Muscular Problems Research Articles

Comparing the Effectiveness of Specific Lumbar Mobilization and Core Stability Exercises in Mechanical Low Back Pain in Decreasing Pain and Disability: A Randomized Control Trial

Low back pain (LBP) is a global neuro - muscular problem developing significant disability of thoracic, lumbar or sacroiliac joint at any age. Objective: To analysis comparative effectiveness of specific lumbar mobilizations and core stability exercises in mechanical low back pain in reducing pain, ROM and disability. Methods: A patient blinded randomized trial was executed in the department of Physical therapy of Mayo Hospital, Lahore including 45 LBP patients randomly distributed into three groups. Each group received Conventional physical therapy in which Group A was control group, Group B received specific lumbar mobilizations while Group C received core stability exercises. NPRS, RMDQ and MODI were used for assessing pain and disability. SPSS version 24.0 was used for analyzing within and between group analysis through Paired T-test and Independent T- test with p-value <0.05. Results: The results showed conventional therapy, specific lumbar mobilization and core stability exercises are effective in improving pain, ROM and functional status. However; Core stability exercises was more effective with p-values for NPRS (p=0.049), MODI (p=0.038), RMDQ (p=0.003) and for Ranges (R-side flexion; 0.008, L-side flexion; 0.033, R-side rotation; 0.00, L-side rotation; 0.00) as compared to lumbar mobilization. Additionally; there was no substantial difference was found between three groups for flexion and extension. Conclusions: Core stability exercises are statistically and clinically more effective than conventional therapy and specific lumbar mobilizations in improving ROM, decreasing pain and functional status.

Symptoms Arising From the Diaphragm Muscle: Function and Dysfunction.

There can be many reasons that damage the function of the diaphragm, either transiently or permanently, involving one hemilate or both muscle portions. The diaphragm is associated only with breathing, but many other functions are related to it. The patient is not always aware of the presence of diaphragmatic dysfunction, and it is not always immediate to identify non-respiratory diaphragmatic symptoms. Pseudoanginal pain, night sweats, difficulty memorizing, or muscular and visceral problems of the pelvic floor are just some of the disorders linked to reduced diaphragmatic contractility. A decline in respiratory contractile force can be the basis for further pathological conditions that can increase the rate of mortality and morbidity. The article reviews the possible symptoms that may be presented by the patient, which are not necessarily related to lung function.

To Reduce the Muscular Problem by Improving Ergonomics Concepts in Apparel Industry

To Reduce the Muscular Problem by Improving Ergonomics Concepts in Apparel Industry

Classroom Practices Adopted by Teachers of Students with Muscular Problem in Schools

Students with muscular problems are required to be dealt professionally by their teachers in their classrooms. This study aimed to seek classrooms practices that teachers of physically handicapped children adapt in classrooms for students with muscular problems in special education schools of Punjab. This study was qualitative with exploratory type. A total number of 20 teachers of students with physical disabilities teaching in special education schools for physically handicapped children including 10 male and 10 females were taken as sample of the study. Semi-structured interview was developed as a tool for this study for the purpose of data collection. Validity of the instrument was confirmed through expert opinion Reliability of the instrument was confirmed through an extensive literature review. The data were analyzed through coding & thematic analysis. Major themes of the study were teacher’s perception, classroom practices, and challenges for teachers, challenges for students with muscular problems, and strategies. Findings of the study revealed the current classroom practices for students with muscular problems and teaching strategies adapted for better learning of the students with muscular problems. Study recommended teachers must be trained to tackle the students with muscular problem in their classroom.

Uncovering the Relationship Between Statins and Muscle Problems in the ELSA-Brasil MSK Cohort.

To investigate the association between statins and muscle problems in a highly diverse sample of Brazilian civil servants. We conducted a cross-sectional data analysis at baseline of the ELSA-Brasil MSK cohort. Pain was identified through self-reported symptoms in large muscle groups (lower back and/or hips/thighs). Muscle strength was assessed using the five-times-sit-to-stand (FTSTS) and handgrip tests, with weakness defined as the lowest and highest quintiles of age- and sex-stratified handgrip strength and FTSTS performance time, respectively. Multivariable logistic regression analyses were conducted to investigate the association between statin use and muscle pain and weakness. Secondary analyses explored the impact of different types of statins and their duration of use on the response variables. A total of 2156 participants (mean age 55.6 ± SD 8.9, 52.8% women) were included, of whom 21.1% were taking statins and 25.1% reported muscle pain. We found no significant association between statin use and muscle problems. Secondary analysis on different types of statins revealed an association between atorvastatin and muscle weakness, as measured by the five-times-sit-to-stand test (OR 1.94, 95% CI 1.12-3.37), but not by the handgrip test (OR 0.75, 95% CI 0.29-1.42). No evidence was found to support a link between the duration of statin treatment and muscle problems. This study challenges previous claims of an efficacy-effectiveness gap between experimental and observational literature on statins. The findings indicate that statin use does not contribute to muscular problems.

NON-SPECIFIC CHRONIC LOW BACK PAIN: WHICH EXERCISE?

Low back pain, one of the skeletal and muscular system problems, is one of the most common chronic diseases in the world. Chronic low back pain is an important disorder that affects the daily, social, and work-life of individuals. The majority of people experience low back pain at least once in their life. In this sense, it affects both social and economic life. Low back pain can be acute or chronic, depending on the duration of the syndrome. Interventional, medication, rehabilitation, and exercise methods can be used in the treatment of chronic low back pain. In this study, it was investigated which exercise among the exercise models was more effective in the treatment of non-specific chronic low back pain. “Exercise” and “Chronic low back pain” were used as keywords in database searches. As treatment approaches, the effects of Abdominal Hypopressive exercise, Pilates, Yoga, Tai Chi, McKenzie, Gait, Dynamic and Static Stabilization Exercises, Motor Control and Gradual Activity Exercises in patients with low back pain were investigated. It has been determined that all the exercise models investigated reduce non-specific chronic low back pain and positively affect the mental state and quality of life of the patients. The fact remains that, it can be said that Pilates exercises come into prominence more than other exercises in terms of the stated effects.

Proteomic and morphological insights and clinical presentation of two young patients with novel mutations of BVES (POPDC1)

Popeye domain containing protein 1 (POPDC1) is a highly conserved transmembrane protein essential for striated muscle function and homeostasis. Pathogenic variants in the gene encoding POPDC1 (BVES, Blood vessel epicardial substance) are causative for limb-girdle muscular dystrophy (LGMDR25), associated with cardiac arrhythmia. We report on four affected children (age 7-19 years) from two consanguineous families with two novel pathogenic variants in BVES c.457C>T(p.Q153X) and c.578T>G (p.I193S). Detailed analyses were performed on muscle biopsies from an affected patient of each family including immunofluorescence, electron microscopy and proteomic profiling. Cardiac abnormalities were present in all patients and serum creatine kinase (CK) values were variably elevated despite lack of overt muscle weakness. Detailed histological analysis of skeletal muscle, however indicated a myopathy with reduced sarcolemmal expression of POPDC1 accompanied by altered sarcolemmal and sarcoplasmatic dysferlin and Xin/XIRP1 abundance. At the electron microscopic level, the muscle fiber membrane was focally disrupted. The proteomic signature showed statistically significant dysregulation of 191 proteins of which 173 were increased and 18 were decreased. Gene ontology-term analysis of affected biological processes revealed - among others - perturbation of muscle fibril assembly, myofilament sliding, and contraction as well as transition between fast and slow fibers. In conclusion, these findings demonstrate that the phenotype of LGMDR25 is highly variable and also includes younger children with conduction abnormalities, no apparent muscular problems, and only mildly elevated CK values. Biochemical studies suggest that BVES mutations causing loss of functional POPDC1 can impede striated muscle function by several mechanisms.

THE EFFECTS OF LAVENDER ESSENTIAL OIL AND GALLIC ACID PRE-TREATMENT ON THE NEUROCOGNITIVE ASSESSMENT OF POST-STROKE WISTAR RATS

Stroke is a multifactorial, fatal and often disabling neurodegenerative disease in which neurons are degenerated leading to cognitive and muscular problems, there is no curative treatment for this disease; the drugs available on the market offer symptomatic relief with some improvement of daily functions. Thus, phytochemicals with multifactorial efficacy may be promising substances for the treatment of cerebral ischemia and its recurrences that would have been prevented by various plants and plant products. The aim of our study is to evaluate the effect of lavender oil and gallic acid administered orally at doses of 200 mg/kg and 100 mg/kg, respectively, prior to stroke induction by middle cerebral artery occlusion in Wistar rats. The aim is to evaluate their effects on post-stroke sequelae, such as anxiety, exploration and memory (spatial and working), which were quantified and compared between: the control, non- pretreated stroke and pretreated stroke batches. The results indicate a better cognitive-motor recovery on an anxious and exploratory level in the rats pretreated with GA and LEO, while memory capacities are superior in the latter compared to the non-pretreated stroke group. These findings reveal and support the neuroprotective effect of gallic acid and lavender essential oil taken separately or in combination.

Understanding the Role and Uses of Alternative Therapies for the Management of Rheumatoid Arthritis.

With the growing popularity of complementary and alternative medicine (CAM) among individuals with chronic pain and muscular problems, a number of patients with rheumatoid arthritis (RA) show their interest in CAM interventions for disease improvement. Various reports published on CAM are based on an animal model of RA; however, there is often a lack of high-quality clinical investigations for explaining the success stories of CAM therapies in patients with RA. CAMs having the potential to be used for therapy in patients with RA have been identified, however lack of awareness and skepticism of their efficacy has made the patients reluctant to choose these drug-less therapies. In this review, we have summarized the existing evidence which suggests promising efficacy of different alternative therapies in managing RA and providing both physical and mental well-being to RA patients.

Characteristics of thyrotoxicosis among thyroid patients and their quality of life in a teaching hospital in Jordan: A cross-sectional study.

Aim:This study aimed to describe the general characteristics of thyrotoxicosis patients, evaluate their quality of life and adherence to medications as an outpatient at endocrine clinic in Jordan.Method:This was a descriptive cross-sectional study. The eligible participants, who were patients from endocrine outpatient clinics at JUH were recruited. The inclusion criteria limited the study to patients aged 18 years and older who were newly diagnosed with or had a past diagnosis of hyperthyroidism disease for any cause. Data were analyzed using Statistical Package for Social Sciences version 24.0 (SPSS® Inc., Chicago, IL, USA).Result:Most participants were females (81.3%) and married (87.9%). The majority were educated and had a bachelor’s degree or higher (41.8%). The average reading for T3 was 6.80±8.26 pmol/l, T4 16.87±7.98 pmol/l, TSH 3.49±11.51 Mu/L, Anti thyroglobulin 2.37±1.73, and Anti thyroglobulin peroxidase 4.80±1.13. There were no significant findings in assessing the effect of treatment types on lab tests (p-value >0.05). The majority of thyrotoxicosis cases were caused by Graves’ disease (64.7%), followed by 17.60% from benign multinodular goiter, 11.80% thyroiditis and 5.90% toxic adenoma. There was no significant correlation (p>0.05) between the type of treatments and the following health related quality of life (HRQOL) sub-domains: generally unwell, social problem, muscular skeletal problems, eye problem, classical symptoms of hyperthyroidism(CSH) hand tremor, CSH palpitation, decreased appetite and constipation.Conclusion:Thyrotoxicosis is understudied in the Middle East, particularly Jordan. The main findings revealed that thyrotoxicosis is more prominent in females, mainly in their 4th decade. Future work should focus on the main possible methods to improve the HRQOL. In addition, awareness programs are required to encourage patients to obey the advice of their physician and increase their self-care towards improving the quality of their life.

English

Fish and fish products bear potential hazards and risks of public health concern. A preliminary study of hazards, injuries and risks among fisherfolk in Tombo, Sierra Leone, West Africa was carried out on November 2018. Sixty subjects from among the organized fish processor groups were interviewed with semi-structured questionnaire. Results obtained from the study were analyzed with Microsoft Excel and presented in tables and charts. The results of the study indicated that females (56.7%) were more involved in fish processing than males (41.7%); and the active age of these processors fell in the age range of 35-45 years. Married people (71.7%), dominated singles, widowed and divorced put together. Dominant religion in the study area was Islam and Christianity. Smoking (hot and cold), frying, packing, icing, filleting, seasoning or the combination of two or more according to the subjects was the prevailing processing methods used by processors in Tombo. Inherent hazards, injuries and risks reported by the respondents included high blood pressure, cardiovascular disease, nervous tension, insomnia, skin disease, bronchitis or asthma, muscular problems or those of the joint, long-term neck and back pains, eye problem, typhoid, malaria, and hearing problem caused by environmental noise. To mitigate the hazard and risks associated with fish processing in Tombo, training on appropriate fish handling and processing techniques; the provision of appropriate handling and processing equipment by responsible stakeholders were considered according to the subjects rational options. Key words: Occupation, hazards, injuries, risks, fish processors, Tombo, Sierra Leone.

Patient-Reported Complications, Symptoms, and Experiences of Living With X-Linked Hypophosphatemia Across the Life-Course.

ContextX-linked hypophosphatemia (XLH) is a rare, genetic phosphate-wasting disease resulting in bone, muscular, and dental problems, beginning in childhood and increasing in adulthood.ObjectiveThis qualitative analysis aimed to explore patient-reported symptoms, complications, and experiences of XLH over the life-course, using data from a large multinational online survey.MethodsResponses to 2 open-ended questions from 209 adults and 86 children/adolescents (proxy report) with self-reported XLH were analyzed in 8 age groups. Two researchers independently coded and analyzed the responses, using thematic analysis, with differences settled among a multidisciplinary group. Six themes were identified, with age subgroup analysis conducted on the 3 most common, according to coding frequency.ResultsWithin theme 1, “Clinical Signs and Symptoms of XLH,” “Pain” was a dominant subtheme across the life-course, but “Skeletal Pathology” dominated the responses of children/adolescents. Within theme 2, “Impacts of Clinical Signs and Symptoms,” interference with “Physical Exertion” and “Emotional Wellbeing” (comprising depression/anxiety in adults and lack of self-esteem in children/adolescents) was reported across all ages. For theme 3, “Negative Treatment Experiences,” “Medication” was problematic for children, with adults reporting lack of “Access to Appropriate Treatment.” Three further themes were identified: “Resilience,” “Positive Treatment Experiences,” and “Information Needs.”ConclusionThe multiple burdens imposed on people with XLH throughout their lifetime encompassed the physical, emotional, and social, although the most challenging symptoms or complications differed between ages. Burden was further exacerbated by adults’ lack of access to appropriate treatment, illustrating the need for age-appropriate multidisciplinary care.

Poor Work Efficiency is Associated with Poor Exercise Capacity and Health-Related Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

IntroductionChronic obstructive pulmonary disease (COPD) is a progressive disease with deteriorating cardiopulmonary function that decreases the health-related quality of life (HRQL) and exercise capacity. Patients with COPD often have cardiovascular and muscular problems that hinder oxygen uptake by peripheral tissues, resulting in poor oxygen consumption efficiency. It is important to develop new physiological parameters to evaluate oxygen consumption efficiency during activities and to evaluate its association with exercise capacity and HRQL. Work efficiency (WE) measures oxygen consumption efficiency during exercise. We hypothesize that patients with poor WE should have exercise intolerance and poor HRQL. Therefore, we aimed to evaluate the association between WE and exercise capacity, HRQL and other cardiopulmonary parameters.Patients and MethodsSeventy-eight patients with COPD were evaluated with spirometry, cardiopulmonary exercise testing, and assessment of dyspnea score and HRQL (using the St. George’s Respiratory Questionnaire [SGRQ]). Cardiopulmonary exercise testing was performed using a cycle ergometer with an incremental protocol and exhaled breath analysis to assess oxygen consumption. WE was defined as the relationship between oxygen consumption and workload.ResultsThere were 31 patients with normal WE (group I) and 47 patients (group II) with poor WE. Patients with poor WE had lower exercise capacity (maximal oxygen consumption, group I vs II as 1050±53 vs 845 ±34 mL/min, p=0.0011), poorer HRQL (SGRQ score 41.1±3.0 vs 55±2.2, p=0.0002), higher exertional dyspnea score (5.1±0.2 vs 6.1±0.2, p= 0.0034) and early anaerobic metabolism during exercise (anaerobic threshold, 672±27 vs 583 ±18 mL/min, p=0.0052).ConclusionWE is associated with exercise capacity and HRQL. Here, patients with poor WE also had exercise intolerance, poorer HRQL, and more exertional dyspnea.

Design and Development of a 3-Axis Accelerometer Biofeedback System for Real-Time Correction of Neck Posture for Long-Time Computer Users.

Background:Due to long-term use of computers and not maintaining the correct position and angle of the body while working with it, various skeletal and muscular problems and pain in the neck area occurs. This study aims to use a biofeedbck system to alert the computer users of an inappropriate angle of their necks, and as a result help them to establish a correct neck position.Method:The user's neck angle is measured using a three dimensional accelerometer and the signal is processed, digitalized, and sent to the computer. User friendly software is designed to process the received data and warn the users when their neck angle is inappropriate.Results:The results show that the application of the biofeedback system reduces the users' total time with inappropriate neck angle to <50%.Conclusion:results demonstrated that training with the biofeedback system has been sufficient to make the habit of maintaining the neck in the correct angle.

Short lingual frenum in infants, children and adolescents. Part 2: Lingual frenum release. Functional surgical approach.

The aim of this study was to review the craniofacial growth impairment and different malfunctions associated with short lingual frenum and to assess the validity of lingual frenum surgery based on minimally invasive laser release with a myofunctional approach. Thirty patients, children and adolescents whose ages ranged from 8 years to 18 years, diagnosed with a short lingual frenum and concomitant orthodontic problems and/or presence of associated muscular or postural problems, were treated in this study. Pre-operative tongue assessment was performed following morphological and functional criteria, consisting of measurement of the free tongue, and of visual assessment of tongue protrusion out of the mouth and elevation to the incisive palatal papilla. Postural evaluation was assessed in frontal and lateral view. Laser surgery was completed with local anaesthesia, using Erbium YAG laser (2940 nm, LightWalker, AT-Fotona, Ljubljana, Slovenia) equipped with sapphire conical tip (600 micron), with energy ranging from 120 to 160 mJ, at 15 Hz frequency, and varying the adjustable pulse duration from 300 µs to 600 µs. Significant improvement was noted in 29 of 30 patients comparing preoperative scores to both three-week and two-month post-op scores. Postural improvement was found in 18 of 30 patients, indicating the multifactorial involvement of different causes for correct body posture. This study confirmed the validity of Erbium:YAG laser surgery as an effective technique in children and adolescents to release a short lingual frenum. The functional approach of the procedure performed with the Erbium:YAG laser, and the concomitant myofunctional therapy demonstrated to be simple and safe in children, and adolescents. Because of the multifactorial causes involved in correct body posture, an adequate osteopathic therapy is important to successfully complete the full body rehabilitation.

Editorial: We Are Trigeminal and Different

Rafael Benoliel: The trigeminal nerve supplies all sensory innervation to the head and associated structures. This is “our” nerve, and it is inevitably involved in the multitude of painful disorders that we manage on a daily basis. Despite distinct embryogenic origins and processing capabilities, trigeminal neurons and cell bodies should not be significantly different from their spinal counterparts. The anatomical set-up is similar, with afferent neuronal cell bodies, both spinal and trigeminal, located in the dorsal root (DRG) and the trigeminal (TG) ganglia, respectively. The DRG and TG structures are similar, and they are essentially homologs of each other. The clearest anatomical differences are the proximity of the trigeminal system to the CNS and the relatively long trajectory of afferent axons in the spinal system. Additionally, the TG is the only sensory ganglion of the body that resides within the CNS. Clinical and laboratory observations, however, suggest differences between the trigeminal and spinal systems that may underlie dissimilar functional properties and response to injury or disease. There may be subtle differences between these two systems, the basis and consequences of which are still unclear. One interesting difference: The trigeminal system is the only nerve involved in spontaneous denervation during shedding of deciduous teeth. Is that indicative of any differences that may be of consequence? Evidence in animal models suggests that the trigeminal nerve is more resistant than the spinal system in developing neuropathic pain (NP) following insult or disease. Moreover, sprouting of sympathetic nerves around large ganglionic neurons following injury is not observed in the TG, but is present in the DRG, and cervical sympathectomy does not alter trigeminal NP behavior, but does so in the spinal system. Together with a rich vascular supply to trigeminally innervated regions (ie, the trigeminovascular system), these may explain some differences in the clinical phenotypes of trigeminal vs spinal pain syndromes. For example, clinically diabetic neuropathy is a common source of NP in the limbs and trunk involving classical signs of paresthesia and allodynia. In the trigeminal system, these effects are not pronounced, and there is a sparsity of reports of typical painful diabetic neuropathic pain or indeed neuropathy at all. Insults to trigeminal nerve branches such as microinjuries (eg, tooth extraction, root canal treatment) or macroinjuries rarely result in chronic NP and are consistently reported at a lower prevalence than following injury to the spinal system. Complex regional pain syndrome, a disabling painful disorder resulting from mild to severe nerve injury that commonly presents in the extremities and is accompanied by sensory, vascular, and muscular problems, has no true equivalent with all of these diagnostic features in the trigeminal system. Conversely, pain syndromes such as migraine, cluster headache, and trigeminal neuralgia exist only in the trigeminal system. Taken together, these findings suggest that the spinal and trigeminal systems may differ, particularly in the way they respond to injury. How and why remain a mystery. Gene expression data may offer some insights. Studies in naïve animals reveal differences in expressed genes between the DRG and the TG, indicating that different molecular mechanisms are involved in the baseline functionality of the two systems. The animal data seem to align well with human data on the DRG and TG. It has recently been shown that spinal and trigeminal neuropathies caused by trauma are accompanied by differentially regulated genes within the DRG and TG. The genes involved suggest that neuroinflammatory signaling and other related pathways are involved. These studies are limited due to the fact that they are “whole-ganglion” analyses and do not indicate from which type of neuron or nonneuronal cell present in the ganglia the changes originate. Yet, overall, the message is that the trigeminal system is different. As molecular techniques improve, we may be able to use these data to identify protective genes and pathways that may be novel targets for pain intervention and to elucidate some of the fascinating differences in diseases present exclusively in the trigeminal system.^1–3 Rafael Benoliel Editor-in-Chief

Alterations of gut microbiota composition in post-finasteride patients: a pilot study

PurposePost-finasteride syndrome (PFS) has been reported in a subset of patients treated with finasteride (an inhibitor of the enzyme 5alpha-reductase) for androgenetic alopecia. These patients showed, despite the suspension of the treatment, a variety of persistent symptoms, like sexual dysfunction and cognitive and psychological disorders, including depression. A growing body of literature highlights the relevance of the gut microbiota-brain axis in human health and disease. For instance, alterations in gut microbiota composition have been reported in patients with major depressive disorder. Therefore, we have here analyzed the gut microbiota composition in PFS patients in comparison with a healthy cohort.MethodsFecal microbiota of 23 PFS patients was analyzed by 16S rRNA gene sequencing and compared with that reported in ten healthy male subjects.ResultsSexual dysfunction, psychological and cognitive complaints, muscular problems, and physical alterations symptoms were reported in more than half of the PFS patients at the moment of sample collection. The quality sequence check revealed a low library depth for two fecal samples. Therefore, the gut microbiota analyses were conducted on 21 patients. The α-diversity was significantly lower in PFS group, showing a reduction of richness and diversity of gut microbiota structure. Moreover, when visualizing β-diversity, a clustering effect was found in the gut microbiota of a subset of PFS subjects, which was also characterized by a reduction in Faecalibacterium spp. and Ruminococcaceae UCG-005, while Alloprevotella and Odoribacter spp were increased compared to healthy control.ConclusionGut microbiota population is altered in PFS patients, suggesting that it might represent a diagnostic marker and a possible therapeutic target for this syndrome.

The Health Status of Informal Waste Collectors in Korea.

Background: A broad, holistic approach was performed among informal waste collectors (IWCs) in Korea to understand their complex multidimensional health and safety problems. Methods: In the quantitative study, a survey of IWCs was conducted at four junk shops in Gangbuk-gu, Seoul, and survey data were used to calculate age-standardized prevalence rates based on comparisons with the general population in Korea. A qualitative study was also performed to provide more details on IWCs’ occupational and musculoskeletal injuries and depression. Results: In the quantitative study, the age-standardized prevalence rate (aSPR) of occupational injury was higher than that of the general standard population (aSPR: 10.42, 95% confidence interval (CI) 5.19–18.64) and that of blue-collar workers (aSPR: 4.65, 95% CI 2.32–8.32). Regarding musculoskeletal problems, compared to employed populations, the aSPRs of shoulder pain (aSPR: 2.63, 95% CI 1.60–4.06), wrist pain (aSPR: 3.33, 95% CI 1.33–6.86), knee pain (aSPR: 1.51, 95% CI 1.01–2.17), and ankle pain (aSPR: 3.54, 95% CI 1.14–8.26) were higher. Regarding psychological problems, depression (aSPR: 2.55, 95% CI 1.27–4.56) and suicidal or self-harm ideation (aSPR: 2.09, 95% CI 1.11–3.58) were higher compared to general populations. Through the qualitative study and case study on muscular problems, more details on the work environment problems of IWCs were obtained. Conclusions: IWCs are exposed to various occupational hazards and lack proper protection. They show a high prevalence of occupational injury, musculoskeletal disease, and depression.

Non-Placement WIL: The Case of an Exercise Prescription Clinic

Universities globally have continued to strategically increase work-integrated learning (WIL) opportunities for students to enhance graduate employability. However, meeting the needs of the increasing number of placements in industry settings places challenges on employers and academic programme coordinators. This paper examines an innovative teaching and learning initiative demonstrating non-placement WIL practice on-campus and online through an exercise prescription clinic (EPC). The benefits provided by these opportunities have not only been for student learning, but for clients, in particular those impacted by neurological and/or muscular skeletal problems. The development of the on-campus EPC has focused on key elements of good practice in WIL highlighted by Agnew, Pill and Orrell (2017). The recent Covid-19 pandemic and the related government restrictions have resulted in the on-campus EPC being flipped online, requiring adaptability and flexibility of both students and clients. This paper reinforces the importance of developing WIL experiences that enhance the learning outcomes for both the student and the client. It also highlights the transferability of authentic industry non-placement WIL clinical experiences for future health professionals to both on-campus and online settings, which enable students the opportunity to engage with a range of clients in a safe environment, enhancing both personal and professional learning outcomes.

Menopausal Symptom Experience Among Middle Aged Women in Pokhara

Introduction: Menopause is the point when a woman no longer has menstrual periods. At this stage, the ovaries have stopped releasing eggs and producing most of their estrogen. Menopause is diagnosed when a woman has gone without a period for 12 consecutive months. The aim of the study is to assess the menopausal symptoms experience among middle aged women.&#x0D; Methods: A descriptive cross-sectional study was carried out among purposively selected 100 menopausal women in Fulbari-11, Pokhara using structured interview schedule. Data was analyzed using descriptive statistics (mean, median, standard deviation, frequency) and Inferential statistics (chi-square) in SPSS version 20. Data were presented in tabular form.&#x0D; Results: The findings revealed that 83 percent had mild symptoms experience. The most menopausal women experienced physical, psychological and sexual symptoms. The physical problems included as joint and muscular symptoms (80%), dryness of vagina (72%), bladder problems (60%), hot flushes (47%) and heart discomfort (43%). Similarly, the common psychological problems included anxiety (79%) physical and mental exhaustion (72%), irritability (70%), depressive mood (67%), and sleeping problems (61%) and sexual problems (37%). Menopausal symptom experience is statistically significant to source of information and type of family. &#x0D; Conclusions: The conclusion of this study is more than 60 percent menopausal women experienced menopausal symptoms. Joint and muscular problems, and psychological problems were the significant problems. Sexual problem is the least.