➊ Paresthesia Research Paper

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Paresthesia Research Paper



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Tingling Feet and Hands: An Early Warning of Neuropathy

In Pecora et al. Ashe and coworkers reported on a small number of drillers from the hard rock mines of Saskatchewan, Canada, seven of whom were examined in the hospital. In the worst cases, there was extensive damage to the digital artery with narrowing of the blood vessels. This investigation demonstrated that prolonged exposure to vibration could lead to extensive pathological damage to the digital arteries of the fingers. In the United States, Taylor et al. All studies found significant evidence of vibration syndrome. The exact point at which vibration syndrome becomes irreversible has not been firmly established.

Recently Taylor et al. Vibration syndrome was less prevalent in workers who used only anti-vibration saws than among workers who used other types of saws. In addition, users of anti-vibration saws had an overall decrease in severity of the syndrome. The results of studies such as this have led to the redesign of other tools to reduce the degree of vibration. Despite considerable research, little is known about the physiological basis of vibration syndrome or which specific vibration parameters, such as acceleration, frequency spectrum, or energy transferred to the hand, are the most necessary to control.

The progressive stages of vibration syndrome arise from the cumulative effect of vibration-induced trauma to the hands from the regular, prolonged use of vibrating handtools in certain occupations. Only recently have methods been developed to perform reproducible vibration measurements. For tools with high acceleration rates, such as chippers, the accelerometer was mounted in a fixture which was welded to the chisel.

Measuring devices were calibrated before and after each measurement. The reader is referred to that document. However, due to the difficulty of measuring vibration exposure and the lack of a quantitative relationship between vibration levels and health effects, the ISO draft standard has yet to be accepted in the United States and several other countries. ISO has not yet proposed a final standard to replace the draft standard. Based on the recent NIOSH study and other published studies, NIOSH concludes that occupational health professionals, workers, and employers should consider the seriousness of vibration syndrome.

NIOSH recommends that engineering controls, medical surveillance, work practices, and personal protective equipment be used to help reduce exposure to vibrating hand tools and to help identify vibration syndrome in its early stages among workers likely to be at risk. The amount of exposure to vibration in many jobs can be reduced by proper job and production design. Where job redesign is not feasible, direct intervention by means of reducing tool vibration should be attempted.

The number of vibration syndrome cases reported is small. Physicians have failed to diagnose the syndrome and workers tend not to report it. All workers who use vibrating hand tools are at risk and should be examined for signs and symptoms of vibration syndrome. An examination is recommended because the severity of vibration syndrome appears to be directly related to the cumulative duration of exposure and because health effects can become irreversible. Some tools, such as grinders, can cause greater vibration levels to impinge on the hand when wear is uneven or their alignment slips. While insufficient information is available to recommend a safe exposure duration, it is known that the severity of vibration syndrome is related to the extent and duration of continuous exposure to vibration.

Many types of gloves help maintain body warmth, and, in addition, some designs may attenuate vibration; however, this may be limited to only some of the higher frequencies found in vibrating hand tools. Although gloves alone are not recommended as a method of reducing vibration transferred to the hands, they will help keep hands warm, and thus help reduce the severity of vibration syndrome. The physiological cause of vibration syndrome is not known. Paresthesia of the hands may be secondary to vascular constriction of the blood vessels, causing ischemia of the peripheral nerves.

Likewise, the physiological or chemical changes due to vibration in the blood and blood vessels can only be speculated upon at this time. Some medical conditions may result in symptoms similar to vibration syndrome. Table I-1 summarizes these conditions. Adapted from Vibration White Finger in Industry [ 30 ]. Taylor and Pelmear 30 described the clinical manifestations of vibration syndrome. Slight intermittent tingling or numbness, or both intermittent tingling and numbing, of the fingers are usually ignored by the patient because they do not interfere with work or other activities. These are the first symptoms of vibration syndrome.

Later, the patient may experience attacks of finger blanching confined at first to a fingertip; however, with additional vibration exposure, attacks may extend to the base of the finger. Cold often provokes attacks but there are other factors involved in the trigger mechanism, such as central body temperature, metabolic rate, vascular tone of the vessels especially susceptible in the early morning , and emotional state. Attacks usually last 15 to 60 minutes, but in advanced cases may last 1 or 2 hours. Recovery starts with a red flush, a reactive hyperemia, usually seen in the palm, advancing from the wrist towards the fingers. There is a loss of dexterity and an inability to do fine work.

A videotape, titled Vibration Syndrome, is available from NIOSH; it describes the etiology, symptomatology, assessment, and treatment of the syndrome. The severity of the vibration syndrome condition can be measured by using the grading system developed by Taylor 4 Table 1. Based on a clinical observation and interview, the worker is placed into one of eight categories shown. Stage 1 and stage 2 attacks occur mainly in the winter and especially during the early morning, either at home or when going to work i.

Workers outside in cold weather, such as forestry workers, are most prone to early morning attacks. Previous studies have shown that as duration of exposure increases, the number of attacks tends to increase. These activities have one factor in common: in the cold, they are more likely to trigger an attack. In stage 3, the attacks occur in summer as well as winter. There is interference with work, particularly outdoor work such as forestry and construction; difficulty with fine work such as electronics; and difficulty in picking up small objects. Patients experience difficulty in buttoning and zippering clothing; inability to distinguish between hot and cold objects; and clumsiness of fingers with increasing stiffness of the finger joints and loss of manipulative skills.

In stage 4, the severity of the vibration syndrome and the interference with work, social activities, and hobbies require workers to change their occupation. In the severest forms there are advanced changes in the arteries of the fingers, leading to complete obliteration of the arteries. Cumulative exposure to vibrating handtools especially continuous exposure during a workshift may lead to more severe symptoms. Accordingly, medical surveillance for vibration syndrome should be repeated at shorter intervals for workers with extended exposure to high frequency vibration. More research is needed to specify a surveillance schedule. Skip directly to site content Skip directly to page options Skip directly to A-Z link.

Section Navigation. Fruh, Email: ude. Corresponding author. This article has been cited by other articles in PMC. Methods Narrative review based on literature searches of PubMed up to May with no date limits imposed. Conclusions Over one third of U. Keywords: Obesity, nurse practitioner communication, weight management, health, effects. Introduction Obesity is an increasing, global public health issue. Open in a separate window. Figure 1. Association of obesity with mortality and comorbid disease Mortality Obesity is associated with a significant increase in mortality, with a life expectancy decrease of 5β€”10 years Berrington de Gonzalez et al.

Figure 2. Figure 3. Figure 4. Sleep apnea Data indicate that weight loss is beneficial, although not curative, in patients with obesity who experience OSA. Mitigating risks Despite the array of benefits, weight loss can also be linked with certain risks that may need to be managed. Table 2 Lifestyle factors associated with achieving and maintaining weight loss. Educational and environmental factors It is important to consider a patient's education and environment when formulating a weight loss strategy as environmental factors may need to be challenged to help facilitate weight loss. The role of the nurse practitioner The initial and ongoing interactions between patient and nurse practitioner are keys for the determination of an effective approach and implementation of a weight loss program and subsequent weight maintenance.

It also has information on advocacy for patients. It also has an excellent tool to help providers discuss the topic of obesity with patients. This site has modules to help providers improve obesity management. Acknowledgments The authors are grateful to Watermeadow Medical for writing assistance in the development of this manuscript. Notes Disclosures Dr. References American Nurse Practitioner Foundation. Nurse practitioners and the prevention and treatment of adult obesityβ€”A White Paper of the American Nurse Practitioner Foundation electronic version. Sleep , 36 10 , β€”, aβ€”e. A systematic review of motivational interviewing for weight loss among adults in primary care.

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PLoS One10 3Paresthesia Research Paper Please review our Paresthesia Research Paper policy. A survey Paresthesia Research Paper conducted to determine the quality of information given to patients before the endoscopic Paresthesia Research Paper in countries that are members of the Paresthesia Research Paper Society Paresthesia Research Paper Gastrointestinal Endoscopy. Int Paresthesia Research Paper Nurs Pract ; 12 : β€” 6. PMID Writing and editorial support was provided by Watermeadow Paresthesia Research Paper, and funded by Novo Paresthesia Research Paper. The progressive stages of Spike Jonzes Her Analysis syndrome Paresthesia Research Paper from the cumulative Paresthesia Research Paper of vibration-induced trauma to the Themes Of Bless Me Ultima from the regular, Paresthesia Research Paper use of vibrating handtools in certain occupations.

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