Wyniki wyszukiwania - Biblioteka Nauki

1

Socio-ecological Vulnerability of Smallholders due to Climate Change in Mountains: Agroforestry as an Adaptation Measure

100%

Pandey R. , Meena D. , Aretano R. , Satpathy S. , Semeraro T. , Kumar Gupta A. , Rawat S. , Zurlini G.

Change and Adaptation in Socio-Ecological Systems

|

2015

|

tom 2

|

nr 1

EN

The present study aims to assess the socioecological vulnerability of smallholders through an index of Tehri Garhwal Himalaya. The index provides a realistic approach to recognize the contributions of social and ecological factors for household welfare vulnerability to climate change. The approach puts forward various indices for each component of vulnerability to climate change - exposure, sensitivity, and adaptive capacity including two more indices: one for overall impact under the exposure of climate change and another for overall vulnerability. The five indices were proposed to assess the vulnerability status of with and without agroforestry practicing households in Himalayan region. These indices are based on 35 indicators (8 for exposure; 12 for sensitivity, 15 for adaptive capacity), selected through inductive approaches. A questionnaire for households was designed for the above aim and was administered to 121 heads of households through face-toface interviews with 77 households practicing agroforestry and 44 without agroforestry. The questionnaire dealt the general household information, and indicators of the vulnerability including the issues related to agroforestry. The results highlight slightly higher adaptive capacity of agroforestry practicing households due to specific contribution of agroforestry. The low contribution of agroforestry among smallholders was due to small land holding. The study also results that remoteness, specific issues of smallholders’ such as poverty, education and employment are responsible for the present condition. In particular this study clearly shows that poverty is the key driver for vulnerability. All of these issues can be addressed if future programs and policies, include and implement regulations to remedy attributive factors. This paper may be applicable to other mountainous regions providing insights for effective adaptation strategies to climate change.

2

Provocative tests used in the diagnosis of carpal tunnel syndrome

84%

Georgiew F.

|

2007

|

tom 11(4)

15-25

EN

The carpal tunnel syndrome (CTS) is the most often diagnosed compressive neuropathy of the upper limb. As a result of the changes within the tunnel of the median nerve, the disease is associated with hypersensitivity to some external factors such as: an increase in pressure within the carpal tunnel, direct or indirect pressure on the wrist level, hypoxia. These factors are used in provocative tests. The aim of this article is to make a distinction between functional test’s classifications used in the CTS diagnosis, depending on the method of ailment provocation. Different modifications used in common tests and their average sensitivity and specificity are also presented. Carpal tunnel syndrome should be diagnosed clinically; although electro-diagnostic studies are a standard method of establishing the diagnosis, they do have limitations. Clinical diagnostic skill must be reinforced by a valuable provocative test: the Provocative Test, the Phalen test + mCCT, Tinel’s sign, Phalen’s and reverse Phalen’s test, Durkan Carpal Compression Test (mCCT). There are also tests, which, due to their low sensitivity and specificity, be not applied in the CTS diagnostics. Provocative tests are more easily performed than electro-diagnostic studies and are the most appropriate diagnostic tools in the ambulatory setting. Provocative tests are commonly needed for establishing the diagnosis for treatment, screening and determining aetiology. To improve the efficiency of provocative tests, we should apply univocal standards for their performance and interpretation. A combination of tests might be more powerful than a single test in establishing the diagnosis. Taking medical history and performing physical examination should be the primary methods of diagnosing CTS. The combination of hand diagram, questionnaires, abnormal sensibility and positive provocative tests will provide a diagnostic tool for CTS with high sensitivity and specificity. The addition of nerve conduction studies is unnecessary in most cases.

3

Diagnostic tests used in diagnosis of carpal tunnel syndrome

84%

Georgiew F. , Otfinowska E. , Adamczyk T.

|

2008

|

tom 12(3)

24-35

EN

In 1854 Paget described for the first time that carpal tunnel syndrome (CTS) results from compression of the median nerve within the carpal tunnel. CTS predominantly involves tingling and numbness in the typical median nerve distribution. Pain, described as deep, aching, or throbbing, occurs diffusely in the hand and radiates up the forearm. Atrophy of the muscles of the thenar is usually seen later in the course of the nerve compression. CTS is most frequent among persons between the ages of 30 to 60 and is two to three times more common in women than in men (peak prevalence in women older than 55 years). Carpal tunnel syndrome may affect 1% to 10% of the population. Incorrect diagnosis of CTS has been identified as one of the most common causes of CTS treatment failure. CTS should be diagnosed clinically. Electro-diagnostic studies are a standard method of establishing the diagnosis. Electrodiagnostic studies are performed to confirm the clinical diagnosis, to assess the severity of median nerve compression and to rule out more proximal compression sites. Abnormalities in nerve conduction study results can be the only objective evidence of carpal tunnel syndrome. Lack of objective data, such as ENG can lead to incorrect diagnosis and inappropriate treatment. Clinical diagnosis should be reinforced by valuable diagnostic tests: the Semmes–Weinstein monofilaments test – performed in neutral and Phalen’s positions, vibration threshold measured by means of tuning forks or a vibrometer, by observation of thenar atrophy and using provocative tests. The use of common, sensitive and specific diagnostic tests should improve decision making about patients referral for specific therapies, facilitate the performance of epidemiologic studies, increase the accuracy of diagnosis. The combination of a results obtained using various methods might be more powerful than a single test in establishing the diagnosis of CTS. The combination of hand diagram, questionnaires, abnormal sensibility, thenar weakness or thenar atrophy and positive provocative tests constitutes a sensitive and specific diagnostic tool to establish the diagnosis of CTS. Standardized clinical criteria for CTS would be an important step in reducing inconsistencies and misdiagnoses.

4

An evaluation of sensitivity of provocative tests used in the carpal tunnel syndrome diagnosis depending on clinical severity of the syndrome

84%

Georgiew F. , Otfinowska E. , Adamczyk T.

|

tom 13(2)

17-22

EN

Background: Using popular provocative tests to diagnose the carpal tunnel syndrome (CTS) facilitates referring patients for specialist treatment and is indispensable to the performance of epidemiologic studies. Patients with severe carpal tunnel syndrome (CTS) are frequently referred for surgery, whereas people with mild CTS are commonly referred for conservative therapy. Finding out which provocative tests are most effective in diagnosing mild cases can aid clinicians in making decisions about further treatment.Objectives: The purpose of this study was to evaluate the sensitivity of provocative tests used for diagnosis of CTS such as Phalen’s, Durkan’s and Tinel’s sign and to find out if the time of paresthesia occurrence during the tests depended on the severity of the syndrome assessed using Levine’s Questionnaire.Material and methods: The study involved 130 women and 33 men with carpal tunnel syndrome confirmed by ENG. 52 patients had bilateral symptoms so a total number of cases examined was 215. Subjects were tested using four CTS provocative tests in random order: Phalen’s, Durkan’s, Provocative and Tinel’s sign. The examiner waited 2 – 3 minutes between each provocative test to ensure that any nerve irritation caused by previous test had abated. Severity level of CTS was assessed using Levine’s Questionnaire .Results: Sensitivity values were: for Phalen’s Test – 85.6%, Durkan’s Test – 86.5%, Provocative Test 84.6%, and Tinel’s sign – 46%. Sensitivity values for Phalen’s, Durkan’s and Provocative tests are higher than 93,1% for moderate, severe and extreme CTS. There is a relationship between testing positive on CTS provocative tests and severity of clinical symptoms. As the severity of CTS increases, the average time of paresthesia occurrence in median nerve distribution decreases. Conclusions: (1) Tinel’s sign should not be recommended as a CTS diagnostic tool because of its low sensitivity. (2) If Levine’s Questionnaire reveals small progression of CTS the sensitivity of the tests is insufficient to confirm CTS. (3) In the case of patients with moderate, severe or extreme CTS according to Levine’s Questionnaire, the diagnosis can be confirmed using valid provocative tests such as Phalen’s, Durkan’s and Provocative.