Multitasking

This is one amenity that I don't want to see at Google - although I confess that I could use it. I've been absent from the blog, and I have been guilty of multitasking.

As the lack of my postings demonstrate, multitasking results in less productivity despite the delusion that more work is being done. There is a large body of evidence that shows that we perform worse when we multitask. The brain by design is limited in concentrating on more than one thing at once. We perform and learn differently when we are multitasking.

Researchers at University of Michigan and Federal Aviation Administration studied patterns in the amounts of time lost when people switched repeatedly between two tasks of varying complexity and familiarity. The results showed that for all types of tasks, subjects lost time when they had to switch from one task to another.

In another study at Vanderbilt University participants were given tasks one at a time and then two at a time. There was a one second delay in response to the second task when the tasks were given at about the same time. There was no delay when the tasks were given one at a time. The one second delay may seem unimpressive, but it can be the difference between life and death in a hazardous traffic situation.

In today's world, multitasking is inevitable. However, it is wise to be aware of multitasking's limitations as well as the personal toll that it takes. Experts suggest turning off the cell phone when driving, ignoring the blackberry when having meals with family and friends, answering email at specific times only, and maybe not lining up 48 hours in advance for the iphone.

References: please see links.

Photo: I've lost the reference. If anyone has it, please send it.

Ergonomics, Obeying the Natural Laws of Work to Avoid Injury

There is a Chinese saying that "To go beyond is as wrong as to fall short". In other words, how long can you tap on that keyboard or sit in that chair before you hurt yourself.

We are not designed to remain as sedentary or perform the fine motor movements for the long uninterrupted hours that we have to do in so many of our jobs. Evidence suggests that prolonged abnormal posture and repetitive movements contribute to neck, limbs and back pain. These conditions are collectively known as overuse syndromes or repetitive stress injury (RSI).

RSI is no small matter. It accounts for 34% of all lost-workday injury and illness and costs almost $20 billion annually according to the Bureau of Labor statistics. The National Academy of Science concluded that an estimated $50 billion is lost by businesses every year from sick leave, decreased productivity and medical costs linked to repetitive stress disorders. The Academy has published 2 reports since 1998 which directly links repetitive motion to work place injury.

The damage sustained from RSI is due to structural changes in the muscle fiber as well as due to decreased blood flow. Nerves can also be involved. The immobile tissue and surrounding inflammation compress the nerve which can cause numbness or tingling and eventually weakness if the nerve is damaged severely.

For those of you who need the evidence see Overuse syndrome: a muscle biopsy study. In this study biopses were taken from hand muscles of injured and normal subjects. It demonstrated the structurall damage in the muscle fibers and correlated the damage with the severity of the injury. In another study Chronic trapezius myalgia, biopsies were taken from neck muscles, and reduced local blood flow was demonstrated in the injured areas. The greater the pain difference, the greater the reduction in blood flow.

Some of the most common RSI injuries are tendonitis and carpal tunnel syndrome. Work-related carpal tunnel syndrome (CTS) now accounts for more than 41% of all repetitive motion disorders in the United States according to Concurrent Medical Disease in Work-Related Carpal Tunnel Syndrome . Hard work never hurt anyone: or did it? is a recent review of occupational associations with soft tissue musculoskeletal disorders of the neck and upper limb that sums it up in its title.

So what should you do? The key to treatment is prevention. Research shows that injuries decrease and productivity increases when employers encourage stretch breaks and stress the importance of ergonomics. -S. Iserphagen.

A few tips are the following:
--Breaks should be taken every 30-45 minutes for at least 5 minutes. If you need assistance there are free downloadable timers that will help remind you to do so.
--Stretch your arms/hands/neck/back during the breaks. This yoga site demonstrates some samples exercises. Other sites are listed below.
--Posture alignment should be maintained. Don't slouch in the couch with the laptop.
-- Work station should be reviewed initially and with each transfer.
Adjust chair, monitor, keyboard, mouse, laptop. Alternate keyboards and mice periodically.
--Shift your gaze from the computer screen to the distance. Don't forget to blink!
--Limit non-essential computer usage. This may be heresy but give the surfing/gaming/emailing/text messaging a rest.
-- If pain occurs or persists, see your doctor who may recommend wrist brace, ice packs, anti-inflammatory medication such as ibuprofen, cortisone injections, physical therapy, and most importantly rest to allow healing. Do not procrastinate in addressing your symptoms. The sooner the better.

Some sites that may be helpful:
Harvard RSI Action
RSI exercises
RSI Page
Safe Computing Tips
Alternative and Ergonomic Keyboards
Alternative Pointing Devices
Work Station Guide

Photo courtesy of joe-ks.com

This post is from a year ago, but due to recent questions about neck, back and wrist pain I am reposting it. One of these days I will put categories on the blog so that these posts are easier to find.

Carve the Pumpkin and Not Your Hands

Most of the hand injuries that I see are work related especially with the computer addicts, but Halloween is always an exception. Here are some tips from the American Society for Surgery of the Hand to minimize pumpkin- carving injuries courtesy of the Orthocarolina hand physicians.

1. Use common sense. Wash and dry pumpkin and utensils before starting. Carve in a well-lit area.

2. Bigger is not better. Do not use large, sharp knives, as they often stick in thicker parts of the pumpkin and require force to dislodge, often seriously cutting carvers' hands when they do so.

3. Invest in a carving kit. Pumpkin carving saws require less force, making them less likely to do harm. Cut away from yourself in small, controlled strokes.

4. Leave the carving to adults. Let kids sketch the pumpkin's design and clean the pulp and seeds. Keep children at a safe distance while the carver works.

If you do cut yourself while carving, apply direct pressure to the wound with a clean cloth, after gently washing the wound with soap and water. If pressure does not stop the bleeding after 15 minutes, or if you experience a change in sensation or color or lose function of your finger or hand, seek immediate medical attention at the orthopedic urgent care or emergency department.

Happy Halloween.

Photo courtesy of encarta.

iPods - Safe Tech Tips

This week is the Apple iPod's fifth year anniversary. I can't turn a corner without bumping into one of the 68 million people using this sleek MP3 player. It's a great device that provides music, keeps the peace between teens and adults, makes those long road trips tolerable, and keeps me sane when I travel. But how long and how loudly can you listen to an iPod safely?

A recent study was published that gives some guidelines for safe listening. The researchers, Cory Portnuff and Brian Fligor studied 5 MP3 players with 5 models of earphones with each player and with different types of music.

"Typical individuals can tolerate about two hours a day of a decibel unit known as 91-dBA before risking hearing loss, Portnuff said. The term dBA stands for "A-weighted decibels, a scale that takes into account that the human ear has different sensitivities to different frequency levels," he said".

The table below is their recommendation for maximum listening time with different earphones without damaging the hearing. **There was no difference in the genres of music or the MP3 players**. It's really all about volume control and how long you spend listening. Please note that these are just general guidelines. Some people have more sensitive ears than others.
Maximum Listening Time Per Day

% of Volume Control	Earbud	Isolator	Supra-Aural	stock earphones
10 - 50 %	No limit	No limit	No limit	No limit
60 %	No limit	14 hours	No limit	18 hours
70 %	6 hours	3.4 hours	20 hours	4.6 hours
80 %	1.5 hours	50 minutes	4.9 hours	1.2 hours
90 %	22 minutes	12 minutes	1.2 hours	18 minutes
100 %	5 minutes	3 minutes	18 minutes	5 minutes

Table 1. Maximum listening time per day using NIOSH damage-risk criteria. “Earbud” includes stock earphones and iPod In-ear earphones. “Isolator” includes Etymotic ER6i earphones and Shure E4c earphones. “Supra-Aural” includes Koss headphones that rest on top of the ear. ©2006 Cory D.F. Portnuff, B.S. and Brian J. Fligor, Sc.D.

Bottomline is that if you are going to listen to the MP3 player for an extended period of time then it seems safest to play it at a level of less than 70% of the volume. Above the 80% volume damage to the hearing could be done fairly rapidly. Similar findings were found in a study of personal stereo systems.

References: please see specific links.
Photo: courtesy of ipodlounge

Don't Get Zapped By Your High Tech Gadgets

Summer is thunder and lightning season. We know the ususal safety precautions of avoiding water, open spaces, and high ground. We know not to stand near trees or under canopies. We are also supposed to avoid metal objects. But how many of you are aware of your metal appendages like the cell phone, headset, blackberry, etc. ?

There was a recent report from London about a 15 year old girl who was struck by lightning while using her phone. While these incidences are rare they serve as a reminder to exercise caution.

When you see lightning or hear thunder even with out the lightning you should turn off your gadgets and keep them away from your skin. Seek shelter in a solid building or in a car with closed windows. If lightning has hit near you and you are unable to find shelter, then it is advised to crouch down with your feet close together and keep a distance of 15 feet from other people. If you feel your skin tingling or your hair standing, lightning is about to strike you. Drop to the ground immediately.

Those who survive being struck by lightning may suffer a variety of symptoms ranging from neurological to musculoskeletal difficulties.

Take the Lightning Safety Quiz.

Photo: courtesy of China Daily.

Burnt by the Sun

Maybe I've been a physician too long. During a recent trip to Hawaii, while every one was admiring the beach, I found myself distracted by the multiple sun bathers who were sizzling like fajitas in the sun. I had to fight the urge to go over and slather them with sunscreen.

So what should you to do to avoid me and the damages caused by the ultraviolet lights of the sun? Ideally it would be best to avoid being outside between the hours of 10 AM and 3 PM, but we all know how abstinence works as a form of prevention for any thing. Experts agree that you should use sunscreen as well as protective clothing when enjoying the outdoors.

There are several brands of sunscreen in the market. Use one that has at least an SPF of 15 which blocks 93% of UVB radiation. An SPF of 30 blocks 97% of the radiation so I prefer this one. I asked Dr. Patricia Wong, a practicing dermatologist in Palo Alto, CA for her preferred sunscreen. She recommends Skinceutical's Ultimate Defense SPF 30 sunscreen because it provides full ultraviolet protection (UVB and UVA) with the minimum number of ingredients which is ideal for patients with sensitive skin. The zinc oxide particles have been formulated so that no white sheen is left on the skin.

It is important to apply sunscreen correctly. It should be applied about 20 minutes before going outdoors. The average adult wearing a bathingsuit needs to use about 1 oz. to cover the body adequately. American Academy of Dermatology recommends reapplication every 2 hours after swimming or heavy perspiration.

There is no effective treatment once the sunburn occurs. Cold compresses, emollients and acetaminophen may relieve symptoms but no medication improves the healing time.
Once again, prevention is key.

Reference: The Medical Letter, Volume 46, Issue 1184, June 7, 2004.
Disclosure: I have no financial or other other interest in Skincutical.

Avoid the Clenching Syndrome

I should have mentioned this in my post on Ergonomics. Psychosocial factors also contribute to repetitive stress injuries. How many of you have been in this scenario?

It's a typical week day. You rush out of the house and drive that long traffic ridden route to work. During this time you think about that manager who has been making your life miserable, the project that is overdue, and the impending performance review that may not be stellar. Unconsciously you start clutching your steering wheel, clenching your teeth, and yes even squeezing your pelvic floor muscles.

By the time you reach work, you have already strained several muscle groups. If this happens on a daily basis then it may contribute to carpal tunnel, tension headaches, neck pain, and coccygodynia (pain in the tail bone area). Not pleasant. So push out the negative thoughts--what are they going to change after all, take a deep breath, and think about a place where you would like to be.

Reference: Sheon, RP, Moskowitz, RW, Goldberg, VM. Soft Tissue Rheumatic Pain: Recognition, Management, Prevention. 3d ed, Williams Wilkins, Baltimore, MD 1996.
Photo: courtesy of uhaweb.hartford.edu