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Objectives/Interrogation: One of the most common complication following distal radial fractures is malunion, especially when treated with close reduction and cast immobilization. The aim of this study is to review the current literature regarding corrective osteotomies to provide the best evidence[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

The hyporheic zone (HZ), as the connecting ecotone between surface- and groundwater, is functionally part of both fluvial and groundwater ecosystems. Its hydrological, chemical, biological and metabolic features are specific of this zone, not belonging truly neither to surface- nor to groundwater. Exchanges of water, nutrients, and organic matter occur in response to variations in discharge and bed topography and porosity. Dynamic gradients exist at all scales and vary temporally. Across all scales, the functional significance of the HZ relates to its activity and connection with the surface stream. The HZ is a relatively rich environment and almost all invertebrate groups have colonized this habitat. This fauna, so-called hyporheos, is composed of species typical from interstitial environment, and also of benthic epigean and phreatic species. The hyporheic microbiocenose consists in bacteria, archaea, protozoa and fungi. The HZ provides several ecosystem services, playing a pivotal role in mediating exchange processes, including both matter and energy, between surface and subterranean ecosystems, functioning as regulator of water flow, benthic invertebrates refuge and place of storage, source and transformation of organic matter. The hyporheic zone is one of the most threatened aquatic environments, being strongly influenced by human activities, and the least protected by legislation worldwide. Its maintenance and conservation is compelling in order to preserve the ecological interconnectivity among the three spatial dimensions of the aquatic environment. Although several researchers addressed the importance of the hyporheic zone early, and most contemporary stream ecosystem models explicitly include it, very little is known about the HZ of Neotropical regions. From a biological standpoint, hyporheos fauna in Neotropical regions are still largely underestimated. This review focuses on a brief presentation of the hyporheic zone and its functions and significance as an ecotone. We also highlighted the key aspects considering also the current status of research in Neotropical regions. ResumoA zona hiporréica, como ecótono de ligação entre a superfície e as águas subterrâneas, é parte funcional seja dos ecossistemas fluviais seja das águas subterrâneas. As características hidrológicas, as características químicas, biológicas e metabólicas são específicas desta zona, não pertencendo verdadeiramente nem a superfície nem às águas subterrâneas. Trocas de água, nutrientes e matéria orgânica ocorrem em resposta a variações na descarga, topografia do álveo e porosidade. Gradientes dinâmicos existem em todas as escalas e variam temporalmente. Em todas as escalas, o significado funcional da zona hyporheic relaciona-se com a sua conexão e atividades com a água superficial. O HZ é um ambiente relativamente rico e quase todos os grupos de invertebrados colonizaram este habitat. Esta fauna, chamada hyporheos, é composta por espécies típicas do ambiente intersticial, e também de espécies bentônicas epígeas e freáticas. A microbiocenose consiste em bactérias, arqueobactérias, fungos e protozoários. O HZ fornece vários serviços para o ecossistema, desempenhando um papel fundamental na mediação de processos de troca, incluindo seja a matéria, seja a energia, entre os ecossistemas superfíciais e os subterrâneos, funcionando como regulador do fluxo de água, de refúgio para invertebrados bentônicos e local de armazenagem, fonte e transformação de matéria orgânica. A zona hyporheic é um dos ambientes aquáticos mais ameaçados, sendo fortemente influenciado pelas atividades humanas, e um dos menos protegidos pela legislação em todo o mundo. A sua manutenção e conservação é necessaria para preservar a interconectividade ecológica entre as três dimensões espaciais do ambiente aquático. Apesar de vários pesquisadores aborem a importância da zona hyporheic a tempo, e a maioria dos modelos de ecossistemas atualmente incluí-lo de forma explicita, muito pouco se sabe sobre o HZ das regiões neotropicais. Do ponto de vista biológico, a fauna hiporréica das regiões neotropicais é ainda largamente subestimada. Esta revisão visa apresentar de forma resumida a zona hiporréica, suas funções e importância como ecótono. Também visa destacar os aspectos principais considerando também o estado actual da investigação em regiões neotropicais.

Purpose: Aim of this study was to evaluate the effectiveness of a Global Posture Reeducation (GPR) program in comparison to a physical therapy Standard Treatment (ST) in patients with low back pain (LBP) at short- and long-term follow-up (i.e. 3 and 6 months). Relevance: To our knowledge, this is the first controlled study comparing a GPR program to a physical therapy ST in patients with chronic LBP. Participants: 100 consecutive patients with a primary complaint of LBP were included in the study: 50 entered the GPR group and 50 entered the ST group. Methods: A multicentre, prospective, non-randomized, rater-blinded study was conducted between March 2008 and September 2009. Primary outcome measures were Roland and Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI). Secondary outcome measures were lumbar Visual Analogical Scale (VAS) and Fingertip-to- Floor test (FFT). Outcome measures were captured at baseline and at 3/6 months by a physical therapist blind to group allocation. Both groups received a treatment delivered by experienced physical therapists; and the number of sessions, the duration of each session and the total amount of treatment were identical. Moreover, both treatments consisted of a one-to-one supervised exercise program actively involving the patient. Analysis: Continuous data were expressed as means and standard deviations (SD), while categorical data were presented as absolute numbers and percentages (%). In order to compare the baseline characteristics of the GPR and ST group, the Student’s t test was used for continuous variables, whereas categorical variables were assessed using the X2 test or the Fisher’s exact test, as appropriate. An intention to treat approach was used to analyze participants according to the group to which they were originally randomly assigned. The way of dealing with missing data was substitution with data of the 3rd-month follow-up (when available for the subject) and with the mean of the non-worsened subjects in ST group and of the non-improved subjects in RPG group. Results: Of the 100 initial participants, 78 completed the study, 42 in GPR and 36 in ST group, respectively. At baseline, the two groups did not differ significantly with respect to gender, age, BMI and outcome measures. At the 6th-month follow-up, when examining differences from baseline, the RPG group revealed a significant reduction of all the outcome measures with respect to ST Group. Conclusions: Our findings point to the relevance of a GPR intervention performed by a physical therapist in improving pain, disability and flexibility as opposed to a ST program, in patients with LBP. These results must be confirmed by further studies with higher methodological standards, including randomisation, large sample size, long-term follow-up and initial clinical assessment for subgrouping classification. Implications: When considering the clinical impact of our research, we can state that the GPR program produced a clinically meaningful improvement. In fact, 48% of subjects in the GPR group obtained a reduction of at least 30% in their RMDQ and VAS scores, compared to the 12% in the ST group.

Temporarily installed mini-piezometers become unusable with time due to the accumulation of inert material inside the tube or during the installation process. This paper aims at presenting a technique for unclogging minipiezometers.

Brazil faces a challenge to develop biomonitoring tools to be used in water quality assessment programs, but few multimetric indices were developed so far. This study is part of an effort to test and implement programs using benthic macroinvertebrates as bioindicators in Rio de Janeiro State. Our aim was first to test the Multimetric Index for Serra dos Órgãos (SOMI) for a different area - Serra da Bocaina (SB) - in the same ecoregion. We sampled 27 streams of different sizes and altitudes in the SB region. Despite the environmental similarities, results indicated biological differences between reference sites of the two regions. Considering these differences, we decided to develop an index specific for the SB region, the Serra da Bocaina Multimetric Index (MISB). We tested twenty-two metrics for sensitivity to impairment and redundancy, and six metrics were considered valid to integrate the MISB: Family Richness, Trichoptera Richness, % Coleoptera, % Diptera, IBE-IOC index, EPT / Chironomidae ratio. A test of the MISB in eleven sites indicated it was more related to land-use and water physico-chemical parameters than with altitude or stream width, being a useful tool for the monitoring and assessment of streams in the bioregion. O Brasil enfrenta o desafio de desenvolver ferramentas de biomonitoramento para serem utilizadas em programas de avaliação da qualidade de águas, porém poucos índices multimétricos foram construídos para esta finalidade. Este estudo faz parte de um esforço para testar e implementar programas de biomonitoramento utilizando macroinvertebrados bentônicos como bioindicadores no Estado do Rio de Janeiro. Nosso objetivo foi primeiro testar se as métricas que compõem o Índice Multimétrico da Serra dos Órgãos (SOMI) eram válidas para serem aplicadas em um área diferente - Serra da Bocaina (SB) - pertencente à mesma ecoregião. Nós amostramos 27 riachos de diferentes tamanhos e altitudes na região da Serra da Bocaina. Apesar das similaridades ambientais, os resultados indicaram haver diferenças entre locais de referencia nas duas regiões. Considerando tais diferenças, nós desenvolvemos um índice específico para região da SB, denominado de Índice Multimétrico da Serra da Bocaina (IMSB). Testamos vinte e duas métricas quanto à sensibilidade e redundância. Seis métricas foram consideradas válidas para integrar o IMSB: Riqueza de Famílias, Riqueza de Trichoptera, % Coleoptera, % Diptera, índice IBE-IOC e Taxa EPT / Chironomidae. O teste do IMSB indicou que o índice estava mais relacionado aos parâmetros físicos e químicos da água e ao uso da terra do que com a altitude ou largura dos rios. Assim, consideramos uma ferramenta útil para monitorar e avaliar riachos na bioregião estudada.

BACKGROUND: Several studies report a high prevalence of low back pain (LBP) among video-terminal (VDT) workers. Targeted ergonomic interventions can help reduce the burden. OBJECTIVES: We investigated the long-term efficacy of an ergonomic postural intervention to address LBP among VDT workers. STUDY DESIGN: Non-randomized, crossover trial. POPULATION AND SETTING: Four hundred employees working in the administrative offices of the two main buildings of the town hall ofForlì who used VDTs for at least 20 hours a week; we randomly selected 100 participants from each building. INTERVENTION: Ergonomic adjustment of the VDT workstation design. OUTCOME MEASURES: Changes in prevalence of LBP and work-related posture. RESULTS: The ergonomic adjustment of the workstation improved work-related posture and reduced LBP in VDT operators who benefited from the intervention. CONCLUSIONS: A personalized ergonomic prevention intervention can improve work-related posture and LBP for VDT workers.

Several studies report a high prevalence of low back pain (LBP) among video-terminal (VDT) workers. Targeted ergonomic interventions can help reduce the burden.We investigated the long-term efficacy of an ergonomic postural intervention to address LBP among VDT workers.Non-randomized, crossover trial.Four hundred employees working in the administrative offices of the two main buildings of the town hall ofForlì who used VDTs for at least 20 hours a week; we randomly selected 100 participants from each building.Ergonomic adjustment of the VDT workstation design.Changes in prevalence of LBP and work-related posture.The ergonomic adjustment of the workstation improved work-related posture and reduced LBP in VDT operators who benefited from the intervention.A personalized ergonomic prevention intervention can improve work-related posture and LBP for VDT workers.

The aim of this study was to create an Italian version of the Pain Catastrophising Scale (PCS-I) and evaluate its psychometric properties in a sample with chronic low back pain.The PCS was culturally adapted in accordance with international standards. The psychometric testing included factor analysis, reliability by internal consistency (Cronbach's alpha) and test-retest repeatability (intraclass coefficient correlations), and concurrent validity by comparing the PCS-I with a numerical rating scale (NRS), the Tampa Scale of Kinesiophobia (TSK), the Roland Morris Disability Questionnaire (RMDQ), the Hospital Anxiety and Depression Scale (HADS) and the Positive Affect and Negative Affect Scale (PANAS) (Pearson's correlation).It took 4 months to develop an agreed version of the PCS-I, which was satisfactorily administered to 180 subjects with chronic low back pain. Factor analysis revealed a three-factor 13-item solution (68% of explained variance). The questionnaire was internally consistent with one exception (α = 0.92 as a whole; 0.89 for Helplessness, 0.87 for Rumination and 0.56 for Magnification subscales) and showed a high degree of test-retest reliability (ICC = 0.842). Concurrent validity showed moderate correlations with the NRS (r = 0.44), TSK (r = 0.59), RMDQ (r = 0.45), HADS (Anxiety: r = 0.57; Depression r = 0.46) and PANAS (Negative Affect r = 0.54). The minimum detectable change was 10.45. The subscales were also psychometrically analysed.The successfully translated Italian version of the PCS has good psychometric properties replicating those of other versions.

Translating, culturally adapting and validating the Italian version of the Pain Stages of Change Questionnaire (PSOCQ-I) to allow its use with Italian-speaking patients with low back pain. The PSOCQ-I was developed by forward–backward translation, a final review by an expert committee and a test of the prefinal version to establish its correspondence with the original English version. Psychometric testing included confirmatory factor analysis, reliability by internal consistency (Cronbach’s a) and test–retest reliability (intraclass coefficient correlation), and construct validity by comparing PSOCQ-I with the Pain Catastrophising Scale (PCS), the Tampa Scale of Kinesiophobia (TSK), the Roland Morris Disability Scale (RMDQ), a pain Numerical Rating Scale (NRS), and the Hospital Anxiety and Depression Scale (Pearson’s correlation). The questionnaire was administered to 308 patients with chronic low back pain. Factor analysis confirmed a four-factor solution (namely, Precontemplation, Contemplation, Action, and Maintenance), achieving an acceptable data-model fit. Internal consistency (a= 0.91–93) and test–retest reliability (intraclass coefficient correlation = 0.74–0.81) were satisfactory. Construct validity showed moderate correlations between Precontemplation and PCS (r= 0.318), TSK (r= 0.385), RMDQ (r =0.320) and NRS (r= 0.335); low correlations were found between the other PSOCQ subscales and PCS (r= – 0.062; 0.039), TSK (r = – 0.164; 0.024), RMDQ (r = – 0.073; 0.004) and NRS (r = – 0.170; 0.020). Low correlations were found between the PSOCQ-I subscales and anxiety (r= – 0.132; 0.150) and depression (r = – 0.113; 0.186). The PSOCQ was translated successfully into Italian, and proved to have a good factorial structure and psychometric properties that replicated the results of other versions. Its use is recommended for research purposes.

PURPOSE: To create an Italian version of the Pain Beliefs and Perceptions Inventory (PBAPI-I) and evaluate its psychometric properties. METHODS: The PBAPI was culturally adapted in accordance with international standards. The psychometric testing included factor analysis, investigating reliability by internal consistency (Cronbach's alpha) and test/retest stability (intraclass correlation coefficient, ICC), and exploring construct validity by comparing the PBAPI-I with a pain numerical rating scale (NRS), the Roland Morris Disability Questionnaire (RMDQ), the Pain Catastrophizing Scale (PCS), the Tampa Scale of Kinesiophobia (TSK), the Hospital Anxiety and Depression Score (HADS) and the Chronic Pain Coping Inventory (Pearson's correlation). RESULTS: One hundred and sixty-seven subjects with chronic low back pain (83 % compliance) completed the tool. Factor analysis revealed a three-factor (Time, Mystery and Self-Blame), 16-item solution (explained variance: 80 %). The questionnaire was internally consistent (α = 0.91-0.96), and its stability was good (ICCs = 0.73-0.82). As expected, the construct validity estimates indicated that the Time and Mystery subscales moderately correlated with the NRS (r = 0.33-0.54), RMDQ (r = 0.34-0.47), PCS (r = 0.37-0.49) and TSK (r = 0.30-0.43), whereas the correlations between the Self-Blame subscale and the same measures were poorer. The correlations with the HADS were moderate and poor (anxiety: r = 0.37-0.05; depression: r = 0.39-0.07). Maladaptive coping strategies were more related to pain beliefs than adaptive strategies. CONCLUSION: The PBAPI-I has good psychometric properties that replicate those of other versions.

Objectives In the past decade many countries around the world have produced clinical practice guidelines to assist practitioners in providing a care that is aligned with the best evidence. The aim of this study was to present and compare the most established evidence-based recommendations for the management of chronic nonspecific low back pain in primary care derived from current high-quality international guidelines. Methods Guidelines published or updated since 2002 were selected by searching PubMed, CINAHL, EMBASE, guidelines databases, and the World Wide Web. The methodological quality of the guidelines was assessed by three authors independently, using the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Guideline recommendations were synthesized into diagnostic and therapeutic approaches that were supported by strong, moderate or weak evidence. Results Thirteen guidelines were included. In general, the quality was satisfactory. Guidelines had highest scores on clarity and presentation and scope and purpose domains, and lowest scores on applicability. There was a strong consensus among all the guidelines particularly regarding the use of diagnostic triage and the assessment of prognostic factors. Consistent therapeutic recommendations were information, exercise therapy, multidisciplinary treatment, and combined physical and psychological interventions. Conclusion Compared to previous assessments, the average quality of the guidelines dealing with chronic low back pain has improved. Furthermore, all guidelines are increasingly aligning in providing therapeutic recommendations that are clearly differentiated from those formulated for acute pain. However, there is still a need for improving quality and generating new evidence for this particular condition.

Background The aim of this non-randomized controlled trial was to evaluate the effectiveness of a Global Postural Reeducation (GPR) program as compared to a Stabilization Exercise (SE) program in subjects with persistent low back pain (LBP) at short- and mid-term follow-up (ie. 3 and 6 months). Methods According to inclusion and exclusion criteria, 100 patients with a primary complaint of persistent LBP were enrolled in the study: 50 were allocated to the GPR group and 50 to the SE group. Primary outcome measures were Roland and Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI). Secondary outcome measures were lumbar Visual Analogue Scale (VAS) and Fingertip-to-floor test (FFT). Data were collected at baseline and at 3/6 months by health care professionals unaware of the study. An intention to treat approach was used to analyze participants according to the group to which they were originally assigned. Results Of the 100 patients initially included in the study, 78 patients completed the study: 42 in the GPR group and 36 in the SE group. At baseline, the two groups did not differ significantly with respect to gender, age, BMI and outcome measures. Comparing the differences between groups at short- and mid-term follow-up, the GPR group revealed a significant reduction (from baseline) in all outcome measures with respect to the SE group. The ordered logistic regression model showed an increased likelihood of definitive improvement (reduction from baseline of at least 30% in RMDQ and VAS scores) for the GPR group compared to the SE group (OR 3.9, 95% CI 2.7 to 5.7). Conclusions Our findings suggest that a GPR intervention in subjects with persistent LBP induces a greater improvement on pain and disability as compared to a SE program. These results must be confirmed by further studies with higher methodological standards, including randomization, larger sample size, longer follow-up and subgrouping of the LBP subjects. Trial registration NCT00789204

This study investigated the effectiveness of a workstation ergonomic intervention for work-related posture and low back pain (LBP) in Video Display Terminal (VDT) workers. 100 VDT workers were selected to receive the ergonomic intervention, whereas 100 were assigned to a control group. The two groups were then crossed-over after 30 months from baseline. Follow-ups were repeated at 5, 12, and 30 months from baseline and then at 6 months following crossover. Outcomes: Work-related posture and LBP point-prevalence using the Rapid Entire Body Assessment method and a Pain Drawing, respectively. The ergonomic intervention at the workstation improved work-related posture and was effective in reducing LBP point-prevalence both in the first study period and after crossover, and these effects persisted for at least 30 months. In conclusion, our findings contribute to the evidence that individualized ergonomic interventions may be able to improve work-related posture and reduce LBP for VDT workers.

Evaluation of an Occupational therapy program for patients with spinal cord injury Study design: Clinical Controlled Trial Objectives: To evaluate the effectiveness of an Occupational Therapy program combined with neuromotor rehabilitation, by assessing the degree of functional independence reached by patients with spinal cord injuries at first hospitalization. Settings: Subjects selected from the Spinal Cord Unit of the Rehabilitation Institute of Montecatone (Imola, Italy). Participants: 36 male patients below age 60, with complete paraplegia (ASIA-A) in thoracic-lumbar level, at first hospitalization. Methods: Patients were divided into experimental and control groups. Subjects in the experimental group underwent neuromotor rehabilitation coupled with an Occupational Therapy program, whereas those in the control group followed neuromotor rehabilitation only. Increase in functional independence at discharge was evaluated by the Valutazione Funzionale Mielolesi (VFM) assessment scale. Results: Patients in the experimental group showed a significant increase in the total VFM score, and in domains concerning transfers and wheelchair use. A significant improvement was observed in unmarried patients as compared to married ones. Conclusion: An Occupational Therapy service within a Spinal Cord Unit allows to achieve a higher level of functional independence.

Background and Purpose The purpose of this study was to evaluate the efficacy of a preventive ergonomic intervention, which was provided by physical therapists, on spinal and upper-extremity work-related posture and symptom complaints of workers who use video display terminals (VDT). Subjects Two hundred employees who spent at least 20 hours per week at a VDT were randomly divided into 2 groups. Group E received the ergonomic intervention and an informative brochure, and group I received only the brochure. Methods Both groups were evaluated at the beginning of the study and at a follow-up 5 months later. The following tools were used: a pain drawing and the Rapid Entire Body Assessment (REBA) method to assess spinal and upper-extremity work-related posture. Results Group E had a lower REBA score and reduced lower back, neck, and shoulder symptoms compared with group I. Discussion and Conclusion The results suggest that a personalized preventive ergonomic intervention can improve spinal and upper-extremity work-related posture and musculoskeletal symptoms for workers who use VDTs.