Despite extensive research into musculoskeletal disorders (MSDs) they continue to plague workers. Manual materials handling (MMH), in particular the concurrence of load manipulation and awkward body posture, has been identified as a key factor in the onset of MSDs. Only a few studies have looked at the interaction between manipulation tasks and working posture during assembly tasks and as a result their relationship has not been widely explored. Assessing the stresses resulting from individual task factors and body posture in isolation and adding them together may be too simplified to estimate an overall risk profile, since this does not take into account that there may be a non-linear interaction in strain responses when manipulation task and body posture interact. Therefore, the present study investigated biophysical, physiological and psychophysical responses to combined tasks, rather than individual tasks of body posture and manipulative tasks. The objective of the research was to establish the interactive effects of constrained body postures and manipulative tasks and to identify whether a cumulative or compensatory reaction occurs during this interaction. Nine conditions were assessed in a laboratory setting, which included combinations of three working postures (standing, sitting and stooping) and three assembly tasks (torque wrenching, precision and no task). Thirty-six subjects were required to complete all nine conditions, with each condition lasting ninety seconds. Muscle activity was recorded for seven muscles from the upper extremity, trunk and lower extremity regions and was complemented by physiological (heart rate, tidal volume, minute ventilation, oxygen consumption, energy expenditure and breathing frequency) and psychophysical (body discomfort) data. At the completion of all nine conditions subjects completed a retrospective psychophysical rating questionnaire pertaining to discomfort felt during the conditions. Responses obtained for the different task and posture combinations revealed compensatory reactions (additive > combined) for most of the conditions assessed for the biomechanical and physiological responses. In the majority of cases for muscle activity, no significant differences were found between the combined and the additive effects (p < 0.05), while for the physiological responses there were mostly significant differences observed. Psychophysical responses indicated that there was a significant difference overall between the additive and combined effects. The results of this study demonstrate that in order to identify risk areas, manipulation tasks and constrained working postures may be considered either in isolation and added together (additive) or as a combined task, since there were very few significant differences observed between these two effects. Further studies are required, however, to provide conclusive evidence.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Background: Professional orchestral string musicians are exposed to many physical and psychological stressors due to demands placed on them from playing their instruments. The prevalence of performance-related musculoskeletal disorders (PRMD’s) in this highly skilled group of individuals has been investigated internationally, consistently showing a high injury rate. There is however, a paucity of literature documenting the prevalence of musculoskeletal injuries in South African professional orchestral string players. It is hypothesized that South African trained orchestral string musicians may be at a greater risk for PRMD development due to the unique training and performance environments encountered in this country. Objectives: This study aimed to determine the demographic and injury profile; prevalence rate of current injury and risk factors for musculoskeletal injury in South African professional orchestral string musicians. Method: The study utilized a self administered quantitative questionnaire distributed to all string players in the three professional orchestras in South African in a semi-supervised fashion. SPSS version 15.0 (SPSS Inc., Chicago, Illinois, USA) was used to analyze the data. A p value < 0.05 was considered as statistically significant. iv v Results: There were 27 respondents, with the average participant being a Caucasian, right handed, non-smoking female, 37.11 years of age, 1.5631 meters tall, with a weight of 62.96 kilograms (BMI = 25.768) who exercised regularly (primarily in the gym). A bachelors degree in Music was the most commonly awarded qualification, obtained between the years 2000 and 2009, from a University outside of the Republic of South Africa. The prevalence of PRMD’s in the sample was 63% (n = 17), with a 95% confidence interval of 42.4% to 80.6%.In this study there was a high rate of injury (6.53 PRMD’s per player over a 12 month period), equating to 111 reported injuries in a population of 27 string players. The upper back (defined as the area between the shoulder blades) was the most commonly injured part of the body (77.8%, n = 21), followed by the upper extremity, mainly the shoulder (70.4%, n = 19). No statistically significant relationships were found in determining and confirming expected risk factors in the string players. Conclusion: Professional orchestral string musicians in South Africa suffer from a high rate of injury which is comparable to international studies of the same nature

Thesis (MSc (Physiological Sciences))--Stellenbosch University, 2008. / Introduction: Skeletal muscle atrophy is a mitigating complication that is characterized by a reduction in muscle fibre cross-sectional area as well as protein content, reduced force, elevated fatigability and insulin resistance. It seems to be a highly ordered and regulated process and signs of this condition are often seen in inflammatory conditions such as cancer, AIDS, diabetes and chronic heart failure (CHF). It has long been understood that an imbalance between protein degradation (increase) and protein synthesis (decrease) both contribute to the overall loss of muscle protein. Although the triggers that cause atrophy are different, the loss of muscle mass in each case involves a common phenomenon that induces muscle proteolysis. It is becoming evident that interactions among known proteolytic systems (ubiquitin-proteosome) are actively involved in muscle proteolysis during atrophy. Factors such as TNF-α and ROS are elevated in a wide variety of chronic inflammatory diseases in which skeletal muscle proteolysis presents a lethal threat. There is an increasing body of evidence that implies TNF-α may play a critical role in skeletal muscle atrophy in a number of clinical settings but the mechanisms mediating its effects are not completely understood. It is also now apparent that the transcription factor NF-κB is a key intracellular signal transducer in muscle catabolic conditions. This study investigated the various proposed signalling pathways that are modulated by increasing levels of TNF-α in a skeletal muscle cell line, in order to synthesize our current understanding of the molecular regulation of muscle atrophy. Materials and Methods: L6 (rat skeletal muscle) cells were cultured under standard conditions where after reaching ± 60-65% confluency levels, differentiation was induced for a maximum of 8 days. During the last 2 days, myotubes were incubated with increasing concentrations of recombinant TNF-α (1, 3, 6 and 10 ng/ml) for a period of 40 minutes, 24 and 48 hours. The effects of TNF-α on proliferation and cell viability were measured by MTT assay and Trypan Blue exclusion technique. Morphological assessment of cell death was conducted using the Hoechst 33342 and Propidium Iodide staining method. Detection of apoptosis was assessed by DNA isolation and fragmentation assay. The HE stain was used for the measurement of cell size. In order to determine the source and amount of ROS production, MitoTracker Red CM-H2 X ROS was utilised. Ubiquitin expression was assessed by immunohistochemistry. PI3-K activity was calculated by using an ELISA assay and the expression of signalling proteins was analysed by Western Blotting using phospho-specific and total antibodies. Additionally, the antioxidant Oxiprovin was used to investigate the quantity of ROS production in TNF-α-induced muscle atrophy. Results and Discussion: Incubation of L6 myotubes with increasing concentrations of recombinant TNF-α revealed that the lower concentrations of TNF-α used were not toxic to the cells but data analysis of cell death showed that 10 ng/ml TNF-α induced apoptosis and necrosis. Long-term treatment with TNF-α resulted in an increase in the upregulation of TNF- α receptors, specifically TNF-R1. The transcription factors NF-κB and FKHR were rapidly activated thus resulting in the induction of the ubiquitin-proteosome pathway. Activation of this pathway produced significant increases in the expression of E3 ubiquitin ligases MuRF-1 and MAFbx. Muscle fibre diameter appeared to have decreased with increasing TNF-α concentrations in part due to the suppressed activity of the PI3-K/Akt pathway as well as significant reductions in differentiation markers. Western blot analysis also showed that certain MAPKs are activated in response to TNF-α. No profound changes were observed with ROS production. Finally, the use Oxiprovin significantly lowered cell viability and ROS production. These findings suggest that TNF-α may elicit strong catabolic effects on L6 myotubes in a dose and time dependent manner. Conclusion: These observations suggest that TNF-α might have beneficial effects in skeletal muscle in certain circumstances. This beneficial effect however is limited by several aspects which include the concentration of TNF-α, cell type, time of exposure, culture conditions, state of the cell (disturbed or normal) and the cells stage of differentiation. The effect of TNF-α can be positive or negative depending on the concentration and time points analysed. This action is mediated by various signal transduction pathways that are thought to cooperate with each other. More understanding of these pathways as well as their subsequent upstream and downstream constituents is obligatory to clarify the central mechanism/s that control physiological and pathophysiological effects of TNF-α in skeletal muscle.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A correlação entre os métodos que calculam risco ergonômico oferece uma contribuição do método ergonômico mais adequado para frigorífico de suíno. Neste contexto, o objetivo deste trabalho foi relacionar o desempenho de quatro ferramentas de fator de risco ergonômico (OCRA - Occupational Repetitive Actions, RULA - Rapid Upper Limb Assessment, REBA - Rapid Entire Body Assessment e TOR-TOM -Taxa de Ocupação Real - Taxa de Ocupação Máxima) através de análise estatística. A coleta dos dados ocorreu no setor sala de cortes por meio da aplicação do método observacional por filmagem. Os métodos calculados foram convertidos para uma escala Likert de cinco pontos e realizado uma análise de variância entre grupos (ANOVA) e comparação múltipla. Como resultado pode-se afirmar que todos os riscos ergonômicos não apresentam diferença significativa entre as ferramentas, e quando realizada a comparação múltipla, os métodos dinâmicos (OCRA e TORTOM) se diferenciaram dos métodos estáticos (RULA e REBA). Através da regressão linear os métodos dinâmicos se mostraram mais adequados para os postos de trabalho em frigorífico. Para concluir, os métodos dinâmicos são adequados para análise de risco ergonômico em frigorífico de suíno e podem ser usados ponderando os objetivos de análise, as necessidades dos postos de trabalho, redução da exposição ao risco ergonômico e como consequência redução da exposição a doenças muscoesqueléticas. / The correlation between the methods that calculate ergonomic risk offers a contribution of the most appropriate ergonomic method for the swine chill. In this context, the objective of this study was to correlate the performance of four ergonomic risk factor tools (OCRA - Rapid Upper Limb Assessment, REBA - Rapid Entire Body Assessment and TOR-TOM - Occupancy Rate Real - Rate of Maximum Occupancy) through statistical analysis. The data collection was performed in the courtroom sector through the application of the observational method by filming. The calculated methods were converted to a five-point Likert scale and performed an analysis of variance between groups (ANOVA) and multiple comparison. As a result it can be stated that all ergonomic risks do not present significant differences between the tools, and when the multiple comparison was made, the dynamic methods (OCRA and TOR-TOM) differed from static methods (RULA and REBA). Through linear regression, the dynamic methods were more adequate for the refrigeration workstations. To conclude, the dynamic methods are suitable for ergonomic risk analysis in pigs and can be used by weighing the objectives of analysis, the needs of the work stations, reducing the exposure to ergonomic risk and as a consequence reducing the exposure to musculoskeletal diseases.

MPH / Department of Public Health / See the attached abstract below

Text in Afrikaans / Summaries in English and Afrikaans / This study aims to investigate the relation between a crane operator in a slab handlingarea's experience of his/her work environment and occupational health. A study of the literature leads one to the conclusion that the nature of crane operators' work environment may cause health problems. According to the literature crane operators are high risk cases regarding musculoskeletal disorders. The empirical study affirms that there are risk factors present in the crane operator's work environment, which may influence his/her occupational health. It is statistically proven that there is a meaningful difference between crane operators with a negative experience of the work environment and crane operators with a positive experience of the work environment, and the amount of illnesses experienced by crane operators as well as their general health. Recommendations are made regarding training, adjustability and flexibility of the work station, job rotation, job expansion and enrichment, and social contact. / Die doel van die studie is om die verband tussen 'n kraanoperateur in 'n platblokhanteringsarea se ervaring van sy/haar werksomgewing en beroepsgesondheid te ondersoek. Die literatuurstudie lei tot die gevolgtrekking dat die aard van kraanoperateurs se werksomgewing aanleiding kan gee tot gesondheidsprobleme. Volgens die literatuur is kraanoperateurs hoerisikogevalle ten opsigte van spierskeletstelselbeserings. Die empiriese studie bevestig dat daar risikofaktore voorkom in die kraanoperateur se werksomgewing wat sy/haar beroepsgesondheid kan be"invloed. Statisties is bewys dat daar 'n betekenisvolle verskil is tussen kraanoperateurs met 'n negatiewe ervaring van die werksomgewing en kraanoperateurs met 'n positiewe ervaring van die werksomgewing en die hoeveelheid siektetoestande wat kraanoperateurs ervaar, en die algemene gesondheid van kraanoperateurs. Aanbevelings om risikofaktore te beheer word gemaak ten opsigte van opleiding, verstelbaarheid en buigbaarheid van die werkstasie, posrotasie, posverbreding en - verryking, en sosiale kontak. / Industrial Psychology / M. Com (Industrial Psychology)

Text in Afrikaans / Summaries in English and Afrikaans / This study aims to investigate the relation between a crane operator in a slab handlingarea's experience of his/her work environment and occupational health. A study of the literature leads one to the conclusion that the nature of crane operators' work environment may cause health problems. According to the literature crane operators are high risk cases regarding musculoskeletal disorders. The empirical study affirms that there are risk factors present in the crane operator's work environment, which may influence his/her occupational health. It is statistically proven that there is a meaningful difference between crane operators with a negative experience of the work environment and crane operators with a positive experience of the work environment, and the amount of illnesses experienced by crane operators as well as their general health. Recommendations are made regarding training, adjustability and flexibility of the work station, job rotation, job expansion and enrichment, and social contact. / Die doel van die studie is om die verband tussen 'n kraanoperateur in 'n platblokhanteringsarea se ervaring van sy/haar werksomgewing en beroepsgesondheid te ondersoek. Die literatuurstudie lei tot die gevolgtrekking dat die aard van kraanoperateurs se werksomgewing aanleiding kan gee tot gesondheidsprobleme. Volgens die literatuur is kraanoperateurs hoerisikogevalle ten opsigte van spierskeletstelselbeserings. Die empiriese studie bevestig dat daar risikofaktore voorkom in die kraanoperateur se werksomgewing wat sy/haar beroepsgesondheid kan be"invloed. Statisties is bewys dat daar 'n betekenisvolle verskil is tussen kraanoperateurs met 'n negatiewe ervaring van die werksomgewing en kraanoperateurs met 'n positiewe ervaring van die werksomgewing en die hoeveelheid siektetoestande wat kraanoperateurs ervaar, en die algemene gesondheid van kraanoperateurs. Aanbevelings om risikofaktore te beheer word gemaak ten opsigte van opleiding, verstelbaarheid en buigbaarheid van die werkstasie, posrotasie, posverbreding en - verryking, en sosiale kontak. / Industrial Psychology / M. Com (Industrial Psychology)

Indiana University-Purdue University Indianapolis (IUPUI) / Symptoms of post-traumatic stress disorder (PTSD) are a common comorbidity in veterans seeking treatment of chronic musculoskeletal pain (CMP). However, little is known regarding the mutual influence of PTSD and CMP in this population. Using cross-sectional and longitudinal data from a randomized clinical trial evaluating a stepped care intervention for CMP in Iraq/Afghanistan veterans (ESCAPE), this dissertation examined the relationships between PTSD and CMP along with other factors including depression, anxiety, catastrophizing and health-related quality of life. The Classification and Regression Tree (CART) analysis was conducted to identify key factors associated with baseline PTSD besides CMP severity. A series of statistical analyses including logistical regression analysis, mixed model repeated measure analysis, confirmatory factor analysis and cross-lagged panel analysis via structural equation modeling were conducted to test five competing models of PTSD symptom clusters, and to examine the mutual influences of PTSD symptom clusters and CMP outcomes. Results showed baseline pain intensity and pain disability predicted PTSD at 9 months. And baseline PTSD predicted improvement of pain disability at 9 months. Moreover, direct relationships were found between PTSD and the disability component of CMP, and indirect relationships were found between PTSD, CMP and CMP components (intensity and disability) mediated by depression, anxiety and pain catastrophizing. Finally, the coexistence of PTSD and more severe pain was associated with worse SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Together these findings provided empirical support for the mutual maintenance theory.