Faculty Bibliography

A population-based survey of approximately 4000 adults in Belgium, a bi-cultural country with a uniform health care system, explored the relationships of socio-cultural and employment factors to the reported experience of low back pain (LBP). Predictors of 1) history of LBP, 2) first LBP, and 3) daily LBP were examined by multiple logistic regression analysis. Thirty-three percent of the population had current LBP, including 5% experiencing their first episode; 26% had past but not current LBP, and 41% had never had LBP. Increasing age (OR > 2.0, P = .000) and female gender (OR 2.16, P = .000) were associated with history of LBP; only gender (OR 1.40, P = .02) was associated with first episode; neither was associated with daily LBP. Language was associated with history (OR 1.80, P = .000) and first occurrence (OR 1.77, P = .000) but not daily LBP. Among those employed, work dissatisfaction was associated with history of LBP (OR > 2.4, P = .02) and daily LBP (OR 3.85, P = .02), but not with first episode. The results suggest that sociocultural factors influence the expression of LBP, but not the risk of chronicity once LBP is reported, and that work satisfaction may not be causally related to LBP, but may intervene along with type of occupation in the possibility of continuing employment once LBP is present. Prospective studies are needed to confirm these results and elucidate causal relationships

Purposes of the study were to measure mechanical vibrations transmitted to train operators, to calculate daily whole-body vibration exposure levels, to compare measured levels with maximum acceptable exposure levels according to the international standard on whole-body vibration, to identify factors that influence vibration levels, and to quantify the effects of these factors on the measured levels. As a result of this study, it was determined that six out of twenty subway lines had vibration levels higher than the daily exposure limits recommended by the international standard, and that train speed was the most significant factor influencing the vibration levels

Thirty-one healthy men were tested for the effects of trunk-flexion positions (0 degrees, 15 degrees, and 35 degrees) in standing on triaxial torques and electromyogram of 10 trunk muscles during voluntary maximal and submaximal isometric trunk extension. At a more flexed position, both erector spinae and latissimus dorsi showed significantly higher RMS-EMG. The abdominal obliques were coactivated only during 100% maximum voluntary exertion at each posture. In all tests, the rectus abdomini were quiet. Mean maximum extension torque increased significantly at 15 degrees and 35 degrees of trunk flexion. The ratio of extension torque over RMS-EMG of the trunk extensor muscles, called the neuromuscular efficiency ratio (NMER), also increased in the more flexed posture. However, NMER has to be interpreted with caution because it is affected both by posture and exertion levels. The effects of posture on the torque generation capability of the trunk question the validity of the current lifting recommendations

Our surveys have shown lifetime prevalence of L.BP. over 30% among schoolchildren. The purpose of this study was to evaluate the relationship between back and isokinetic trunk strength, anthropometric parameters, and sports activities. One hundred and seventeen healthy children aged 10-16 years were included. All these volunteers had semi-structured interview, anthropometric and dynamic strength measurements. Lifetime prevalence of back pain was 44.5% and point prevalence was 13%. In this cross-sectional study, anthropometric and strength profiles were significantly related to age and gender. Non specific low back pain was not correlated to trunk muscle strength and/or sports activities

The purpose of this study was to determine trunk muscle performance in the sitting, semistanding, and standing postures during isometric and dynamic extension and flexion movements. Twenty-five male subject volunteers, with no previous history of back pain participated in the study. A triaxial dynamometer that measures torque, angular position, and velocity was used to measure isometric and dynamic motor output. The dynamometer allows testing in the sitting and standing postures. A custom-designed module also allowed testing in the semistanding posture. Each subject was tested in two sessions. The first session included the physical examination and three trials of isometric maximum voluntary contractions in the three postures. The second session included the dynamic performance against a resistance equal to 50% of the effort, as measured in the first session. Subjects were instructed to perform five repetitive flexion and extension cycles as fast and accurately as possible with maximum effort. An analysis of variance with repeated measures design was used to investigate the effects of the postures (standing, semistanding and sitting), the direction of exertion (flexion and extension), and the interaction effects of the isometric and dynamic parameters (maximum and average torque, velocity, power, and range of motion). The effects of direction (F = 98, P < 0.0001) and the interaction of posture and direction (F = 7.9, P < 0.001) were significant. The maximum isometric flexion strength was significantly higher in the standing posture than in semistanding and sitting. The maximum isometric extension was not affected by the posture (sitting, semistanding and standing).(ABSTRACT TRUNCATED AT 250 WORDS)

Thirty-six 45-55-year-old men with healthy low backs were studied with respect to body composition, isokinetic and isometric trunk strength, trunk muscle endurance, and cross-sectional area and radiological density of mm erector spinae. Results were compared to those of men in the same age group with intermittent low back pain (LBP) (n = 91) and with chronic LBP (n = 21). The back healthy group was significantly stronger and had longer trunk muscle endurance times than men with chronic LBP. Men with intermittent LBP had strength and endurance values in between the back healthy and chronic groups. There were no significant differences between any of the groups with respect to body composition and cross-sectional area of mm erector spinae. Radiological density for mm erector spinae was significantly decreased in the chronic LBP group compared to the back healthy and intermittent LBP groups. The deconditioning syndrome and its relationship to intermittent and chronic LBP is discussed

This chapter has reviewed the role of back school and educational programmes for the common and non-specific acute and subacute low back pain patient. The following seems to come out of this review. Education is an important part of patient care. However, several questions arise about the content of the education, the selection of patients, the patient compliance to instruction given, how the information is retained, and which outcome measures should be used. It is also important to realize that the back school is a modality or a tool that may be used as an adjunct, but as a sole treatment it seems to have less impact than in combination with other structured or goal-oriented programmes. When a back school is instituted in a hospital or in industry, it requires administrative and budgetary support and a multidisciplinary staff to successfully carry out the programme. The information given must be adapted to the needs of the participants and all members of the team must give the same information to the patient. A poorly structured back school where patients are dumped because the physician or other health care provider has nothing else to offer is a poor solution for the patient, a poor solution for the health care provider, and can only increase the patient's discomfort and health care costs

Controversial opinions have been published concerning the frequency of LBP among children and adolescents. Studies from orthopaedics or neurosurgical departments have reported low figures for prevalence of specific LBP due to serious disorders. Field surveys, on the contrary, have shown that cumulative life prevalence of non-specific LBP in children and teenagers can be comparable to the prevalence data for adult populations. Some specific diagnoses are more common or characteristic of children complaining of LBP. Age, gender, sports activities and family history of LBP have been found to be significantly associated with an increased prevalence in non-specific LBP among children. Low back pain among children and teenagers is common and should be recognized. This chapter provides guidelines for a clinical approach and differential diagnoses. Most back pain in these age groups is benign and should be treated as such

Monoclonal antibody CCH2 is commonly used for the detection of human cytomegalovirus (HCMV) infected cells in tissue sections as well as in cultured cells. The specificity of CCH2 was determined by screening a recombinant lambda-gt11 cDNA gene bank from HCMV-infected fibroblasts. By sequencing a reactive clone, the antigen was identified to be the non-structural DNA binding protein p52 of HCMV (UL44 reading frame). The viral insert from the lambda clone was recloned in bacterial expression vectors. For this, a new vector, pRos-RS, was constructed. The resulting clones were tested in immunoblot analyses. They were reactive with CCH2 as well as with reconvalescent sera positive for antibodies against HCMV, by this proving the specificity of CCH2. Using this monoclonal antibody in confocal microscopy, the subcellular localization of p52 in infected cells was analyzed. In these analyses, p52 was found to be nuclear and to be associated with the nuclear membrane at late times after infection