Participants of the individual intervention (II)received nursing consultations every six months and those of the groupintervention (GI) took part in weekly meetings for three months. Data werecollected through four questionnaires: Identification questionnaire, Problem Areasin Diabetes Questionnaire (PAID), Summary of Diabetes Self-Care ActivitiesQuestionnaire (SDSCA) and the Diabetes Knowledge Scale (DKN-A). Data were analyzedusing the Friedman and Mann Whitney tests, considering a statistical significanceof p ≤ 0.05.  there was an increase in knowledge about the disease in the II (p<0.003) andGI (p<0.007), with reduction of the impact on the quality of life in the II(p<0.007) and improvement in self-care actions in the GI (p<0.001).  in both intervention models improvements were observed in the indicators, overthe six month monitoring period. Accordingly, the Ministry ofHealth, through the National Health Agency (ANS), stimulated changes in privatehealthcare providers, and the Normative Resolution (RN) No. 94, of 2005, established thecriteria for the development of health promotion programs. This is due to health promotion being a community empowerment process inthe practice of improving the quality of life and health, including greaterparticipation in the control of this process, and contributing to the development ofintegral healthcare.The high rates of morbidity and mortality from type 2 diabetes mellitus (T2DM) determinethe need for proposals for the reorientation of a healthcare model that prioritizes thepractices that promote health and the integrality of the care, in botalthcare.. Thus, health promotion and health education are strictly linked,considering that for effective health promotion it is necessary to articulate technicaland popular knowledge, and mobilize institutional and community, public and privateresources. Thus, health education constitutes a tool to improve individual andcollective health conditions, reinforcing the maintenance of positive health habitsthrough a multi-dimensional approach toward the health-disease process.In this context, health education is the theoretical and methodological basis for healthpromotion actions, as it can support both diseases prevention and rehabilitation andpromote citizenship, personal and social responsibility related to health and contributein the training of multipliers and caregivers. Thus,  process.. Thus, health education differs from the traditional model of knowledgetransmission.Health education is now considered a social process, which is defined as any influenceexperienced by individuals, capable of modifying their behavior. It is related to theimplementation of problem-solving activities by health professionals, which valorize theeveryday experience of individuals and social groups, and encourage the activeparticipation of the learner in the educational process. It involves the adoption ofapproaches systematically planned and implemented in a non-coercive manner. Thus, .Accordingly, educational activities, in which a key element is health education, areexperiences materialized in organized and systematized activities, inherent to thehealthcare project at all levels of care. They permit the appropriation of knowledge,improvement of the quality of life of the population, reduction of problems and damageoriginating from the diseases and a critical reflection regarding the actions necessaryto resolve such problems, involving system users and health professionals, especiallynurses..Therefore, for educative actions to generate learning, it is necessary for them to bebased on an accessible and emancipatory type of health education, that is, the dialogicmodel of health education that is primed by problematization, the construction ofknowledge and skills, and based on dialogue, prolonged changes in behavior and greaterautonomy for the individual..In this sense, the national and international literature on health education and T2DM,produced between 1997 and 2007, shows that the majority of studies were experimental andemployed the following strategies: interactive education, community educationalintervention, operative groups, seminars, monitoring of clinical and biochemicalparameters, home visits, educational conferences, activities regarding nutrition andphysical exercise, ophthalmological exams, case reports and educationalcolonies.. Therefore, among the relevant factors to be considered in the evaluationof such programs, the literature highlights knowledge about the disease, the impact ofdiabetes on the quality of life and the adoption of self-care actions, which may predictdisease control in the daily life of the individual(-).It should be noted that studies on educational activities based on dialogic healtheducation and developed in the private sector with individuals with T2DM are stillincipient. Despite this gap in the literature, a study that aimed to analyze healthpromotion actions in diabetes education, developed in groups of a private healthcareprovider, reports that the activities were dynamic and driven by the needs cited by theparticipants. In the same study, the authors consider the importance of studies that aimto evaluate the effectiveness of the educational programs, aiming to support theredirection of new strategies also within the private health context. Therefdividual-12..In accordance with the above, in a study that evaluated the effectiveness of individualand group intervention offered by the outpatient clinic of a public hospital in BeloHorizonte, the authors found that the results of both strategies were similar regardingattitudes, changes of behavior and quality of life, however, with greater effectivenessin the group intervention, with regards to laboratory exams.These findings highlight the importance of knowing the effectiveness of different typesof educative health actions, in the context of a private healthcare provider. Thus, thefollowing research question arose: is there a significant difference between individualand group educational interventions, related to the effectiveness regarding knowledgeabout the disease, the impact of diabetes on the quality of life and the adoption ofself-care actions? Linked to the research question, the aim of this study was to comparethe effectiveness of two educational interventions used by a healthcare provider in themonitoring of individuals with type 2 diabetes mellitus (T2DM), regarding knowledge ofthe disease, impact on quality of life and adoption of self-care actions.Therefore, aiming for collaboration to overcome the traditional model of healtheducation, the present study proposed the implementation of individual and collectiveeducational activities, mainly based on dialogue, with individuals with T2DM.This was a comparative, longitudinal and prospective study, developed in a healthcareservice of Londrina, state of Paraná. The choice of this institution was made due itoffering a "Chronic Patient Monitoring Program", which aims to perform health education,and more specifically, to encourage self-care, behavior change, improved quality of lifeand the reduction of healthcare costs.People with hypertension and diabetes are included in the program and monitored byprivate physicians. The program consists of biannual nursing consultations, telephonemonitoring and educational group activities. During the nursing consultation a physicalexamination, anamnesis and general guidance regarding the disease, treatment andself-care attitudes are carried out. Telephone monitoring is performed by the same nurseresponsible for accompanying the patient, three months after the consultations. Duringthis monitoring a pre-established script is used to identify attitudes that favorself-care, with an important focus on the use of medicines, doubts and problems thatarise in the daily life. The group health education activities are provided for peoplewith available time and interest. The group educational intervention consisted of 12weekly meetings, with duration of 120 minutes each, for a period of three months, beingheld on fixed dates and times. The groups are conducted by a multidisciplinary team,consisting of a nurse, nutritionist, psychologist and social worker.In the groups, health education activities are carried out in order to encourage changesin habits related to nutrition and disease care at the family and individual levels. Theexpectations and doubts of the participants regarding a particular theme are identifiedat each meeting. Entertainment and audiovisual resources - figures, fictional food andposters, are used in the discussion of these aspects.For the present study, a population was selected by convenience from a specific field ofstudy: individuals who were enrolled in the Monitoring Program, between October 2011 andFebruary 2012. All individuals with T2DM (with or without comorbidities), of bothgenders, over 18 years of age, and enrolled in the program during this period wereinvited to participate in the study while waiting to be attended.In the period mentioned above, of the 270 subjects enrolled, 85 did not have a diagnosisof T2DM, and of the 185 who met the inclusion criteria, 35 refused to participate in thestudy. Therefore, 150 subjects with T2DM were effectively studied, who, for the purposesof the study, were divided between individual and group interventions, according tooption/availability, as the health service provider, being private, did not allow theparticipants to be allocated randomly.Data were collected through semi-structured interviews, conducted in a private roomwithin the institution, between October 2011 and July 2012, at three different moments,according to the trajectory of the patients in the service: the first moment (M1)occurred at the time of inclusion into the program, during the first nursingconsultation; the second moment (M2) occurred three months later, during the telephonecontact; and the third moment (M3), six months after the first, during the secondnursing consultation. It should be noted that, as a function of this investigation,guidance and clarification of doubts, usually performed during the consultations andtelephone contacts, throughout the study period, only occurred after the application ofthe data collection instruments. In total, four questionnaires were used, as describedbelow..- Identification questionnaire - applied only at the first moment, consisting of openand closed questions that addressed: a) sociodemographic characteristics  andb) clinical characteristics: presence of comorbidity ; time of diagnosis of diabetes; use of diabetes medications; and dataregarding the clinical and laboratory examinations. Data for glycated hemoglobin wereobtained from consultation of patient records and capillary blood glucose was verifiedat the three moments. Controlled postprandial glycemia was considered when ≤ 160 mg/dland uncontrolled glycemia when > 160 mg/dl, good glycemic control of glycatedhemoglobin was considered when ≤ 7%, and inadequate glycemic control when > 7%mg/dl., consisting of 20 questions, distributed over four dimensions: emotional,food-related, social support and treatment problems. The total score ranges from 0-100points, with higher scores indicating high levels of emotional distress.- Problem Areas in Diabetes Questionnaire (PAID), validated in Brazil, consisdistress., consisting of 17 items, distributed over six dimensions, which enables theevaluation of adherence to self-care activities, taking as reference the frequency withwhich certain activities were carried out in the previous seven days. In the analysis ofthe adherence, the questionnaire items were parameterized in number of days of the week,from zero to seven, zero being the worst possible situation and seven the morefavorable. In the items that assess the consumption of foods high in fat and sugar, thevalues are reversed.- Summary of Diabetes Self-Care Activities Questionnaire (SDSCA), validated inBrazil, consisreversed., consisting of 15 items related to the general knowledge of DM, whichinvolves: basic physiology, food groups and their replacements, DM management insituations of complications, and general principles of disease care. The responses are presented in a multiple choice scale and the total scoreranges from zero to 15 points, with scores lower than seven indicating unsatisfactoryknowledge, and scores equal to or greater than eight indicating satisfactoryknowledge.- Diabetes Knowledge Scale (DKN-A), also validated in Brazil, consisase care. The renowledge.The data from individuals who participated in at least eight of the 12 meetings heldwere considered for analysis. The IBM SPSS 20. software was used for the performance ofthe statistical tests To verify that the groups of participants were comparable in termsof sociodemographic and clinical variables, at the moment before the interventions, thenonparametric test of proportions was applied. The only significant difference was inthe use of antidiabetic medication, thus demonstrating that the groups were notstatistically different in the majority of the variables used, enabling comparisons tobe performed.Based on the Kolmogorov-Smirnov and Shapiro-Wilk tests, the data distribution wasconsidered non-normal. Therefore, Friedman's test was used for the comparison of eachtype of intervention, at the three different observation moments, and Friedman'sMultiple Comparison test was performed to verify the difference, to evidence at exactlywhich moments the differences occurred; and the Mann Whitney test to compare the resultsof the Individual Intervention with those of the Group Intervention, at each moment. Inall tests, the level of significance was set as p-value ≤ 0.05.The development of the study met the national and international standards of ethics inresearch involving human subjects, according to Resolution 196/96 of the National HealthCouncil. The project that gave rise to this study was approved by the PermanentCommittee of Ethics in Research with Human Subjects (COPEP), of the State University ofMaringá (Authorization No. 516/2011). All participants, after clarification of theobjectives and criteria for participation, signed two copies of the Informed ConsentForm (ICF).Of the 150 individuals included in the study, 120 (80%) participated in the secondassessment, and 114 (76%) in the third. Considering the mode of intervention, the lossof 31 subjects (28.9%) was verified from the individual intervention and five (11.63%)from the group intervention. Among the reasons for leaving, 28 cases were due totermination of the health plan, six due to change of city and two due to seriouscomplications in the health status.Regarding the initial assessment, it was found that the 150 individuals participating inthe study had a mean age of 60 years (± 12.49 years), a mean individual of income of 5.5minimum wages (± 9.85), more than half (56%) were female, and the majority were white (80%), lived with a partner (74%), and had more than eight years of education (64%). Itwas also found that the majority of the participants had satisfactory knowledge aboutthe disease (71.3%), perceived a high impact on their quality of life (76%) andpresented good adherence to self-care practices.It can be observed in The data from this study show improvements in the scores related to knowledge about thedisease, after six months of intervention, in both groups; improvements in the scoresrelated to the impact of the disease on the quality of life, after three and six months,only for the individual intervention; and a positive influence regarding the adherenceto self-care practices, at three and six months, only for the group intervention. conducted with T2DM subjects, which also identified the effectiveness ofboth types of intervention, individual and group, at different moments and referred tothe same aspects evaluated. However, in the present study, the group interventionconstituted an extra activity in relation to the individual intervention, in that itsparticipants took part in both approaches. Educational activities implemented by healthprofessionals together with individuals, families and community, are essential forcontrolling this disease, as the complications of diabetes are directly related toknowledge about the disease, considering that this supports the performance of dailyself-care and the adoption of a healthier lifestyle. Individual or group interventions comprise the educational strategies mostcommonly used in the health promotion and monitoring of patients withdiabetes. However, it is important to consider that certain educational strategiescan encourage the active participation of the individual in controlling the disease andpreventing its complications or, on the contrary, simply strengthen the curativecharacter focused on the disease and on the transmission of information.Thus, these findings corroborate the results of an experimental study conductifestyle. Individiabetes. Howeveormation.. In addition, in the present study, an increase of values related toknowledge of the disease was observed over six months, both among participants of theindividual intervention as well as among those who participated in the groupintervention. Strategies aimed at health education should be employed, aiming for thedevelopment of self-care. In health education, one of the indicators most used for assessment indiabetic patients has been the level of knowledge about the disease, as this variable isrelated to the efficacy of the program.The number of individuals who, at the beginning of the program, already presentedsatisfactory knowledge regarding the disease was high, a fact that differs from asimilar study conducted in a primary health unit, in which the level of knowledge wasconsidered unsatisfactory for the majority of the individuals, which was shown to beassociated with the low educational level of the study participants. In addelf-care. In hea program., therefore the presence of the diagnosis of diabetes influences theself-perception of physical and psychological well-being.Regarding the impact of the disease on the quality of life, it was observed that at thestart of the intervention individuals perceived a high impact of diabetes in theirlives, and after six months there was a reduction of this impact, being significant forthe participants of the individual intervention. These data show how the performance ofmonitoring of these individuals can benefit them, as highlighted by the literature,which refers to the care of the disease, coping with emotional imbalances, management ofthe treatment and improved quality of life, therefll-being.. Therefore, in line with the results of the present study, it has beenconcluded that individual monitoring by the nurse, directed toward self-management anddisease control, helps to reduce the impact on the quality of life ofindividuals.A study conducted in Denmark, with 143 T2DM individuals, found no significant differencebetween individual and group interventions with regard to improving the quality of life,except for the improvement of clinical data in the individual intervention, which mayhave contributed to these individuals evidencing a lower impact of thedisease. Therefividuals.However, it should be emphasized that statistically significant decreases in the impactof the disease on the quality of life occurred in the individuals who only participatedin the nursing consultations . This may be related, in part, tothe small number of group intervention participants, undermining the identification ofassociations even when they existed.In clinical terms, the absence of changes in the impact of the disease among the groupintervention participants could be, on one hand, due to a possible lack of motivation ofsome people, when they realized that other participants improved their quality of life,causing them to become despondent, due to their difficulties. On the other hand, thepossibility of nurses not valuing the moment of individual care should be considered, asthey believed that the patients were being well assisted in the group and, therefore,gave more time and care to those that only received the nursing consultation.. The multidisciplinary team, therefore, tends to favor the reduction of thestress associated with the disease, receptivity to the treatment, self-esteem, sense ofself-efficacy and a more positive perception regarding the health.In relation to self-care, an increase of positive actions  was identified in participants of both groups.However, after six months, this reduction was only significant for the individuals thatalso participated in the group intervention. This data can be related to the fact thatthe group activities make possible dialogue, reflection, exchange of knowledge and,consequently, the co-responsibility of individuals with diabetes for their own health.In addition, the participation of a multidisciplinary team in the group activity enablesthe integrality of the healthcare, as it favors the contact with and access to knowledgeof different health professionals. The mue health..Furthermore, the commitment of individuals to self-care practices largely depends oncultural and educational aspects related to personal skills and limitations, lifeexperience, health status and the resources available. When an individual is unable tomeet their self-care requirements, it is the function of the nurse and healthcare careteam to determine at what level this occurs, defining the necessary methods ofsupport.Finally, the allocation of the participants into groups by convenience, no control ofvariables e.g. the presence of comorbidities, and also the rate of loss in the groupswere considered limitations. Regarding the group intervention, it is emphasized that thenon-randomization of the participants resulted in the inclusion of people who hadalready shown an interest in participating in this activity, which may have facilitatedthe change in self-care attitudes. There was also a large difference between theeducational approaches, in terms of the frequency of meetings, with the members of theindividual intervention participating in only the two nursing consultations and the telephone contact, while those of the group intervention participated in thesesame activities and at least eight weekly meetings.Despite these limitations, the results are valid, especially when comparing the behaviorof the groups at the three different moments. They can support and motivate theprofessional practice in the implementation of health education activities in differentcontexts.The study results show that the individual intervention for people with T2DM, throughbiannual nursing consultations, favored the clarification of doubts, the acquisition ofknowledge about the disease and the reduction of its impact on the quality of life ofthe individuals. Furthermore, by adding health education actions in groups to theseconsultations, in addition to promoting the acquisition of knowledge, the occurrence ofgreater adherence to self-care practices was also observed, although the reduction ofthe impact of the disease on the quality of life of patients was not significant.The results also showed that in the two types of intervention significant changesoccurred from M1 to M2 or M3, but not from M2 to M3. This means, on one hand, that theacquired knowledge and behavior have permanence in time, as they did not decrease fromM1 to M3; while on the other hand, apart from the influence of personal motivation,usually observed at the beginning of the interventions, it was found that people have alimit for the acquisition of knowledge and behavioral skills. These particularitiesindicate that health professionals who treat patients with chronic diseases, such asT2DM, must consider the need for adjustments in the educational program, aiming toensure the maintenance of the benefits achieved, regardless of the type of educationalintervention used.Thus, the performance of studies to assess the effects of the interventions 12 monthsafter their completion is proposed, in order to identify whether the benefits remainover the long term, which would characterize the residual effect of interventionspreviously performed. Therefore, it is appropriate to propose the continuation ofstudies of this nature, through qualitative methodologies that enable the identificationof the elements that contribute to changes, the comprehension of how these elements workin these changes, and the clarification of the boundaries between individual and groupinterventions in the modulation of self-care, considering that the educational processconstitutes something dynamic and therefore subject to continuous and multidimensionalassessment.


The authors declare that MICRO-PLUS Konzentrate GmbH, now a subsidiary of BIOMIN Holding GmbH, financially sponsored this project. The authors GM and CP are affiliated with BIOMIN, which produces the phytogenic feed additive used in this trial. BS, affiliated with MICRO-PLUS Konzentrate GmbH at the time the experiment was conducted, is currently affiliated with BIOMIN following the acquisition.At the time this experiment was conducted, the Institutional Animal Ethics Committee standards for conducting research on poultry species were not established, thus no committee approval was required, and the experiment was conducted according to the ethical norms of the University. The principal investigator of the study has provided the journal’s Editorial Office a retrospective statement that approval was not needed.GM: final approval of the version to be submitted, drafting the article, or revising it critically for important intellectual content; BS: contributions to conception and design of the experiment and analysis and interpretation of data; SH: contributions to conception and design of the experiment, acquisition of data, and analysis and interpretation of data; CP: final approval of the version to be submitted, drafting the article, or revising it critically for important intellectual content.


The Latin American Symposium on Oncological Gastroenterology (SLAGO) took place between the the 16th and 20th of April, 2013. This important conference has been organized by the Chile Cancer Foundation every two years since 2007.This event brings together specialists from the majority of the Latin American countries, as well as recognised professionals from the United States, Canada and Europe. The growth of this event in its short history has been enormous. When the first convention took place in 2007, there were a total of 230 participants; in this fourth edition in 2013, the number of participants surpassed 1,100. These figures and the quality of the event have made the SLAGO convention the third most important oncological gastroenterology event in the western world, after ASCO GI and the ESMO congress. Since the second version of this conference, it has been held in Viña del Mar, Chile, a beautiful coastal city on the pacific, where the event will continue to be held.This conference brings together all the different fields that are part of oncological gastroenterology, such as medical oncologists, radiotherapists, oncological digestive surgeons, endoscopic digestive gastroenterologists, radiologists, pathologists and a panel of experts in nutrition and palliative medicine.Course on Pre ONS Oncology Nursing CongressFirst Meeting of Oncology NursingFirst Latin American Symposium on pharmaceutical chemicalsOncological Kinesiology workshopsCourse on Nutrition and Digestive CancerPalliative medicine workshopPsycho-oncology workshopColorectal Cancer ConsensusOncological patient reunionAmong the participants and attendees at this important event, the following countries can be highlighted: Germany, Argentina, Canada, Belgium, Bolivia, Brazil, USA, Spain, France, New Zealand, Peru, Mexico, Uruguay, Venezuela and Chile.SLAGO, in its essence, encourages the participation and development of gastroenterology and oncology in Latin America and aims to be an instance of best practice and on-going training for the various professionals involved in this area of oncology. For this reason, as well as looking for transversality amongst the various professions in parallel, the following activities have been developed:The main purpose of this convention was to discuss current therapies and diagnostics and bring together health professionals who research new treatments on a daily basis, encouraging them to share experiences and the latest treatment options for neoplasia which compromise the entire digestive system.www.slago.com.This Congress was chaired by Dr Jorge Gallardo of Chile, and various topics of interest were developed. The curriculum and slideshows can be downloaded from After these five days of activity, it can be concluded that both the Latin American and Caribbean participants agreed that this conference is the largest gathering of the highest impact in the region, which ranks as one of the most important and busiest in this field, and they have therefore committed themselves to spread the word and attend the next SLAGO conference in 2015.hereWatch videos from the conference


One of the great founders of the Romanian surgery school, Professor Ion Juvara was honored in the continuity tradition of recognizing the value of the ancestors in the enthusiastic and full of warmth environment of the beginning of the academic year in the Aula Magna of “CAROL DAVILA” UNIVERSITY OF MEDICINE AND PHARMACY in Bucharest.The laborious activity of Professor Ion Juvara was abundantly and excitedly presented by famous personalities of the University: Acad. Ioanel Sinescu, Rector of “Carol Davila” University of Medicine and Pharmacy, Prof. Mircea Beuran, MD, Head of the Surgery Clinic of the Emergency Hospital in Bucharest and the Head of the Surgery Department, Prof. Traian Patrascu, MD, Head of the Surgery Clinic of “Cantacuzino” Hospital, Prof. Dan Sabau, MD, from “Lucian Blaga” University in Sibiu, famous followers of the exceptional surgeon and also Prof. Radu Palade, MD, a famous surgeon, son of the great scientist George Emil Palade, who had the chance of meeting Ion Juvara when he was only 3 years old. The ceremony was admirably completed by the memories full of emotion and nostalgia of the great surgeon’s family who was also present at the event. Just as the speakers underlined, Prof. Ion Juvara, MD, was a true personality, who has unmistakably marked the Romanian surgery field of the second half of the last century. Born 100 years ago in Bucharest, he enrolled, when still being young, on a singular trajectory of performance; occupying the first position in all the professional competitions he took part in.Among the professors who have marked the professional trajectory of young Ion Juvara, there are two great personalities of the Romanian medical school: Francisc Reiner and Nicolae Hortolomei, and among the friends from his youth – the future laureate of Nobel Prize, George Emil Palade.As the speakers confirmed, the scientific level, the impeccable technique, and last, but not least, the courage based on the objective appreciation of his own possibilities, allowed professor Juvara to approach the pioneering fields of surgery in that period of time: the first surgeries on the thyroid gland made together with professor Hortolomei, the first thymectomies, the new interventions on the thorax or heart, being only few of the paths opened by this great surgeon’s talent and visionary spirit.His prodigious scientific activity includes 460 presented or published papers. The main scientific contributions, which have remained in history as true “milestones” in the field of surgery are the ones concerning the thyroid gland, organic hypoglycemia due to pancreatitis or the treatment of myasthenia gravis by using thymectomy. The studies on reinterventions in gastric surgery and in extrahepatic biliary tracts have also been of great interest until present, his preoccupation for a clear and an in-depth study of knowledge in a field so sensitive and difficult, of imperfections and surgical failures being remarkable. In 1996, at the venerable age of 83 years old, at the end of a fulfilled road both from the family point of view and from a professional one, professor Ion Juvara stepped quietly out of life, entering the legend.And the legends never die! Executive EditorAssoc. Prof. Dr. Eng. Victor Lorin Purcarea


Advances in medical science procedures and their utilization in the field of oncology improved the survival of patients. In consequence, these advances have influenced the practice of physiotherapy. Physiotherapists utilize physical agents with the objective to enhance the health, welfare and quality of life and thus they can play important role in the management and rehabilitation of patients with prostate cancer (PCa). Urinary incontinence (UI) and erectile dysfunction (ED) are effects normally associated with the radical prostatectomy and radiotherapy due to the damage of the muscles of the pelvic floor (MPV). The aim of this work is to present findings related to the PCa and how the physiotherapist can guide the patient in relation to the knowledge and understanding of the anatomic structures related directly with the pelvic floor, the correct breathing and the perception of the MPV, as other muscles of the pelvis. Interventions of the physiotherapy will re-train the muscles of the pelvis by improving the active retention strength of the MPV in order to overcome the insufficiency (mainly the UI and ED) of the injured muscles. In conclusion, it is suggested to consider and to offer to the PCa patients the techniques related to the physiotherapy before and after the treatment. Cancer is characterized by an uncontrolled growth of abnormal cells in the body and it is considered a national health priority area in several countries due to the burden that it places on the individual, families and the community -3.An important consideration is that the non-communicable diseases (NCD), including cancer, are overtaking infectious disease as the leading health-care threat in some of middle-income and low-income countries and NCD are the major health and socio-economic issue. In general, Latin American and Caribbean countries are struggling to try to respond to increasing morbidity and death from advanced disease. The health-care systems in these countries face many challenges to treat patients with advanced cancer, due to (i) inadequate funding; (ii) inequitable distribution of resources and services; (iii) training, and distribution of health-care personnel and equipment; (iv) lack of adequate care for many populations and (v) geographic situation pf the houses of the patients. Moreover, the information to the prevention is not totally available to the entire population , 4a, 4b.Nevertheless, advances in health and in general biomedical investigations have improved survival and quality of life of the patients with cancer. In consequence, older cancer survivors have represented an important group in the population -6. TheseBesides the knowledge about clinical interventions, the physiotherapist needs to be in contact with the recent advances, in general, of the scientific literature involving cancer. Moreover, this professional must know about the risk factors and participate in actions and attempts to aid in the prevention of this disease -9.The risk of some cancers, such as prostate, may be reduced in people living in areas of high ambient solar radiation or with high sun exposure in comparison with the individuals where the converse is the case -12. In aNaturally, the information about the protection against the unnecessary and undesirable exposition of the sunlight is also very important , 16.The general knowledge about the actions to aid to prevent the prostate cancer (PCa) is highly desirable, due to undesirable clinical conditions due to the consequences of some techniques used to treat the Pca, as the radical prostatectomy (RP) and the radiotherapy (RT). These conditions can bring bothersome, as the urinary incontinence (UI) and the erectile dysfunction (ED), as they can comprise directly the sexual health and the quality of life of the patient. It is important that the interprofessional team, including a physiotherapist, be prepared to discuss these questions and to present strategies to help the patient in the various stages of the treatment , 18.The procedures of the physiotherapy, in general, have the purpose of developing, maintaining and restoring the maximum movement and functional ability of each individual, considering the specific limitations, the disease and the medications related to the patient. The role of the physiotherapist within the interdisciplinary group is well defined in various clinical conditions, as with the patient with PCa , 9, 19.et al, 2012  the knowledge and understanding of the anatomic structures related directly with the pelvic floor, (ii) the correct breathing and (iii) the perception of the muscles of the pelvic floor, as other muscles of the pelvis. Specific attention is given to the comprehension of the functions of these muscles, especially to the relevance of the levator ani muscle , 25-31. al, 2009 , during al, 2009  that hasal, 2009  has beenUI and ED has been also treated with the various exercises (kinesiotherapy) involving the muscles of the pelvic floor in patients submitted to RP. Prior to a pelvic floor muscle exercise program, an anal assessment is performed to grade the strength, endurance and speed of the anal sphincter and the puborectalis muscle. Pelvic floor muscle exercises are individually taught to ensure that they are being performed correctly , 32. TheSexual health is a state of physical, emotional, mental and social well-being in relation to sexuality. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors -36. ConsFigure PCa is the most commonly diagnosed solid cancer among men worldwide and is the most frequent of all cancers in Europe and North America. Mortality rates tend to be higher in less developed regions of the world including parts of South America, the Caribbean, and sub-Saharan Africa , 38, 39.In Table The high relevance of the cancer can also be demonstrated by the number of scientific research  identified on September 10th 2012 in the database system PubMed  . The keyThe early diagnosis of PCa has been facilitated by the determination of the prostate specific antigen (PSA), rectal touch and ultrasonography, which has subsequently led to a high cure rate in the early stages (stage I/II) of the disease. , 41-43. In general, RP is a curative and appropriated therapy for any patient whose tumour is clinically confined to the prostate. Other factors affecting treatment decisions include patient factors, such as (i) Current symptoms , (ii) Current age (preference under the age of 70 years), (iii) Concurrent illnesses may determine suitability or not for surgery, (iv) Patient preference  -48.In Table RT is another option for treatment of PCa and it uses high-energy X-rays or other types of ionizing radiation to try to kill the cancer cells in various organs/tissues. In addition, RT combined with androgen deprivation therapy (ADT) is used in patients with locally advanced tumors and/or those with high Gleason scores, characterized as intermediate or high-risk profiles .Table Naturally, the clinical conditions and the early diagnosis of the PCa will minimize the undesirable findings due to the therapeutic procedure. Severe complications following RT can occur and these undesirable findings depend on the type of the procedure used in the surgery and UI and ED have also been associated with the RT , 47, 50.As presented before, UI and ED are undesirable side effects normally associated with the RP and RT due to the damage of the muscles of the pelvic floor , 45, 46.ED, in general, is usually due to a multifactorial etiology, comprising organic, psychological, or mixed aspects, and may often require a multidisciplinary approach for assessment and treatment. Organic causes encompass vascular, neurologic, hormonal, as a result of medications, pelvic surgery (mainly RP), RT, diabetes or mixed factors. In general, any condition that can cause damages to the nerves or impair blood flow in the penis may lead to ED. Pelvic surgery  might damage cavernous nerves and arteries near the penis, causing ED , 46.The economic burden of ED is not just limited to the cost of diagnosis and treatment. Other impacts on the Society and in diary life that are difficult to quantify are shown in Table et al, 2009 , physiology and hydrodynamic transport urine of the voiding mechanism, thus detailing the stages of filling and emptying as well as the sphincter behavior. Common urodynamic findings in post-RP patients are (a) internal sphincter deficiency and (b) bladder dysfunction (detrusor instability and decreased compliance) , 25-30.et al, 2009  using physiotherapy procedures, since both the duration and degree of UI after RP decrease in these case , 53-55.When a patient with PCa is referred to undertake physiotherapy procedures before the surgery or radiotherapy, it is possible to teach him about the perception of the muscles of the pelvic foor, facilitating the performance of exercises involving these muscles associated with an ideal breathing, just after the RP or RT , 25-30.Besides the ED, another clinical conditions related to the sexual functions can appear in the patient submitted to a RP, as the loss of ejaculation and the decrease of the libido and orgasm , 46, 48.Several options of treatment are available to treat ED, as psychosexual counseling, medication, use of physiotherapy , intracavernous injection therapy, vascular surgery, and use of a penile prosthesis. The clinical interventions used in the physiotherapy provide noninvasive methods that are easy to perform, painless, and inexpensive , 52, 53.Most physiotherapy treatments for ED focus also on pelvic floor muscles. It is relevant to consider also the arrangement of the muscles at the base of the penis, as well as the other local structures that, with the time without erection, can lead to veno-occlusive ED. ED can be a result of a sequence of penile morphologic alterations post-RP. The physiotherapist will guide the patient to do exercises for the muscles direct related to the pelvic floor and also to the muscles indirectly related with the pelvis, such as abdominal and gluteal muscles. When they are contracted an increase of the local blood flow to the pelvic region is verified. This process seems to lead to a release of NO to the penis, acting on endothelium vasodilation and dependent on the flow, increasing in oxygen supply to the penile tissue and keeping the erectile tissue healthy , 29, 53.The physiotherapist, from his assessment, can also help the patient with PCa in the presurgical period in which the exercises for the pelvic floor and for the respiration that will be performed in the post-surgical period can be learned early by the patient. Moreover, the knowledge and the perception of the muscles of the pelvic floor by the patient will be very important. As these muscles are located inside the pelvis, they are considered a continence muscle group giving structural support for the pelvic organs and the pelvic sphincters . Based on urethral continence maintained by muscles of the pelvic floor, the procedures of the physiotherapy of this muscle group can retake the control of the urinary continence or maximize it, also by nerve stimulation, according to the consensus, which can inhibit the detrusor muscle, increasing the quality of life of patients with PCa , 25-30.On physical examination is evaluated the strength and the tone of the pelvic floor muscles through the anal sphincter, perineal sensation and bulb-cavernosum reflex. Maneuver effort, such as coughing, can evaluate the sphincter function, which can be performed with the patient standing, with the bladder full, and where he is asked to simulate cough. From this assessment is given the goal of treatment , 25-30.The perception of the muscles of the pelvic floor may be increased with the use of the electrotherapy and this technique might guide the patient to correct contraction of the muscles of the pelvic floor. Two types of electrodes can be used in the electrotherapy; internal  and external electrodes Figure  and 3b , 55, 57.In Figure Beneficial effects of pre- and postoperative pelvic floor re-education are clear, since both the duration and degree of UI after RP can be distinguishably decreased , 21, 54.Concerning ED, when a man wakes up from a RP he will almost certainly have ED initially. If there is going to be a recovery of erectile function, it may take 18-24 months to occur. Approximately 30% of men will recover erectile function and medication  will usually boost this recovery. However, physiotherapy procedures could be another suitable option without contraindications. In addition, the patient that has learned about the exercises involving the muscles of the pelvic floor can start these exercises immediately just after the surgery or after the catheter removal , 58.Mechanical vacuum devices cause erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. The physiotherapist will guide the patient to do exercises for the muscles direct related to the pelvic floor  and also et al, 2002  develops strategies towards the prevention, research, education and control of the cancer. Important medical developments and relevand scientific findings have permitted that people with cancer can survive with their disease and with the side effects of their disease and its treatment for longer , 68, 70 People are living longer with their cancers, which in many cases are treated as chronic disease, due to the early detection and advances in treatment options. Physiotherapy has responded to the improved outcomes and patient demand for quality of life improvements by instituting new treatments and education, such as informing about the possible importance of the sunlight in the prevention of the PCa , 5, 70 aet al, 2009 (As Katz and Katz, 2008  and Bernal, 2009 , it is rWhen the available procedures to minimize the clinical complications of the RP or of the RT are considered, it is highly relevant to emphasize that the decrease of the appearance of complications occurs in patients thar have undergone physiotherapy before the RP and the improvement of the symptoms is observed due to the procedures of the physiotherapy just after the RP , 18. Duret al, 2009 (et al, 2006 (et al, 2009 (Dorey al, 2009  have repal, 2006  suggest al, 2009  describeet al, 2012 (Zhu al, 2012  have evaet al, 2011 (Khoder al, 2011 , have evet al, 2010 (Yamanishi al, 2010  have evaet al, 2005 (et al, 2009 (Wilson al, 2005  and Doreal, 2009  has repoet al, 2012 (Baumann In conclusion, the knowledge of the patient about his situation as well as the involvement of the family and partner must be strongly considered. Moreover, it is also important to explain and present all the possibilities involving the treatment of the PCa. In addition, it is highly desired thal all the modalities of procedures that are available to aid in the prevention of undesirable clinical conditions. Furthermore, it is suggested that is necessary to consider the techniques related to the physiotherapy before and after the treatment of choice to the PCa.


The present study was conducted to investigate the prevalence of musculoskeletal disorders and eye and vision complaints among the computer users of King Abdulaziz University (KAU), Saudi Arabian Airlines (SAUDIA), and Saudi Telecom Company (STC). Stratified random samples of the work stations and operators at each of the studied institutions were selected and the ergonomics of the work stations were assessed and the operators' health complaints were investigated. The average ergonomic score of the studied work station at STC, KAU, and SAUDIA was 81.5%, 73.3%, and 70.3, respectively. Most of the examined operators use computers daily for ≤ 7 hours, yet they had some average incidences of general complaints  and relatively high level of incidences of eye and vision complaints and musculoskeletal complaints. The incidences of the complaints have been found to increase with the (a) decrease in work station ergonomic score, (b) progress of age and duration of employment, (c) smoking, (d) use of computers, (e) lack of work satisfaction, and (f) history of operators' previous ailments. It has been recommended to improve the ergonomics of the work stations, set up training programs, and conduct preplacement and periodical examinations for operators. The one thing that has had the greatest impact on our lives in modern time is the computer. Along with smaller size and affordable prices, there has been the advent of the Internet. This has ensured that people use this technology either at their work place or at home. Meanwhile, the applications of computer technology and the accompanying use of video display terminals (VDTs) are revolutionizing the workplaces worldwide, and their use will continue to grow in the future.Although these developments may perform operators' tasks efficiently, they could face some factors such as work stress, repetitious tasks, boredom, interpersonal factors, unsafe postures, and poor design of workstation that will negatively affect their health, performance, and productivity. For example, the development of VDTs technology may have contributed to the increase of users' health problems such as cumulative trauma disorders (CTDs) of upper extremity and back pain –54 as weHowever, the application of ergonomics principles to office workstations will reduce such health risks. For example, one of the goals of the ergonomic processes is to design or modify people's work and other activities to be within their capabilities and limitations , 85–88. Currently computer related injuries are developing into an epidemic among computer users. It is estimated that, worldwide, 25% of computer users are already suffering from computer related injuries . The UniThe tremendous use of computer by the staff members, technicians, and students at King Abdulaziz University (KAU), by our experience, has been accompanied by increase in the number of attendances to University Medical Directorate (Services) with general, eye and vision, and musculoskeletal complaints. When this observation was brought to the attention of KAU officials, they urged and encouraged concerned personnel to study the nature of this problem and propose remedial actions.Meanwhile, one of the first institutions that had applied computer technology in Saudi Arabia was the Saudi Airlines tickets' reservation offices (SAUDIA). It is considered to be one of most eligible areas to conduct a study regarding VDT health related problems. Putting this in mind, KAU urged concerned personnel to include it in the present study. Also, the Saudi Telecom Company (STC) works in Jeddah comprises nearly 430 VDT workstations where 360 operators and mostly 70 supervisors work for whole shifts. There have been some claims that these operators and supervisors suffer some general musculoskeletal and eye and vision complaints. Consequently, these works have been decided to be included in this study.to evaluate the magnitude of the problem of inconveniences in the use of computers in KAU, SAUDIA, and STC, as well as the inconveniences in the computers' workstations,to investigate computers' operators health complaints,to investigate environmental and behavioral factors contributing to the occurrence of the complaints,to propose remedial actions that might contribute to reducing these complaints.The objectives of the present study wereInventories of the computer workstations and operators in the different colleges and units of KAU, in the different departments and units of SAUDIA tickets' reservation offices, and in the different departments and units of STC head office in Jeddah had, primarily, been conducted to assess the magnitude of computer use there. The findings of the inventories are summarized in Representative random samples of 100 workstations, and operators , were selected from each of the three institutions, considering that the selection of the sampled stations and operators had been affected by the readiness of the individual administrations and operators in the different departments and units to participate in the study. The selected stations are also presented in U.S. Department of Health and Human Services, Centers of Disease Control, and Prevention (CDC), Evaluation Checklist;National Institute for Occupation Safety and Health (NIOSH) Ergonomics Work-Place Evaluations of Musculoskeletal Disorders Checklist;U.S. Department of Labor, Occupational Safety, and Health Agency (OSHA) Computer Workstation Ergonomic Checklist;University of California Computer Workstation Self-Evaluation Checklist;California State University Ergonomics Evaluation Checklist;Cornell University Ergonomics Checklist;University of Virginia Library Ergonomics Evaluation Form;Institute for Occupational Physiology at the University of Dortmund Checklist for Computer Workstation;Atlantic Mutual Centennial Insurance Company Workstation Checklist.A study form entitled “Ergonomics Rating of Computer Applications” was developed to assess the ergonomics status of the studied computer workstations. The form was designed after reviewing the ANS/HFES Committee document , and manThe ergonomics score for the evaluation of the workstation is 43, distributed by the different components. Each component has certain number of scores, determining the maximum score of the component as shown in Each score item is clearly presented to be answered by “Yes” or “No” to avoid any personal differences or any bias by the evaluators. The “Yes” answers are counted to represent the score out of 50, and some ten stations were evaluated to test the study from and found to be satisfactory for the conduct of the study. Furthermore, the evaluation of the workstations was carried out, only, by the authors for quality assurance of the data collection. The study form has been designed in four major sections including the following.Section (1). It includes basic information of investigated organizations (colleges/units), particularly as related to presented services.Section (2). It includes ergonomics rating of investigated workstations by checking the details of each component of the work place, includingdesk, as related to space of desk top, layout of the desk, top equipment, desk top and distance from operator's eye, and existence of comfortable resting facility for operators' hands and rest;seat, as related to dimensions, casters, operators' leg clearance, armrests, back rest, seat cushion, and seat comfort ability and stability;footrest, as related to need, availability, and status of footrest;display screen, as related to location, height and tilting of the monitor, distance from operator's eye, freedom of screen from glare and reflection, stability of image and freedom from flickering, ease to read characters, and possibility of adjusting screen brightness and contrast;keyboard, as related to dimensions, location with reference to operator's hands and elbows, and exchanging operation between keyboard and mouse without operator's hand extension or twisting wrist;mouse, as related to its location with reference to operator smooth running and operator's awareness of its details of operation and maintenance;document holder, as related to need, availability, and status of the document holder;space and room layout, as related to adequate access to work place, availability of space to maneuver the seat, work correct posture, availability of adequate space for equipment needed for work, location of monitor with reference to windows, freedom of work area from obstructions, and hazards of tripping and neatness of the work area;task and posture, as related to freedom of operator's hands from phone while typing and resting his hand wrists;illumination, as related to level of lighting, status of luminaries and illumination fixtures, use of blinds on windows, and background of the screen with surrounding environment;noise and thermal environment, as related to level of quietness and status of air conditioning in work area.Section (3). It includes work organization rating, by investigating work organization, work hours, rest pauses and noncomputer work assignment, and work load.Section (4). It includes training and provision of information, by investigating operator's on-the-job and formal training, certainty of his use of software, keying habits, operator's capability of control of his workstation and work environment, and operator's adoption of good posture and avoiding visual fatigue at work.A study form entitled “Impact of Computer Use on Operators” was developed to evaluate the effect of computer use on operator's health as reviewed and/or recommended by the NIOSH , WHO 5]5], and ASection (1). It includes basic data, including name, gender, address, workstation, age, education, and smoking habit.Section (2). It includes work data, including work type, duration of employment, formal training, work speed, daily hours of computer use, nature of computer use (continuous or intermittent), and work satisfaction.Section (3). It includes health disorders before present work, including previous ailments or complaints of the musculoskeletal system and complaints of the eye and vision.Section (4). It includes current symptoms, including the general complaints and their frequency, the eye and vision symptoms and their frequency, the maximum work hours before their occurrence and the time required for their release, and the musculoskeletal disorders and their location, description, frequency, and persistence, as well as the approached medical treatment and the sickness absenteeism as related to the work-related ailments.The collected data were visually inspected for fliers, then introduced into PC, and subjected to statistical analysis using Microsoft Excel 2007.The ergonomics scores of the studied workstations in the three institutions are illustrated in The demographic and occupational characteristics of the studied populations of the computer users/operators in the three institutions are presented in Tables Most of the study populations were nonsmokers  and 26% of them at STC were light smoker (smoking index less than 200) that might be added to the proportion of the nonsmoker there to be 88%. This distribution might, however, be biased by the relatively young age of the examined subjects.Considerable proportion of the populations either had no vision problems before employment , or were short-sighted , while the rest were long-sighted or had other vision problems . Similarly, more than one half of the populations at the three study locations had no musculoskeletal symptoms before employment , while considerable proportions of the populations had neck pain . The rest of the populations had such symptom at one or more body locations.More than one half of the population of KAU (52%) was either typist (23%) or involved in comprehensive office tasks (29%), while 40% of them were involved in data entry (22%) and data acquisition (22%). However, at SAUDIA, 77% of the populations were involved in data entry (54%) or data acquisition (23%) while 20% of them were involved in communication tasks and none of them was typist. Similarly, at STC, 86% of the populations were involved in communication tasks (53%) or data entry (33%), and none of them was typist. While 58% and 61% of the populations at KAU and SAUDIA, respectively, received on-the-job training only, and the rest received formal training for different periods, the opposite existed at STC, where 72% of the population received formal training for different periods, and only 28% of the population received on-the-job training only. Consequently, 61% of the populations at KAU and 70% at SAUDIA considered their work speed as average  or slow , while 45% of the population at STC considered their work speed as fast and 55% of them considered their work speed as either average (49%) or slow (6%).Considerable proportions of the populations at KAU and STC used computer for 7, 8, or 9 hours per day (44% and 39%), while the whole population at SAUDIA (100%), and 53% of them at STC, used computer for 6 hours. On the other hand, 36% of the operators at KAU used computer for 3, 4, or 5 hrs. per day, while none of them at SAUDIA, and 9% of them at STC, operated computers for these shorter periods. However, only 53% of the SAUDIA population operated computer continuously in comparison to 85% of the STC and 61% of KAU populations. Meanwhile, mostly 70% of KAU (69%) and STC (68%) populations had rest pauses <25% of the work shift, and 22% of the two populations got rest pauses 30%–40% of the shift, while the whole SAUDIA population had 25%–29% of their shift as rest pauses, in comparison to 9% and 10% of the other two populations.Eighty-two percent of the computer users in KAU, 72% of the operators at SAUDIA, and 60% of operators at STC were satisfied (and many were even very satisfied) at their work, particularly as related to their excellent satisfaction by their colleagues, work control, job attitude, and vigilance requirement, while the boredom from repetitive work and monotony and the work stress were the main causes of dissatisfaction among them, particularly the SAUDIA and STC populations .The operators' health complaints are presented in Tables Only 41% and 46% of KAU and STC populations, in comparison to 61% of SAUDIA population, reported eye and vision symptoms. The most predominant eye symptoms were eye redness, tearing, pain, and redness, and the most predominant vision symptoms were blurring, particularly for distance objects, as well as sensitivity to light .Thirty percent, 49%, and 39% of the KAU, SAUDIA, and STC populations were free from musculoskeletal symptoms. The main occurring symptoms were aching, tingling, numbness, pain, and stiffness, which occurred, mostly sometimes, and, to a less extent, often . The higThe effects of age and duration of employment  on the incidence of operators' health complaints are shown in Tables The impact of the ergonomics score of the workstation on the incidence of operators' complaints is shown in Out of the many factors considered for their effects on the incidences of the operators' complaints and symptoms, the smoking habit, the type of work, workers satisfaction, and the operators' history of musculoskeletal complaints and of eye and vision before joining present work showed some effects as indicated in Tables It is worth noting that the lowest eye and vision complaints occurred among the operators who had the lowest level of education , which might be interpreted by their relatively lower involvement in vision tasks than the operators having higher levels of education.As related to the impact of type of work on the incidence of complaints, results in Nevertheless, the work satisfaction showed clear impact on the incidence of health complaints among the examined computer users, where the percentages of those who were free from complaints got higher by the improvement of work satisfaction ; meanwhiThe history of previous ailments among computer users/operators, also, had some impact on the reported complaints among them, where the percentages of the present complaints among the subjects who had no previous ailments were less than among the other subjects reporting related ailments' history Tables –18.The average ergonomics score at STC was 81% which may be considered as a good level. However, and unexpectedly, the average ergonomics scores at KAU and SAUDIA were only 73.3% and 70.3%, respectively. It had been anticipated that the average ergonomics scores for the computer workstations existing in leading institutions like KAU and SAUDIA should be considerably higher.Although the examined populations in KAU and STC were relatively young and, consequently, had relatively short employment work duration, were relatively highly educated, had relatively low smoking index and low history of ailments before employment, had some type of on-the-job and/or formal training, mostly use computer daily for <7 hours and continuously getting rest pauses, and were mostly satisfied at work, yet they had somewhat high incidences of general complaints , vision complaints, and musculoskeletal complaints. However, within SAUDIA population, surprisingly, the highest health complaints were among the youngest operators, who also had the lowest duration of computer work, as well as among those who had on-the-job and/or formal training; meanwhile, no systematic effect of the workstations' ergonomic scores on the incidence of the complaints was observed. These anomalies might be attributed to having some of the operators who developed complaints there left or changed their work.Naturally, the operators who were satisfied by their work and those who were conducting comprehensive works  as well as those who had no, or inconsiderable, history of previous ailments had the least incidence of the health complaints.Meanwhile, higher incidences of the complaints existed among the smoking operators and those who did not work continuously with computer, as well as those who rated themselves as fast operating.In summary, the incidence of the various complaints had been demonstrated, generally, to increase by (a) the decrease in the ergonomics score of the workstations, (b) the progress of age and duration of employment, (c) the increase of smoking habit, (d) the continuous daily use of computer, (e) the lack of work satisfaction, and (f) the history of operators' previous ailments. However, unexpectedly, no effect could be demonstrated of the operators' formal training and the daily hours of computer use, on the incidences of the complaints.It is anticipated that the incidences of the different complaints among the examined population increased by their progress in the duration of work. Therefore, it is recommended that rapid actions should be taken to improve the ergonomics of the computer workstations. The improvement of each workstation should be considered separately with reference to the evaluation checklist of its individual components.Setting up training programs for computer operators to efficiently use their computers and optimize their posture and movements inside their computer workstations based on ergonomics principles is highly recommended. Also, motivation of workers to learn about computer work-related health disorders, their causes, etiology, preferable postures and movements, and the role of fitness exercise, and encouraging them to take rest pauses within their work shifts, all are recommended.It is recommended to conduct preplacement examination for computers' operators to exclude subjects with history of ailments that might be aggravated by computer use and to have available health baseline for the employed subjects as well as periodical medical examination  to assure normal health background and to early discover any deviation from normality.Finally, the study recommends extending the research to cover the sectors of computer and VDTs users, particularly those employed by small offices and medium-size enterprises where it is anticipated to have ergonomics poorly designed workstations. Also, particular interest may be forwarded to investigating the presently studied complaints among the female computer users in KSA.


Iron (Fe) is an essential micronutrient and its deficiency is a serious nutritional problem for all living organisms. This is because Fe is not only a basic requirement in cellular functions such as the redox reactions in photosynthesis and respiration, but is also required in the enzymatic processes like DNA replication, lipid metabolism, and nitrogen fixation in plants  from the Ministry of Education, Culture, Sports, Science and Technology of Japan; a Grant-in-Aid for Scientific Research from Nara Institute of Science and Technology supported by The Ministry of Education, Culture, Sports, Science and Technology, Japan. SZ acknowledges the DBT, New Delhi, India for award of CREST, Overseas fellowship to undertake this research.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Background: The global burden of conduct disorder is a major public health concern. Although there are different reports on the prevalence of conduct disorder in different Middle Eastern countries, to date, no research has reviewed them. Therefore, we aimed to conduct a systematic review and meta-analysis on the literature and present the prevalence of conduct disorder among children and adolescents in Middle Eastern countries.Methods: Those cross-sectional studies with any type of random or non-random sampling, which described the prevalence of conduct disorder prior to age of 18, for at least one gender in the general or school-based populations who resided in Middle Eastern countries were included in this review. The scientific databases of PubMed, Scopus, Google Scholar, Index Medicus for the Eastern Mediterranean Region (IMEMR), Islamic World Science Citation Center (ISC), and Grey Literature including conference proceedings, and hand searching of key journals were searched from 1995 to the end of 2014. Two reviewers assessed the quality of the included studies independently and extracted the relevant data. Discussion: This review provided a picture of different frequencies of conduct disorder in Middle Eastern countries and analyzed the sources of heterogeneity. Systematic Review Registration: PROSPERO CRD42014014996 Conduct disorder is characterized by aggressive behaviors towards people and animals, deceitfulness or theft, destruction of property and serious violations of rules which persist in the child or adolescent during the past 12 months prior to age 18  revealed a prevalence rate of 32.9% for conduct disorder in Iranian children and adolescents . AnotherIn this systematic review, we aimed to investigate the prevalence of conduct disorder in the Middle East. Although there are different reports of prevalence of conduct disorder in different regions of the Middle East, to date, no research has reviewed them. Therefore, we conducted a systematic review and meta-analysis on the literature and presented the prevalence of conduct disorder among children and adolescents in the Middle East. Also, the heterogeneity of conduct disorder frequencies in the various countries of the Middle East was assessed, and the potential sources of heterogeneity were analyzed.Inclusion and Exclusion CriteriaCross-sectional studies including descriptive and survey studies, with any type of random or non-random sampling were included in this systematic review. The included studies described the prevalence of conduct disorder among children and adolescents prior to age of 18 for both genders, and at least one gender, in the general or school-based populations, residing in Middle Eastern countries. Moreover, the included studies defined conduct disorder based on the third, fourth and fifth versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM).We excluded clinical or interventional studies, and researches reporting the prevalence of conduct disorder with comorbidities, and we also excluded those studies conducted on single or high-risk groups.Search StrategyTo identify the included studies, we systematically searched five databases including PubMed, Scopus, Google Scholar, Index Medicus for the Eastern Mediterranean Region (IMEMR), and Islamic World Science Citation Center (ISC). We also searched grey literature including conference proceedings. Moreover, hand searching of key journals and reference lists of all the included studies were reviewed. Moreover, we searched all studies from 1995 to the end of 2014. The following key-terms were included: Conduct disorder, prevalence, and The Middle Eastern countries . Also, tThe two authors selected the included studies independently based on the full texts.Data Collection and AnalysisData ExtractionRelevant data were independently extracted from the included studies and entered into the data extraction form by the two reviewers, who resolved the inconsistencies of the extracted data through consensus. The extracted data included the followings: The first author, publication year, journal, survey years, study design, name and population of the study location , district of study location , sample size, response rate, gender, age, type of sampling, sample population , type of school (state/private), instruments, paternal and maternal occupation, level of paternal and maternal education, number of siblings, family income, maternal and paternal loss, addiction and crime of family. Quality AssessmentFor this review, we used the method and result sections of the STROBE checklist for quality assessment of the selected cross-sectional studies . This toStatistical Analysis and Data SynthesisWe used graphical methods and fixed or random effect models for the statistical analysis of the data. Sub-groups analysis or meta-regression was used to assess the sources of heterogeneity. Also, sensitivity analysis was performed, and publication bias was assessed using graphical methods and statistical tests. In this review, we investigated the studies conducted on the prevalence of conduct disorder in Middle Eastern countries from 1995 to the end of 2014 in order to analyze the sources of heterogeneity. The findings revealed a picture of different frequencies of conduct disorder in Middle Eastern countries, and contributed to a better understanding of the heterogeneities among the various reported prevalence rates of conduct disorder. The findings of this review may improve policy decisions, leading to a reduction in conduct disorder symptoms and providing improved special services for children and adolescents with conduct disorder.We will not be able to combine or meta-analyze the results, if there is methodological heterogeneity between the studies. Also, we may not be able to access to all gray literature in our review.This review provided a picture of different frequencies of conduct disorder in Middle Eastern countries and analyzed the sources of heterogeneity.


Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC.


Department of Health and Human Services, the task force is an independent, nonfederal, unpaid panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC.


Most biliary tract neoplasms are malignant and have been traditionally divided into cancers of the gallbladder, the extrahepatic bile ducts, and ampulla of Vater. Although infrequent, bile duct carcinomas and cancer of the gallbladder are not rare. In the United States, an estimated 6,000 to 7,000 new cases of carcinoma of the gallbladder and 3,000 to 4,000 new cases of carcinoma of the bile ducts are diagnosed annually. Familiarity with the imaging characteristics of gallbladder and bile duct neoplasms is important to expedite diagnosis and appropriate treatment of patients who often present with nonspecific symptoms of right upper quadrant pain, jaundice, and weight loss. This workshop presents the CT and ultrasound features of biliary tract neoplasms important for early diagnosis, staging, and follow-up of these often lethal neoplasms


The economic burden of chronic diseases and conditions  requires new solutions not only in traditional clinical settings (in-patient treatments), but also in innovative healthcare scenarios (out-patient long-term monitoring).New technologies can provide clinicians and patients with many solutions at different levels: diagnostic and monitoring, early risk detection, treatment and rehabilitation, provision of feedback and alerts, and motivational strategies that facilitate changes in dysfunctional behaviors or maintenance of healthy lifestyles. A health technology assessment approach is necessary in order to collect evidence to evaluate the clinical and cost effectiveness of new tools and to strengthen the political choice to use health technologies in clinical fields.Telemedicine, e-health, and m-health scenarios can improve health outcomes, quality of life, and well-being and facilitate functional patient empowerment and engagement. Mobile technologies in particular can offer advantageous solutions: m-health could be considered an evolution of e-health and defined as the practice of medicine and public health as supported by mobile communication devices. Indeed, the m-health approach has the potential to overcome many of the limitations associated with the traditional, restricted, and highly expensive in-patient treatment of many chronic pathologies.A range of electronic health systems have been implemented in chronic disease management using stationary and mobile computers, smartphones, and other mobile platforms with differing access to data technology. New innovations in technology are required to meet the challenges associated with overcoming various barriers such as organizational and technological difficulties, lack of technology acceptance, costs of system implementation and maintenance, lack of system interoperability with other informatic tools, reduced communication between clinicians and patients, and difficulties in data processing due to the limitations of devices used in patient monitoring.There is potential for the development of a new and innovative model of healthcare as represented by such technologies as telemedicine, e-health applications, biomedical sensors and devices, integrated platforms and technologies for remote monitoring and management, web and Internet based clinical protocols, and m-health solutions. This model has the potential to offer healthcare that is tailored to the specific needs of the individual, whilst providing the benefits of a mobile, noninvasive, balanced, integrated, and lifestyle friendly framework that is useful from both a preventative and intervention-focused perspective.The major aim of this special issue is to bring to light new international developments in the management and rehabilitation of a range of chronic diseases and clinical conditions, such as stroke, dementia, cardiovascular diseases, dialysis patients, or those with facial paresis. A range of technological developments, lifestyle, and environmental factors have been described in relation to these diseases, including a rehabilitation system for stroke patients using vibrotactile feedback, a new system of facial movement analysis for facial paresis, an exploration of the effects of exercise for dialysis and cancer patients, and the influence of environment on those with dementia and coronary artery disease.In conclusion, as demand for the management of a range of chronic conditions increases in the imminent future, there is likely to be considerable scope for the integration of clinical psychology and medicine. A key future challenge for those working in both traditional and m-health/e-health settings will be to further develop the evidence base for chronic care management in order to enhance technological standards and fine-tune both clinical protocols and organisational models.Gianluca CastelnuovoGiancarlo MauriSusan SimpsonAngela ColantonioStephen Goss


Journal of Neuroinflammation is an Open Access, online journal published by BioMed Central. Open Access publishing provides instant and universal availability of published work to any potential reader, worldwide, completely free of subscriptions, passwords, and charges. Further, authors retain copyright for their work, facilitating its dissemination. Open Access publishing is made possible by article-processing charges assessed "on the front end" to authors, their institutions, or their funding agencies. Beginning November 1, 2004, the Journal of Neuroinflammation will introduce article-processing charges of around US$525 for accepted articles. This charge will be waived for authors from institutions that are BioMed Central members, and in additional cases for reasons of genuine financial hardship. These article-processing charges pay for an electronic submission process that facilitates efficient and thorough peer review, for publication costs involved in providing the article freely and universally accessible in various formats online, and for the processes required for the article's inclusion in PubMed and its archiving in PubMed Central, e-Depot, Potsdam and INIST. There is no remuneration of any kind provided to the Editors-in-Chief, to any members of the Editorial Board, or to peer reviewers; all of whose work is entirely voluntary. Our article-processing charge is less than charges frequently levied by traditional journals: the Journal of Neuroinflammation does not levy any additional page or color charges on top of this fee, and there are no reprint costs as publication-quality pdf files are provided, free, for distribution in lieu of reprints. Our article-processing charge will enable full, immediate, and continued Open Access for all work published in Journal of Neuroinflammation. The benefits from such Open Access will accrue to readers, through unrestricted access; to authors, through the widest possible dissemination of their work; and to science and society in general, through facilitation of information availability and scientific advancement. Journal of Neuroinflammation is an Open Access, online journal that is published by BioMed Central, an independent publisher committed to Open Access for peer-reviewed biomedical research [Journal of Neuroinflammation. Open Access publishing is made possible by article-processing charges (APCs) assessed "on the front end" to authors, their institutions, or their funding agencies. The Journal of Neuroinflammation will introduce APCs of around US$525 per article for manuscripts submitted on or after November 1, 2004. This charge will be waived for all authors from institutions that are BioMed Central members, and in additional cases for reasons of genuine financial hardship.research . Among tTraditional journals generally do not charge authors for publication . Instead, article access is traditionally paid for by readers, either through subscriptions or through fees assessed for online viewing and downloading. Over the past decade, escalating journal subscriptions have resulted in cash-strapped libraries cancelling journal subscriptions , thus liJournal of Neuroinflammation's Open Access policy changes the way in which articles are published. First, all articles become freely and universally accessible online, immediately upon acceptance, so an author's work can be read by anyone at no cost. 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