The burden of musculoskeletal disease - a global perspective

Musculoskeletal diseases are one of the major causes of disability around the world and have been a significant reason for the development of the Bone and Joint Decade. Rheumatoid arthritis, osteoarthritis and back pain are important causes of disability-adjusted-life years in both the developed and developing world. COPCORD studies in over 17 countries around the world have identified back and knee pain as common in the community and are likely to increase with the ageing population. Musculoskeletal conditions are an enormous cost to the community in economic terms, and these figures emphasise how governments need to invest in the future and look at ways of reducing the burden of musculoskeletal diseases by encouraging exercise and obesity prevention campaigns.

Musculoskeletal disorders (MSDs) in dancers and former dancers participating in the largest dance festival in the world

Objective: To verify the presence of musculoskeletal disorders (MSD) in dancers and former dancers participating in the 27th Joinville Dance FestivalMaterial and methods: The research was conducted at the 27th Joinville Dance Festival in Santa Catarina, Brazil, with 173 participants in the competition, where 139 were dancers and 34 were former dancers with at least ten years of practiceIn order to obtain information related to MSDs, dancers answered a specific questionnaireResults: The study group consisted of adults (28±9 years) with body mass index within the normal range (21.3±2.3) with high weekly training time (955.7±837.2) and featuring long-time experience in dancing (18±7years)The lumbar spine and knees were the most affected by MSDsThe pain of high intensity was the symptom that most often appeared in reports among survey participantsConclusion: It is important to have deeper knowledge of the prevalence of pain among professional dancers, the factors associated with pain conditions and its impact on everyday life in order to plan new forms of prevention and plan new forms of prevention and treatment within a multidisciplinary approach© 2012 Elsevier Masson SAS.

Determinants of reduced walking speed in people with musculoskeletal pain

OBJECTIVE: Maintenance of good walking speed is essential to independent living. People with musculoskeletal disease often have reduced walking speed. We investigated determinants of slower walking, other than musculoskeletal disease, that might provide valuable additional targets for therapy. METHODS: We analyzed data from the Somerset and Avon Survey of Health, a community based survey of people aged over 35 years. A total of 2703 participants who reported hip or knee pain at baseline (1994/1995) were studied, and reassessed in 2002-2003; 1696 were available for followup, and walking speed was tested in 1074. Walking speed (m/s) was used as outcome measure. Baseline characteristics, including comorbidities and socioeconomic factors, were tested for their ability to predict reduced walking speed using multiple linear regression analysis. RESULTS: Age, female sex, and immobility at baseline were predictive of slower walking speed. Other independent risk factors included the presence of cataract, low socioeconomic status, intermittent claudication, and other cardiovascular conditions. Having a cataract was associated with a decrease of 0.10 m/s (95% CI 0.03, 0.16). Those in social class V had a walking speed 0.22 m/s (95% CI 0.126, 0.31) slower than those in social class I. CONCLUSION: Comorbidities, age, female sex, and lower socioeconomic position determine walking speed in people with joint pain. Issues such as poor vision and social-economic disadvantage may add to the effect of musculoskeletal disease, suggesting the need for a holistic approach to management of these patients.

The Role of ULK1 in the Pathophysiology of Osteoarthritis

L'arthrose est la maladie musculo-squelettique la plus commune dans le monde. Elle est l'une des principales causes de douleur et d’incapacité chez les adultes, et elle représente un fardeau considérable sur le système de soins de santé. L'arthrose est une maladie de l’articulation entière, impliquant non seulement le cartilage articulaire, mais aussi la synoviale, les ligaments et l’os sous-chondral. L’arthrose est caractérisée par la dégénérescence progressive du cartilage articulaire, la formation d’ostéophytes, le remodelage de l'os sous-chondral, la détérioration des tendons et des ligaments et l'inflammation de la membrane synoviale. Les traitements actuels aident seulement à soulager les symptômes précoces de la maladie, c’est pour cette raison que l'arthrose est caractérisée par une progression presque inévitable vers la phase terminale de la maladie. La pathogénie exacte de l'arthrose est encore inconnue, mais on sait que l'événement clé est la dégradation du cartilage articulaire. Le cartilage articulaire est composé uniquement des chondrocytes; les cellules responsables de la synthèse de la matrice extracellulaire et du maintien de l'homéostasie du cartilage articulaire. Les chondrocytes maintiennent la matrice du cartilage en remplaçant les macromolécules dégradées et en répondant aux lésions du cartilage et aux dégénérescences focales en augmentant l'activité de synthèse locale. Les chondrocytes ont un taux faible de renouvellement, c’est pour cette raison qu’ils utilisent des mécanismes endogènes tels que l'autophagie (un processus de survie cellulaire et d’adaptation) pour enlever les organelles et les macromolécules endommagés et pour maintenir l'homéostasie du cartilage articulaire. i L'autophagie est une voie de dégradation lysosomale qui est essentielle pour la survie, la différenciation, le développement et l’homéostasie. Elle régule la maturation et favorise la survie des chondrocytes matures sous le stress et des conditions hypoxiques. Des études effectuées par nous et d'autres ont montré qu’un dérèglement de l’autophagie est associé à une diminution de la chondroprotection, à l'augmentation de la mort cellulaire et à la dégénérescence du cartilage articulaire. Carames et al ont montré que l'autophagie est constitutivement exprimée dans le cartilage articulaire humain normal. Toutefois, l'expression des inducteurs principaux de l'autophagie est réduite dans le vieux cartilage. Nos études précédentes ont également identifié des principaux gènes de l’autophagie qui sont exprimés à des niveaux plus faibles dans le cartilage humain atteint de l'arthrose. Les mêmes résultats ont été montrés dans le cartilage articulaire provenant des modèles de l’arthrose expérimentaux chez la souris et le chien. Plus précisément, nous avons remarqué que l'expression d’Unc-51 like kinase-1 (ULK1) est faible dans cartilage humain atteint de l'arthrose et des modèles expérimentaux de l’arthrose. ULK1 est la sérine / thréonine protéine kinase et elle est l’inducteur principal de l’autophagie. La perte de l’expression de ULK1 se traduit par un niveau d’autophagie faible. Etant donné qu’une signalisation adéquate de l'autophagie est nécessaire pour maintenir la chondroprotection ainsi que l'homéostasie du cartilage articulaire, nous avons proposé l’hypothèse suivante : une expression adéquate de ULK1 est requise pour l’induction de l’autophagie dans le cartilage articulaire et une perte de cette expression se traduira par une diminution de la chondroprotection, et une augmentation de la mort des chondrocytes ce qui conduit à la dégénérescence du cartilage articulaire. Le rôle exact de ULK1 dans la pathogénie de l'arthrose est inconnue, j’ai alors créé pour la première fois, des souris KO ULK1spécifiquement dans le cartilage en utilisant la technologie Cre-Lox et j’ai ensuite soumis ces souris à la déstabilisation du ménisque médial (DMM), un modèle de l'arthrose de la souris pour élucider le rôle spécifique in vivo de ULK1 dans pathogenèse de l'arthrose. Mes résultats montrent que ULK1 est essentielle pour le maintien de l'homéostasie du cartilage articulaire. Plus précisément, je montre que la perte de ULK1 dans le cartilage articulaire a causé un phénotype de l’arthrose accéléré, associé à la dégénérescence accélérée du cartilage, l’augmentation de la mort cellulaire des chondrocytes, et l’augmentation de l'expression des facteurs cataboliques. En utilisant des chondrocytes provenant des patients atteints de l’arthrose et qui ont été transfectées avec le plasmide d'expression ULK1, je montre qu’ULK1 est capable de réduire l’expression de la protéine mTOR (principal régulateur négatif de l’autophagie) et de diminuer l’expression des facteurs cataboliques comme MMP-13 et ADAMTS-5 et COX-2. Mes résultats jusqu'à présent indiquent que ULK1 est une cible thérapeutique potentielle pour maintenir l'homéostasie du cartilage articulaire.

Prevalencia de desordenes musculo-esqueléticos y factores asociados en trabajadores de una caja de compensación familiar en el año 2012

Objetivo: determinar la prevalencia de síntomas osteomusculares generales y los factores asociados en los trabajadores de una Caja de compensación en Bogotá, Colombia, 2012 Métodos: estudio observacional, de corte transversal, en los trabajadores que desarrollan actividades asistenciales y administrativos. Se aplicaron encuestas de síntomas y factores ergonómicos específicos para el individuo basado en el Cuestionario Estandarizado Nórdico para la detección y análisis de los síntomas músculo-esqueléticos asociados con preguntas tomadas de la Encuesta de Condiciones de Trabajo y Salud. Resultados: la población de estudio fue de 232 trabajadores, 68,97% eran mujeres y el 31,3% eran varones. La edad media es de 24,5 años. La mayor prevalencia de trastornos musculoesqueléticos está en la mano y la muñeca derecha con un 12,07% de la población, seguido por el hombro derecho con un valor de 6,9%, seguido por cuello y espalda. Se encontró una p <0,05 para molestias en mano y muñeca derecha en las personas que tienen puestos administrativos, requieren hacer un trabajo rápido y el ritmo de trabajo está determinado por sus jefes. Conclusión: Los trastornos musculoesqueléticos son una situación muy compleja, que está influenciada por factores individuales, psicosociales y ambientales que interactúan incrementando el riesgo de producir ciertas enfermedades. Es necesario llevar a cabo un enfoque multivariado para personas con este tipo de patología.

Propuesta de un modelo de prevención de lesiones osteomusculares y su relación con los factores de riesgo psicosociales para una empresa productora de flores de la sabana de Bogotá

Es difícil lograr la eliminación total de las causas osteomusculares, teniendo en cuenta que para la aparición de desordenes incide no solo la parte laboral, sino también los aspectos sociales, entre los que se encuentran, los hábitos del comportamiento como: Practicas deportivas, alimentación, chequeos médicos, etc. y desde luego, los factores metabólicos y fisiológicos propio de cada ser. Sin embargo, a través, de la intervención se pretende gestionar el impacto que la actividad económica y las tareas ejercen sobre la salud de los operarios. Para ello fue necesario realizar un análisis de las condiciones del trabajador desde cuatro categorías: todo lo referente a la parte organizacional, técnica, productiva, y personal de la empresa. Con técnicas especificas de recolección de información para cada una de las categorías, entre la cuales se incluyeron observaciones a la población, entrevistas para un grupo de trabajadores seleccionados bajo criterios específicos y para la parte técnica incluyendo los agrónomos y el medico de la Organización.

Caracterización del ausentismo laboral por causas médicas en una empresa de alimentos de la ciudad de Bogotá, D.C. 2013 – 2014.

Resumen: Introducción: El ausentismo laboral por causa médica es un problema por la afectación que genera en el trabajador y en la empresa. Objetivo: Caracterizar el ausentismo laboral por causas médicas de una empresa de alimentos de Bogotá. Materiales y métodos: Estudio de corte transversal con datos secundarios de registros de incapacidades de los años 2013 y 2014. El procesamiento de la información se realizó con el programa SPSS, se obtuvieron medidas de tendencia central y de dispersión. Se determinó el número y la duración de incapacidades, la duración media de estas, el sistema afectado, se realizó el análisis de frecuencia por centro de costo y género. Resultados: Se registraron un total de 575 incapacidades, 387 fueron por enfermedad de origen común y 188 por accidentes de trabajo. Se perdieron 3.326 días por ausentismo, de los cuales en 45,09% se presentó en 2013 y el 54,91% restante en 2014, de estos 1985 se generaron en eventos de origen común y 1341 por accidentes de trabajo. La principal causa de incapacidades por enfermedades de origen común fueron patologías asociadas al sistema músculo esquelético, y para las originadas en accidentes de trabajo fueron las lesiones en manos. Conclusiones: para el año 2014 los accidentes de trabajo disminuyeron con respecto al año 2013 y el sistema más afectado respecto a enfermedad común fue el osteomuscular. Es conveniente que se implemente un sistema o programa de vigilancia y análisis en puestos de trabajo para identificar los factores de riesgo asociados y minimizar los riesgos.

Study of postures in sugarcane cutters in the Pontal of Paranapanema-SP, Brazil

The expansion of sugarcane monoculture in Brazil in the last decades has pointed out to the necessity of considering the question of sugarcane cutters occupational health. In this work we present a cross-sectional study aiming to examine the occupational posture of a group of sugarcane cutters, which work in a cane field located in the region of Pontal do Paranapanema-SP, Brazil. The study was made using the Ergonomic Analysis of Work - EAW methodology and the postural analysis method by Win-OWAS. Through the obtained records of postures, it was observed that during a workday the sugarcane cutters remain standing erect on two legs or in one leg 66% of the time and that their trunk remain tilted and in rotation, according to 63% of the positions categorized. It was also observed that the sugarcane cutter trunk performs repetitive and boundless movements during his routine of work, which can expose this individual to additional wear of their musculoskeletal functions. The activities in which the individual engages have favorable or adverse influence on his posture. The repetitive movements involved in specialized occupations are equivalent to repeated exercises, thus may be responsible for the excessive development of certain muscle groups. The study suggests that the postures adopted by sugarcane cutters can overload their musculoskeletal system and predispose the cutters to work-related musculoskeletal diseases.

Stabilization of lumbo-pelvic region and electromyography of the abdominal muscles

It is usual to find athletes that can perform de curl up test easily, but are unable to maintain the stabilization of the low back during the double straight leg lowering (DSLL). In spite of having strong abdominal muscles, its stabilization role seems not to be effective. Thus, the purpose of this study was to verify the relation among individuals with strong abdominal muscles and the ability in perform posterior pelvic tilt (PPT); the ability to stabilize the low back during the DSLL and the eletromyographic activity of the abdominal muscles. Eighteen male subjects (aged 19.27 ± 3.5), without history of muscle skeletal dysfunction, performed both the PPT and DSLL tests. During these tests electromyographic signals of the rectus abdominis (RA), obliquus internus abdominis (01) and obliquus externus abdominis (OE) were recorded, the angle of the hip and the pressure under the low back were measured The results of analyses of variance (ANOVA) show that most volunteers accomplished the PPT test, actively flattening the low back with regular or good quality. However, none of them was able to stabilize the low back during the DSLL test. During the PPT test all abdominal muscle portions analysed were activated without significant differences. In an attempt of maintaining the lumbo-pelvic region stabilized during the DSLL, it was observed a tendency of higher bilateral activation of OE when compared to RA and 01 muscle portions between 70 and 20 degrees of hip flexion.

Absence motivated by illness: A non-concurrent prospective study of physical education teachers in the municipal education system of the city of Campinas, São Paulo, Brazil

The object of this investigation was to identify and analize aspects of the health status related to absenteism in physical education teachers in the municipal education system of the city of Campinas, Brazil, as related to the medical leave program. The non-concurrent prospective study was accomplished by means of a comparison with teachers who work only in the classroom, refering to a three year period. In the variables of greatest interest, the Pearson non-parametric chi-square (X2) statistical test was adopted. Calculations of relative risk and level of confidence were made using the Epi-info computer program. Significant differences were observed in the following diagnostic groups favoring the not exposed group: i) Supplementary Classification of factors that exercise influence over the health status and access to health services and ii) Digestive system illness; while the physical education teachers showed a significant difference in: i) diseases of the musculoskeletal and connective tissue system and ii) Injuries and poisoing. Possible explications for some of the adverse effects as well as the protective ones that were observed include physical activity as a way of life along with being a physical education teacher and on the other side, peculiar behavior of epidemiological descriptive characteristics, like sex and age, within the socio-economic context of the country. © Copyright Moreira Jr. Editora.

Factors that contribute to low bone density in postmenopausal women in different Amazonian communities

Background: The aim of this study was to verify socioeconomic differences, nutrition, body balance and quality of life (QoL) in postmenopausal women with low bone mineral density (BMD) in two Amazonian communities. Methods: A total of 42 female volunteers participated in the study. The volunteers were separated into two groups: Villa (n= 20; 53±5.5 years) and City (n= 22; 56±7.9 years). The following evaluation instruments were used: dual energy X-ray absorptiometry (DXA); a socioeconomic questionnaire; a QoL questionnaire; a dietary habits questionnaire; and a balance test. Parametric and nonparametric tests were used. Results: The data showed significant differences in socioeconomic level (Δ%=+15.9%, p=0.000),lumbar spine L2-L4 (Δ%=+0.10%,p=0.007), balance(Δ%=+4.3%,p=0.03)and some important aspects of nutrition, such as the consumption of milk (Δ%=+34%, p=0.01) and alcohol (+14.8%, p=0.0001). These significant differences also contributed to the total QoL score (Δ%=+76.2%, p=0.000) and the majority of the QoL-related functions. Conclusion: This study verified that socioeconomic level, nutritional status, physical activity levels and QoL can influence the BMD of postmenopausal women. The study suggests new strategies for official health organizations to use in order to prevent and treat osteoporosis. In addition, this study can provide an orientation to physical activity, nutrition and medical professionals. © The Author(s), 2011.

Caracterização do tratamento medicamentoso com estatinas em unidade básica de saúde

Study Model: Retrospective study. Study Objective: To characterize statin treatment management due to lipid alterations and side effects throughout statin treatment in basic healthcare unit. Methods: Medical reports of women from a basic healthcare unit were analyzed, obtaining: disease presence, regular medication prescription, statin type and dosage, biochemical exams results, musculoskeletal complaints, and statin use cessation, going back the information until the medical consultation of first prescription. Results: Prescribed statins were Simvastatin and Atorvastatin at low doses (10-20 mg). Dose (48,4%) and/or type (25,4%) alterations occurred for lipid profile adequacy. Lipid levels were reduced without creatine kinase elevation. Treatment withdrawn (30,6%) was mainly due to their own decision (74%), which was strongly associated with records of musculoskeletal complaints (Odds Ratio: 6,40[1,53-26,78]). Conclusion: Statin treatment was effective in reducing serum lipid levels and self-reported pain was underestimated, characterizing the major limiting factor for treatment adherence.

Avaliação da obesidade na prevalência e gravidade das disfunções temporomandibulares

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Study of postures in sugarcane cutters in the Pontal of Paranapanema-SP, Brazil

The expansion of sugarcane monoculture in Brazil in the last decades has pointed out to the necessity of considering the question of sugarcane cutters occupational health. In this work we present a cross-sectional study aiming to examine the occupational posture of a group of sugarcane cutters, which work in a cane field located in the region of Pontal do Paranapanema-SP, Brazil. The study was made using the Ergonomic Analysis of Work - EAW methodology and the postural analysis method by Win-OWAS. Through the obtained records of postures, it was observed that during a workday the sugarcane cutters remain standing erect on two legs or in one leg 66% of the time and that their trunk remain tilted and in rotation, according to 63% of the positions categorized. It was also observed that the sugarcane cutter trunk performs repetitive and boundless movements during his routine of work, which can expose this individual to additional wear of their musculoskeletal functions. The activities in which the individual engages have favorable or adverse influence on his posture. The repetitive movements involved in specialized occupations are equivalent to repeated exercises, thus may be responsible for the excessive development of certain muscle groups. The study suggests that the postures adopted by sugarcane cutters can overload their musculoskeletal system and predispose the cutters to work-related musculoskeletal diseases.