[The Place of Groin, Colson and McGregor Flaps in the Acute Care of Deep Burns to the Hand Dorsum : A Series of 6 Cases In Lille's Burn Centre]

The acute management of deep burns to the dorsum of the hand and fingers represents a challenge for the reconstructive surgeon. The exposure of osteo-tendinous structures often requires flap coverage, in a context where loco-regional or free flaps are not always feasible. The aims of reconstruction are to preserve a maximum of digital length, provide supple tissue, obtain protective sensitivity, and achieve a functional hand at 1 year. We report here on a series of 8 deep burns to the dorsum of the hand. Six hands were covered by Colson abdominal flap-graft and two by pedicled inguinal flap. Four out of 6 patients were reviewed in consultation, 1 patient was lost to follow-up, and 1 patient died. Clinical evaluation was performed by a surgeon other than the operator. Functional results are highly variable. Coverage time varies according to lesion depth and patient severity. Flap weaning took place at an average of 30 days. DASH scores ranged from 17.5 to 93/100, with average to poor total active motion (TAM) scores. The aesthetic result was satisfactory, with a Vancouver score of 4.5/13 on average, and an overall patient opinion of 3.75/10 on the POSAS scale. For deep burns to the dorsum of the hand and fingers, local flaps are rarely possible, and loco-regional flaps are not feasible in cases of associated upper limb damage. For medium to large surface areas, pedicled inguinal flaps and pocketing are two reliable techniques. Nevertheless, they require relative immobilization of the upper limb, which leads to stiffness. The question of digital pinning in the intrinsic or straight position remains unresolved, and does not appear to prevent secondary deformities. There is also a learning curve for these two flaps, even though they are reputed to be easy to lift. McGregor's flap or pocketing can be weighed against free flaps. However, the operating time is long, the surgical technique is complex, and vascular damage is common in the burn patient population. Although there have been enormous technical advances since their descriptions, the pedicled inguinal flap and pocketing remain alternatives to be considered in the acute management of deep burns to the dorsum of the hand. In this presentation, we propose a surgical management algorithm to situate these two techniques in the plastic surgeon's therapeutic armament.

A systematic review of Radiesse® (calcium hydroxylapatite): evidence and recommendations for the body

A filler composed of calcium hydroxylapatite and carboxymethylcellulose gel (CaHA/CMC) has been shown to possess biostimulatory and skin-tightening properties that have been applied not just to the face but also to the body to boost rejuvenation. Recently, evidence and recommendations for CaHA/CMC treatment of the face have been provided, but they are still lacking in terms of body treatment. This article aims to perform a systematic review of the literature on CaHA/CMC applications on the body and provide evidence from the literature. Currently, the only FDA-approved indication on the body is treating the hands and a recent European Union Medical Device Regulation approval has been released for decolletage treatment. The application of hyperdilutions on the neck, feet, arms, thighs, abdomen, and other body parts has been proven to provide a skin-tightening effect. However, despite their wide use with a good safety profile in clinical practice, recent trends and guidelines of diluted and hyperdiluted CaHA/CMC have yet to be supported by randomized controlled trials.

Prevalence and burden of atopic dermatitis involving the head, neck, face, and hand: A cross sectional study from the TARGET-DERM AD cohort

BACKGROUND

Atopic dermatitis (AD) is severely burdensome, and there has been poor characterization of any differences in impact based on the area affected.

OBJECTIVE

To estimate the prevalence and HRQoL impact of head/face/neck/hand (HFNH) involvement among patients with moderate-to-severe atopic dermatitis.

METHODS

All TARGET-DERM AD registry patients with moderate/severe Investigator Global Assessment (vIGA-AD) were assessed using the Patient Oriented SCORing Atopic Dermatitis, Patient Oriented Eczema Measure (POEM) and the (Children's) Dermatology Life Quality Index ((C)DLQI).

RESULTS

541 participants met the criteria (75.0% adults) and 84% (N = 453) reported HFNH involvement. HFNH and non-HFNH involved participants had similar characteristics; 55.2% female and 46.9% White. Compared to the non-HFNH involved, the involved had severe vIGA-AD (28.5% vs 16.3%, P = .02) and higher median body surface area affected (15% vs 10%, P ≤ .01) and were twice as likely to have higher (C)DLQI and POEM scores.

LIMITATIONS

This was an analysis of real-world and patient reported outcome data.

CONCLUSION

Real-world HFNH involved AD patients were associated with significantly worse quality of life, POEM/(C)DLQI, and more severe disease. Detailed assessments of specific areas affected by AD are needed to personalize treatment.

Motion Capture Technologies for Ergonomics: A Systematic Literature Review

Muscular skeletal disorder is a difficult challenge faced by the working population. Motion capture (MoCap) is used for recording the movement of people for clinical, ergonomic and rehabilitation solutions. However, knowledge barriers about these MoCap systems have made them difficult to use for many people. Despite this, no state-of-the-art literature review on MoCap systems for human clinical, rehabilitation and ergonomic analysis has been conducted. A medical diagnosis using AI applies machine learning algorithms and motion capture technologies to analyze patient data, enhancing diagnostic accuracy, enabling early disease detection and facilitating personalized treatment plans. It revolutionizes healthcare by harnessing the power of data-driven insights for improved patient outcomes and efficient clinical decision-making. The current review aimed to investigate: (i) the most used MoCap systems for clinical use, ergonomics and rehabilitation, (ii) their application and (iii) the target population. We used preferred reporting items for systematic reviews and meta-analysis guidelines for the review. Google Scholar, PubMed, Scopus and Web of Science were used to search for relevant published articles. The articles obtained were scrutinized by reading the abstracts and titles to determine their inclusion eligibility. Accordingly, articles with insufficient or irrelevant information were excluded from the screening. The search included studies published between 2013 and 2023 (including additional criteria). A total of 40 articles were eligible for review. The selected articles were further categorized in terms of the types of MoCap used, their application and the domain of the experiments. This review will serve as a guide for researchers and organizational management.

Microbiological Analysis of Surgeons' Hands in a Public Hospital in São Luis, Maranhão State, Brazil: A Cross-Sectional Study

Antisepsis of the hands of medical personnel is one of the most important steps in the process of patient care, since direct contact can cause the cross-transfer of potentially pathogenic microorganisms at surgical sites. This study aimed to analyze the prevalence of microorganisms on the hands of 131 surgeons in a university hospital before the surgical procedure. Swabs were collected from each clinician's hands before and after handwashing. The samples were placed in a transport medium and immediately delivered to a private clinical analysis laboratory from São Luis-Maranhão. The microorganisms were identified by ionization source mass spectrometry and matrix-assisted laser desorption (MALDI-TOF), and antibiotic susceptibility tests (AST) were performed using the Vitek2 and Phoenix-BD automated system. The results showed a high frequency (100%) of microorganisms before handwashing, but after surgical antisepsis, the rate dropped significantly (p < 0.05) to 27.5%. The gram-positive species most detected were Staphylococcus spp. and Micrococcus luteus, representing 83.9%, followed by gram-negative species, Stenotrophomonas maltophilia, Acinetobacter baumanii, Pseudomonas aeruginosa, Pseudomonas gessardi, Pantoea septica, Serratia marcescens, and Burkholderia lata. The effectiveness of hand antisepsis was 72.5%, demonstrating that surgeons' hands are an important source of microorganisms that can cause infections in hospitalized patients in different care settings.

Effects of High Temperature and Heavy Precipitation on Drinking Water Quality and Child Hand Contamination Levels in Rural Kenya

Climate change may impact human health through the influence of weather on environmental transmission of diarrhea. Previous studies have found that high temperatures and heavy precipitation are associated with increased diarrhea prevalence, but the underlying causal mechanisms have not been tested and validated. We linked measurements of Escherichia coli in source water (n = 1673), stored drinking water (n = 9692), and hand rinses from children <2 years old (n = 2634) with publicly available gridded temperature and precipitation data (at ≤0.2 degree spatial resolution and daily temporal resolution) by the GPS coordinates and date of sample collection. Measurements were collected over a 3-year period across a 2500 km² area in rural Kenya. In drinking water sources, high 7-day temperature was associated with a 0.16 increase in log₁₀ E. coli levels (p < 0.001, 95% CI: 0.07, 0.24), while heavy 7-day total precipitation was associated with a 0.29 increase in log₁₀ E. coli levels (p < 0.001, 95% CI: 0.13, 0.44). In household stored drinking water, heavy 7-day precipitation was associated with a 0.079 increase in log₁₀ E. coli levels (p = 0.042, 95% CI: 0.07, 0.24). Heavy precipitation did not increase E. coli levels among respondents who treated their water, suggesting that water treatment can mitigate effects on water quality. On child hands, high 7-day temperature was associated with a 0.39 decrease in log₁₀ E. coli levels (p < 0.001, 95% CI: -0.52, -0.27). Our findings provide insight on how climate change could impact environmental transmission of bacterial pathogens in Kenya. We suggest water treatment is especially important after heavy precipitation (particularly when preceded by dry periods) and high temperatures.

Analysis of the force–time curve and median frequency of surface electromyographic signals during isometric hand grip test for estimation of a temporal pattern for muscle strengthening

Purpose

This work presents methods developed for the analysis of dynamometric and electromyographic signals acquired during sustained maximal isometric hand grip tasks. In these analyses, we try to find a temporal pattern that could indicate the beginning of the decrease in hand grip strength. This information is essential for choosing the best isometric activity time for hand rehabilitation.

Methods

The technique applied to the dynamometric signal was to find the time interval that precedes the drop of the isometric force RMS (root mean square) curve to values lower than the effective value. The technique applied to the surface electromyography (sEMG) signals was the identification of the instant when the lowest value of the median frequency of the signal occurs. The dynamometry data collection was carried out bilaterally in 19 men and 21 women. The electromyography data collection was carried out bilaterally in only 19 women.

Results

The statistical results (5% significance level) for the dynamometry data indicated that the time from the beginning of the test to the beginning of the decay of strength was approximately 7.6 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\pm$$\end{document} ± 3.2 s, while the results for the sEMG data indicated that the time from the beginning of the test to the appearance of the lowest value of the median frequency was approximately 10.1 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\pm$$\end{document} ± 2.9 s.

Conclusions

The method of using the RMS values of the Force, presented by this work, found results of approximately 7 s, while the method most currently used (Median Frequency) found values of approximately 10 s. These results may help the rehabilitation professional to decide with more security the isometric time of exercises.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42600-023-00262-2.

Exploring the Differences Between Dominant and Nondominant Feet and Hands Bone Mineral Density

The assessment of regional bone mineral density (BMD) has proved to be useful for illustrating the impact of focal bone demineralization diseases on bone mass. In these scenario, a common practice is to compare the affected limb with the contralateral limb. However, there are no studies comparing BMD differences between dominant vs nondominant limbs at these sites. In addition, most studies have assessed BMD in specific ROIs (regions of interests) instead of in the whole limb. The purpose of our study was to compare the BMD of dominant vs nondominant hands and feet in healthy individuals, using both the whole limb software and specific ROIs. We performed a cross-sectional analysis on untrained women and men over 18 years of age who volunteered to participate. BMD (g/cm²), bone area (cm²) and BMC (bone mineral content) (g) were measured by Lunar Prodigy DXA (GE Healthcare, Madison, WI, USA), using 2 different approaches: whole limb/region software and specific ROIs. A total of 42 subjects (11 men and 31 women) were included. Mean age was 44.19 ± 10.49 years. BMD was greater in the dominant in comparison with the nondominant hand. The difference was 0.014 (95% CI, 0.009-0.018) for the whole hand BMD, 0.023 (95% CI, 0.003-0.044) for ROI 1, and 0.016 (95% CI, 0.003-0.029) for ROI 2. No significant differences were found between dominant and nondominant foot BMD, using the whole limb software and specific ROIs. To our knowledge, this is the first study to explore the differences in BMD, bone area and BMC in terms of limb dominance, supporting the usefulness of DXA as an accurate and objective complementary diagnostic or follow-up tool in focal bone demineralization diseases.

Blisters and Calluses from Rowing: Prevalence, Perceptions and Pain Tolerance

Background and Objectives: Rowing is a sport that involves constant gripping, pulling/pushing, and rotational movements of the hands, in a cyclic periodic manner with every stroke, with hundreds of strokes being taken within a short period of time. Dermatological issues on rowers’ hands (fingers and palms) in the form of blisters and calluses are common knowledge within the community, but their prevalence and the rower’s perceptions and pain tolerance to them has never been systematically evaluated. This work addresses these lacunae. Materials and Methods: Analysis of data collected from a survey on a sample of competitive (117) and noncompetitive rowers (28) who row on-water (total 145). Results: It was found that approximately 69% of rowers participating in this study have calluses on their hands for most of their time (considered by them as not painful). The incidence of blisters was found to be lower (but perceived as more painful). Their incidence was found to be fairly independent of the frequency and intensity of training, but they seem to affect most rowers equally at the beginning of season or during a change of position (nonconditioned hands). Blisters and calluses were reported to be mainly located on the proximal phalanges and metacarpo-phalangeal joint area of both hands, i.e., on the lower parts of the fingers and the upper inner palms. Conclusions: Rowers demonstrated a sense of acceptance of these dermatological issues, even a sense of pride in what they represent. The incidence of blisters becoming infected was estimated to be so low that most rowers would not have encountered such serious, albeit rare, consequences.

Normal or tingly? A story about hands and feet

AIMS

Spontaneous sensations (SPS) are sensations that are felt in the body in the absence of external stimulation. The literature on SPS has used explicit measures, such as questionnaires to explore SPS, while no studies to date have examined SPS on an implicit level. This study was conducted to collect representative stimuli that can be used to build such a task, for example, an Implicit Association Test.

METHODS

An online survey was completed by 18 participants to identify the most frequent words used to describe our limbs in the presence or absence of SPS.

RESULTS

Individuals who perceive and those who do not perceive SPS in their limbs describe their limbs as normal, while the most frequently described SPS were itching and tingling.

CONCLUSIONS

Thus, we use the same words/adjectives to describe how we perceive our limbs. However, the way we experience SPS varies as we experience more SPS in hands than feet.

Microbial contamination of the hands of healthcare providers in the operating theatre of a central hospital

Background

Effort is invested in maintaining the sterility of the operating field, but less attention is paid to potential healthcare associated infection (HAI) sources through patient contact with non-scrubbed healthcare providers (HCPs). A single microbiological assessment of hands can provide a good assessment of the potential dynamic transmission of microorganisms. The aim of this study was to identify and quantify the microbial growth on the hands of HCPs in the operating theatres of Chris Hani Baragwanath Academic Hospital.

Methods

A prospective, contextual and descriptive study design was followed. Seventy-five samples were collected using convenience sampling from an equal number of surgeons, anaesthetists and nurses. Specimens were taken using agar plates and underwent semi-quantitative analysis.

Results

All the hands of the HCPs displayed growth; 95% grew commensals and 64% grew pathogens. Eighteen commensal microorganisms and 21 pathological microorganisms were noted. Comparisons of commensal, pathological and combined levels of contamination among the three groups were not statistically significant (p = 0.061, p = 0.481, p = 0.236). No significant difference between the growth of combined microorganisms (p = 0.634) and pathological microorganisms (p = 0.499) among the groups. Surgeons had significantly more commensal growth (p = 0.041). There was no statistically significant difference between sexes (p = 0.290).

Conclusion

It was concerning that 100% of the hands of HCPs who were about to commence with the surgical list had microbial growth. These HCPs could have already been in contact with patients and equipment in the theatre environment.

A four-tendon robotic finger with tendon transmission inspired by the human extensor mechanism

This paper presents a tendon-driven robotic finger with its inspiration derived from the human extensor mechanism. The analytical model presented relates the contractions of the intrinsic muscles of the human hand to abduction-adduction and coordinated motion of proximal and distal interphalangeal joints. The design presented is simplified from the complex webs of fibers appearing in prior works, but preserves the dual role the interossei have of abducting/adducting the finger and flexing it at the metacarpal-phalangeal joint with the finger outstretched. The anatomical feature in our design is that the proximal interphalangeal joint passes through a set of lateral bands as the finger flexes. We discovered that by including a mechanical stop that causes the lateral bands to 'fold' at large enough flexion aids coordinated movements of the two interphalangeal joints as the finger flexes. Because it involves engineering running and sliding fits, this finger admits a concise kinematic model, which accurately predicts the tendon excursions from a known pose. In this work, however, we evaluate what happens when the model is used to search for a sequence of tendon excursions corresponding to a desired movement. We perform several such sequences of tendon excursions experimentally and present the poses that result using motion capture. We also demonstrate executing several types of grasps on an underactuated robotic hand that incorporates this finger design.

The prevalence and risk factors of musculoskeletal disorders in the hands of fishermen working as oyster shuckers

OBJECTIVES

This study aimed to investigate the prevalence of musculoskeletal disorders in the hands and wrists of fishermen working as oyster shuckers, and to identify the risk factors associated with oyster shucking.

MATERIAL AND METHODS

A total of 590 fishery workers including those working as oyster shuckers in 2015-2017 were included in the study analysis. Hand osteoarthritis (OA), carpal tunnel syndrome (CTS), and ulnar impaction syndrome were diagnosed using X-ray, magnetic resonance imaging, and physical examinations according to each diagnostic criterion. The Rapid Entire Body Assessment was used as a measurement tool for analyzing the occupation-related burden factors.

RESULTS

The prevalence of hand OA, CTS, and ulnar impaction syndrome was higher in oyster shuckers than in aquaculture/offshore fishery workers. The prevalence of upper limb disease was higher in oyster shuckers than in other fishery workers, even in the prevalence of exposure to occupational burden factors. In oyster shuckers, the incidence of hand and wrist OA was 84%, that of CTS was 72%, and that of ulnar impaction syndrome was 41%. In addition, oyster shuckers were more likely to be exposed to occupational burden factors than were other types of fishermen.

CONCLUSIONS

The prevalence of hand OA, CTS, and ulnar impaction syndrome was higher in oyster shuckers. Therefore, proper stretching or exercises for rest and musculoskeletal relaxation, along with health-care education and promotion, will be needed for the fishermen's repeated posture and impact work. Int J Occup Med Environ Health. 2021;34(5):603-15.

Participatory co-design of patient-reported outcome indicators and N-of-1 evaluation of a dressing glove for Epidermolysis bullosa

OBJECTIVE

In autosomal recessive dystrophic Epidermolysis bullosa, repeat blistering results in finger webbing and severe contractures of the hands. The aim of this study was to codesign patient-reported outcome indicators for hand therapy with patients, carers and clinicians, and use these to proof-of-concept test a novel dressing glove for recessive dystrophic Epidermolysis bullosa, with cost analysis.

METHOD

Qualitative interviews and focus groups with patients and carers generated content for the indicators. Validity and reliability were established through expert review, piloting and consensus between patients, carers and clinicians. The indicators were self-reported by patients before and while wearing the dressing glove in an N-of-1 study. Time for dressing changes and use of conventional products were also self-reported.

RESULTS

A total of 11 indicators were initially generated from the thematic analysis. Expert review, piloting and consensus involved six patients, five carers and eight clinicians (total n=19). Participants agreed 14 indicators, covering hand skin condition (n=4), webbing between the digits (n=4), experiences of wearing and changing dressings (n=2), hand function (n=2), wrist function (n=1) and hand pain (n=1). In Phase 3, 12 patients scored indicators before wearing the gloves and four patients completed scoring while wearing the gloves. Statistically significant improvements between pre-glove and with-glove periods were found for most participants' experience scores. Skin appearance also improved for most participants.

CONCLUSIONS

The indicators generated useful data, differentiation between scores and participants demonstrating proof-of-concept for patients with recessive dystrophic Epidermolysis bullosa who could wear the dressing gloves. The indicators are being used in routine practice, supporting clinical follow up, commercialisation and regulatory governance of the dressing glove.

Evidence for an effector-independent action system from people born without hands

What are the principles of brain organization? In the motor domain, separate pathways were found for reaching and grasping actions performed by the hand. To what extent is this organization specific to the hand or based on abstract action types, regardless of which body part performs them? We tested people born without hands who perform actions with their feet. Activity in frontoparietal association motor areas showed preference for an action type (reaching or grasping), regardless of whether it was performed by the foot in people born without hands or by the hand in typically-developed controls. These findings provide evidence that some association areas are organized based on abstract functions of action types, independent of specific sensorimotor experience and parameters of specific body parts.

Many parts of the visuomotor system guide daily hand actions, like reaching for and grasping objects. Do these regions depend exclusively on the hand as a specific body part whose movement they guide, or are they organized for the reaching task per se, for any body part used as an effector? To address this question, we conducted a neuroimaging study with people born without upper limbs—individuals with dysplasia—who use the feet to act, as they and typically developed controls performed reaching and grasping actions with their dominant effector. Individuals with dysplasia have no prior experience acting with hands, allowing us to control for hand motor imagery when acting with another effector (i.e., foot). Primary sensorimotor cortices showed selectivity for the hand in controls and foot in individuals with dysplasia. Importantly, we found a preference based on action type (reaching/grasping) regardless of the effector used in the association sensorimotor cortex, in the left intraparietal sulcus and dorsal premotor cortex, as well as in the basal ganglia and anterior cerebellum. These areas also showed differential response patterns between action types for both groups. Intermediate areas along a posterior–anterior gradient in the left dorsal premotor cortex gradually transitioned from selectivity based on the body part to selectivity based on the action type. These findings indicate that some visuomotor association areas are organized based on abstract action functions independent of specific sensorimotor parameters, paralleling sensory feature-independence in visual and auditory cortices in people born blind and deaf. Together, they suggest association cortices across action and perception may support specific computations, abstracted from low-level sensorimotor elements.

Does Enzymatic Debridement Allow Us To Perform Conservative Treatment On Clinically Deep Hand Burns? A Retrospective Review

The hands are one of the main locations of burns. In deep second-degree and third-degree burns, the gold standard of treatment is surgical debridement and subsequent coverage, which can result in suboptimal aesthetic and functional results. The aim of our study is to assess whether treatment by initial enzymatic debridement (NexoBrid®) of deep second-degree and third-degree burns prevents the need for surgery. We carried out a retrospective study of 53 hands with deep burns treated in our centre from May 2015 to December 2016. Two experts evaluated the initial photographs of the burns and classified them as surgical or nonsurgical (interobserver kappa index = 0.83). These assessments were compared with the actual need for surgery on each hand. Sixteen of the 32 (50%) hands that the experts considered surgical spontaneously epithelialized. Four of the 17 hands (23.5%) that were not considered surgical required a split-thickness skin graft for healing. Enzymatic debridement helps to preserve viable tissue, which reduces the number and extension of surgical interventions, thus favouring better results.

Relationship between hand hygiene and cutaneous findings during COVID-19 pandemic

BACKGROUND

In the current situation of the COVID-19 pandemic, healthcare workers (HCWs) have to comply with hygiene conditions and use gloves more frequently and for a longer period of time than they would previously to avoid infection and prevent transmission.

AIMS

We aimed to characterize the adverse skin reactions occurring after hand hygiene and glove use in HCWs in a tertiary university hospital to determine the possible causative factors and whether the use of these measures is affected.

METHODS

Between April 15 and May 1, 2020, a cross-sectional survey was conducted, using online questionnaire, answered by HCWs in a tertiary university hospital.

RESULTS

The increase in general hand-skin problems during the pandemic period was statistically significant (P = .004). The most common symptom was dryness. During the pandemic period, 67 (24.3%) HCWs thought that the conditions were caused by glove use, and 197 (71.4%) thought that they were due to alcohol-based hand antiseptics. The incidence of other hand-skin conditions except for vesicles was statistically higher in women than in men (P < .001).

CONCLUSIONS

Increased number of hand-skin conditions during the pandemic should not be ignored, since hand hygiene and glove use are expected to increase.

Ultraviolet Light Gel Manicures: Is There a Risk of Skin Cancer on the Hands and Nails of Young Adults?

BACKGROUND: There appears to be limited research on whether the ultraviolet radiation used in nail lamps for gel manicures is increasing the incidence of skin cancer on the hands and nails of young adults. OBJECTIVE: We sought to assess evidence in the literature regarding the incidence of skin cancer on the hands and nails of young adults who receive gel manicures cured by ultraviolet light. METHODS: An extensive systematic literature review was conducted, focusing on patients aged 40 years or younger with a history of gel manicures diagnosed with nonmelanoma or melanoma skin cancers on the dorsum of their hands and nails. The Surveillance, Epidemiology and End-results Program (SEER) (SEER 9 and SEER 21) was chosen to analyze trends in the incidence of melanoma from 2007 to 2016. The SEER*Stat Client-serve Mode software was used to retrieve the incidence rates of melanoma of the skin among individuals aged 0 to 39 years from 1975 to 2016. RESULTS: There have been no cases reported of patients younger than the age of 40 years with a history of chronic gel manicures diagnosed with nonmelanoma skin cancer or melanoma on the dorsum of the hands or nail matrices. SEER revealed little to no change in the incidence of melanoma among patients under the age of 65 years. CONCLUSION: The literature is controversial regarding whether ultraviolet radiation from chronic gel manicures increases the risk of skin cancer on the hands and nails. A comprehensive literature search and the SEER database revealed that gel manicures have little to no carcinogenic risk.

Hands in the Real World

Robots face a rapidly expanding range of potential applications beyond controlled environments, from remote exploration and search-and-rescue to household assistance and agriculture. The focus of physical interaction is typically delegated to end-effectors-fixtures, grippers or hands-as these machines perform manual tasks. Yet, effective deployment of versatile robot hands in the real world is still limited to few examples, despite decades of dedicated research. In this paper we review hands that found application in the field, aiming to discuss open challenges with more articulated designs, discussing novel trends and perspectives. We hope to encourage swift development of capable robotic hands for long-term use in varied real world settings. The first part of the paper centers around progress in artificial hand design, identifying key functions for a variety of environments. The final part focuses on the overall trends in hand mechanics, sensors and control, and how performance and resiliency are qualified for real world deployment.

Removing Hand Form Information Specifically Impairs Emotion Recognition for Fearful and Angry Body Stimuli

Emotion perception research has largely been dominated by work on facial expressions, but emotion is also strongly conveyed from the body. Research exploring emotion recognition from the body tends to refer to “the body” as a whole entity. However, the body is made up of different components (hands, arms, trunk, etc.), all of which could be differentially contributing to emotion recognition. We know that the hands can help to convey actions and, in particular, are important for social communication through gestures, but we currently do not know to what extent the hands influence emotion recognition from the body. Here, 93 adults viewed static emotional body stimuli with either the hands, arms, or both components removed and completed a forced-choice emotion recognition task. Removing the hands significantly reduced recognition accuracy for fear and anger but made no significant difference to the recognition of happiness and sadness. Removing the arms had no effect on emotion recognition accuracy compared with the full-body stimuli. These results suggest the hands may play a key role in the recognition of emotions from the body.

The Patient and Observer Scar Assessment Scale: Translation for portuguese language, cultural adaptation, and validation

Evaluating scars is fundamental to analyse the outcome of treatments that include surgical intervention. Scales facilitate this type of assessment, but most of these measuring instruments are in different languages. The Patient and Observer Scar Assessment Scale (POSAS) is one of the most robust instruments available in the literature for the evaluation of scars, although there is no validated version in Brazilian Portuguese. The aims of this study were to culturally translate and validate POSAS for the Portuguese language of Brazil and to test its reproducibility, face validity, content, and construct. Following the methodology proposed by Beaton DE, Bombardier C, Guillemin F, Ferraz, MB, Spine 2000, 25, 3186, the questionnaire was translated and adapted to the Brazilian culture. The reproducibility, face, content, and construct validity were then analysed. In all, the scale was applied to 35 patients with postoperative scars (patient version) and 35 hand surgery specialists (version for the observer). The internal consistency was tested by Cronbach's alpha, and construct validation was performed by correlating the translated instrument with the Brazilian Portuguese translation of the Vancouver Scar Scale (VSS). The cultural adaptation of POSAS Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP) was confirmed. Both subscales showed strong internal consistency (Cronbach's α = 0.77-0.93), demonstrating reliability. The reproducibility was excellent, and the adapted scale demonstrated significant intra- and inter-observer reproducibility (r > 0.9) (P < 0.05). The validity of the construct was significant and showed good sensitivity between POSAS EMP/UNIFESP and the VSS. This study confirmed that POSAS EPM/UNIFESP can be used to evaluate patients with surgical scars in the Brazilian population. It has proven to be useful for clinical and research purposes, lending itself to capturing medical opinions and those of the patients themselves.

Retrospective Study of the Results of Surgical Treatment of 31 Giant Cell Tumors of the Tendon Sheath in the Hand

Objective

To evaluate the results of the treatment of 31 giant-cell tumors of the tendon sheath of the hand cared for between 2006 and 2015.

Methods

A group of patients for the present retrospective evaluation was defined, covering the period between February 2006 and November 2015, in which 31 records of patients who underwent surgery due to cell tumor of the tendon sheath of the fingers were studied and evaluated. The recommended treatment was complete excision of the tumor with preservation of the adjacent structures. The diagnosis was confirmed by pathological examination. The progress of the treatment after surgery was evaluated, especially regarding the rate of tumor recurrence.

Results

Taking all 31 patients into consideration, there was a predominance of the female gender and white ethnicity. Most of these patients were aged between 30 and 50 years. The most affected side was the left one, and most tumors were in the flexor face. There was a predominance of the radial fingers, along with their distal end. A total of 27 patients are being followed up at regular intervals at an outpatient clinic, and three cases of tumor recurrence have been identified.

Conclusion

An appropriate surgical technique is essential in order to prevent GCTTS recurrences. The results obtained in this research are in agreement with the literature.

Feeling a Touch to the Hand on the Foot

Where we perceive a touch putatively depends on topographic maps that code the touch's location on the skin [1] as well as its position in external space [2-5]. However, neither somatotopic nor external-spatial representations can account for atypical tactile percepts in some neurological patients and amputees; referral of touch to an absent or anaesthetized hand after stimulation of a foot [6, 7] or the contralateral hand [8-10] challenges the role of topographic representations when attributing touch to the limbs. Here, we show that even healthy adults systematically misattribute touch to other limbs. Participants received two tactile stimuli, each to a different limb-hand or foot-and reported which of all four limbs had been stimulated first. Hands and feet were either uncrossed or crossed to dissociate body-based and external-spatial representations [11-14]. Remarkably, participants regularly attributed the first touch to a limb that had received neither of the two stimuli. The erroneously reported, non-stimulated limb typically matched the correct limb with respect to limb type or body side. Touch was misattributed to non-stimulated limbs of the other limb type and body side only if they were placed at the correct limb's canonical (default) side of space. The touch's actual location in external space was irrelevant. These errors replicated across several contexts, and modeling linked them to incoming sensory evidence rather than to decision strategies. The results highlight the importance of the touched body part's identity and canonical location but challenge the role of external-spatial tactile representations when attributing touch to a limb.

Ageing profiles of Caucasian and Chinese cohorts - focus on hands skin

OBJECTIVE

In spite of hand care being a dynamic segment of skin care, hands skin physiology has been receiving little attention in comparison to facial skin. In the present study, we aimed at gathering a comprehensive set of skin data from the dorsal part of the hand to study age related-changes in two ethnic groups (Caucasian and Chinese).

METHODS

Skin topographic, skin colour/colour heterogeneities, skin chromophores and skin biophysical measurements of 116 Caucasian and Chinese female volunteers aged 30-65 years old were collected in Ireland and in China as part of a cross-sectional study.

RESULTS

Topographic alterations happened at both micro and macro scales with a noticeable delay in the onset of 10 years for the Chinese cohort. Similar evolution of skin colour with ageing was observed between the two cohorts and strong dissimilarities were seen when it came to colour heterogeneities and melanin hyper concentration, with a 20-year delay in severity for the Chinese cohort. A similar sharp drop of skin hydration occurred when reaching the 60's regardless of the group and substantial differences were recorded for skin biomechanical properties of the skin.

CONCLUSION

These results provide additional insights about hand skin physiology in relation to ageing and ethnic differences, especially when put into perspective with what is currently known about facial ageing. This research yield additional material for hand cream product rationale and strategies for mitigating the appearance of ageing hands.

Transmission of vibration through glove materials: effects of contact force

This study investigated effects of applied force on the apparent mass of the hand, the dynamic stiffness of glove materials and the transmission of vibration through gloves to the hand. For 10 subjects, 3 glove materials and 3 contact forces, apparent masses and glove transmissibilities were measured at the palm and at a finger at frequencies in the range 5-300 Hz. The dynamic stiffnesses of the materials were also measured. With increasing force, the dynamic stiffnesses of the materials increased, the apparent mass at the palm increased at frequencies greater than the resonance and the apparent mass at the finger increased at low frequencies. The effects of force on transmissibilities therefore differed between materials and depended on vibration frequency, but changes in apparent mass and dynamic stiffness had predictable effects on material transmissibility. Depending on the glove material, the transmission of vibration through a glove can be increased or decreased when increasing the applied force. Practitioner summary: Increasing the contact force (i.e. push force or grip force) can increase or decrease the transmission of vibration through a glove. The vibration transmissibilities of gloves should be assessed with a range of contact forces to understand their likely influence on the exposure of the hand and fingers to vibration.

Plasticity based on compensatory effector use in the association but not primary sensorimotor cortex of people born without hands

What forces direct brain organization and its plasticity? When brain regions are deprived of their input, which regions reorganize based on compensation for the disability and experience, and which regions show topographically constrained plasticity? People born without hands activate their primary sensorimotor hand region while moving body parts used to compensate for this disability (e.g., their feet). This was taken to suggest a neural organization based on functions, such as performing manual-like dexterous actions, rather than on body parts, in primary sensorimotor cortex. We tested the selectivity for the compensatory body parts in the primary and association sensorimotor cortex of people born without hands (dysplasic individuals). Despite clear compensatory foot use, the primary sensorimotor hand area in the dysplasic subjects showed preference for adjacent body parts that are not compensatorily used as effectors. This suggests that function-based organization, proposed for congenital blindness and deafness, does not apply to the primary sensorimotor cortex deprivation in dysplasia. These findings stress the roles of neuroanatomical constraints like topographical proximity and connectivity in determining the functional development of primary cortex even in extreme, congenital deprivation. In contrast, increased and selective foot movement preference was found in dysplasics' association cortex in the inferior parietal lobule. This suggests that the typical motor selectivity of this region for manual actions may correspond to high-level action representations that are effector-invariant. These findings reveal limitations to compensatory plasticity and experience in modifying brain organization of early topographical cortex compared with association cortices driven by function-based organization.

Visual and visuomotor processing of hands and tools as a case study of cross talk between the dorsal and ventral streams

A major principle of organization of the visual system is between a dorsal stream that processes visuomotor information and a ventral stream that supports object recognition. Most research has focused on dissociating processing across these two streams. Here we focus on how the two streams interact. We tested neurologically-intact and impaired participants in an object categorization task over two classes of objects that depend on processing within both streams-hands and tools. We measured how unconscious processing of images from one of these categories (e.g., tools) affects the recognition of images from the other category (i.e., hands). Our findings with neurologically-intact participants demonstrated that processing an image of a hand hampers the subsequent processing of an image of a tool, and vice versa. These results were not present in apraxic patients (N = 3). These findings suggest local and global inhibitory processes working in tandem to co-register information across the two streams.

Using Hand Signs to Teach HIV Medications

Objective. To describe an innovative active learning strategy that uses students' hands to facilitate learning and retention of major concepts related to nucleotide/nucleoside reverse transcriptase inhibitors (NRTIs). Methods. Students wrote the names of the NRTIs on their fingers, then an interactive activity used a variety of hand signs to teach the drugs. Focus groups were conducted with a total of 20 students one year after being exposed to the new teaching strategy. Students were asked five knowledge-based questions related to the subject matter to assess retention of the material. Results. On average, students answered 64% of the questions correctly. Most students (95%) used their hands to answer the knowledge-based questions. There was a statistically significant association between using hands to answer the question and answering the question correctly. When asked which active learning method was most effective, 14 (70%) participants reported "hands." Conclusion. Using students' hands was well received by this cohort of students. More research is needed to determine if this active learning method could be considered for use in other disease states to help students learn complex medications with many nuances.

Bromelain-based enzymatic debridement and minimal invasive modality (mim) care of deeply burned hands

The objective was to critically review the data and assess the implications of NexoBrid [NexoBrid-NXB formerly Debrase Gel Dressing-DGD]^a in the special field of deep hand burns. Detailed analysis of endpoints in the treatment of hand burn patients was conducted as part of a multi-center, open label, randomized, controlled two-arm study to evaluate the safety and efficacy of NXB enzymatic debridement, comparing it to the current standard of care (SOC). These results were compared to a large cohort of patients treated with NXB in a previous, single arm study. Thirty-one burned hands were treated with NXB and 41 hand burns were in the SOC group. In the NXB group, 4 out of 31 hand burns (12.9%) required some excisional debridement compared to 29 out of the 41 (70.7%) in the SOC group (p<0.0001). Mean percentage of burn wound area excised in the NXB group was 4.4 ± 13.1% compared to 52.0 ± 41.4% in the SOC group (p<0.0001). None of the NXB-treated hands required escharotomy compared to 4 out of the 41 (9.7%) in the SOC group. NXB enzymatic debridement demonstrated a statistically significant reduction in burn wound excision and auto-grafting compared to SOC, and seems to prevent the need for emergency escharotomy. ^a DGD is produced by MediWound and distributed under the name NexoBrid®.

Thermographic Evaluation of the Hands of Pig Slaughterhouse Workers Exposed to Cold Temperatures

Brazil was rated the fourth leading producer and exporter of pork meat in the world. The aim of this study was to evaluate the temperature of the hands of pig slaughterhouse workers and its relation to the thermal sensation of the hands and the use of a cutting tool. The study included 106 workers in a pig slaughterhouse. An infrared camera FlirThermaCAM E320 (Flir Systems, Wilsonville, OR, USA) was used to collect the images of the dorsal and palmar surfaces of both hands. A numerical scale was used to obtain the thermal sensation. Chi-square test, Pearson correlation and Student’s t test or Wilcoxon were used (p ≤ 0.05). The majority of workers felt cold in the hands (66%) and workers who used the knife felt the coldest. There was an association between the thermal sensation and the use of knife (p = 0.001). Workers who used the tool showed correlation between the thermal sensation and the temperatures of the left fingers, with a difference between the temperatures of the right and left hands of those who used the knife (p ≤ 0.05). The hands (left) that manipulated the products presented the lowest temperatures. Findings indicate that employers of pig slaughterhouses should provide gloves with adequate thermal insulation to preserve the health of workers’ hands.

A unified framework for developing effective hygiene procedures for hands, environmental surfaces and laundry in healthcare, domestic, food handling and other settings

Hygiene procedures for hands, surfaces and fabrics are central to preventing spread of infection in settings including healthcare, food production, catering, agriculture, public settings, and home and everyday life. They are used in situations including hand hygiene, clinical procedures, decontamination of environmental surfaces, respiratory hygiene, food handling, laundry hygiene, toilet hygiene and so on. Although the principles are common to all, approaches currently used in different settings are inconsistent. A concern is the use of inconsistent terminology which is misleading, especially to people we need to communicate with such as the public or cleaning professionals. This paper reviews the data on current approaches, alongside new insights to developing hygiene procedures. Using this data, we propose a more scientifically-grounded framework for developing procedures that maximize protection against infection, based on consistent principles and terminology, and applicable across all settings. A key feature is use of test models which assess the state of surfaces after treatment rather than product performance alone. This allows procedures that rely on removal of microbes to be compared with those employing chemical or thermal inactivation. This makes it possible to ensure that a consistent "safety target level" is achieved regardless of the type of procedure used, and allows us deliver maximum health benefit whilst ensuring prudent usage of antimicrobial agents, detergents, water and energy.

Transmission of vibration through gloves: effects of contact area

For three samples of material (12.5, 25.0 and 37.5 mm diameter) from each of three gloves, the dynamic stiffnesses and the vibration transmissibilities of the materials (to both the palm of the hand and the thenar eminence) were measured at frequencies from 10 to 300 Hz. Additional measurements showed the apparent masses of the hand at the palm and the thenar eminence were independent of contact area at frequencies less than about 40 Hz, but increased with increasing area at higher frequencies. The stiffness and damping of the glove materials increased with increasing area. These changes caused material transmissibilities to the hand to increase with increasing area. It is concluded that the size of the area of contact has a large influence on the transmission of vibration through a glove to the hand. The area of contact should be well-defined and controlled when evaluating the transmission of vibration through gloves. Practitioner Summary: The transmission of vibration through gloves depends on both the dynamic stiffness of glove material and the dynamic response of the hand. Both of these depend on the size of the contact area between a glove material and the hand, which should be taken into account when assessing glove transmissibility.

Volume correction in the aging hand: role of dermal fillers

The hands, just like the face, are highly visible parts of the body. They age at a similar rate and demonstrate comparable changes with time, sun damage, and smoking. Loss of volume in the hands exposes underlying tendons, veins, and bony prominences. Rejuvenation of the hands with dermal fillers is a procedure with high patient satisfaction and relatively low risk for complications. This study will review relevant anatomy, injection technique, clinical safety, and efficacy of dermal filler volumization of the aging hand.

Survival of Enteric Viruses in the Environment and Food

Enteric viruses are those human viruses that are primarily transmitted by the fecal-oral route, either by person-to-person contact or by ingestion of contaminated food or water. The importance of viral foodborne diseases is increasingly being recognized, and several international organizations have found that there is an upward trend in their incidence. Thus, in this review, state-of-the-art information regarding virus persistence in food and the environment is compiled.

Transmission of vibration through gloves: effects of material thickness

It might be assumed that increasing the thickness of a glove would reduce the vibration transmitted to the hand. Three material samples from an anti-vibration glove were stacked to produce three thicknesses: 6.4, 12.8 and 19.2 mm. The dynamic stiffnesses of all three thicknesses, the apparent mass at the palm and the finger and the transmission of vibration to the palm and finger were measured. At frequencies from 20 to 350 Hz, the material reduced vibration at the palm but increased vibration at the finger. Increased thickness reduced vibration at the palm but increased vibration at the finger. The measured transmissibilities could be predicted from the material dynamic stiffness and the apparent mass of the palm and finger. Reducing the dynamic stiffness of glove material may increase or decrease the transmission of vibration, depending on the material, the frequency of vibration and the location of measurement (palm or finger). Practitioner Summary: Transmission of vibration through gloves depends on the dynamic response of the hand and the dynamic stiffness of glove material, which depends on material thickness. Measuring the transmission of vibration through gloves to the palm of the hand gives a misleading indication of the transmission of vibration to the fingers.

OUTCOME OF PHYSICAL THERAPY AND SPLINTING IN HAND BURNS INJURY. OUR LAST FOUR YEARS' EXPERIENCE

OBJECTIVE

Burn injuries in hands are much more complex and the appearance of contractures is a common complication. Hand burn injuries often result in limited functionality, flexion and extension of fingers and present a major hindrance in rehabilitation. The aim of physical therapy and splinting after hand burn injury is to maintain mobility, prevent the development of the contracture and to promote the functionality of hand and good cosmetic results. The purpose of this study is to presents our experience of 38 children with hand burn injuries, admitted and treated at the Department of Plastic Surgery, UCCK-Pristina, Kosovo, during the years 2012-2015.

METHODS

Physical therapy is focused on active/passive range of motion in affected joints, management of cicatrix, strengthening exercise, coordination and use of splints for correction contractures. Patients were evaluated in three, six months and the definitive evaluation is done after 9 months of physical therapy and splinting.

RESULTS

We have improvement in range of motion (ROM), functionality, coordination, muscle force, decrease of keloids scars.

CONCLUSION

This study shows the importance of physical therapy and splinting, achieving good results in preventing contracture, improving range of motion, muscle force and good cosmetic results.

Hand rejuvenation

Aging of the hands results from both natural processes and chronic ultraviolet light exposure. Together, these cause textural and pigmentary changes, excess skin laxity, rhytides, and soft tissue atrophy that presents as prominent bones and tendons with easily visible veins. Many options are available for the reversal of these changes. Photoaging can be improved with chemical peels and light-based treatments (such as Q-switched lasers), resurfacing lasers, intense pulsed light, and photodynamic therapy. Soft tissue atrophy can be corrected with autologous fat, nonanimal stabilized hyaluronic acid, calcium hydroxylapatite, and poly-L lactic acid injections. The literature shows that these treatments have favorable outcomes for most patients; but in order to reduce known complications, it is important to understand the proper use and limitations of each modality.

Seeing is not feeling: posterior parietal but not somatosensory cortex engagement during touch observation

Observing touch has been reported to elicit activation in human primary and secondary somatosensory cortices and is suggested to underlie our ability to interpret other's behavior and potentially empathy. However, despite these reports, there are a large number of inconsistencies in terms of the precise topography of activation, the extent of hemispheric lateralization, and what aspects of the stimulus are necessary to drive responses. To address these issues, we investigated the localization and functional properties of regions responsive to observed touch in a large group of participants (n = 40). Surprisingly, even with a lenient contrast of hand brushing versus brushing alone, we did not find any selective activation for observed touch in the hand regions of somatosensory cortex but rather in superior and inferior portions of neighboring posterior parietal cortex, predominantly in the left hemisphere. These regions in the posterior parietal cortex required the presence of both brush and hand to elicit strong responses and showed some selectivity for the form of the object or agent of touch. Furthermore, the inferior parietal region showed nonspecific tactile and motor responses, suggesting some similarity to area PFG in the monkey. Collectively, our findings challenge the automatic engagement of somatosensory cortex when observing touch, suggest mislocalization in previous studies, and instead highlight the role of posterior parietal cortex.

Gaining the upper hand: evidence of vertical asymmetry in sex-categorisation of human hands

Visual perception is characterised by asymmetries arising from the brain's preferential response to particular stimulus types at different retinal locations. Where the lower visual field (LVF) holds an advantage over the upper visual field (UVF) for many tasks (e.g., hue discrimination, contrast sensitivity, motion processing), face-perception appears best supported at above-fixation locations (Quek & Finkbeiner, 2014a). This finding is consistent with Previc's (1990) suggestion that vision in the UVF has become specialised for object recognition processes often required in "extrapersonal" space. Outside of faces, however, there have been very few investigations of vertical asymmetry effects for higher-level objects. Our aim in the present study was, thus, to determine whether the UVF advantage reported for face-perception would extend to a nonface object - human hands. Participants classified the sex of hand images presented above or below central fixation by reaching out to touch a left or right response panel. On each trial, a briefly presented spatial cue captured the participant's spatial attention to either the location where the hand was about to appear (valid cue) or the opposite location (invalid cue). We observed that cue validity only modulated the efficiency of the sex-categorisation response for targets in the LVLVF and not the UVF, just as we have reported previously for face-sex categorisation (Quek & Finkbeiner, 2014a). Taken together, the data from these studies provide some empirical support for Previc's (1990) speculation that object recognition processes may enjoy an advantage in the upper-hemifield.

Atypical Anterior Spinal Artery Infarction due to Left Vertebral Artery Occlusion Presenting with Bilateral Hand Weakness

Background

Infarct of the anterior spinal artery is the most common subtype of spinal cord infarct, and is characterized by bilateral motor deficits with spinothalamic sensory deficits. We experienced a case with atypical anterior-spinal-artery infarct that presented with bilateral hand weakness but without sensory deficits.

Case Report

A 29-year-old man presented with sudden neck pain and bilateral weakness of the hands. Magnetic resonance imaging (MRI) of the brain did not reveal any lesion. His motor symptoms improved rapidly except for mild weakness in his left wrist and fingers. Magnetic resonance angiography showed proximal occlusion of the left vertebral artery; a spine MRI revealed left cervical cord infarction.

Conclusions

Bilateral or unilateral hand weakness can be the sole symptom of a cervical cord infarct.

Detection of pathogenic micro-organisms on children's hands and toys during play

AIMS

This study aimed to determine if the children's leisure activities impact the presence of pathogens on their hands and toys.

METHODS & RESULTS

To assess the microbiological hazard in playground areas, a pilot study that included 12 children was conducted. We then conducted an intervention study; children's hands and toys were washed before playing. Faecal coliforms, pathogenic bacteria and Giardia lamblia were quantified by membrane filtration, selective media and flotation techniques, respectively; rotavirus, hepatitis A and rhinovirus by RT-PCR. Pilot study results revealed faecal contamination on children's hands and toys after playing on sidewalks and in public parks. Pathogenic bacteria, hepatitis A and G. lamblia on children's hands were also found. In the intervention study, Staphylococcus aureus and Klebsiella pneumoniae were found on children's hands at concentrations up to 2·5 × 10(4) and 1 × 10(4) CFU hands(-1), respectively. E. coli and Kl. pneumoniae were detected on toys (2·4 × 10(3) and 2·7 × 10(4) CFU toy(-1), respectively). Salmonella spp, Serratia spp and G. lamblia cysts were also present on toys.

CONCLUSION

Children's play activities influence microbial presence on hands and toys; the transfer seems to occur in both ways.

SIGNIFICANCE AND IMPACT OF THE STUDY

Control strategy needs to be implemented to protect children from infectious diseases.

Translation, cultural adaptation and reproducibility of the Cochin Hand Functional Scale questionnaire for Brazil

OBJECTIVE

To translate, to perform a cultural adaptation of and to test the reproducibility of the Cochin Hand Functional Scale questionnaire for Brazil.

METHODS

First, the Cochin Hand Functional Scale questionnaire was translated into Portuguese and was then back-translated into French. These translations were reviewed by a committee to establish a Brazilian version of the questionnaire to be tested. The validity and reproducibility of the Cochin Hand Functional Scale questionnaire was evaluated. Patients of both sexes, who were aged 18 to 60 years and presented with rheumatoid arthritis affecting their hands, were interviewed. The patients were initially interviewed by two observers and were later interviewed by a single rater. First, the Visual Analogue Scale for hand pain, the Arm, Shoulder and Hand Disability questionnaire and the Health Assessment Questionnaire were administered. The third administration of the Cochin Hand Functional Scale was performed fifteen days after the first administration. Ninety patients were assessed in the present study.

RESULTS

Two questions were modified as a result of the assessment of cultural equivalence. The Cronbach's alpha value for this assessment was 0.93. The intraclass intraobserver and interobserver correlation coefficients were 0.76 and 0.96, respectively. The Spearman's coefficient indicated that there was a low level of correlation between the Cochin Hand Functional Scale and the Visual Analogue Scale for pain (0.46) and that there was a moderate level of correlation of the Cochin Scale with the Health Assessment Questionnaire (0.66) and with the Disability of the Arm, Shoulder and Hand questionnaire (0.63). The average administration time for the Cochin Scale was three minutes.

CONCLUSION

The Brazilian version of the Cochin Hand Functional Scale was successfully translated and adapted, and this version exhibited good internal consistency, reliability and construct validity.

Elements of morphology: standard terminology for the hands and feet

An international group of clinicians working in the field of dysmorphology has initiated the standardization of terms used to describe human morphology. The goals are to standardize these terms and reach consensus regarding their definitions. In this way, we will increase the utility of descriptions of the human phenotype and facilitate reliable comparisons of findings among patients. Discussions with other workers in dysmorphology and related fields, such as developmental biology and molecular genetics, will become more precise. Here we introduce the anatomy of the hands and feet and define and illustrate the terms that describe the major characteristics of the hands and feet.