increased central drive to their muscles. These findings may suggest that patients' excess fatigue is peripheral in origin, with increased central drive arising secondary to muscle wasting or denervation, although a central activation defect has not been excluded. Impaired physical performance in low back pain patients does not seem to be caused by lack of central drive.
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PMID:Increased central drive during fatiguing contractions of the paraspinal muscles in patients with chronic low back pain. 848 53

There is little information regarding the functional status and quality of life of cardiac transplant patients. This investigation is the largest study describing outcome up to 10 years after cardiac transplantation. We conducted a cross-sectional survey of 200 cardiac transplant recipients using the Sickness Impact Profile and a supplementary questionnaire. The response rate was 48%. The median duration post-cardiac transplantation was 2.3 years (range, 0.5 to 9.7 years). The median age was 53 years (range, 27.1 to 68.7). In comparison to previously published studies, our sample of cardiac transplant recipients had worse quality of life than normals, similar scores to cardiac arrest survivors and post-myocardial infarction patients, and better quality of life than patients with low back pain. We found that those not working (44%) reported a lower quality of life. Musculoskeletal-neurologic complaints were highly prevalent, with generalized weakness in 54% responding, fatigue in 42%, and low back pain in 37%. Lower quality of life was found in patients reporting a higher number of musculoskeletal-neurological disorders. We conclude that there are specific areas for rehabilitation intervention in patients post-cardiac transplantation, and suggest areas for future research directed towards enhancing quality of life for cardiac transplant recipients.
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PMID:Health status and quality of life following cardiac transplantation. 848 57

Fractures of the pubic rami are almost invariably associated with fractures of the posterior arch of the pelvic ring. Two women, aged 50 and 67 years, with septic arthritis of the symphysis pubis attended by severe low back pain, were followed with CT and MR imaging of the pelvis, as well as bond scintigraphy in one patient. In the first patient sacral fractures with severe displacement were revealed, prompting stabilizing symphysiodesis. In the second patient an undisplaced fatigue fracture was confirmed in the right half of the sacrum. In patients with pelvic laxity following arthritis of the symphysis and post-traumatic osteolysis associated with low back pain, displaced or occult fractures of the bones adjacent to the sacroiliac joints should be considered.
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PMID:Fatigue fracture of the sacral bone associated with septic arthritis of the symphysis pubis. 861 61

Unexpected loads, which often occur in the working environment, can lead to high forces in the spine and, thus, may be a cause of low back injury. This paper discusses the effect of "sudden load" on the erector spine reaction and amplitude. Muscle responses were mediated by several factors, including fatigue, posture, expectation and rehabilitation, in chronic low back pain patients. The subjects were fatigued by holding a 20% maximum voluntary contraction for 1 min. A functional restoration program was tested for its efficacy in reducing reaction time and EMG amplitude in chronic low back pain patients. Reaction time was longer and EMG amplitude lower in patients than in their matched controls. EMG reaction time and magnitude decreased in patients after a 2-week rehabilitation program, including specific training of coordination and posture control. The results of the modelling showed higher spinal compressive load and lower shear forces when the load was expected than when the load was unexpected. The effect of sudden loads can be exacerbated if a worker is not standing on a flat surface or is fatigued. Chronic low back pain patients have less ability to protect themselves from sudden loads, but they can be trained to improve their response by means of an appropriate rehabilitation program.
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PMID:European Spine Society--the AcroMed Prize for Spinal Research 1995. Unexpected load and asymmetric posture as etiologic factors in low back pain. 868 14

A cross-sectional study concerning working conditions and the fatigue complaints of assembly line workers employed in two different electronic factories (A and B) in Vietnam was conducted from August to September 1994. While general working conditions, such as noise, dust, heat and lighting, were worse in Factory B, the prevalence rate of the subjective fatigue after working time was significantly higher among workers in Factory A. Fatigue symptoms in category I (Drowsiness and dullness) were particularly apparent among workers in Factory A. More interestingly, one-third of workers in Factory A complained of stiff shoulders and low back pain. Our field observation results suggest that the ergonomic inappropriateness of the assembly line in Factory A, may be causing a high rate of subjective fatigue among workers.
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PMID:A comparative study of fatigue complaints among assembly line workers employed in the two electronic factories in Vietnam. 870 17

The purpose of this study was to explore the menopause experiences of Chinese women in Taiwan. Six hundred and seventy-three women, aged 40 to 60 years, in the Taipei metropolitan area were chosen as the sample. These women were categorized into four groups in terms of their menopausal experiences: surgical menopause, natural menopause, perimenopause, and premenopause. The results show that the three most frequently reported discomforts that women experienced during menopause were backache/lumbago, amentia, and tiredness. The frequency of reported discomforts was low compared with frequencies reported in Western countries. The surgical group reported higher rates of symptoms than others. In addition, the hormone use rate was 13.5% for the natural menopause group, 34.4% for the surgical menopause group, 12% for the perimenopause group, and 1.9% for the premenopausal group. Higher hormone use rates were inconsistent with the general negative attitudes toward hormone use in Chinese society. Among those 59 women ever using hormones, only one third reported improvement in their symptoms. Women in Taiwan have an inadequate knowledge of menopause. Further health care education and research are needed.
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PMID:Menopause and hormone using experiences of Chinese women in Taiwan. 885 Jul 65

The risk of experiencing low back pain is associated with mechanical factors. Anatomic factors, such as advancing pregnancy, can also place extra mechanical stress on the lower back. Mechanical factors, such as those related to the workplace, can be minimized by ergonomic interventions. A constrained, seated posture, in combination with exposure to whole-body, jolt/vibration can impose significant stresses on the posterior intervertebral disc and can lead to back muscle fatigue. Interventions that reduce the jolt/vibration magnitude and duration of exposure will decrease the mechanical work performed on the intervertebral disc. Such interventions range from jolt/vibration isolating seats and vehicle cabs, to decreasing exposure time and maintaining simple supported postures during ingress and egress. Improvements in seat configuration can reduce the intervertebral disc pressure and the strain on the posterior disc.
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PMID:Mechanical stress reduction during seated jolt/vibration exposure. 889 14

Because of the inability of strength tests to accurately discriminate between low back pain patients and healthy subjects, a multifactorial evaluation of low back pain patients is warranted. It is postulated that measurements of endurance, kinematics, postural stability, and coordination, in addition to strength, are necessary to fully document the patients' functional capabilities. This research study was conducted in order to understand the effects of fatigue on the above factors. Twelve healthy male subjects performed a repetitive lifting test in which a submaximal load was lifted at a maximal rate. Knee, hip, and trunk motion was measured using videography and electrogoniometry, postural stability was measured using a forceplate, and coordination parameters were determined using phase-plane analysis. Fatigue was documented by a 31% reduction in lifting power. At the end of the endurance test, there was less knee and hip range of motion and greater spine peak flexion, while the coordination measures demonstrated that there was greater hip and lumbar spine extension earlier in the lifting phase. The postural stability declined as the test endured. Utilization of these measures may guide physical therapists in their rehabilitation of low back pain patients.
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PMID:The effect of fatigue on multijoint kinematics, coordination, and postural stability during a repetitive lifting test. 897 70


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