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Treatment of fibromyalgia fibromyalgia

Treatment of fibromyalgia

Fibromyalgia can be difficult to treat and usually have better results if treatment is managed by physicians from various disciplines familiar with this condition and its treatment , a multidisciplinary treatment approach called.

Some specialists involved in treating fibromyalgia include physicians, general internists, rheumatologists, physiotherapists, among others. Some large cities have clinics for pain or rheumatology clinic where you can get specific treatment for fibromyalgia.

has to take into account that many people with fibromyalgia has been part of his life going from one doctor to another without knowing what was wrong. Health education, information and communication with other affected persons are an important form of therapy. The customized treatment plan is usually effective to suit the individual needs of each patient. Some patients have mild symptoms and need very little treatment once they understand the disorder sufferers and what worse. Others, however, need a program of comprehensive care, including medications, exercise and training on techniques for pain management.

Pharmacotherapy

anti-inflammatory drugs used to treat many rheumatic diseases are not useful for people with fibromyalgia, as a defining feature of it is not conditions exist in the muscles despite the patient's pain. However, it has been reported that moderate doses of NSAIDs (NSAIDs) or analgesics can relieve some pain but has not assessed the extent of placebo effect in these cases, probably important when dealing with patients with a long history of contacts with the health system.

A subset of NSAIDs, especially the selective inhibition of COX-2, can also provide pain relief, causing fewer side effects on the stomach and intestines than traditional NSAIDs. Most doctors refuse to prescribe narcotic painkillers or tranquilizers type, except in the most severe cases of fibromyalgia.

drugs that facilitate sleep and help relax the muscles to rest in many people with fibromyalgia. Doctors also prescribe drugs, commonly known as antidepressants, to treat fibromyalgia. These drugs work by raising the active level of serotonin, norepinephrine or both in the brain. Low serotonin levels are not linked only to clinical depression, but also with sleep disorders associated with fibromyalgia. At lower doses than prescribed to treat major depression, antidepressants appear to relieve pain in people with fibromyalgia and increasing, so the chances of achieving a restful night.

There are three main classes of antidepressants: tricyclic antidepressants, selective inhibitors of serotonin reuptake inhibitors (SSRIs) and dual (recapture several neurotransmitters). Sometimes also prescribed a drug called cyclobenzaprine (Flexeril, Yurelax), classified as a muscle relaxant but similar to tricyclic antidepressants. In recent months are being implemented programs to verify the usefulness of SNRI antidepressants, ie, selective inhibitors of serotonin reuptake norepinephrine.

Although many people sleep better and feel more comfortable when taking antidepressants, the observed improvement varies widely from one person to another (which again raises the possibility that the placebo effect is playing an important role .) These medications can have side effects such as daytime sleepiness, constipation, dry mouth and increased appetite which in turn can generate energy malnutrition. Some SSRIs or SNRIs may make sleeping difficult. These side effects are rarely serious, but can be annoying. Some studies have suggested that by combining antidepressants tricyclics with SSRIs, may increase the benefits of each drug, while the side effects of both drugs cancel each other.

have recently been conducted to the successful use of anticonvulsants or antiepileptic; pregabalin (Lyrica) ® and gabapentin (Neurontin) ® been used successfully in the treatment of acute pain in neurological diseases such as Guillain-Barre syndrome, peripheral polyneuropathy and multiple sclerosis, and fibromyalgia. These drugs cause adverse side effects on the digestive system (stomach, intestine and liver). Its main side effect is weight gain, which in turn promotes greater fatigue and pain at certain points such as knees, ankles, back, etc.

There recommendations of the herb St. John's Wort it can function as antidepressants, but with fewer side effects. The herb St. John, who comes from the flower of an herb of the same name, is frequently prescribed in Europe. Little is known about the long-term effects produced by different brands of St. John's wort. should not ever use the St. John's wort if you are taking other antidepressants and should always consult with a specialist, because it has many incompatibilities with drugs and foods.

not be forgotten that the treatment of fibromyalgia is based on a three-legged stool (exercise, psychotherapy and medication) and, if broken or unbalanced some of these legs, the treatment is ineffective.

currently considered the treatment to be carried out is multidisciplinary, with the collaboration of various medical specialties. research groups exist on this disease in Spain (Barcelona and Granada in particular) and also in Mexico and other Latin American countries.

nonpharmacologic treatments

Some options are massage, aerobics and stretching exercises (yoga), acupuncture, massage clinic, occupational therapy, cognitive therapy, Reiki, etc. Also, food supplements that provide nutrients and cellular free radical release in the body can help greatly with the pain and fight disease. A widely used dietary supplement is magnesium.

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fibromyalgia

The nine paired red circles are recognized as common tender points associated with fibromyalgia.

Given the nature of fibromyalgia, there are no laboratory tests available for diagnosis of it, in fact the results of x-rays, blood tests and muscle biopsies are normal.

The clinical diagnosis is established by exclusion of other pathologies and the presence of characteristic symptoms and signs.

To diagnose fibromyalgia, rheumatology doctor should assess the patient's clinical history and symptoms, studies and analysis.

The differential diagnosis must rule out other conditions with symptoms similar to fibromyalgia.

Fibromyalgia is often confused with other rheumatic different, such as lupus erythematosus, rheumatoid arthritis, spondyloarthropathies, osteoarthritis, chronic fatigue syndrome, deficiency of vitamin D or vitamin B12, polymyalgia rheumatica or Sjögren syndrome and neurological disorders (transverse myelitis, multiple sclerosis, peripheral polyneuropathy.

Therefore, the differential diagnosis is essential to the patient's future, as both the diagnostic approach and prognosis and even therapy are different for each condition.

It is therefore essential to make tomography, magnetic resonance, electrical study members (conduction velocity and EMG), evoked potentials, blood tests (VCR, CRP, rheumatoid factor, antinuclear antibody).

After ruling out other diseases, it verifies the existence of so-called tender points, which is not the same as trigger points or myofascial trigger points syndrome.

There are a total of 18 points

can be considered to have fibromyalgia if, by applying a pressure of nine pounds on those points The patient reported pain in 11 or more of them. This technique was developed by American College of Rheumatology .

These points are distributed throughout the body: knees, shoulders, neck, buttocks, elbows, hips, etc..

However, this approach was initially adopted as a form of "case definition", which is why the diagnosis requires a thorough evaluation by a physician who specializes in rheumatic disease (rheumatologist).

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PATHOGENESIS CLINICAL

symptoms of fibromyalgia

Pain

The main element that characterizes fibromyalgia is diffuse and widespread musculoskeletal pain or stiffness prominent affects at least 3 anatomic locations for more than 3 months, without which there can diagnose the disorder.

The pain is usually severe and often difficult described, and generally gets worse with physical exertion, cold and emotional stress.

common sites in which they develop symptoms of fibromyalgia include the lumbar (lower back), neck, chest and thighs.

Altered muscle refers to a localized painful cramping and is sometimes associated with other problems (pregnancy, for example).

In some cases there is localized muscle spasm.

Other symptoms may include urinary incontinence, headache, migraine, abnormal periodic movements of the extremities (paroxysmal movements), especially of the legs (leg syndrome trigger), difficulty concentrating and difficulty remembering things ( bad memory) but it is often an increased sensitivity to touch, generalized itching, dry eyes and mouth, ringing and ringing in the ears (tinnitus), vision disturbances (phosphenes) and some neurological symptoms of motor incoordination.

has associated with Raynaud's disease as a clinical manifestation of rare presentation during the course of the disease.

mental disorders

Between 70 and 90% of fibromyalgia sufferers sleep problems also concern expressed as a restless sleep, light and unstable.

is often associated also a heterogeneous group of symptoms including severe weakening (adynamia) and even disabling (fatigue), changes in bowel habits, rigidity in the upper or lower limbs, and frequently accompanied by depressive episodes panic attacks.

Sleep disorders are very common in patients with this disease. These disorders consist primarily of abundant nightmares, restless sleep, which may be causing a condition known as excessive daytime sleepiness, and a lot of painful shocks in the muscles during sleep.

Tiredness and fatigue

The in the extreme fatigue is present in all the activities of people with fibromyalgia, making daily tasks are inevitably more difficult. Depending on the severity and the degree of variation, this fatigue can range from tolerable to an almost insurmountable disability which limits their tasks in both the family and professional.

inseparably Coupled to this fatigue, as it increases and causes severe, is the poor quality of sleep, which prevents persons with this disorder have a restful sleep and therefore prevent the break as exacerbate the fatigue and fatigue in the future.

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Fibromyalgia Fibromyalgia causes of fibromyalgia

Pathogenesis of fibromyalgia

long been erroneously assigned to the character of fibromyalgia psychological or psychosomatic illness to the point that was called psychogenic rheumatism . However, MRI studies performed in patients with health problems have revealed that the pains are expressed as low-intensity stimulation, unlike healthy people, the brain areas responsible for pain, such as primary and secondary somatosensory cortex somatosensory, prefrontal cortex, inferior parietal lobe, the anterior cingulate cortex, insula, lymph baseline, the putamen and cerebellum. It is likely that such a low threshold of tolerance of pain causes the patient with fibromyalgia this tenderness, a state of excessive pain, pressure and other stimuli.

Anyway debate continues about whether fibromyalgia is a disease in itself or whether it is actually a set symptoms (ie, a syndrome) for rheumatic diseases, neurological or immunological diagnosis is difficult and expensive or, simply, this is the accentuation of a set of processes (fatigue, sleep disorders, pain, etc.). disease are not in themselves but their combination creates significant problems for the normal life of those suffering. Like many of the common symptoms of other disorders, patients with fibromyalgia who do not receive a correct diagnosis and those who are not informed in detail about their illness is often a cumbersome and costly provocárseles pilgrimage by different systems and services consequent health proposal for a list of paraclinical tests and specific therapies, sometimes aggressive and iatrogenic effects that worsen the prognosis of the process and returns the patient's future uncertain.

No physical abnormalities were detected in the points that the patient reports pain, which is why most current hypotheses about its causes are directed towards seeking neuroscience phenomena at the level of awareness central nervous system and maintenance of altered pain responses of neurotransmitters. Although the results of physical examination is usually normal and people have a healthy, careful examination of the muscles of people with fibromyalgia reveals touch-sensitive areas at specific locations called tender points. These are areas of the body that are painful when pressure is exerted on them. The presence and pattern of these points differ characteristically hypersensitive fibromyalgia from other conditions.

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Stress

Etiology of fibromyalgia

Although the causes have not been well clarified, is thought to be caused or aggravated by physical or mental stress, physical trauma, excessive exposure to moisture or cold, poor sleep or rheumatic disease. Many cases begin after specific events, such as viral or bacterial infections, car accidents, etc. Fibromyalgia can also occur without any predisposing factor.

have been integrated as well, covering the different theories and complex relationships between the mechanisms of sleep-wake (circadian rhythm disorders), the hypothalamic-pituitary-adrenal, the processing centers tracks pain (phenomena of central and peripheral sensitization of pain) and autonomic nervous system (alterations in autonomic tone or sympathetic-vagal, sympathetic hyperactivity with hyporeactivity sustained sympathetic response to stress).

Genetics

Graphical representation of the molecule catechol O-methyltransferase, COMT gene which is involved in the probable etiology of fibromyalgia.

Some hypotheses point to a genetic predisposition for fibromyalgia is 8 times more common among members of the same family, with emphasis on research on the COMT gene that synthesizes the catechol O-methyltransferase enzyme in the pathway of catecholamines, and serotonin-related genes and substance P. In many cases, patients with fibromyalgia have low levels of the metabolite of serotonin, 5-hydroxyindoleacetic acid (5-HIAA) and tryptophan (neurotransmitters responsible for regulation of nerve impulses) and high levels of substance P in cerebrospinal fluid. Has also found a low level of blood flow thalamic region of the brain, and abnormalities in cytokine function. However, these variations are not only present in fibromyalgia, because they have found similar patterns in other diseases, including chronic fatigue syndrome, irritable bowel syndrome and depression itself.

Other studies have found high levels of anti-polymer antibodies in patients with fibromyalgia, which could indicate that it is an autoimmune disease.

psychosomatic factors

anxiety and depression caused by emotional distress (marital separation, problems with children, loss of employment, professional failure, etc..) And the sadness that occur in response to continued unrest that causes the disease could also be triggers of this health problem. In 62% of patients in a study with a diagnosis of fibromyalgia were shown to have significant psychological problems requiring professional treatment, while among patients diagnosed with rheumatoid arthritis, had a prevalence of mental disorders of 28.6%.

Most likely, the relationship between stress and fibromyalgia is much less linear than suggested by some authors and is limited to a specific subgroup of patients still can not be identified.

A number of studies have shown that stress is an important predisposing factor in the development of fibromyalgia. Consequently, it is proposed that fibromyalgia is the result of stress-induced changes in hippocampal function and integrity. This proposal is based in part on observations preclinical studies in nonhuman primates that exposure to psychological duress resulting in changes in brain tissue, including atrophic changes and metabolic changes in the hippocampal complex. The evidence supporting this hypothesis have been generated mainly from two studies using magnetic resonance spectroscopy of single voxel or monovóxel (1H-MRS) to demonstrate the complex metabolic abnormalities in the hippocampus in patients with fibromyalgia with significant correlations between metabolic alterations hippocampus and the severity of clinical symptoms.

Sleep Disorders

Within current theories on the pathogenesis of fibromyalgia are alterations in sleep architecture (polysomnography characterized by fragmented sleep, reduced deep sleep stages non-REM, among others) alterations in the functioning of the autonomic nervous system (dysautonomia) and phenomena of abnormal pain processing (awareness of pain.)

Studies electroencephalography (EEG) have shown that patients with fibromyalgia, have intrusion-wave sleep slow and that the circumstances that interfere with stage four sleep, such as pain, depression, serotonin deficiency, certain medications or anxiety can cause or worsen the condition. According to the hypothesis of sleep disturbance, an event such as trauma or illness causes sleep disorders so that start chronic pain that characterizes fibromyalgia. Hypothesized to stage four sleep is essential for nervous system function mediated by serotonin and tryptophan, as it is during this phase, some neurochemical processes in the body to "reset." In particular, pain causes the release of the neuropeptide substance P in the spinal cord, which has an amplifying effect on pain and causing nerves next to those who initiate the stimulus is more sensitive to pain. Entoces theory assumes that the lack of sleep, for whatever reason, can become a source of disease onset and symptoms.

environmental factors

Other hypotheses have proposed that fibromyalgia can occur due to environmental factors. Contact may cause an allergic reaction to metals, either by dental restoration, metal prostheses, cosmetics, tattoos, piercings or jewelry, vaccines and treatments with metal salts. Studies conducted in patients with allergies to metals who, by eliminating the source of metal, and still others have improved on that fibromyalgia is gone. Furthermore, ultrastructural alterations were found in biopsies of muscle, studied by electron microscopy in these patients.

There are descriptions of cases of fibromyalgia in clinical manifestations consistent with a viral infection such as Epstein-Barr virus, or bacterial (eg Lyme disease) that may lead to an aberrant immune reaction. However, has not yet been able to establish a definite correlation between symptoms and some of these health problems.

sometimes appears after you have diseases that weaken the body, such as rheumatoid arthritis and lupus erythematosus, but this does not seem to be the cause itself, but a circumstance that raises a hidden defect regulating the body's responsiveness to certain painful stimuli.

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HISTORY

History of fibromyalgia

Propaganda remedies including an apparent cure of neurasthenia, the name given in the nineteenth century to fibromyalgia.

The first description appears to have been Britain's Sir Richard Manningham in his publication of fever or fever and fatigue, citing descriptions similar to those made by Hippocrates.

In 1869 the American physician George M. Beard wrote a book called "American Nervousness' neurasthenia using the term applied to those who had loss of strength, fatigue or a chronic fatigue.

In 1843 the anatomist Robert R. Froriep described an association between rheumatism and stiff muscles, tender points: Musckelschwiele.

3 to 6% OF GLOBAL FIBROMYALGIA paced

Epidemiology of fibromyalgia

is known that Fibromyalgia affects more women than men by a ratio of 9 / 10:1 and could affect 3-6% of the general population. It is observed mainly between 20 and 50 years of age, although cases of children and the elderly suffering from this disease. It affects 4.5% of adult women in the general English population and 0.2 for adult males. This contrasts with a prevalence of around 10% in countries like Israel, America, Britain or Canada. Between 10 and 20% of revenues in rheumatology clinics are diagnosed with fibromyalgia, however it is estimated that about 90% of those who should be framed a table of fibromyalgia remain undiagnosed, either because of ignorance of the medical staff about it or because many professionals do not recognize them as a disease. People with rheumatoid arthritis and other autoimmune diseases are particularly likely to develop fibromyalgia.

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FIBROMYALGIA FIBROMYALGIA PATIENTS ASSOCIATIONS

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Fibromyalgia

Fibromyalgia (FM) is a term coined in 1976 (from the Latin fiber, fiber, which refers to the connective tissue, from the Greek myo, muscle, and severe pain, pain referred to a group of symptoms and musculoskeletal disorders poorly understood, which is mainly characterized by extreme fatigue, persistent pain, stiffness, variable intensity of the muscles, tendons and surrounding soft tissue, and a wide range of other psychological symptoms such as difficulty sleeping, morning stiffness, headaches and problems with thinking and memory, sometimes called "blackouts," which often prevent the routine operation of the subject. It is a disorder not contagious present in approximately 3 to 6 percent of young women, usually between 20 and 50 years of age.

Fibromyalgia is considered a controversial diagnosis, some authors claim should not be considered as a disease because, among other reasons, lack of abnormalities on physical examination, laboratory tests or objective medical imaging studies to confirm the diagnosis.

Although historically has been considered a musculoskeletal disorder and neuropsychiatric, evidence from research in the past three decades have revealed alterations in the central nervous system affecting the brain regions that may be related to both clinical symptoms as phenomena discovered during clinical investigations. Although there is no universally accepted cure for fibromyalgia, there are treatments that have been shown in controlled clinical trials to be effective in reducing symptoms such as patient education, exercise, behavioral therapies, and in some cases, consumption certain drugs.

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Occupational

Hollister Em Woodbury

TABLE OF DISEASES

Royal Decree 1995/1978 of 12 May, approving the schedule of occupational diseases in the social security system. BOE of 25 August.

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MEEK, as Lolita Bosch



"I find doubly courageous MEEK. Not that talk about sex and it happens in a public bath, that it is, but because in it the author has succeeded in breaking the prejudices of any player making a world seemingly sordid peripheral, something extraordinary. And I think that this is precisely one of the purposes of literature. Do not expect extraordinary things but teach us to look at things as if they were. For the freedom with which the writer has thought or the closeness with which forces the reader to relate to certain aspects that are close but which is, again and again, to flee. (...) virgin it is impossible to read. And when a writer manages to break prejudices of the reader and forces him to look tenderly looked askance things before opening the book, one can say that the book works in one of its most important. Because it teaches you to look differently.
(...) And that, as undoubtedly will happen with the readers of MEEK, would make them freer. And I would also have a memory that is more courageous, more imaginative, more willing to tell.
Therefore, I will not say anything about his history or his most tender person or the everyday-literary spiral in which they join. Because I really think you should read this book and go with him. Thank
"
LOLITA BOSCH in presenting the Library MEEK Bertrand de Barcelona (20/03/2010)

[Thank you, Lolita ]

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PROFESIONOGRAMA: FIREFIGHTER TRAINING DEAFNESS

LOWS TO MAKE WORK A FIREFIGHTER
1. Auto up and down stairs 30 meters to 60 º with team full firefighter's self contained breathing apparatus (maximal exercise capacity and balance).
2. Lifting and moving in different spatial positions and body weight of 35 Kg. (Strength and mobility capabilities).
3. To work in different body positions and situations in height without vertigo (flexibility, agility and balance).
4. Able to use a Self Breathing Apparatus (ERA) and to work, raise a fourth floor with two 25 meter folded hoses.
5. Able to walk for three hours outdoors in hot weather forest backpacking (35 Kg.).
6. Slopes to jump 1.5 meters.
7. To stretch hose fire. Equivalent to drag a weight of 50 Kg. for 100 meters.
8. Able to raise and lower the fire truck. To make the connection and disconnection of hoses. Movements involves rotation of the arm and wrist with a maximum force.
9. Able to move with agility in an environment of obstacles, without corrective eye (minimum visual acuity).
10. To discriminate odors, such as methane, odor, chlorine, etc.
11. Able to detect different touch stimuli, eg heat, cold.
12. To work for long periods in forest fires and major accidents, at least 8 hours without a controlled diet (endocrine system intact, diabetes).
13. Psychological or mental attitude that allows:
- understand and respond appropriately to the information from colleagues, orders and the environment.
- Intellectual level of consistency and minimum discrimination allowed to develop properly in hostile environments.
- correct general attitude compatible with the generally accepted standards.

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ANATOMY AND PHYSIOLOGY OF THE EAR
Hearing is a complex process designed to receive sound waves that propagate in the air, convert them into electrical nerve stimuli and transmit them to the cerebral cortex, which processes and identified as sound.
The ear is the organ responsible for hearing. Schematically presents each of its parts and its operation.
The ear is divided into three parts clearly differentiated
-
-OUTER EAR MIDDLE EAR INNER EAR

-

OUTER EAR
What is "ear" or pinna, whose function is to "collect" and amplify the sound wave, and channel it into the ear canal, which ends at the eardrum.
The eardrum is an elastic membrane that completely seals the pipe and makes the border between the outer ear and middle ear. The tympanum
healthy upon receipt of the sound wave vibration occurs. MIDDLE EAR

is a cavity carved into the thick skull, connected with the pharynx through a passage called the Eustachian tube, which serves to atmospheric pressure existing in the external ear and middle ear pressure are equal.
Going up or down mountain passes will notice a "deafening" because it decreases or increases, respectively, the atmospheric pressure outside.
This implies that the eardrum bulges to stress, decreasing its ability to vibrate. When spontaneously or by some movement of the jaw is "open" the eustachian tube is roughly equal pressures in the middle ear and the outside, and produces the typical "popping." Part "noble" is the middle ear ossicular transmission system ": the tiny bones that are responsible for transmitting the vibration to the inner ear. The Hammer, has a thin extension attached to the eardrum, which receives the vibrations from it. Hammer transmits this vibration to Yunque, in which is articulado.Este, in turn, contact the stirrup, a small bone that fits perfectly into a closed window with a membrane, the oval window. The oval window separates the middle ear, inner ear, and she applies the movement vibration of the eardrum, transmitted and amplified by the ossicles. INNER EAR

The inner ear is the ear neurological, where the receptors that convert mechanical vibrations into nerve impulses. The inner ear is also called "Caracol" or "Cochlea" because it is a coiled tubular-shaped shell, dug into the skull. The vibrations of the stirrup are transmitted via the oval window to the inner ear.
In this one, filled with liquid, is a "wave" which introduces the vibration vibrating in all inner ear structures and ending at the round window, which gives the middle ear.
The wave liquid in its path, vibrates the cochlear duct.
Facing a court given transverse level, understand the ultimate mechanism of hearing: The vibration wave in the inner ear, "go" in one direction by the scala vestibuli and "back" by the tympanic membrane vibrates the Basilar, so that the hair cells in the Organ of Corti "rub" with the tectorial membrane.
This friction causes the nerve impulse is transmitted to the brain, where it identifies the drive as sound. Snail Along this mechanism works, but not all cells of Corti are capable of collecting all the sounds: The closer to the window pick up sounds sharper and more distant the most serious.

hearing impairment BUSINESS
noise damages the inner ear, high tones being more harmful than the bass.
The tones are those which occur more frequently in the industrial environment. Hence
audiometric examination of workers who have been subjected to prolonged exposure to high noise levels reveals, loss of hearing acuity in the higher frequency ranges: between 3,000 and 6,000 Hz, and in particular, about of 4,000 Hz
The lesion begins around 4,000 Hz, and then spreads to nearby frequencies. Over time will expand to involve the Conversational BANDA (are the frequencies between 500 and 2,000 Hz). These frequencies correspond with which "normally" gives the human voice.
According to reports from the International Organization for Standardization (ISO), workers who have been exposed to intensities above 85 dB, is characteristic of hearing loss by noise.
noise destroys the hair cells of the organ of Corti (in the inner ear), resulting in a PURA Sensorineural hearing loss (of perception), with decreased levels of hearing both by air (via the ear) or via bone (transmission of sound through the skull). This deafness, besides being perception, is irreversible, that is permanent, and that does not recover the hearing and no treatment.
The use of headphones (sound amplifiers) only enhances the subjective feeling of the person, especially in the early stages of evolution of deafness, but it is not effective because the lesion is in the perception, not the transmission of sonidos.Por other hand, is a progressive lesion, depending on the intensity and duration of noise exposure, progresses inexorably.
To understand the changes in the perception of sounds, often used the following example: It is as if the intention is to listen to the recording on a disc, which is in good conditions, in suitable equipment, without deterioration, connect the buttons ... etc. but it is impossible to hear if there is no network connection. The defect in the connection will prevent hearing the recording, but they operate the volume control.
preventive purposes, it is interesting to note that the beginning of this hearing loss, typically in the range of 4,000 Hz (scotoma), some people in the 6,000 Hz indicative of the onset of injury.
frequencies of 4,000 - 6,000 Hz are not included among those used in conversational band, therefore, the person is unaware of hearing loss in the beginning, it does not have any difficulties to hear the human voice. When he feels that there is some difficulty hearing the voice, it's a very advanced stage, and from there the sense of loss evolution was affecting even the social sphere of the individual.
As already mentioned, is an irreversible hearing loss, no treatment, and affects both ears (bilateral) similar (symmetrical). This is the most common, but do not exclude that in some cases affects only one ear. For example, when the sound source is not environmental but comes from one side only. A typical example is the deaf driver's left ear when the noise from outside the factory receive it on that side the open window, staying healthy, the other ear because the head itself performs the function of shielding.
Demonstration of one-sidedness of the injury, it is easy to check by examining the conditions of the job.
professional to confirm the origin of this hearing, in addition to the features described, is added the existence of a history of occupational exposure to high levels of ruido.Una way to facilitate this data is done by including in the file of Occupational Health, the results of the measurements at the workplace (sonometrías). It is also necessary to rule out hearing loss from another source, such as transmission or those caused by infectious or toxic causes. (You can also find a hearing professional association with other injuries added, for example, a repetition otitis (infection) by the improper use of a shield with deafness ... etc.
It should be noted that adds natural aging ear with age, affecting differently.

hearing loss or deafness PROFESSIONAL (Royal Decree 1995/1978, of 12 May, BY ADOPTING THE TABLE OCCUPATIONAL DISEASES IN THE SOCIAL SECURITY SYSTEM - BOE of 25 August)
is a definitive injury caused by occupational disease (Article 140 of the LAW OF SECURITY SOCIAL of 05/30/1974). And susceptible to financial compensation, as described in "Bodies of the hearing" of the INJURY UPDATE SCALE mutilations and deformities final and non-disabling (MO April 5, 1974).
can also be classified as PERMANENT DISABILITY RATING OF STAY (LAW OF THE SOCIAL SECURITY) when incapacitated for the performance of at least 33% of the main tasks of his usual occupation, and / or poses an additional risk in office (Example: unable to communicate or understand notices, not hearing alarms ... etc.), and depending on the degree of injury. In this case correspond to an indemnity equal to 24 months of their basic salary (depending on price), not leading either to the termination of employment.
In some conventions, and seeking improved protection worker, is articulated the possibility of changing jobs to get rid of the risk exposure that has been injured. In this case, you should remember as well that do not cause detrimental effects on wage perception.
The economic compensation has been cast previously mentioned, in any case fall within the company (unless it is self-insurance), and correspond to the insurance company (Mutual), or ultimately to the INSS. (Cited as: there are conventions which mentions that this compensation the company can deduct the salary of the employee / a. This situation, which could be a source of interpretation error, or failure of information needs to be avoided, since in practice becomes an economic asset for the Company and not for the worker, that is precisely who treated. Would be a strange situation that encourages increased risks at work, because the more injured there, increase the economic contribution to the payment of their wages).
Also important to take precautions, is that the permanent partial disability rating, or "diminished capacity" (in Conventions) by deafness, may be supported to take up or stay in some jobs.
This aspect is referred to the "scales of competence" that determine some companies for internal application. Union intervention is essential in this field, avoiding situations such discriminatory procedures, or reduction of jobs, among others. Types of hearing loss

The occupational deafness is hearing loss caused by certain conditions job.The entitled to compensation varies across countries, for example in Italy, there is a list of 22 types of activities, and treble sound trauma considered as work accidents.
In Spain the right to compensation for deafness is contained in box Permanent non-disabling injuries)
DEAFNESS OR HEARING LOSS TYPES OF BUSINESS:
· HEARING LOSS BY EXPOSURE TO NOISE
· HEARING LOSS FOR MIDDLE EAR TRAUMA BAROMETRIC
· HEARING LOSS FOLLOWING embolism
· BIPOACUSIA cranial trauma or craniofacial
· HEARING LOSS BY EXPOSURE TOXIC AGENTS

INDUSTRIAL NOISE EXPOSURE FOR HEARING LOSS HEARING LOSS BY TRAUMA BAROMETRIC

is an injury to the tympanic membrane middle ear caused by sudden changes in barometric pressure associated with changes in the normal function of the eustachian tube. Can be produced in two similar forms, by increasing pressure or by decreasing it in fast sea diving, or when a diver rises to the surface, intense chopped aviation and landing at excessive speed. There is a blockage of the middle ear with moderate to severe pain, and bleeding in case of eardrum rupture. Prevention is based on the proper execution of the decompression endotimpánica and treatment of rhino-pharyngeal any condition that may cause stenosis of the uterine decompression sickness Eustaquio.HIPOACUSIA
When air is breathed at high pressure, large quantities of nitrogen dissolved in the blood. If the return to normal pressure is not successful, strokes arise by the passage of this nitrogen from the blood into the tissues. Symptoms include hearing loss arises, it will be irreversible, with buzzing and balance disorders.
HEARING LOSS BY CRANIAL TRAUMA OR CRANIOFACIAL
is due to a fracture of the skull (by a blow to the chin that causes fouling of the mandibular condyle, breaking the eardrum or middle ear, causing hearing loss ... transmission) or a concussion without fracture. In the latter case, the hearing loss is sensory type, usually monolateral. HEARING LOSS BY TOXIC AGENTS

toxicants are nervous structures of the ear: source industrial (ototoxicity), certain drugs or drug ingestion (the manufacture of drugs not known to cause deafness), for example, alcohol, lead, carbon monoxide, mercury, carbon disulfide, and certain solvents such as benzene and trichlorethylene.

HEARING LOSS CALCULATION OF EARLY LOSS

INDEX (ELI). An index of early loss of occupational origin. Assesses the loss in dB at 4000Hz, subtracting the estimate of Presbycusis: Presbycusis

VALUE OF AGE dB dB MEN WOMEN

25 0 0 35 30 2 March
March 7

45 40 May 11 August 15 50 December 20


55 26 60 32 17 15 65 38 18

LOSS ELI GRADE CLASSIFICATION HEARING
CORRECTED - 8dB A
Excellent - Good
8-14 dB B - 15 - Normal 22 dB C
- 23-29 dB hearing loss suspected
D - + 30 dB E Deafness clear
AVERAGE SPEECH LOSS (SAL). Conversational rate of loss. It is estimated the average loss for each ear conversational frequencies (DB dB 500 Hz + 1000 Hz + 2000 Hz)

SAL GRADE HEARING LOSS CONVERSATIONAL MEDIA
- 16 dB (worse ear) A Normal
- 17-30 dB (one ear) B Difficulty hearing the whisper
- 31 -45 dB (better ear) C Difficulty hearing normal tone of voice
- 46-60 dB (better ear) D Difficulty hearing high-pitched voice
- 61-90 dB (better ear) hearing difficulty except E
amplified voice - 91 -100 dB (better ear) F Difficulty hearing even with amplification

CLASSIC GRADE: for rapid assessment in the light of audiometry. HEARING LOSS
GRADE I: Scotoma to 4000 Hz, 6000Hz recovery. HEARING LOSS
GRADE II: Scotoma to 4000 Hz, expanded to treble. HEARING LOSS
GRADE III: Scotoma broad band conversational interest.

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Making friends.


do not know what amuses me more, if I quoted in the press release Intereconomia or taken with so much joy his right-wing extremism.

(Thanks for the cut, Mr. Albert )

Lymphoma Of The Stomach

Majete MEEK, back cover text

Marx, you know, the Karl Marx of communism and stuff, reported to have said that under capitalism the humiliation kilo sold cheap, with the cost of an inter average wage take home, likes it or not, a proportional amount of humiliation or comparable to its own weight, job or mortgage degustation. The dying protagonist of this sensational novel overweight probably in excess of abusing alcohol and those other enemies of the man who named the Catechism of our childhoods: the devil, the world and the flesh (other). One night, what night that night, goes through a sauna, and not to release fat, and perfect surf and lucid state of recklessness to make a brief summary of his life. So far the novel could be an example of cheap neoexistencialismo that crushes us lately the neocostumbrismo fractal. But, fortunately, and suddenly, sudden, and because other (small tribute to Pedro Salinas) "something." A novel in which "something" is now, apparently seen and read what they read, a notable exception, but also that "something happens" is to unravel with great and cruel narrative heard, some of the roots under visible in our silences most mundane and perverse, the exception gives way to the exceptional. And this is the case.

(Thank you, Constantine )

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To try to understand international reality in all its dimensions is essential to consult the ' Royalty ' Site of HOLA, an essential reference where Today, among its highlights, news discovered two annexes that give us a clear explanation of the world from the point of view of the wording of the magazine more consulted in private doctors' offices. Here they are:

Moulay el Hassan, son of Mohamed VI, presided over his first official act without their parents

never too early to assume responsibility, but If the heirs to the throne is especially important to raise awareness of the role of service to the kingdom and to be acquired as soon as possible.

The Princess of Asturias will launch in March his first official trip abroad alone

proximity between the two, it should be noted an interesting parallel, a classic 'ancient regime'-between the condition of the infant and the woman, as the Maclean's highlighted with the same enthusiasm and level with the first official acts of a child alone for seven years and a thirty-something princess. With two balls (excuses).

Not satisfied with this regression, the drafters of the HOLA Web offer us another gem to be made these ladies very happy right either devouring its pages every week, women who alternate reading the magazine with pleasant morning television, where, day in and the other also makes programs for juvenile offenders matter for debate, amending the Law of Least a verbena and increased penalties for teens a chimera. There is nothing better to reinforce that regression and repressive approach the start of the news of the prince: "It's never too early to assume responsibility, but in the case of the heirs to the throne is especially important to raise awareness of the role of service to the kingdom and to be acquired as soon as possible. " O, which is the same: if they vote, they can fuck and if they can take real responsibilities, they can go to the clink. The poor, yes. The princes engaged in the services realm.

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IdeHOLAgía

Leo in 'social peace' by Antonio Donate :

"If there would not have forgotten culture. Forgetting generates the element of surprise. "

And I give all the reason, I see your bet amnesic and climb up to go for oblivion as the Creator of all germs. If there is no forgetting, there is nothing: only memory. We would live paralyzed, buried for all the memories accumulated in a suffocating Diogenes Syndrome of feelings, words, numbers, gestures, smells, experiences, daring that made us cowards and fears that allowed us to survive.

Without the culture would not have forgotten or, even worse, there would Pop Star Queen -AKA Karmele Marchante - because she would remember who it was, who wanted to be and everything he told Manuel Vázquez Montalbán one afternoon, back in 1996 at the Palace Hotel in Madrid, as the writer wrote in his splendid review 'A Pole in the court of King Juan Carlos ", where the reporter claimed in a fit cacophonous maverick lucidity:

"We installed in fatalism. It is not disputed anything or expect anything new. What is now more like gossip and gossip. Not really conversing. I complained that no new model that Older models do not work for me, I've always liked cross the pond violations. Now I have no space for transgression, as before. "

Today, thanks to his amnesia, has managed Karmele discovered as a new model offender, find a new space as a frustrated singer Eurovision limp as a battering ram of a chain of missing links has been able to turn it into a version pinturera feist where they overlap the portrait of a woman covered in lace lazy with the court jester. Because there is no current model that the path at the expense of repeating the same parody that other channel created two years ago to bust Eurovision, a festival that shows the opposite effect to the theory of Oñate novel, if not memory existed, there would be Eurovision, which survives only as a parody of himself, as a device whose Warholian pop photocopies appear increasingly saturated color, dirtier and less distinguishable from an original and senseless.

turn on the TV, are the four and a half and I hope to get out of 'Save me' Some other pearl among the mud from getting to round out this portrait of Karmele memory. No way. She is not today. So that, in turn, give me a text superimposed on the torso of a former contestant on Big Brother:

"How is the curriculum of GH11 Rebecca since leaving the house? A cover Interviú , several boyfriends and an alleged attempt to rape. "

Obviously, I again turn off the television and mentally review my resume since I left my parents house (Great Horror 1) for twenty years and a cover in Interviú , several boyfriends, a rape, a happy marriage and a novel, ' MEEK ', which will hit bookstores on March 19. Buy it!

(Twenty years have passed since I left GH1, how awful. How long and short distance from there to here, that place I learned in Luis Cernuda :

Where such penalties and no more than names ,
native Heaven and Earth around a memory;
Where is finally free myself unknowingly,
dissolved in fog, absence, Absence
mild as meat as a child.
There, far away;
Donde habite el olvido.)

(Posted FRONTLINE, March 2010)

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Donde habite el olvido VICTIM OF AGRO-Sartorialist (Based on a true story)

I keep posting my page on FRONTLINE. Here is the February issue:

Gran Via, in late September Saturday, just minutes after being held in the Puerta del Sol a farmers demonstration in protest against the abuse of intermediaries and the ruin of field, what their work is worth what they cost compared to fruits and vegetables. I go to La Casa del Libro, buy "A worldly country" the last collection of poems by John Ashberry , a poet who touches me forever. Having regard for the occasion brown shoes with yellow laces, tights burgundy (bordeaux), buff breeches, a silk scarf in silver and purple Belgian designer Dries van Noten , a vintage coat and a huge frame bag, also in Burgundy, from Yves Saint Laurent . (After doing this detailed tour of my outfit I realize that I am one of the few contributors to this magazine that earn more with clothes than without it. Damn it my picture ...) I hope

on the sidewalk of the odd Great Way to spend a free taxi to take me to dinner at the house a couple of friends that I have promised a delicious curry, when suddenly appear beside me one farmer demonstrators, agricultural union flag in hand, please ask me to pose with him before the digital camera wielding his teenage son , which portrays us repeatedly that portrays me alone so many. I smile like an idiot. The boy looks at me fascinated. I suppose in the main street of the Valencian people are not as bold as I mess. At least alive. Shoot me again. I smile.

For a taxi. Free. I give the address where you want to take me, a street named constellation that is only found in the GPS, and then I pull out my Blackberry to tweet: "I have just been the victim of agro-Sartorialist ." I understand that an entry is very contemporary because that week was in Madrid and Barcelona Sartorialist presenting a couple of outlets in his first book with pedestrian street photography style.

Later at night, back to the Hotel de las Letras where I stay, I think in some agricultural association newsletter will appear one day a picture of me. If the agricultural union newsletters include among its pages a section of people, fashion or society. I also think that if given a bad day come, I always I can earn a living as a steward extravagant agricultural fairs and charge for my perch.

Once in the bed of my hotel room reading randomly choose one of the poems Ashberry, the book I bought that morning, before I knew that I would become a fashion icon in the vast rural or editorial sense of union publications. Abro "A worldly country" by any page and I find a great poem, whose final read:

"It's just a scrap, seriously, a fragment of life
in which no one else seemed interested. It is not what can one take:
is part of the decoration, dancing to forever. "

down And I smoke, so I light a cigarette. To compensate.

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MEEK On sale March 19, 2010



(Click above to enlarge and read the synopsis)