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The influence of environmental risk
factors on the psychophysical health
of adolescents
Prof. Witold Lukas
Department of Family Medicine, Silesian Medical Academy
• 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
A 15-year-old boy is taken to his family physician to evaluate a twoweek-old pain – akin to paresthesia – in his right shoulder, arm and
 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
• He takes no medications and has no drug allergies.
• His family history is also unremarkable.
• His vital signs are normal.
Plenary discussion
• The patient’s problems and their possible
Working in groups
Group I – a diagnostic criteria of Internet
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.
Internet addiction
• Presentation of the groups’ work.
Pathological use of electronic media
• Plenary presentation
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.
Pathological use of electronic media
• 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
– Scale of Internet use (2004 – 58%, 2008 – 80%) < 15
• An excessive amount of time spent online.
• Partial or total loss of control over time spent
online with a reduction in baseline daily
• An inability to control the urgent need to be
connected online.
• Feelings of anxiety, frustration and/or tension
remaining after being connected online.
Virtual crimes – identity theft
Online suicidal or narcotic clubs
Virtual (second) life
Health-related problems associted
with Internet overuse
• Some congenital abnormalities (can be exacerbated)
• Ocular problems
• Eye ball pain
• Vision disturbances, e.g. double vision
• Abnormalities in postural and motoric function
carpal tunnel syndrome
Health-related problems associated
with Internet overuse
– 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
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
Health-related problems associated
with Internet overuse
– A limited vocabulary and frequent use of slang
– Poor mental concentration
– Memory deterioration
– Reading without understanding the text
– Difficulties following commands
– Writing slowly
Problems associated
with Internet overuse
• 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
Carpal tunnel syndrome
Carpal tunnel syndrome (CTS)
– is present in about 1% of the population
Congenital anomalies – additional tendons
Inflammatory conditions – synovitis, tendonitis, tenosynovitis
Rheumatoid arthritis
Diabetic or alcoholic neuropathy
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
• 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
• 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
Carpal tunnel syndrome
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
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
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
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.
• 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