Objectives:The most frequent manner of attending childbirth imposes on midwives assuming poor body position affecting the musculoskeletal system. Long professional experience does not mitigate the negative effects. The adopted movement habit, as well as the type, number and frequency of actions influence the body posture. The aim of the study was to identify ergonomic threats of basic occupational midwives activities and how particular spinal segments arrangements while attending childbirth using the same technique in senior midwives differ from those of junior ones. It was also checked whether pain influences the working position assumed by midwives. Materials and Methods: Examinations were conducted in 95 midwives aged 21-50 (X = 29.25±9.34): 51 graduates of BSc midwifery who worked 680 h in delivery rooms during obligatory practical classes and apprenticeship and 44 senior midwives with professional experience of 7-27 years (X = 14.84±5.98). The study was threefold. The spinal alignment while performing work activities associated with attending childbirth was assessed using the OWAS system and the SonoSens Monitor, the center of gravity projection on basal plane -using the AccuGait AMTI stabilometric platform. The measurements were taken during a simulation of attending childbirth (on examination model). A survey was conducted aimed at identifying spinal pain. Results: Midwives' working postures require unnatural body alignments. Postural instability in the working position and no maximal usage of basal plane were observed. The work overload may afflict the musculoskeletal system, which was confirmed by different pain discomforts in 67.3% of the examinees. Conclusions: Spinal alignment while attending childbirth is individually differentiated and in every case non-ergonomic. Identifying explicitly spinal overloads is difficult, but the most prevalent ones affect lumbar and cervical regions altogether. Spinal pain is frequently noted, both in junior and senior midwives, and is characteristic for midwives working in maximal movement ranges. occupational duties involve various tasks. Excluding those connected with nursing care it may be generalized that a continual and a recurrent component of their work is attending childbirth. A characteristic feature of midwives' work is the requirement of adopting a specific body position which has adverse effects on their musculoskeletal system. This motivates for seeking the causes of locomotor system overloads and finding possibilities to alleviate them. OBJECTIVESThe aim of the study was to identify ergonomic hazards associated with routine basic occupational activities performed by midwives and how particular spinal segments arrangements while attending childbirth using the same technique differ in senior midwives from those of the young graduates of BSc midwifery. It was also checked whether experiencing pain influences the working position of midwives. MATERIALS AND METHODSExaminations were conducted in 95 midwives aged 21-50 (X = 29.25±9.34). There were 51 g...
Despite the excellent efficacy and safety profile of omalizumab in chronic spontaneous urticaria (CSU), there are scarce data concerning its role in the treatment of refractory cases with different phenotypes of urticaria. We describe our experience with the therapy of nine patients with CSU co-existing with delayed pressure urticaria (DPU) or angioedema or both and refractory to treatment with high-dose antihistamines. The first patient, with severe CSU and recurrent angioedema, did not respond well to cyclosporine A or corticosteroids and suffered from numerous side effects of longterm corticosteroid therapy. The second patient presented with severe symptoms of DPU, which first of all prevented any daily activities of the professional routines. Both patients showed a complete remission of urticaria after the first injection of omalizumab. The third patient with CSU and severe DPU had been ineffectively treated for more than 20 years with various medications. Following the administration of omalizumab, the symptoms of CSU subsided but those of DPU intensified, and the drug was withdrawn after two cycles. In another four patients with refractory CSU and angioedema, the symptoms subsided after the first administration of omalizumab, and the patients have been in remission for about 5 weeks. In the remaining two patients, the symptoms did not resolve despite four 300 mg doses of omalizumab. It is important to establish a therapeutic regimen with omalizumab (150-300 mg; every 4-8 weeks) tailored to individual patient's needs and dependent on the type of urticaria; this may minimize unnecessary the medication exposure, adverse drug effects, and healthcare costs.
1. Non-ergonomic postural behaviours are common among young people. 2. Changing the body position does not eliminate the impact of the inappropriate habit. 3. An attempt to modify non-ergonomic postural behaviours usually results in pain, which may act as a demotivating factor. 4. Discomfort associated with the modification of habitual postural behaviours is reduced after 3-4 months of regular training.
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