Background
The prevalence of musculoskeletal symptoms among sedentary workers is high. Interventions that promote occupational standing or walking have been found to reduce occupational sedentary ...time, but it is unclear whether these interventions ameliorate musculoskeletal symptoms in sedentary workers.
Objectives
To investigate the effectiveness of workplace interventions to increase standing or walking for decreasing musculoskeletal symptoms in sedentary workers.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, OSH UPDATE, PEDro, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to January 2019. We also screened reference lists of primary studies and contacted experts to identify additional studies.
Selection criteria
We included randomised controlled trials (RCTs), cluster‐randomised controlled trials (cluster‐RCTs), quasi RCTs, and controlled before‐and‐after (CBA) studies of interventions to reduce or break up workplace sitting by encouraging standing or walking in the workplace among workers with musculoskeletal symptoms. The primary outcome was self‐reported intensity or presence of musculoskeletal symptoms by body region and the impact of musculoskeletal symptoms such as pain‐related disability. We considered work performance and productivity, sickness absenteeism, and adverse events such as venous disorders or perinatal complications as secondary outcomes.
Data collection and analysis
Two review authors independently screened titles, s, and full‐text articles for study eligibility. These review authors independently extracted data and assessed risk of bias. We contacted study authors to request additional data when required. We used GRADE considerations to assess the quality of evidence provided by studies that contributed to the meta‐analyses.
Main results
We found ten studies including three RCTs, five cluster RCTs, and two CBA studies with a total of 955 participants, all from high‐income countries. Interventions targeted changes to the physical work environment such as provision of sit‐stand or treadmill workstations (four studies), an activity tracker (two studies) for use in individual approaches, and multi‐component interventions (five studies). We did not find any studies that specifically targeted only the organisational level components. Two studies assessed pain‐related disability.
Physical work environment
There was no significant difference in the intensity of low back symptoms (standardised mean difference (SMD) ‐0.35, 95% confidence interval (CI) ‐0.80 to 0.10; 2 RCTs; low‐quality evidence) nor in the intensity of upper back symptoms (SMD ‐0.48, 95% CI ‐.96 to 0.00; 2 RCTs; low‐quality evidence) in the short term (less than six months) for interventions using sit‐stand workstations compared to no intervention. No studies examined discomfort outcomes at medium (six to less than 12 months) or long term (12 months and more). No significant reduction in pain‐related disability was noted when a sit‐stand workstation was used compared to when no intervention was provided in the medium term (mean difference (MD) ‐0.4, 95% CI ‐2.70 to 1.90; 1 RCT; low‐quality evidence).
Individual approach
There was no significant difference in the intensity or presence of low back symptoms (SMD ‐0.05, 95% CI ‐0.87 to 0.77; 2 RCTs; low‐quality evidence), upper back symptoms (SMD ‐0.04, 95% CI ‐0.92 to 0.84; 2 RCTs; low‐quality evidence), neck symptoms (SMD ‐0.05, 95% CI ‐0.68 to 0.78; 2 RCTs; low‐quality evidence), shoulder symptoms (SMD ‐0.14, 95% CI ‐0.63 to 0.90; 2 RCTs; low‐quality evidence), or elbow/wrist and hand symptoms (SMD ‐0.30, 95% CI ‐0.63 to 0.90; 2 RCTs; low‐quality evidence) for interventions involving an activity tracker compared to an alternative intervention or no intervention in the short term. No studies provided outcomes at medium term, and only one study examined outcomes at long term.
Organisational level
No studies evaluated the effects of interventions solely targeted at the organisational level.
Multi‐component approach
There was no significant difference in the proportion of participants reporting low back symptoms (risk ratio (RR) 0.93, 95% CI 0.69 to 1.27; 3 RCTs; low‐quality evidence), neck symptoms (RR 1.00, 95% CI 0.76 to 1.32; 3 RCTs; low‐quality evidence), shoulder symptoms (RR 0.83, 95% CI 0.12 to 5.80; 2 RCTs; very low‐quality evidence), and upper back symptoms (RR 0.88, 95% CI 0.76 to 1.32; 3 RCTs; low‐quality evidence) for interventions using a multi‐component approach compared to no intervention in the short term. Only one RCT examined outcomes at medium term and found no significant difference in low back symptoms (MD ‐0.40, 95% CI ‐1.95 to 1.15; 1 RCT; low‐quality evidence), upper back symptoms (MD ‐0.70, 95% CI ‐2.12 to 0.72; low‐quality evidence), and leg symptoms (MD ‐0.80, 95% CI ‐2.49 to 0.89; low‐quality evidence). There was no significant difference in the proportion of participants reporting low back symptoms (RR 0.89, 95% CI 0.57 to 1.40; 2 RCTs; low‐quality evidence), neck symptoms (RR 0.67, 95% CI 0.41 to 1.08; two RCTs; low‐quality evidence), and upper back symptoms (RR 0.52, 95% CI 0.08 to 3.29; 2 RCTs; low‐quality evidence) for interventions using a multi‐component approach compared to no intervention in the long term. There was a statistically significant reduction in pain‐related disability following a multi‐component intervention compared to no intervention in the medium term (MD ‐8.80, 95% CI ‐17.46 to ‐0.14; 1 RCT; low‐quality evidence).
Authors' conclusions
Currently available limited evidence does not show that interventions to increase standing or walking in the workplace reduced musculoskeletal symptoms among sedentary workers at short‐, medium‐, or long‐term follow up. The quality of evidence is low or very low, largely due to study design and small sample sizes. Although the results of this review are not statistically significant, some interventions targeting the physical work environment are suggestive of an intervention effect. Therefore, in the future, larger cluster‐RCTs recruiting participants with baseline musculoskeletal symptoms and long‐term outcomes are needed to determine whether interventions to increase standing or walking can reduce musculoskeletal symptoms among sedentary workers and can be sustained over time.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
To investigate the effectiveness of workplace interventions to increase standing or walking for decreasing ...musculoskeletal symptoms in sedentary workers.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
To investigate the effectiveness of workplace interventions to increase standing or walking for preventing the ...development or recurrence of musculoskeletal symptoms in sedentary workers.
Conventional analytic approaches for studying diet patterns assume no dietary synergy, which can lead to bias if incorrectly modeled. Machine learning algorithms can overcome these limitations.
We ...estimated associations between fruit and vegetable intake relative to total energy intake and adverse pregnancy outcomes using targeted maximum likelihood estimation (TMLE) paired with the ensemble machine learning algorithm Super Learner, and compared these with results generated from multivariable logistic regression.
We used data from 7572 women in the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be. Usual daily periconceptional intake of total fruits and total vegetables was estimated from an FFQ. We calculated the marginal risk of preterm birth, small-for-gestational-age (SGA) birth, gestational diabetes, and pre-eclampsia according to density of fruits and vegetables (cups/1000 kcal) ≥80th percentile compared with <80th percentile using multivariable logistic regression and Super Learner with TMLE. Models were adjusted for confounders, including other Healthy Eating Index-2010 components.
Using logistic regression, higher fruit and high vegetable densities were associated with 1.1% and 1.4% reductions in pre-eclampsia risk compared with lower densities, respectively. They were not associated with the 3 other outcomes. Using Super Learner with TMLE, high fruit and vegetable densities were associated with fewer cases of preterm birth (–4.0; 95% CI: −4.9, −3.0 and −3.7; 95% CI: −5.0, −2.3), SGA (−1.7; 95% CI: −2.9, −0.51 and −3.8; 95% CI: −5.0, −2.5), and pre-eclampsia (−3.2; 95% CI: −4.2, −2.2 and −4.0; 95% CI: −5.2, −2.7) per 100 births, respectively, and high vegetable densities were associated with a 0.9% increase in risk of gestational diabetes.
The differences in results between Super Learner with TMLE and logistic regression suggest that dietary synergy, which is accounted for in machine learning, may play a role in pregnancy outcomes. This innovative methodology for analyzing dietary data has the potential to advance the study of diet patterns.
The Philippines is ranked 3rd globally for tuberculosis incidence (554/100,000 population). The tuberculosis ward at San Lazaro Hospital, Manila receives 1,800-2,000 admissions of acutely unwell ...patients per year with high mortality. Objectives of this prospective cohort study were to quantify the association of under-nutrition (primary) and diabetes (secondary) with inpatient mortality occurring between 3-28 days of hospital admission in patients with suspected or previously diagnosed TB.
We enrolled 360 adults (≥18 years); 348 were eligible for the primary analysis (alive on day 3). Clinical, laboratory, anthropometric and enhanced tuberculosis diagnostic data were collected at admission with telephone tracing for mortality up to 6 months post-discharge. In the primary analysis population (mean age 45 years, SD = 15.0 years, 70% male), 58 (16.7%) deaths occurred between day 3-28 of admission; 70 (20.1%) between day 3 and discharge and documented total post-day 3 mortality including follow-up was 96 (27.6%). In those in whom it could be assessed, body mass index (BMI) ranged from 11.2-30.6 kg/m2 and 141/303 (46.5%) had moderate/severe undernutrition (BMI<17 kg/m2). A sex-specific cut-off for mid-upper arm circumference predictive of BMI<17 kg/m2 was associated with inpatient Day 3-28 mortality in males (AOR = 5.04, 95% CI: 1.50-16.86; p = 0.009; p = 0.032 for interaction by sex). The inability to stand for weight/height for BMI assessment was also associated with mortality (AOR = 5.59; 95% CI 2.25-13.89; p<0.001) as was severe compared to normal/mild anaemia (AOR = 9.67; 95% CI 2.48-37.76; p<0.001). No TB specific variables were associated with Day 3-28 mortality, nor was diabetes (HbA1c ≥6.5% or diabetes treatment). Similar effects were observed when the same multivariable model was applied to confirmed TB patients only and to the outcome of all post-day 3 in-patient mortality.
This research supports the use of mid-upper arm circumference for triaging acutely unwell patients and the design and testing of nutrition-based interventions to improve patient outcomes.
Abstract
Background
The Philippines is a high TB and multidrug-resistant TB burden country. Although the scale-up of GeneXpert testing is occurring, the benefits of universal Xpert-Mycobacterium ...tuberculosis/ rifampicin (MTB/RIF) testing in inpatients have not been documented.
Methods
Routine GeneXpert testing irrespective of priority criteria for testing was conducted within a prospective cohort of all adults with known or presumptive TB admitted to a tertiary infectious diseases hospital in Manila. Study-specific TB diagnosis was decided upon bacteriological results, chest x-ray assessment, if already on anti-TB treatment (ATT) at admission and a cough duration of ≥2 wk.
Results
Of submitted sputum samples, 87.1% (277/318) had valid acid-fast bacilli (AFB) microscopy and Xpert® MTB/RIF results. Xpert® MTB/RIF was positive in 97.7% (n = 87/89) of AFB-positive patients and 25.5% (n = 48/188) of AFB-negative patients. Bacteriological confirmation in smear negative cases not on ATT prior to admission was 25.2% (34/135). Rifampicin resistance was detected in 26/135 Xpert positive cases (19.3%), including nine who might not otherwise have been detected, representing a 53% increase in yield.
Conclusion
Universal GeneXpert testing in this setting enhanced the yield of bacterial confirmation, revealing a high incidence of rifampicin resistance and suggesting a need for further investigations in Xpert-negative/smear-positive patients who may not have mycobacterial TB.
Germline mutations in telomere biology genes cause dyskeratosis congenita (DC), an inherited bone marrow failure and cancer predisposition syndrome. DC is a clinically heterogeneous disorder ...diagnosed by the triad of dysplastic nails, abnormal skin pigmentation, and oral leukoplakia; Hoyeraal-Hreidarsson syndrome (HH), a clinically severe variant of DC, also includes cerebellar hypoplasia, immunodeficiency, and intrauterine growth retardation. Approximately 70% of DC cases are associated with a germline mutation in one of nine genes, the products of which are all involved in telomere biology. Using exome sequencing, we identified mutations in Adrenocortical Dysplasia Homolog (ACD) (encoding TPP1), a component of the telomeric shelterin complex, in one family affected by HH. The proband inherited a deletion from his father and a missense mutation from his mother, resulting in extremely short telomeres and a severe clinical phenotype. Characterization of the mutations revealed that the single-amino-acid deletion affecting the TEL patch surface of the TPP1 protein significantly compromises both telomerase recruitment and processivity, while the missense mutation in the TIN2-binding region of TPP1 is not as clearly deleterious to TPP1 function. Our results emphasize the critical roles of the TEL patch in proper stem cell function and demonstrate that TPP1 is the second shelterin component (in addition to TIN2) to be implicated in DC.
Six baleen whale species are found in the temperate western North Atlantic Ocean, with limited information existing on the distribution and movement patterns for most. There is mounting evidence of ...distributional shifts in many species, including marine mammals, likely because of climate‐driven changes in ocean temperature and circulation. Previous acoustic studies examined the occurrence of minke (Balaenoptera acutorostrata) and North Atlantic right whales (NARW; Eubalaena glacialis). This study assesses the acoustic presence of humpback (Megaptera novaeangliae), sei (B. borealis), fin (B. physalus), and blue whales (B. musculus) over a decade, based on daily detections of their vocalizations. Data collected from 2004 to 2014 on 281 bottom‐mounted recorders, totaling 35,033 days, were processed using automated detection software and screened for each species' presence. A published study on NARW acoustics revealed significant changes in occurrence patterns between the periods of 2004–2010 and 2011–2014; therefore, these same time periods were examined here. All four species were present from the Southeast United States to Greenland; humpback whales were also present in the Caribbean. All species occurred throughout all regions in the winter, suggesting that baleen whales are widely distributed during these months. Each of the species showed significant changes in acoustic occurrence after 2010. Similar to NARWs, sei whales had higher acoustic occurrence in mid‐Atlantic regions after 2010. Fin, blue, and sei whales were more frequently detected in the northern latitudes of the study area after 2010. Despite this general northward shift, all four species were detected less on the Scotian Shelf area after 2010, matching documented shifts in prey availability in this region. A decade of acoustic observations have shown important distributional changes over the range of baleen whales, mirroring known climatic shifts and identifying new habitats that will require further protection from anthropogenic threats like fixed fishing gear, shipping, and noise pollution.
Limited information exists on the distribution and movement patterns for most baleen whale species in the western North Atlantic Ocean. Previously, we conducted a broad‐scale passive acoustic monitoring study to analyze North Atlantic right whale seasonal distribution and shifts therein, based on identified changes in occurrence patterns starting in 2010. This study uses similar acoustic datasets and protocols to understand the seasonal distribution of humpback, sei, fin, and blue whales within the western North Atlantic, and to determine whether any of these species exhibited similar shifts in distribution patterns across time.
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