1. The influence of environmental risk factors on the psychophysical health of adolescents WORKSHOP Prof. Witold Lukas Department of Family Medicine, Silesian Medical Academy

2. The home environment represents the most frequent source of risk factors, not only because it is directly or indirectly associated with “civilization diseases” health hazards, but because it also correlates with various behavioural addictions. The aggressively promoted, so-called “modern” lifestyle very often causes a deterioration in human relationships.

3. CASE: A 15-year-old boy is taken to his family physician to evaluate a two- week-old pain – akin to paresthesia – in his right shoulder, arm and hand.  His mother states that the boy suffers from insomnia and that his school performance has been deteriorating over the last few months. Since then, his vision acuity has worsened, causing a gradual deterioration in reading ability. He reports pain in the wrist and palm area. His past medical history is unremarkable, except for R scoliosis. He takes no medications and has no drug allergies. His family history is also unremarkable. His vital signs are normal.

4. Plenary discussion The patient’s problems and their possible causes.

5. Working in groups Group I – a diagnostic criteria of Internet addiction. Group II – prophylactic and therapeutic strategies related to Internet overuse. Group III – (1) somatic disorders in people addicted to the Internet; (2) a clinical examination and additional tests for carpal tunnel syndrome.

6. Internet addiction Presentation of the groups’ work.

7. Pathological use of electronic media Plenary presentation

8. The Internet has had a great impact on the world and has provided many benefits to its users. However, at the same time, there are many negative aspects associated with the Internet. The concept of "Internet addiction" has been proposed as an explanation for the uncontrollable, damaging use of this technology. Primary care and family physicians are often unprepared to properly deal with this problem, especially since the symptoms of online abuse can be masked.

9. Pathological use of electronic media (PUEM) Addiction to TV, cell phones or the Internet Addiction to the content of information from cyberspace –Scale of Internet use (2004 – 26%, 2008 - 45%) > 15 y.o. –Scale of Internet use (2004 – 58%, 2008 – 80%) < 15 y.o.

10. SYMPTOMS OF INTERNET ADDICTION: An excessive amount of time spent online. Partial or total loss of control over time spent online with a reduction in baseline daily activities. An inability to control the urgent need to be connected online. Feelings of anxiety, frustration and/or tension remaining after being connected online.

11. COMMON PATHOLOGIES ENCOUNTERED ONLINE: Cyberviolence Pedofilia Virtual crimes – identity theft Online suicidal or narcotic clubs Pornography Virtual (second) life

12. Health-related problems associted with Internet overuse Somatic: Some congenital abnormalities (can be exacerbated) Ocular problems Eye ball pain Vision disturbances, e.g. double vision Abnormalities in postural and motoric function –scoliosis –myalgias –headaches –vertigo –carpal tunnel syndrome –insomnia –fatigue

13. Health-related problems associated with Internet overuse Psychical: –Desensitization –Loss of distinction between reality and fiction –Loss of personal identity –Substitution of personal identity with one’s virtual self –Loss of creativity –Hopelessness, helplessness and confusion –Disturbed communication –Sphere of interest limited to online topics only –Depression (due to limited personal contacts) –Increased aggression –Insomnia (Internet Rely Chatting (IRC) between the hours of 23.00-3.00)

14. Health-related problems associated with Internet overuse Psycho-social : –Social phobia –An escape to virtual reality –Deterioration or loss of connections to family and friends –Freedom from social structures (anonymity) –Freedom from legal rules

15. Health-related problems associated with Internet overuse Educational: –A limited vocabulary and frequent use of slang –Poor mental concentration –Memory deterioration –Reading without understanding the text –Difficulties following commands –Writing slowly

16. Problems associated with Internet overuse Prophylaxis: Keeping a daily log of time spent online. Monitoring and limiting time spent on different activities online. Focusing on performing only the necessary tasks online. Organizing a break every 30 minutes. Organize one day per week free from the computer.

17. CARPAL T U NN E L SYNDROME (CTS)

18. Carpal tunnel syndrome

19. Carpal tunnel syndrome (CTS) – is present in about 1% of the population

20. Congenital anomalies – additional tendons Inflammatory conditions – synovitis, tendonitis, tenosynovitis Rheumatoid arthritis Gout Diabetic or alcoholic neuropathy Acromegaly Pregnancy Obesity Functional acquired conditions – repeated movement and excessive flexion of the wrist and fingers due to - playing a musical instrument (e.g. the piano)- using crutches - typing, - gymnastics - status post radial fracture - biking - occupational hazards related to excessive wrist flexion

21. Paraesthesias and weakness of the first, second and third digits Dropping objects out of the hand Wasting of the thumb muscle Paraesthesias in the radial-palmar aspect of the hand Pain in the wrist and palm area Positive results of provocative tests – Tinel’s and Phaleno’s

22. Electromyography and nerve conduction velocity tests help evaluate or confirm neuropathy and document isolated nerve involvement, including the main type of fiber involved (sensory or motor). These tests also indicate the level of compression of the median nerve, in the volar aspect of the wrist. Test results are most revealing if the test is performed in the morning or after work. Computerized tomography (CT) and Magnetic Resonance Imaging (MRI)

23. The method of testing the strength of the abductor pollicis brevis muscle. The palm of the examined patient is immobilized by the palm of the person examining. The patient moves his finger while keeping the thumb nail pointed upwards the entire time. The examining doctor checks finger strength. Carpal tunnel syndrome

24. The method of testing the strength of the opponens pollicis muscle. The palm of the examined patient is immobilized by the palm of the person examining. The patient moves one of his fingers so that the pulp touches the palmar surface of a finger joint as close to the fifth finger as possible. During the last phase of the movement, the fingernail should be pointed upwards. The examining doctor checks the strength of that movement. Carpal tunnel syndrome

25. Tinel’s sign. Tapping the site of the course of the median nerve in the distal part of the forearm, between the wrist and palm, causes pain and paraesthesia. Carpal tunnel syndrome

26. Phalen’s test. The bent position of the wrist causes compression of the median nerve, which causes carpal tunnel syndrome. Pain and paraesthesia appear after a few seconds. Carpal tunnel syndrome

27. Wrist immobilization with a splint for 2-3 weeks at night or as needed daily Surgical decompression (tendonectomy) Local steroids - (a single dose) Vit. B6 50 mg 1x daily