Sagittal standing spinal alignment and back pain in 8 to 12-year-old children from the Region of Murcia, Spain: The ISQUIOS Program

2020 ◽  
Vol 33 (6) ◽  
pp. 1003-1014 ◽  
Author(s):  
Pilar Sainz de Baranda ◽  
Pilar Andújar ◽  
Mónica Collazo-Diéguez ◽  
Antonio Pastor ◽  
Fernando Santonja-Renedo ◽  
...  
Keyword(s):  
Back Pain ◽  
Thoracic Kyphosis ◽  
Standing Position ◽  
Cross Sectional Study ◽  
Mean Value ◽  
Spinal Alignment ◽  
Cross Sectional ◽  
Spinal Curvatures ◽  
Sagittal Spinal Alignment ◽  
The Mean

BACKGROUND: The child’s spine shows changes in posture and balance of its curvatures during growth and musculoskeletal spinal conditions are likely to develop, such as back pain (BP). OBJECTIVE: The purposes of this study were (a) to describe the sagittal spinal alignment in a relaxed standing position and (b) to analyze its association with BP among 8 to 12-year-old children. METHODS: This was a cross-sectional study. A total of 731 elementary schoolchildren (379 girls and 352 boys), from 16 Spanish schools, participated. An unilevel inclinometer was used to quantify the sagittal spinal curvatures (thoracic and lumbar) in a relaxed standing position. Sagittal spinal morphotype was analyzed by sex, age, weight, height, and BMI. Children’s parents or legal guardians filled in a questionnaire according to the children’s responses about the BP suffered in the previous week and the preceding year. RESULTS: The mean angular value of thoracic kyphosis was 36.08 ± 8.99∘ and significantly higher in males than in females (p= 0.036). In contrast, the mean value of lumbar lordosis was 32.11 ± 7.46∘, being higher in females than in men (p< 0.01). The thoracic curve tends to increase by age (p= 0.003). Children who had low back pain (LBP) in the previous week had a significantly greater lumbar curve (35.88 ± 8.20∘) than those who did not have LBP in the preceding week (32.24 ± 7.30∘). The angle for lumbar curvature was a small predictor of LBP occurrence in the assessed children (OR = 1.082 [small]; 95% CI = 1.009–1.160, p= 0.028). CONCLUSIONS: To conclude, almost 3/4 of the students were classified with normal thoracic kyphosis; however, 27.36% of the students had thoracic hyperkyphosis. Lumbar hyperlordosis was identified in 9.05% of the students, and was 2.5 times more frequent in girls. The lumbar curvature was a small predictor of LBP occurrence in the assessed children and the angle of lumbar curvature that most accurately identified individuals at risk of developing LBP was determined to be 33∘. The results of this study indicate the need to assess sagittal spinal curvatures at school during development ages.

scholarly journals Sitting Posture, Sagittal Spinal Curvatures and Back Pain in 8 to 12-Year-Old Children from the Region of Murcia (Spain): ISQUIOS Programme

2020 ◽  
Vol 17 (7) ◽  
pp. 2578 ◽  
Author(s):  
Pilar Sainz de Baranda ◽  
Antonio Cejudo ◽  
María Teresa Martínez-Romero ◽  
Alba Aparicio-Sarmiento ◽  
Olga Rodríguez-Ferrán ◽  
...  
Keyword(s):  
Back Pain ◽  
Pelvic Tilt ◽  
Sitting Position ◽  
Spinal Alignment ◽  
Cross Sectional ◽  
Spinal Curvatures ◽  
Mean Values ◽  
Sitting Posture ◽  
Sagittal Spinal Alignment ◽  
Lumbar Kyphosis

To explore sagittal spinal alignment and pelvic disposition of schoolchildren in a slump sitting position is needed in order to establish preventive educational postural programs. The purposes of this study were to describe sagittal spinal alignment and pelvic tilt (LSA) in a slump sitting position and to explore the association of sagittal spine and pelvic tilt with back pain (BP) among 8–12-year-old children. It was a cross-sectional study. Sagittal spinal curvatures, BP and pelvic tilt were assessed in 582 students from 14 elementary schools. It was found that 53.44% of children had slight thoracic hyperkyphosis and that 48.80% presented moderate lumbar hyperkyphosis and 38.66% presented slight lumbar hyperkyphosis. Those who did not suffer from BP in any part of the back had a higher lumbar kyphosis (24.64 ± 7.84) or a greater LSA (107.27 ± 5.38) than children who had some type of BP in the previous year or week (lumbar kyphosis: 23.08 ± 8.06; LSA: 105.52 ± 6.00), although with no clinically relevant differences. In fact, neither sufferers nor those who did not have BP presented normal mean values for lumbar kyphosis or LSA according to normality references. This study demonstrates the need to assess sagittal morphotype in childhood since schoolchildren remain incorrectly seated for many hours and it greatly affects their spinal curvatures.

scholarly journals Classification System of the Sagittal Integral Morphotype in Children from the ISQUIOS Programme (Spain)

2020 ◽  
Vol 17 (7) ◽  
pp. 2467 ◽  
Author(s):  
Fernando Santonja-Medina ◽  
Mónica Collazo-Diéguez ◽  
María Teresa Martínez-Romero ◽  
Olga Rodríguez-Ferrán ◽  
Alba Aparicio-Sarmiento ◽  
...  
Keyword(s):  
Injury Risk ◽  
Dynamic Balance ◽  
Correct Diagnosis ◽  
Standing Position ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Spinal Curvatures ◽  
Normal Ranges ◽  
Forward Bending ◽  
Sagittal Spinal Alignment

The sagittal spinal morphology presents 4 physiological curvatures that increase endurance to axial compression forces and allow adequate postural balance. These curves must remain within normal ranges to achieve a static and dynamic balance, a correct functioning of the muscles and an adequate distribution of the loads, and thus minimize the injury risk. The purpose of this study was to categorize the sagittal spinal alignment according to the different morphotypes obtained for each curve in standing, slump sitting, and trunk forward bending positions in schoolchildren. It was a cross-sectional study. Sagittal spinal curvatures were assessed in 731 students from 16 elementary schools. In the sagittal standing position assessment, 70.45% and 89.06% of schoolchildren presented a “normal” morphotype for both dorsal and lumbar curves, respectively. After the application of the “Sagittal Integral Morphotype” protocol according to the morphotypes obtained in the three positions assessment (standing, slump sitting, and trunk forward bending), it was observed how the frequency of normal morphotypes for the dorsal and lumbar curve decreased considerably (only 32% and 6.6% of children obtained a “normal sagittal integral morphotype” for the thoracic and lumbar curvatures, respectively). These results show how it is necessary to include the slump sitting and trunk forward bending assessment as part of the protocol to define the “integral” sagittal alignment of the spine and establish a correct diagnosis. The use of the diagnostic classification presented in this study will allow early detection of misalignment not identified with the assessment of standing position.

scholarly journals Oral contraceptive among risk factors for women with ischemic stroke

2021 ◽  
Vol 12 (1) ◽  
pp. 548
Author(s):  
Carla S. PALUDO ◽  
Amanda SACHETTI ◽  
Maiara S. PAIXÃO
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Oral Contraceptive ◽  
Oral Contraceptives ◽  
Contraceptive Use ◽  
Cross Sectional Study ◽  
Mean Value ◽  
Northern Region ◽  
Cross Sectional ◽  
The Mean

Objective: To evaluate the frequency of use of oral contraceptives and other risk factors among women with ischemic stroke seen at a hospital in the northern region of the state of Rio Grande do Sul. Methods: Prospective, cross-sectional study. The population was characterized by patients admitted with a diagnosis of ischemic stroke during a period from March to August 2019 and the sample by female patients found in the population. The data were collected through an individual interview using a questionnaire developed by the researchers and tabulated for further analysis. All analyzes were performed using the statistical program Bioestat 5.0, considering p = 0.05. Results: In the characterization of the sample, an average age of 68.2 years was observed. The occurrence of gender was 52.4% for women. The mean hospital stay was 12.2 ± 8.91 days. Outcome of hospital discharge was 89.1%. The mean value of body mass index was 25 ± 4.89 kg / m², with an average of 27.4 kg / m² in patients who used oral contraceptives and 25.23 kg / m² in patients who did not use oral contraceptives. The sample had a 34.5%incidence of oral contraceptive use. The average age of those who used oral contraceptives was 62.4 years and of the patients who did not use it was 70.3 years. Conclusion: The study showed a high use of oral contraceptives in the sample, with percentage values very close to other factors evaluated, thus showing itself as a probable risk factor for the development of ischemic stroke.

scholarly journals Facteurs Épidémiologiques et Pronostiques Associés Aux Étiologies Des Hémorragies Digestives Hautes au CHU Campus de Lomé

2021 ◽  
Vol 17 (34) ◽  
pp. 44
Author(s):  
Aklesso Bagny ◽  
Lidawu Roland-Moise Kogoe ◽  
Laconi Yeba Kaaga ◽  
Late Mawuli Lawson-Ananissoh ◽  
Debehoma Redah ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Cross Sectional Study ◽  
Mean Value ◽  
Peptic Ulcers ◽  
Gi Bleeding ◽  
Cross Sectional ◽  
Hémorragies Digestives ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
The Mean

Objectif : Décrire les aspects épidémiologique, clinique et pronostique associés aux étiologies des hémorragies digestives hautes au CHU Campus de Lomé Patients et méthode: Etude transversale à collecte rétrospective, à visée descriptive et analytique menée du 1er Janvier 2014 au 31 Décembre 2019. Le seuil de significativité était retenu pour p<0,05. Résultats: Deux cent cinquante et un patients avaient été inclus. L’hémorragie était d’origine hypertensive portale chez 69 patients (27,71%) ; ulcéreuse gastro-duodénale chez 100 patients (39,84%). Chez 25 patients (9,96%), la fibroscopie oesogastroduodénale était normale. Une rupture de varices oesophagiennes était retrouvée chez 98,55% des patients présentant une hypertension portale. Les ulcères gastroduodénaux représentaient 54,94% des hémorragies digestives hautes d’origine non hypertensive portale. La valeur moyenne du score de Rockall était de 4(±1) chez les patients présentant une hémorragie d’origine hypertensive et de 3(±1) chez les patients avec hémorragie non hypertensive portale (p<0,001). La valeur moyenne du score de Glasgow-Blatchford était de 10(±3) chez les patients présentant une hémorragie d’origine hypertensive et 9(±3) chez les patients avec hémorragie digestive haute d’origine non hypertensive (p<0,001). La récidive hémorragique et le décès étaient survenus chez les patients présentant un saignement d’origine hypertensive portale dans respectivement 54,84% (p<0,001) et 71,42% (p<0,001). Conclusion: Les lésions inflammatoires aiguës et chroniques représentent la première étiologie des hémorragies digestives hautes dans le service d’Hépato-gastroentérologie du CHU Campus. Ces hémorragies sont associées à la prise de médicaments gastrotoxiques et à un moindre risque de récidive hémorragique et de décès. Objective: To describe epidemiological et prognostic outcomes associated with etiologies upper gastrointestinal bleeding in Campus Teaching Hospital of Lome Patients and method: Cross-sectional study with retrospective collection, descriptive and analytical aim carried out from January 1, 2014 to December 31, 2019. Results: Two hundred and one patients were included. The hemorrhage was of portal hypertensive origin in 69 patients (27.71%); peptic ulcer in 100 patients (39.84%). In 25 patients (9.96%), the oesogastroduodenal fibroscopy was normal. Ruptured esophageal varices were found in 98.55% of patients with portal hypertension. Peptic ulcers accounted for 54.94% of upper GI bleeding of non-portal hypertensive origin. The mean value of the Rockall score was 4(±1) in patients with hemorrhage of hypertensive origin and 3(±1) in patients with non-portal hypertensive hemorrhage (p<0.001). The mean Glasgow-Blatchford score was 10(±3) in patients with hemorrhage of hypertensive origin and 9(±3) in patients with upper GI hemorrhage of nonhypertensive origin (p<0.001). Hemorrhagic recurrence and death occurred in patients with bleeding of hypertensive origin in 54.84% (p<0.001) and 71.42% (p<0.001) respectively. Conclusion: Acute and chronic inflammatory lesions represent the first etiology of upper GI bleeding in the Gastroenterology Department of the Campus Teaching Hospital of Lome. These hemorrhages are associated with the use of gastrotoxic drugs and with a lower risk of recurrence of hemorrhage and death.

scholarly journals Prevalence and predictors of dyslipidemia on HAART and HAART naive HIV positive clients attending Debre Tabor Hospital, Debre Tabor, Ethiopia

2021 ◽  
Author(s):  
Anemut Tilahun Mulu ◽  
Getachew Yideg Yitbarek ◽  
Fitalew Tadele Admasu ◽  
Chalachew Yenew Denekew ◽  
Biruk Demissie Melese
Keyword(s):  
Venous Blood ◽  
Cross Sectional Study ◽  
Mean Value ◽  
Anthropometric Measurement ◽  
Hiv Positive ◽  
Cross Sectional ◽  
Immunodeficiency Virus ◽  
Debre Tabor ◽  
The Mean ◽  
Cd4 Cell

Abstract Background: HAART has been reported to be associated with a number of side effects in human immunodeficiency virus patients among which dyslipidemia is a common metabolic disorder. Methods: A facility based comparative cross-sectional study among 228 HIV positive persons was conducted from July to August 2020. Socio-demographic and clinical data were collected using structured questionnaires. Fasting venous blood sample was drawn for Lipid profiles and CD4 cell determination. Anthropometric measurement was done. Data was analyzed using SPSS version 22 for windows. Result: A total of 228 HIV patients were enrolled in the study. Prevalence of dyslipidemia in HAART naive and on HAART HIV positive persons was 61(53.5%) and 84 (73.7%), respectively. The prevalence of TC≥200 mg/dl was 50% and 30%; HLD-c<40 mg/dl was 43.8% and 36%; LDL-c≥130mg/dl was 48.3% and 28.1%; and TG≥150 mg/dl 59.6% and 39% among on HAART and HAART naïve, respectively. Age greater than 40 years (AOR = 3.27, 95% C.I: 1.47 - 7.25), blood pressure ≥ 140/90 (AOR = 16.13, 95% C.I: 5.81 - 44.75), being on HAART (AOR = 2.73, 95 % C.I: 1.35 - 5.53) and body mass index > 25kg/m2 (AOR = 1.92, 95 % C.I: 1.20 - 4.81) were identified as determinants of dyslipidemia. Conclusion: The mean value of lipid profile was significantly higher among HIV positive clients on HAART as compared to those HAART naïve HIV positive clients.

scholarly journals Factors influencing the dental caries in pregnant women: a cross-sectional study

2021 ◽  
Vol 10 (1) ◽  
pp. e32810111226
Author(s):  
Gabriela Bohrer Bolsson ◽  
Jessica Klöckner Knorst ◽  
Marília Cunha Maroneze ◽  
Maísa Casarin ◽  
Patrícia Pasquali Dotto ◽  
...  
Keyword(s):  
Dental Caries ◽  
Pregnant Women ◽  
Basic Research ◽  
Cross Sectional Study ◽  
Mean Value ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Mean ◽  
The City ◽  
Santa Maria

Objective: To assess factors associated with the average number of dental caries in pregnant women. Method: Basic research design: This cross-sectional study was performed between January 2017 and December 2018 in Santa Maria, Brazil. Clinical setting and participants: Multistage random sampling resulted in the recruitment of 256 pregnant women from public health centers across the city. Clinical exams and semi-structured questionnaires including demographic, socioeconomic and behavioral questions were performed by trained interviewers. Main outcome measure: The experience of dental caries was evaluated through the mean value of the Decay, Missing, and Filled Surface Index (DMFS) by 4 trained and calibrated examiners. Multilevel Poisson regression models were used to evaluate the influence of different variables on the average number of dental caries. Rate ratio (RR) and respective 95% confidence intervals were calculated (CI 95%). Results: The prevalence of untreated dental caries was 62.7% in the sample, while the mean DMFS index was 10.27 (± 10.92). Women who smoked during pregnancy had a higher mean DMFS (RR 1.41; 95% CI 1.25-1.57). Furthermore, pregnant women who had poor self-ratings of oral health had a higher average DMFS (RR 1.21; 95% CI 1.10-1.32). Conclusions: The results showed that older age, ethnicity, fewer years in education and the presence of dental plaque resulted in higher means of DMFS.

scholarly journals IgM Anti PGL-1 Antibody Level in Patients with Leprosy: A Comparative Study between Ear Lobes Capillary and Median Cubital Vein Blood Samples

2018 ◽  
Vol 6 (8) ◽  
pp. 1346-1348
Author(s):  
Khairina Nasution ◽  
Kristina Nadeak ◽  
Syahril Rahmat Lubis
Keyword(s):  
Blood Sample ◽  
Filter Paper ◽  
Cross Sectional Study ◽  
Mean Value ◽  
Cross Sectional ◽  
Blood Samples ◽  
Significant Difference ◽  
Median Cubital Vein ◽  
The Mean ◽  
Antibody Levels

BACKGROUND: To establish the diagnosis of leprosy accurately, additional examination such as serologic examination with ELISA is required. There are considerations about taking a blood sample from the earlobe region.AIM: To determine the differences in IgM anti-PGL-1 antibody levels from earlobe capillary and median cubital vein blood sample in leprosy patients.METHODS: An observational analytic study using a cross-sectional study involving 30 patients with leprosy. ELISA examination of earlobe blood samples with filter paper, and the median cubital vein blood samples with filter paper and conventional methods were performed to determine IgM anti-PGL-1 antibody levels.RESULTS: The mean value of IgM anti PGL-1 antibody levels from earlobe blood samples with filter paper (1476.62 μ/ml) was relatively similar with median cubital vein blood samples with conventional method (1476.77 μ/ml), but the mean value of IgM anti PGL-1 antibody levels from median cubital vein blood samples with filter paper (1210.37 μ/ml) was lower from other methods. However, there was no statistically significant difference between them.CONCLUSION: There are no significant differences between the mean levels of IgM anti-PGL-1 antibody from earlobe and the median cubital vein blood samples.

scholarly journals Gonial Angle by Lateral Cephalogram in Orthodontic Patients of a Tertiary Care Hospital: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (237) ◽  
Author(s):  
Manju Bajracharya ◽  
Anjana Rajbhandari ◽  
Resina Pradhan ◽  
Pushkar Manandhar ◽  
Surendra Maharjan ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Cross Sectional Study ◽  
Mean Value ◽  
Growth Patterns ◽  
Sectional Study ◽  
Lateral Cephalogram ◽  
Cross Sectional ◽  
Gonial Angle ◽  
Orthodontic Patients ◽  
The Mean

Introduction: The Gonial angle is an important parameter of the craniofacial complex for growth Patterns prediction. The gonial angle on lateral cephalometric radiograph represents the mandibular morphology concerning mandibular body and ramus. The objective of this study was to find out the mean value of gonial angle in lateral cephalometric radiographs of patients of orthodontic department in a tertiary care center. Methods: The descriptive cross-sectional study was conducted among patients from the Department of Orthodontics at People’s Dental College and Hospital between 8th December 2020 to 8th February 2021 at People’s Dental College and Hospital, Kathmandu, Nepal after obtaining Ethical approval (Reference Number. 01, CH100 09,2077/2078) by the Institutional Review Committee. A convenience sampling technique was used to collect 166 pre-treatment lateral cephalograms radiographs of patients between 17-30 years. Data were collected and entered using Statistical Package of Social Science 16. Results: The mean value of gonial angle on lateral cephalogram radiographs was 132.84±3.70 in hyperdivergent, 119.94±5.57 in hypodivergent and 124.06±3.88 in normodivergent vertical skeletal patterns and between male and female were 132.52±4.32, 133.07±3.28 in hyperdivergent, 121.46±3.78, 119.14±6.42 in hypodivergent and 123.74±5.14, 123.94±3.90 in normodivergent vertical skeletal patterns of Orthodontic Patients. Conclusions: The gonial angle value on lateral cephalometric radiographs was greater in hyperdivergent than hypodivergent and normodivergent vertical skeletal patterns. The hyperdivergent vertical skeletal pattern of female was greater than of male patient’s lateral cephalometric radiographs while hypodivergent and normodivergent vertical skeletal patterns of males were greater than female lateral cephalogram radiographs of Nepalese orthodontic patients.

scholarly journals Comparing School-Aged Refraction Measurements Using the 2WIN-S Portable Refractor in Relation to Cycloplegic Retinoscopy: A Cross-Sectional Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ziming Liu ◽  
Emmanuel Eric Pazo ◽  
Hong Ye ◽  
Cui Yu ◽  
Ling Xu ◽  
...  
Keyword(s):  
Gold Standard ◽  
Intraclass Correlation ◽  
Cross Sectional Study ◽  
Mean Value ◽  
Spherical Equivalent ◽  
Sectional Study ◽  
Altman Analysis ◽  
Cross Sectional ◽  
Bland Altman Analysis ◽  
The Mean

Purpose. To assess the repeatability and agreement of refractive measurements using 2WIN-S photoscreening with the gold-standard cycloplegic retinoscope refraction. Design. Single centre, cross-sectional study. Methods. Spherical, cylindrical, axis, and spherical equivalent of 194 bilateral eyes of 97 children were assessed using a retinoscope and 2WIN-S. One week later, another operator repeated the 2WIN-S measurements. The primary outcome measures were to assess the repeatability and agreement between spherical equivalent, J0, and J45 readings of 2WIN-S. The repeatability of measurements was assessed by the within-subject standard deviation (2.77 Sw) and intraclass correlation coefficient (ICC). The agreement between devices was assessed using 95% limits of agreement. The extent of the agreement between cycloplegic retinoscopy and noncycloplegic 2WIN-S measurements was assessed using Bland–Altman analysis. Results. The mean age ± SD was 10.3 ± 2.46 year (range, 4–14 years). The sphere, cylinder, and spherical equivalent measurements were found to be consistent with both apparatus (r value >0.86). ICC for SE, J0, and J45 was 0.900, 0.666, and 0.639, respectively; Sw for SE, J0, and J45 was 0.61D, 0.30D, and 0.31D, respectively; Bland–Altman analysis of retinoscopy with cycloplegia and 2WIN-S for SE was 184/194 (95%) in 95% confidence interval, and the mean value was 0.46. J0 was 184/194 (95%), and the mean value is −0.04. J45 was 181/194 (93%), and the mean value is −0.15. Conclusion. The objective refractive measurement of 2WIN-S had good reliability and high agreement with the gold-standard retinoscopy refraction in children and adolescents. While consistency was observed, it is essential to take into consideration that it is a screening tool.

scholarly journals Risk Factors Associated with the Prevalence of Upper and Lower Back Pain in Male Underground Coal Miners in Punjab, Pakistan

2020 ◽  
Vol 17 (11) ◽  
pp. 4102
Author(s):  
Madiha Ijaz ◽  
Muhammad Akram ◽  
Sajid Rashid Ahmad ◽  
Kamran Mirza ◽  
Falaq Ali Nadeem ◽  
...  
Keyword(s):  
Back Pain ◽  
Lower Back Pain ◽  
Work Experience ◽  
Health And Safety ◽  
Cross Sectional Study ◽  
Mean Value ◽  
Personal Factors ◽  
Coal Miners ◽  
Cross Sectional ◽  
Lower Back

There is not enough data available on occupational health and safety issues of underground coal miners in Pakistan. This study focuses on spinal disorders in association with personal and occupational factors. The Nordic Musculoskeletal Questionnaire was used for a cross-sectional study of 260 workers of 20 mines located in four districts of Punjab, Pakistan. Regression models were created for upper back pain and lower back pain of workers whose mean age is 19.8 years (±SD 1.47). Results identify the coal cutting as the most harmful work with odds ratios (ORs) 13.06 (95% confidence interval (CI) 13.7–21.5) for lower back pain and 11.2 (95% CI 3.5–19.4) for upper back pain in participants. Those with greater years of work experience had higher odds of upper back pain (2.4, 95% CI 1.4–3.5) and lower back pain (3.3, 95% CI 1.1–4.4). Number of repetitions (mean value 25.85/minute with ±SD 9.48) are also significant for spinal disorder with ORs of 4.3 (95% CI 3.2–7.4) for lower back and 1.3 (95% CI 1.0–2.4) for upper back. Many other occupational and personal factors are positively associated with the back pain in underground coal mines workers, requiring immediate ergonomic intervention.

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