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The objective of this study was to examine the relationship between upper limb symptoms and keyboard use in a population survey. A questionnaire was mailed to 21,201 subjects aged 16-64 years, selected at random from the registers of 34 British general practices. Information was collected on occupation and on regular use of keyboards (for >4 h in an average working day), pain in the upper limbs and neck, numbness or tingling in the upper limbs, headaches, and feelings of tiredness or stress. Associations were explored by logistic regression, with the resultant odds ratios converted into prevalence ratios (PRs). Among 12,262 respondents, 4899 held non-manual occupations. These included 1871 regular users of keyboards (e.g. computer operators, data processors, clerks, administrators, secretaries and typists). Pain in the neck or upper limbs and sensory symptoms were common in the non-manual workers overall (with 1 week period prevalences of 30 and 15%, respectively), and were associated with older age, smoking, headaches and tiredness or stress. After adjustment for these factors, regular keyboard use was significantly associated with pain in the past week in the shoulders (PRs 1.2-1.4) and the wrists or hands (PR 1.4), but not with elbow pain or sensory symptoms over the same period, or with neck or upper limb pain that prevented normal activities in the past year. Disabling symptoms were somewhat less prevalent among symptomatic keyboard users than among other symptomatic workers. We conclude that use of keyboards was associated with discomfort at the shoulder and wrist or hand, but risk estimates were lower than generally reported in workplace surveys. Previous estimates of risk in the occupational setting may have been biased by shared expectations, concerns, or other aspects of illness behaviour.
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PMID:Use of keyboards and symptoms in the neck and arm: evidence from a national survey. 1158 13

The aim of the present study was to investigate baseline neurophysiological characteristics of the central and autonomous regulation and their reactivity to different tests in a group of persons with so-called 'electrical hypersensitivity', which is often considered as a form of psychosomatic disorders. Twenty patients with combinations of neuroasthenic symptoms (general fatigue, weakness, dizziness, headache) and facial skin (itching, tingling, redness) have been investigated. An equal number of symptom-free persons served as a control group. The examination comprised self-reported measures, testing of visual functions, measurements of blood pressure, heart rate and its variability, electrodermal activity, respiration, EEG and visual evoked potentials (VEP). Several variables were found to differ between the patient and the control groups. The mean value of heart rate in rest condition was higher in the patient group compared to the controls (mean value of inter-beat intervals were 0.80 and 0.90 s, respectively). Heart rate variability and response to standing test were decreased in the patient group compared to the controls. Patients had faster onset, higher amplitudes, and left-right hand asymmetry of the sympathetic skin responses. They had a higher critical fusion frequency (43 vs. 40 Hz), and a trend to increased amplitude of steady-state VEPs at stimulation frequencies of 30-70 Hz. The data indicated that the observed group of patients had a trend to hyper sympathotone, hyperresponsiveness to sensor stimulation and heightened arousal.
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PMID:Neurophysiological study of patients with perceived 'electrical hypersensitivity'. 1181 90

Adolescent patients who report physical symptoms that are unexplained by physical disease or pathophysiologic processes are prevalent in health care settings. Physical symptoms with no notable physical pathology are often referred to as medically unexplained symptoms (MUS). Common MUS found in adolescent populations include headaches, abdominal pain, back pain, fatigue, dizziness, numbness and tingling sensations in the limbs, and gastrointestinal symptoms. The most important diagnostic concern is the exclusion of neurologic and other general medical conditions. Failure to diagnose real physical pathology appropriately can have serious, deleterious consequences. However, it is also important for physicians to address psychological and other psychosocial factors that may play a role in the etiology or maintenance of MUS. The onus often falls on the primary care physician to screen for such problems and to make cost-effective and appropriate referrals. This article reviews some alternative treatment guidelines for physicians to assist in the assessment, intervention, and referral process for adolescent patients with MUS. The advantages of integrating psychological screening practices into the evaluation process and present recommendations regarding the management of such patients are discussed.
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PMID:Psychological assessment and treatment of somatization: adolescents with medically unexplained neurologic symptoms. 1227 Aug 4

A 40-year-old man had experienced headaches for 6 days and a 51-year-old man (2 weeks after an operation for perianal abscess) had experienced tingling sensations in the left hand for 10 days. After an epileptic seizure both underwent a CT scan of the brain. On these an abnormality was visible, probably a malignant astrocytoma. After several days of complaint reduction with dexamethasone, drowsiness and leftsided hemiparesis occurred. Emergency operations revealed a brain abscess. In the younger patient drainage and the administration of antibiotics were followed by fatal brain oedema. In the eldest drainage and the administration of antibiotics were followed by the extraction of infected teeth; he recovered with a slight loss of strength in the left hand. Brain abscesses are rare in the Netherlands. The diagnosis can be difficult because clinical signs and symptoms are not specific and because an underlying systemic infection is often not apparent. Diffusion-weighted magnetic resonance imaging can nowadays differentiate purulent brain processes from cystic brain tumors. Early treatment (burr hole aspiration and antibiotics) is usually curative. Nevertheless, mortality continues to be almost 10% and (permanent) morbidity 45%.
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PMID:[Brain abscess: a difficult diagnosis]. 1290 52

Analysis of this survey of 244 responding cytotechnologists shows that a high percentage still suffer from musculoskeletal disorders commonly associated with poor ergonomic design in the workplace, despite the variety of ergonomically designed microscopes that have been introduced into the market. Although Kalavar and Hunting surveyed a small group of cytotechnologists in the Washington, DC, area in 1996, no broad-based study has focused specifically on these professionals. The landmark study of microscope ergonomics, published by Soderberg in 1980, documented widespread musculoskeletal complaints in the electronics industry. This article identifies and discusses the types of musculoskeletal discomforts experienced by cytotechnologists. We propose that both practicing and student cytotechnologists receive training in ergonomic principles and appropriate interventions, such as improved work practices, proper ergonomic aids, well-designed workstations, and ergonomically designed equipment. More than 85% of respondents reported some musculoskeletal discomfort. Among the symptoms presented are headache, neck pain and stiffness, pain of the lower and upper back, and upper-extremity discomfort. Neurological symptoms, such as numbness, tingling, and/or pain in the hand and fingers, are often associated with repetitive motion. More than one-third reported numbness, tingling, and/or pain in the left-hand fingers, usually used for the fine-focus control knob. Almost one-half of respondents reported such symptoms for the right hand and fingers, normally used to manipulate the mechanical stage controls. Only 9% of the respondents were left-handed. Most (91%) were right handed. Although just over one-third (34.4%) of respondents worked for an employer with an ergonomics program, ergonomic assessments had been performed for only about one-half (17.6%) of these. In addition, approximately 10% of respondents indicated that ergonomics assessments had been performed on their workstations, even though the employer did not have an ergonomics program. Because of the high prevalence of reported symptoms, we recommend that all cytologists be trained in basic ergonomic principles and the proper use of ergonomic aids. These interventions should reduce the prevalence of musculoskeletal discomfort in medical microscopists.
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PMID:Ergonomics and cytotechnologists: reported musculoskeletal discomfort. 1464 99

Dinitrotoluenes (DNTs) are nitroaromatic compounds appearing as pale yellow crystalline solids at room temperature. Dinitrotoluenes exist as a mixture of 2 to 6 isomers, with 2,4-DNT, and 2,6-DNT being the most significant. About 500 persons are estimated to be potentially exposed yearly to 2,4-DNT and 2,6-DNT during the production of munitions and explosives. The main route of human exposure at ammunition facilities is inhalation, but dermal contact and inadvertent ingestion can also be substantial. In factory workers, exposure to DNTs has been linked to many adverse health effects, including cyanosis, vertigo, headache, metallic taste, dyspnea, weakness and lassitude, loss of appetite, nausea, and vomiting. Other symptoms including pain or parasthesia in extremities, abdominal discomfort, tremors, paralysis, chest pain, and unconsciousness have also been reported. The primary targets of DNT toxicity are the hematopoietic system (pallor, cyanosis, anemia, and leukocytosis), the cardiovascular system (ischemic heart disease), the nervous system (muscular weakness, headache, dizziness, nausea, insomnia, and tingling pains in the extremities) and the reproductive system (reduction of sperm counts, alteration of sperm morphology, and aspermatogenesis). An association between DNT exposure and increased risk of hepatocellular carcinomas and subcutaneous tumors in rats, as well as renal tumors in mice, has been established. Epidemiologic studies of DNT toxicity have been limited to small groups of workers who had been occupationally exposed at various ammunitions production facilities. Clearly defining the health effects of DNTs with a high degree of confidence has therefore been difficult because of the multigenic nature of occupational exposure. In an attempt to update the toxicologic profile of the DNTs, we hereby provide a critical review of the environmental and toxicologic pathology of DNTs, with a special emphasis on their potential implications for public health.
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PMID:Environmental toxicology and health effects associated with dinitrotoluene exposure. 1467 15

A phase 1 smallpox vaccine trial involving 350 adult volunteers was conducted. Of these subjects, 250 were naive to vaccinia virus vaccine (i.e., "vaccinia naive"). Volunteers received a new cell-cultured smallpox vaccine or a live vaccinia virus vaccine. Nine self-limiting rashes (3.6%) were observed in the vaccinia-naive group. None of the vaccinia-experienced patients had a rash. Rashes appeared 6-19 days after vaccination and had 5 different clinical presentations. Five volunteers had urticarial rashes that resolved within 4-15 days, 1 had an exanthem that lasted 20 days, and 1 each presented with folliculitis, contact dermatitis, and erythematous papules found only on the hands and fingers. Volunteers reported pruritus, tingling, and occasional headaches. Relief was obtained with antihistamine and acetaminophen therapy. No volunteer experienced fever or significant discomfort.
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PMID:Urticaria, exanthems, and other benign dermatologic reactions to smallpox vaccination in adults. 1503 27

The main aim of the present study was to explore the midlife experience for women living in Australia and Japan. The specific objectives of the study included: (i) comparing menopausal symptoms between the two groups; and (ii) comparing the factor structure of symptoms and exploring their relationship to menopausal status. Postal questionnaires were distributed to two structured, random population based samples of midlife women aged 45-60 years; consisting of 712 women living in Australia and 1502 women living in Japan. Analysis showed significant differences in menopausal symptoms related to psychological symptoms (P < 0.001), including anxiety (P < 0.001) and depression (P < 0.001), somatic symptoms (P < 0.001), and vasomotor symptoms (P < 0.01). The analysis, which excluded hormone replacement therapy (HRT) users, found that there were significant differences seen across menopausal status in the following symptoms: difficulty in sleeping (P < 0.01), difficulty in concentrating (P < 0.01), feeling dizzy or faint (P < 0.001), loss of interest in most things (P < 0.01) and loss of feeling in hands or feet (P < 0.001). In the postmenopausal stage specifically, significant differences were seen in the areas of feeling tense or nervous (P < 0.01), feeling unhappy or depressed (P < 0.01), parts of body feeling numb or tingling (P < 0.05), headaches (P < 0.01), and sweating at night (P < 0.05). Our analysis revealed that the experience of menopause for women is different between Australian and Japanese women.
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PMID:Relationship between menopausal symptoms and menopausal status in Australian and Japanese women: preliminary analysis. 1529 65

Ten-year-old Tim P. presented at a local emergency room complaining of bloody diarrhea. Despite treatment, his diarrhea continued with additional symptoms of nausea, raspy voice, headaches, abdominal pain, tingling of the feet and hands, lethargy, and eczema. Do you recognize the health risks and clinical aspects of arsenic, and could you assist Tim and his family?
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PMID:Arsenic in a child's world. 1579 28

Headache originating front-orbital area can be divided to (1) Which has no autonomic symptoms such as lacrimation, rhinorrea, rhinostasis. This include psychogenic headache and epileptic headache. In the case of psychogenic headache, pericranial tenderness is not observed, and headache is medium in intensity. Most often patient complains of a headache originating frontal area. There are more than five various symptoms such as general malaise, numbness, tingling sensation, vertigo, sleeplessness. However, although symptoms are multiple, patients spend a life commonly. In other words, a patient is protected by a headache against his or her stress. No medication is needed in such a case. In epileptic headache, pressing type pain is felt over the forehead for several minutes to a few hours. Tremor or convulsion sometimes follow the headache. EEG shows spike and wave activities. In the case of focal epilepsy, headache occurs contralateral to the focus. Anti-epileptic drugs such as VPA or CBZ is a choice in such case, and headache as well as seizure disappears. (2) Front-orbital headache with autonomic symptoms include various trigeminal autonomic cephalalgias. These include cluster headache, episodic paroxysmal hemicrania, hemicrania continua, among others. Precise history taking is necessary for the treatment, because no drug is 100% effective.
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PMID:[Headache originating front-orbital area]. 1565 1


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