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Clinical features and laboratory findings of 300 inpatients with vibration disease before and after treatments were reviewed. Having been using chain saws or pneumatic hammers for a long period, the patients were afflicted with Raynaud's phenomenon, numbness, pain or stiffness of fingers, pain of elbows and neck, stiffness of shoulders and lumbago. They had high incidences of complaints due to the disorder of the central nervous system, especially of the higher center of the autonomic nervous system; i.e. headache (52.0%), palmar hyperhidrosis (70.0%), forgetfulness (78.2%), fatiguability (61.3%), tinnitus (41.8%), impotence (55.1%), etc. Laboratory findings of the autonomic nerve activity tests, electroencephalograms and audiograms also suggested the disorder of the central nervous system. Treatments during three months had improved significantly the subjective symptoms and the objective findings (p less than 0.05 to 0.001). Thus, vibration disease should be considered as a systemic disease, including disorders of the central nervous system, especially of the higher center of the autonomic nervous system, and disturbances of the peripheral functions.
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PMID:Clinical features and laboratory findings of vibration disease: a review of 300 cases. 91 75

To determine the risk factors of the subjective symptoms experienced by chain saw workers, we surveyed 206 forestry workers using this device in their work. The strength of the relationship between their symptoms and such potential risk factors as occupational, behavioral, and physical factors was evaluated by a multiple logistic regression model. It was found that many years of chain saw operation, and numerous hours of chain saw operation per day, increased the risk of white finger, numbness of hands and arms, chillness of hands and arms and difficulty in joint movement, indicating that these symptoms were closely related to vibration exposure. Many years of forestry work before chain saw work also increased the risk of joint pain, suggesting that bone and joint disorders are related to heavy manual work not using a chain saw. A second job involving manual labor increased the risk of weakness in the arms, stiffness of the shoulders, and lumbago. Infrequent bathing was associated with increased risk of pain in hands and arms and lumbago. Older workers had a higher prevalence of stomach discomfort. No risk factor was found to significantly increase the risk of easy fatigability, forgetfulness and sleep disorder. It was found that not only exposure to vibration but also other factors contributed to the prevalence of pain in hands and arms, joint pain, weakness in arms, stiffness of shoulder, and lumbago. Second job and infrequent bathing appeared to be related to the occurrence of certain subjective symptoms. These contributory factors should be taken into account when evaluating subjective symptoms encountered in field studies of forestry workers.
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PMID:[Multivariate analysis on the relationship between subjective symptoms and risk factors for the development of symptoms including working conditions, life habits and physical status in forestry workers using chain saw]. 133 68

The problems of alcoholism and drug addiction are major concerns in India. Alcohol and drugs were used in the past to obtain relief from pain and misery and to attain a state of forgetfulness. India is presently facing the problem of increased trafficking in drugs; heroin and hashish are supplied to the west through the subcontinent. Addiction has become a major problem in metropolitan centers. The Ministry of Welfare is responsible for drug abuse prevention programs and the rehabilitation of addicts. The Ministry of Health and Family Welfare is concerned with drug treatment. A deaddiction center, established at the All India Institute of Medical Sciences, became operational in 1988; it is responsible for health manpower training, research, and documentation. India has witnessed an exponential growth in the literature on drug abuse; it is no longer possible for a single library to acquire all of the international literature. There is a clear need to establish a drug abuse information center in India. This paper describes the aims, objectives, and planning for such a center and recommends the establishment of a national center in New Delhi with regional centers in other geographic areas.
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PMID:The need for a drug abuse documentation center in India. 222 97

Using the "Bi-Digital O-Ring Test," generalized abnormal circulation of the distribution of the 3 cerebral arteries at each side of the brain (i.e., anterior cerebral artery, middle cerebral artery and posterior cerebral artery) can be predicted, without any expensive instruments usually in a few minutes. When abnormality was found in the bifurcation area of the common carotid artery by the "Bi-Digital O-Ring Test," there were always abnormal findings of the area of the brain where circulation was coming from either one or both of the anterior or middle cerebral arteries. When abnormal "Bi-Digital O-Ring" response was found at the vertebral artery and posterior cerebral artery representation point, discovered by the author, at the side of the 6th cervical vertebra (corresponding to the entry point of the vertebral artery into the transverse foramen), the areas of the cerebrum, cerebellum and brain stem where circulation is coming from the posterior cerebral artery, basilar artery and vertebral artery were also abnormal. Most of these abnormalities were found to be associated with problems of the cervical vertebrae and spastic muscles of the neck and shoulders and are often reversible. In this study, the author was able to differentiate abnormal brain circulation of any major branch of arteries in the brain due to organic changes or functional reversible changes by relaxing these spastic muscles and improving the circulation of the neck and shoulder area by giving either manual acupuncture, massage, or transcutaneous electrical stimulation. This in turn often improved brain circulation. If it was a functional abnormality, within a few minutes after one of these procedures the "Bi-Digital O-Ring Test" usually showed normal response or improvement. However, if it was an organic abnormality, the abnormality remained. When the supra-orbital arterial blood pressure at both sides of the forehead decreases below 40 or 30 mmHg, most patients develop so-called "Cephalic Hypotension Syndrome," which is characterized by sleep disturbance pattern; difficulty in concentration; easy forgetfulness of recent events; irritability; decreased pain threshold with or without depression; spastic skeletal muscles, particularly the neck, shoulder and back areas. All of these symptoms can be explained by decreased circulation to the Nucleus Raphe Centralis Superior (controls sleep and waking pattern), Nucleus Raphe Magnus (serotonin & modulation of pain), Nucleus Reticularis Giganto Cellularis (controls muscle tone), etc. in reticular formation.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Simple and quick non-invasive evaluation of circulatory condition of cerebral arteries by clinical application of the "Bi-Digital O-Ring Test". 286 68

Three hundred fourteen male forestry workers using vibrating tools were analyzed to evaluate the relationship among 11 items of the special examinations for the diagnosis of vibration syndrome and the relationship between the items and 13 subjective symptoms. The following results were obtained: Age of the workers had the strongest relationship to the grip strength. However, it showed less strong relationship with other items, such as the threshold of pain sense and that of vibration sense, and the degree of Raynaud's phenomenon (number of fingers affected). Working time in years with vibrating tools showed statistically significant correlations with the threshold of pain sense, that of vibratory sense, and with the degree of Raynaud's phenomenon. The threshold of pain sense, that of vibratory sense, and the degree of Raynaud's phenomenon correlated with each other but not with the skin temperature nor the recovery time of blood flow in the finger nail-beds. The rise of pain threshold exhibited the strongest association with the subjective symptoms. Vibratory sense threshold at 250 Hz also showed similar association with the latter. The skin temperature and the recovery time of blood flow had no association with any complaints except for gastric disorders. The grip strength, only when extremely lowered, was associated with the rise of ratio of complaints, i.e. percentage of the number of workers who complain among all the workers. The age was associated in general with the decreased ratio of complaints except for muscle weakness in arms and forgetfulness.
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PMID:[Vibration syndrome among forestry workers. Subjective symptoms and diagnostic norm]. 632 24

We present a 81-year old male who developed dementia, gait disturbance and right hemiparesis. He was well until the age of 74 when he developed a hemorrhagic infarction in the right occipital region, which left him left homonymous hemianopsia. One year later he had one TIA attack consisting of dizziness, headache, and some clouding of consciousness. At that time, atrial fibrillation was found. At age 79, he was attacked by right hemiparesis. Cranial CT scans revealed a lesion consistent with a hemorrhagic infarct in the left middle cerebral artery territory. Two months prior to his final admission, he had a gradual onset of forgetfulness, labile affect, nocturnal agitation and hallucination which were followed by gait disturbance and urinary incontinence. On admission, he was alert but moderately demented. In addition he showed difficulty in repetition, limb kinetic and ideomotor apraxia of the left hand indicative of sympathetic apraxia, and constructional apraxia bilaterally. Granial nerves appeared intact except for left homonymous hemianopsia. His gait was wide-based and small stepped. No weakness or ataxia was noted. Deep reflexes were diminished on the left side. Plantar reflex was equivocally extensor of the left. Light touch and pain was slightly diminished on the right side. Cranial CT scans revealed a large low density area in the left fronto-temporo-parietal region. Also ventricular dilatation, diffuse low density change in the subcortical white matter, and diffuse cortical atrophy were seen. His clinical course was complicated by melena, anemia, pneumonia, cardiac failure and renal failure. He expired 2 months after his admission.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A 81-year-old man with dementia, gait disturbance, hemiparesis, and sympathetic apraxia]. 833 25

This exploratory study was conducted among a sample of 299 women out of a total sample of 861 who had attended three primary health care clinics (La Feria, San Jose, and Maipu) in southern and western portions of Santiago, Chile. The interviews were conducted during June, August, and November 1993. The women were aged 25-54 years. Most were overdue for a Pap smear. The women had been seen at these clinics during January 1987 and January 1989. 248 refused to be interviewed, and 314 were lost to follow-up. One question about the purpose of the Pap test was answered only by 199 women. 34% of the 299 women interviewed reported a failure to have a Pap test due to forgetfulness. 27% did not think it was necessary to have the test every 3 years. 8% reported fear of the procedure. This proportion of fearful women remained the same regardless of educational level. The most educated women were the most likely to be up to date with Pap smear testing. 30% of women aged over 45 years were up to date with their Pap tests. 28% had knowledgeable answers about the purpose of the Pap test; 58% gave fair answers and 10% gave incorrect answers. 30% trusted that health care personnel had good quality information. 36% believed that mass media had good quality information, but 12% thought the media also gave incorrect information. 43% of better educated women, 25% of less educated women, and 23% of least educated women had good quality information. The proportion of good quality information was 19% among women aged over 45 years, 30% among women aged 36-45 years, and 27% among women aged under 36 years. 60% of the common fears were blamed on the criticism given by health workers for delaying a Pap test. 39% feared pain. Over 25% feared loss of their IUD during the Pap test.
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PMID:Knowledge and fears among Chilean women with regard to the Papanicolaou test. 904 47

It is widely believed that patients' reluctance to report pain and adhere to treatment recommendations are significant barriers to cancer pain control. However, few investigators have examined barriers to cancer pain management from the cancer patient's perspective. Ambulatory patients with cancer who had experienced cancer-related pain in the previous month or were currently taking analgesics for cancer pain control were asked to participate in this study. Information regarding (a) pain assessment, (b) pain medication use, (c) concerns and barriers to compliance, (d) communication patterns regarding pain and pain control, and (e) demographics were collected during a 10-min structured interview. Approximately 20% of patients with a current cancer diagnosis who were approached reported that they had experienced pain or taken analgesic drugs during the preceding month. Eighty-eight percent of these patients ranked their pain as five or greater (scale, 0-10), and 81% reported impaired function due to pain. Major barriers to effective treatment included forgetfulness, the belief that pain should be tolerated, concerns about side effects, and fear and disdain of dependence, addiction, and tolerance. One-third of patients felt that their pain could not be better controlled than it currently was. Patients reported frequent communication regarding pain and pain control with physicians (52%), nurses (41%), and pharmacists (17%). The low pain prevalence, coupled with high pain intensity and associated dysfunction, appears to be a reflection of patient's unwillingness to report pain of mild to moderate intensity. In addition to previously recognized factors, stoicism and fatalism represent significant barriers to cancer pain control.
J Pain Symptom Manage 1998 May
PMID:Cancer pain survey: patient-centered issues in control. 965 32

Patients with chronic pain often complain of difficulties with cognitive functioning. Previous studies suggest that these occur with no history of head trauma or neurological disease. This study examined potential predictors of cognitive complaints in 275 consecutive patients referred to a university pain management center. Patients completed a brief set of self-report measures of problems with cognitive functioning, biographical information, pain severity, pain location, depression, anxiety, sleep quality, medication use, and litigation status during their first visit to the clinic. The most frequently reported cognitive complaints included forgetfulness (23.4%), minor accidents (23.1%), difficulty finishing tasks (20.5%), and difficulty with attention (18.7%). Fifty-four percent of patients reported at least one problem with cognitive functioning. Correlation analyses showed that using antidepressants, pain severity, pain-related anxiety, and depression were moderately associated with total cognitive complaints. Regression analyses showed that depression accounted for the largest unique proportion of variance in cognitive complaints (DeltaR2 = 29%). Given the high frequency of complaints of impaired cognitive functioning, this realm of functioning deserves routine assessment. When these complaints are encountered, a careful evaluation considering a range of neurological, social, and emotional influences is in order.
J Pain Symptom Manage 2001 May
PMID:Predicting complaints of impaired cognitive functioning in patients with chronic pain. 1136 60

Clinical symptoms and self-reported health status in persons reporting multiple chemical sensitivities (MCS) are presented from a 9-year follow-up study. Eighteen (69%) subjects from a sample of 26 persons originally interviewed in 1988 were followed up in 1997 and given structured interviews and self-report questionnaires. In terms of psychiatric diagnosis, 15 (83%) met DSM-IV criteria for a lifetime mood disorder, 10 (56%) for a lifetime anxiety disorder, and 10 (56%) for a lifetime somatoform disorder. Seven (39%) of subjects met criteria for a personality disorder using the Personality Diagnostic Questionnaire-IV. Self-report data from the Illness Behavior Questionnaire and Symptom Checklist-90-Revised show little change from 1988. The 10 most frequent complaints attributed to MCS were headache, memory loss, forgetfulness, sore throat, joint aches, trouble thinking, shortness of breath, back pain, muscle aches, and nausea. Global assessment showed that 2 (11%) had "remitted", 8 (45%) were "much" or "very much" improved, 6 (33%) were "improved", and 2 (11%) were "unchanged/worse". Mean scores on the SF-36 health survey showed that, compared to U.S. population means, subjects reported worse physical functioning, more bodily pain, worse general health, worse social functioning, and more emotional-role impairment; self-reported mental health was better than the U.S. population mean. All subjects maintained a belief that they had MCS; 16 (89%) acknowledged that the diagnosis was controversial. It is concluded that the subjects remain strongly committed to their diagnosis of MCS. Most have improved since their original interview, but many remain symptomatic and continue to report ongoing lifestyle changes.
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PMID:The Iowa follow-up of chemically sensitive persons. 1200 35


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