Associations of sickness absence for pain in the low back, neck and shoulders with wider propensity to pain.

OBJECTIVES: To explore the association of sickness absence ascribed to pain at specific anatomical sites with wider propensity to musculoskeletal pain. METHODS: As part of the CUPID (Cultural and Psychosocial Influences on Disability) study, potential risk factors for sickness absence from musculoskeletal pain were determined for 11 922 participants from 45 occupational groups in 18 countries. After approximately 14 months, 9119 (78%) provided follow-up information about sickness in the past month because of musculoskeletal pain, including 8610 who were still in the same job. Associations with absence for pain at specific anatomical sites were assessed by logistic regression and summarised by ORs with 95% CIs. RESULTS: 861 participants (10%) reported absence from work because of musculoskeletal pain during the month before follow-up. After allowance for potential confounders, risk of absence ascribed entirely to low back pain (n=235) increased with the number of anatomical sites other than low back that had been reported as painful in the year before baseline (ORs 1.6 to 1.7 for ≥4 vs 0 painful sites). Similarly, associations with wider propensity to pain were observed for absence attributed entirely to pain in the neck (ORs up to 2.0) and shoulders (ORs up to 3.4). CONCLUSIONS: Sickness absence for pain at specific anatomical sites is importantly associated with wider propensity to pain, the determinants of which extend beyond established risk factors such as somatising tendency and low mood. Better understanding of why some individuals are generally more prone to musculoskeletal pain might point to useful opportunities for prevention.

Determinants of international variation in the prevalence of disabling wrist and hand pain.

BACKGROUND: Previous research has indicated that wide international variation in the prevalence of disabling low back pain among working populations is largely driven by factors predisposing to musculoskeletal pain more generally. This paper explores whether the same applies to disabling wrist/hand pain (WHP). METHODS: Using data from the Cultural and Psychosocial Influences on Disability (CUPID) study, we focused on workers from 45 occupational groups (office workers, nurses and other workers) in 18 countries. Among 11,740 participants who completed a baseline questionnaire about musculoskeletal pain and potential risk factors, 9082 (77%) answered a further questionnaire after a mean interval of 14 months, including 1373 (15%) who reported disabling WHP in the month before follow-up. Poisson regression was used to assess associations of this outcome with baseline risk factors, including the number of anatomical sites other than wrist/hand that had been painful in the 12 months before baseline (taken as an index of general propensity to pain). RESULTS: After allowance for other risk factors, the strongest associations were with general pain propensity (prevalence rate ratio for an index ≥6 vs. 0: 3.6, 95% confidence interval 2.9-4.4), and risk rose progressively as the index increased. The population attributable fraction for a pain propensity index > 0 was 49.4%. The prevalence of disabling WHP by occupational group ranged from 0.3 to 36.2%, and correlated strongly with mean pain propensity index (correlation coefficient 0.86). CONCLUSION: Strategies to prevent disability from WHP among working populations should explore ways of reducing general propensity to pain, as well as improving the ergonomics of occupational tasks.

Health related quality of life in celiac children and adolescents. / Calidad de vida relacionada a la salud en niños y adolescentes con enfermedad celiaca.

INTRODUCTION: The lifelong gluten-free diet (GFD) is the treatment of celiac disease (CD). Being a restrictive diet, it limits daily life and can impact on the health-related quality of life (HRQoL). Our objective was to assess HRQoL of celiac patients on a GFD, the concordance between patients - caregivers, and to compare the local results with international data. PATIENTS AND METHOD: Patients aged 8-18 years on a GFD for >6months (37 dyads) were evaluated. The "Celiac Disease Dutch Questionnaire" (CDDUX) was applied, which evaluates in two questionnaires (one applied to the child and another one to the caregiver/parent), three areas: i) having CD, ii) communication with others, and iii) the diet. Reliability, dimensionality, and internal consistency were assessed using the Cronbach coefficient. RESULTS: More than 50% of patients and caregivers reported "well/very well" on sub-scales "having CD" and "GFD"; "communication" showed high percentages of "bad/very bad". Although there were no significant differences in HRQoL (global and subscale) perceived by patients and caregivers, there were when analyzing the answers of caregivers, who assigned better scores to boys (p=0.022) and to patients maintaining a non-strict GFD (p=0.049). Concordance between patients and caregivers was 39.2%. DISCUSSION: HRQoL of the assessed celiac children was satisfactory, among the best repor ted in Latin America. "Having CD" and the need for a "GFD" have less influence on HRQoL than "communication" with others about the disease. The concordance found suggests that the caregivers' perception does not necessarily reflect what patients perceive.

Work and health in Latin America: results from the working conditions surveys of Colombia, Argentina, Chile, Central America and Uruguay.

OBJECTIVE: To describe working and employment conditions, and health status between non-agricultural employees with a written contract from Colombia, Argentina, Chile, Central America and Uruguay. METHODS: We compared data from the first working condition surveys (WCS) of Colombia, Argentina, Chile, Central America and Uruguay. For comparative purposes, we selected a subsample of 15 241 non-agricultural employees aged 18-64 years and working with a written contract. We calculated prevalences and 95% CIs for the selected variables on working and employment conditions, and health status, separated by sex. RESULTS: Across all countries, at least 40% of women and 58% of men worked >40 hours a week. The most prevalent exposures were repetitive movements, followed by noise and manual handling, especially among men. Psychosocial exposures were very common among both sexes. Workers in Chile (33.4% of women and 16.6% of men) and Central America (24.3% of women and 19.1% of men) were more likely to report poor self-perceived health and were least likely to do so in Colombia (5.5% of women and 4.2% of men). The percentage of workers reporting occupational injuries was <10% across all countries. CONCLUSIONS: This study provides, for the first time, a broad picture of work and health in different Latin American countries, based on the national WCSs available. This allows for a better understanding of occupational health and could serve as a baseline for future research and surveillance of work and health in the Region. However, greater efforts are needed to improve WCSs comparability.

Informal employment and health status in Central America.

BACKGROUND: Informal employment is assumed to be an important but seldom studied social determinant of health, affecting a large number of workers around the world. Although informal employment arrangements constitute a permanent, structural pillar of many labor markets in low- and middle-income countries, studies about its relationship with health status are still scarce. In Central America more than 60% of non-agricultural workers have informal employment. Therefore, we aimed to assess differences in self-perceived and mental health status of Central Americans with different patterns of informal and formal employment. METHODS: Employment profiles were created by combining employment relations (employees, self-employed, employers), social security coverage (yes/no) and type of contract--only for employees--(written, oral, none), in a cross-sectional study of 8,823 non-agricultural workers based on the I Central American Survey of Working Conditions and Health of 2011. Using logistic regression models, adjusted odds ratios (aOR) by country, age and occupation, of poor self-perceived and mental health were calculated by sex. Different models were first fitted separately for the three dimensions of employment conditions, then for employment profiles as independent variables. RESULTS: Poor self-perceived health was reported by 34% of women and 27% of men, and 30% of women and 26% of men reported poor mental health. Lack of social security coverage was associated with poor self-perceived health (women, aOR: 1.38, 95% CI: 1.13-1.67; men, aOR: 1.36, 95% CI: 1.13-1.63). Almost all employment profiles with no social security coverage were significantly associated with poor self-perceived and poor mental health in both sexes. CONCLUSIONS: Our results show that informal employment is a significant factor in social health inequalities among Central American workers, which could be diminished by policies aimed at increasing social security coverage.

[Musculoskeletal pain in Central American workers: results of the First Survey on Working Conditions and Health in Central America]. / Dolor musculoesquelético en trabajadores de América Central: resultados de la I Encuesta Centroamericana de Condiciones de Trabajo y Salud.

OBJECTIVE: Examine the prevalence of musculoskeletal pain (MSP) in the six Spanish-speaking countries of Central America using a single standardized instrument, the First Survey on Working Conditions and Health in Central America in workers from all manual and non-manual labor sectors, using social security coverage as an indicator of formal versus informal employment. METHODS: The workers (n = 12 024) were surveyed in their homes. The age-adjusted prevalence of MSP during the previous month was calculated for pain in the back (upper, or cervical; middle, or thoracic; and lower, or lumbar) and arm joints (shoulder, elbow, and wrist). Prevalence was estimated by sex, occupation (manual or non-manual), economic sector (agriculture, industry, or services), and social security coverage. Poisson regression models were used to calculate the prevalence rates and 95% confidence intervals, with stratification by country and anatomical site. RESULTS: By sites, the age-adjusted prevalence of cervical-dorsal MSP was the highest, especially in El Salvador (47.8%) and Nicaragua (45.9%), and lumbar MSP was less prevalent, especially in Panama (12.8%) and Guatemala (14.8%). After additional adjustments, the prevalence of MSP was higher in women and manual workers for all the sites and in all the countries. There were no differences in MSP in terms of social security coverage or sector of economic activity. CONCLUSIONS: The high prevalence of MSP in Central America, regardless of sector of activity or social security coverage, indicates that the prevention of MSP should be a priority in occupational health programs in low- and middle-income countries, especially for women and manual workers.

Assessment of long-term and recent pesticide exposure among rural school children in Nicaragua.

OBJECTIVE: This study assessed pesticide exposure of children in rural Nicaragua in relation to parental pesticide use, from around conception to current school age, as part of an epidemiological evaluation of neurodevelopment effects. METHODS: We included 132 children whose parents were subsistence farmers or plantation workers, or had an agricultural history. As proxies for children's long-term exposures, we constructed cumulative parental pesticide-specific use indices for periods before and after the child's birth from data obtained using an icon-calendar-based questionnaire, of application hours (h) for plantation workers and subsistence farmers, and of kilograms of active ingredients (ai) only for subsistence farmers. Pesticide residues of TCPY, 3-PBA and 2,4-D were analysed in children's urine as indicators for current exposures. RESULTS: Life-time indices were highest for the organophosphates chlorpyrifos (median 114 h (min 2; max 1584), 19.2 kg ai (min 0.37; max 548)) and methamidophos (84 h (6; 1964), 12.2 kg ai (0.30; 780)). The P50 values of children's urinary residues were 3.7 µg/g creatinine for TCPY, 2.8 for 3-PBA and 0.9 for 2,4-D; TCPY values are comparable with those in other countries, but 3-PBA and 2,4-D are considerably higher. The maximum levels for all three pesticides are the highest reported for children. Residues increased on days after application, but most high residue levels were unrelated to parental pesticide applications. CONCLUSION: Urinary pesticide residues reveal high environmental exposure among children in rural Nicaragua. The quantitative parental pesticide use indices as proxies for children's exposures during different periods may be useful for the evaluation of developmental health effects.

Patterns of change of multisite pain over 1 year of follow-up and related risk factors.

BACKGROUND: Multisite musculoskeletal pain is common and disabling. This study aimed to prospectively investigate the distribution of musculoskeletal pain anatomically, and explore risk factors for increases/reductions in the number of painful sites. METHODS: Using data from participants working in 45 occupational groups in 18 countries, we explored changes in reporting pain at 10 anatomical sites on two occasions 14 months apart. We used descriptive statistics to explore consistency over time in the number of painful sites, and their anatomical distribution. Baseline risk factors for increases/reductions by ≥3 painful sites were explored by random intercept logistic regression that adjusted for baseline number of painful sites. RESULTS: Among 8927 workers, only 20% reported no pain at either time point, and 16% reported ≥3 painful sites both times. After 14 months, the anatomical distribution of pain often changed but there was only an average increase of 0.17 painful sites. Some 14% workers reported a change in painful sites by ≥3. Risk factors for an increase of ≥3 painful sites included female sex, lower educational attainment, having a physically demanding job and adverse beliefs about the work-relatedness of musculoskeletal pain. Also predictives were as follows: older age, somatizing tendency and poorer mental health (each of which was also associated with lower odds of reductions of ≥3 painful sites). CONCLUSIONS: Longitudinally, the number of reported painful sites was relatively stable but the anatomical distribution varied considerably. These findings suggest an important role for central pain sensitization mechanisms, rather than localized risk factors, among working adults. SIGNIFICANCE: Our findings indicate that within individuals, the number of painful sites is fairly constant over time, but the anatomical distribution varies, supporting the theory that among people at work, musculoskeletal pain is driven more by factors that predispose to experiencing or reporting pain rather than by localized stressors specific to only one or two anatomical sites.

Revisión de la fisiología anorrectal y posibles compuestos bioactivos para la erocosmética / Anorectal physiology and possible bioactive compounds for erocosmetics: A review / Fisiologia anorretal e possíveis compostos bioativos para erocosméticos: uma revisão

RESUMEN Objetivo: realizar una revisión bibliográfica sobre la fisiología ano-rectal, el proceso de relajación y contracción del músculo liso del tracto digestivo y posibles materias primas y formulaciones que podrían incorporarse a formulaciones erocosméticas de uso tópico en la región ano-rectal. Métodos: la revisión bibliográfica se realizó utilizando diferentes descriptores y mediante la consulta en las bases de datos ScienceDirect, PubMed, Clinical Key, Google Scholar y Google Patents. Resultados: inicialmente la revisión de la literatura permite comprender la anatomía y fisiología ano-rectal y los mecanismos que modulan la continencia anal, el tono basal del esfínter anal interno y el reflejo inhibitorio rectoanal (RAIR). Posteriormente, se obtuvo información sobre ejemplos de afrodisíacos naturales y se analizaron formulaciones cosméticas utilizadas como lubricantes anales con el fin de estudiar a profundidad los ingredientes de origen natural e identificar su utilidad, mecanismos de acción tópicos y su función dentro de la formulación. Conclusiones: el entendimiento de la fisiología ano-rectal permite el estudio y desarrollo de formulaciones cosméticas con propiedades analgésicas, anestésicas y relajantes, como los lubricantes anales. Productos naturales como la manzanilla, árnica, Aloe vera y mentol han sido estudiados para su uso cosmético y tópico como analgésicos, anestésicos o relajantes, por lo que su utilidad comprobada los hace útiles en el desarrollo de productos erocosméticos destinados para ser utilizados en la región anogenital.

SUMMARY Aim: To review the anorectal physiology, the process of relaxation and contraction of the smooth muscle of the digestive tract, and possible raw materials and formulations that could be incorporated into erocosmetic formulations for topical use in the anorectal region. Methods: The bibliographic review was carried out using different descriptors and by consulting the databases ScienceDirect, PubMed, Clinical Key, Google Scholar and, Google Patents. Results: Initially, a literature review was carried out to understand anorectal anatomy and physiology and the mechanisms that modulate anal continence, the internal anal sphincter basal tone, and the recto-anal inhibitory reflex (RAIR). Subsequently, information related to natural aphrodisiacs examples was obtained, and cosmetic formulations used as anal lubricants were analyzed to study the natural ingredients and identify their usefulness, mechanisms of action, and function in the formulation. Conclusion: Understanding anorectal physiology allows the study and development of cosmetic formulations with analgesic, anesthetic, and relaxing properties, such as anal lubricants. Natural products such as chamomile, arnica, Aloe vera, and menthol have been studied for cosmetic and topical use as analgesics, anesthetics, and relaxants, so the evidence makes them helpful in developing erocosmetic products intended to be used in the anogenital region.

RESUMO Objetivo: revisar a fisiologia anorretal, o processo de relaxamento e contração da musculatura lisa do trato digestivo e possíveis matérias-primas e formulações que possam ser incorporadas em formulações erocosméticas de uso tópico na região anorretal. Métodos: a revisão bibliográfica foi realizada utilizando diferentes descritores e consultando as bases de dados ScienceDirect, PubMed, Clinical Key, Google Scholar e, Google Patents. Resultados: inicialmente, foi realizada uma revisão da literatura para entender a anatomia e fisiologia anorretal e os mecanismos que modulam a continência anal, o tônus basal do esfíncter anal interno e o reflexo inibitório retoanal (RAIR). Posteriormente, foram obtidas informações relacionadas aos exemplos de afrodisíacos naturais e analisadas formulações cosméticas usadas como lubrificantes anais para estudar os ingredientes naturais e identificar sua utilidade, mecanismos de ação e função na formulação. Conclusão: a compreensão da fisiologia anorretal permite o estudo e o desenvolvimento de formulações cosméticas com propriedades analgésicas, anestésicas e relaxantes, como os lubrificantes anais. Produtos naturais como camomila, arnica, Aloe vera e mentol foram estudados para uso cosmético e tópico como analgésicos, anestésicos e relaxantes, de modo que as evidências os tornam úteis no desenvolvimento de produtos erocosméticos destinados ao uso na região anogenital.

Plants with antioxidant activity and their potential use as sun protector agents in Costa Rica

SUMMARY Aims: To carry out a bibliographic review related to plants available in Costa Rica that have demonstrated antioxidant power and a sun protection factor (SPF) suitable to be used in sunscreen products. Methods: The bibliographic review was carried out using different descriptors and by consulting different databases. Results: Information about antioxidant power about acerola, avocado, carrots, passion fruit, moringa, banana, pumpkin and amaranth, guava, matico, ginkgo, blackberry, mango, coffee was obtained. The information obtained suggests that the mentioned plants could be used for the formulation of sunscreens. Conclusion: Sun protection products should be used every day to prevent skin damage; some sunscreens produce allergic reactions, so it is necessary to investigate natural options to be used in sun protection products. Some natural products exhibit SPF values that allow their incorporation as sun protection agents, adjuvants, or enhancers in sunscreens.

Objetivo: llevar a cabo una investigación bibliográfica sobre plantas disponibles en Costa Rica que han demostrado su poder antioxidante y un factor de protector solar (SPF) apto para ser utilizados en protectores solares. Métodos: la revisión bibliográfica se realizó utilizando diferentes descriptores y mediante la consulta en diferentes bases de datos. Resultados: se obtuvo información sobre el poder antioxidante de las plantas: acerola, aguacate, zanahoria, maracuyá, moringa, banano, calabaza y amaranto, guayaba, matico, ginkgo, mora, mango, café. La información obtenida sugiere que las plantas mencionadas podrían ser utilizadas para la formulación de protectores solares. Conclusiones: los protectores solares deben ser utilizados diariamente para prevenir el daño sobre la piel. Algunos de estos productos generan reacciones alérgicas y por esta razón es necesario investigar posibles opciones naturales para ser incorporadas en bloqueadores solares. Algunos productos naturales exhiben valores de SPF que permiten su uso como agentes protectores solares, adyuvantes o potenciadores en los bloqueadores solares.

Objetivo: realizar uma pesquisa bibliográfica sobre plantas disponíveis na Costa Rica que demonstraram poder antioxidante e um fator de proteção solar (FPS) adequado para uso em protetores solares. Métodos: a revisão bibliográfica foi realizada usando diferentes descritores e consultando diferentes bases de dados. Resultados: foram obtidas informações sobre o poder antioxidante das plantas: acerola, abacate, cenoura, maracujá, moringa, banana, abóbora e amaranto, goiaba, matico, ginkgo, amora, manga, café. As informações sugerem que as referidas plantas poderiam ser utilizadas para a formulação de protetores solares. Conclusões: protetores solares devem ser usados diariamente para prevenir danos à pele. Alguns desses produtos geram reações alérgicas e por isso é necessário investigar possíveis opções naturais para serem incorporadas aos protetores solares. Alguns produtos naturais apresentam valores de FPS que permitem seu uso como protetores solares, adjuvantes ou potencializadores em protetores solares.

Epidemiological Differences Between Localized and Nonlocalized Low Back Pain.

STUDY DESIGN: A cross-sectional survey with a longitudinal follow-up. OBJECTIVES: The aim of this study was to test the hypothesis that pain, which is localized to the low back, differs epidemiologically from that which occurs simultaneously or close in time to pain at other anatomical sites SUMMARY OF BACKGROUND DATA.: Low back pain (LBP) often occurs in combination with other regional pain, with which it shares similar psychological and psychosocial risk factors. However, few previous epidemiological studies of LBP have distinguished pain that is confined to the low back from that which occurs as part of a wider distribution of pain. METHODS: We analyzed data from CUPID, a cohort study that used baseline and follow-up questionnaires to collect information about musculoskeletal pain, associated disability, and potential risk factors, in 47 occupational groups (office workers, nurses, and others) from 18 countries. RESULTS: Among 12,197 subjects at baseline, 609 (4.9%) reported localized LBP in the past month, and 3820 (31.3%) nonlocalized LBP. Nonlocalized LBP was more frequently associated with sciatica in the past month (48.1% vs. 30.0% of cases), occurred on more days in the past month and past year, was more often disabling for everyday activities (64.1% vs. 47.3% of cases), and had more frequently led to medical consultation and sickness absence from work. It was also more often persistent when participants were followed up after a mean of 14 months (65.6% vs. 54.1% of cases). In adjusted Poisson regression analyses, nonlocalized LBP was differentially associated with risk factors, particularly female sex, older age, and somatizing tendency. There were also marked differences in the relative prevalence of localized and nonlocalized LBP by occupational group. CONCLUSION: Future epidemiological studies should distinguish where possible between pain that is limited to the low back and LBP that occurs in association with pain at other anatomical locations. LEVEL OF EVIDENCE: 2.

Formulation and antimicrobial activity evaluation of a 0. 2% chlorhexidine canine mouthwash with essential oils / Formulación y evaluación de la actividad antimicrobiana de un enjuague bucal canino de clorhexidina al 2% y aceites esenciales

Background: Periodontal disease is the infection and inflammation of the gums, bones, and tissues involved in teeth support, and it is one of the most common diseases affecting pet dogs. Essential oils have shown antimicrobial activity against bacteria causing periodontal disease; therefore, they are considered potential therapeutic agents. Objectives: The main objective was to formulate and evaluate the antimicrobial activity of a 0.2% chlorhexidine canine mouthwash with essential oils. Methods: Three microemulsion formulations were obtained by constructing a pseudo-ternary phase diagram using the phase titration method. Different surfactant agents were evaluated, and hydrogenated castor oil was selected as the emulsifier agent. The antimicrobial activity of oregano essential oil (Origanum vulgare), thyme essential oil (Thymus vulgaris), and the three formulations were evaluated against Staphylococcus aureus, Streptococcus mutans, Streptococcus salivarius, and Escherichia coli. Results: Pure thyme and oregano essential oils showed higher antimicrobial activity than a 0,2% chlorhexidine solution. The formulations with essential oils plus chlorhexidine and chlorhexidine alone showed antimicrobial activity. The formulation containing only essential oils did not show antimicrobial activity. Conclusions: A canine mouthwash was formulated with chlorhexidine and thyme, and oregano essential oil. Based on the evaluation of antimicrobial activity, two of the proposed formulations could be a therapeutic option to reduce the risk and prevent periodontal disease in canines

Antecedentes: La enfermedad periodontal es la infección e inflamación de las encías, huesos y tejidos que brindan soporte a los dientes, es una de las enfermedades más comunes que afectan a los perros de compañía. Los aceites esenciales han mostrado actividad antimicrobiana contra las bacterias que causan la enfermedad periodontal; por lo tanto, son considerados como potenciales agentes terapéuticos. Objetivos: El objetivo principal de este trabajo fue formular y evaluar la actividad antimicrobiana de un colutorio canino de clorhexidina al 0,2% con aceites esenciales. Métodos: Se obtuvo tres formulaciones en microemulsión mediante la construcción de un diagrama de fase pseudoternario por el método de titulación de fase. Se evaluaron diferentes tensioactivos y se seleccionó el aceite de ricino hidrogenado como agente emulsificante de la formulación. La actividad antimicrobiana del aceite esencial de orégano (Origanum vulgare), el aceite esencial de tomillo (Thymus vulgaris) y las tres formulaciones fue evaluada contra Staphylococcus aureus, Streptococcus mutans, Streptococcus salivarius y Escherichia coli. Resultados: Los aceites esenciales puros de tomillo y orégano mostraron una mayor actividad antimicrobiana que una solución de clorhexidina al 0,2%. Las formulaciones con aceites esenciales más clorhexidina y únicamente clorhexidina mostraron actividad antimicrobiana. Mientras que la formulación que contiene solo aceites esenciales no mostró actividad antimicrobiana. Conclusión: Se formuló un enjuague bucal canino con clorhexidina y aceite esencial de tomillo y orégano. Según la evaluación de la actividad antimicrobiana, dos de las formulaciones propuestas podrían ser una opción terapéutica para disminuir el riesgo y prevenir la enfermedad periodontal en caninos

[Basic questionnaire and methodological criteria for Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean]. / Cuestionario básico y criterios metodológicos para las Encuestas sobre Condiciones de Trabajo, Empleo y Salud en América Latina y el Caribe.

This article aimed to present a basic questionnaire and minimum methodological criteria for consideration in future Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean. A virtual and face-to-face consensus process was conducted with participation by a group of international experts who used the surveys available up until 2013 as the point of departure for defining the proposal. The final questionnaire included 77 questions grouped in six dimensions: socio-demographic characteristics of workers and companies; employment conditions; working conditions; health status; resources and preventive activities; and family characteristics. The minimum methodological criteria feature the interviewee's home as the place for the interview and aspects related to the quality of the fieldwork. These results can help improve the comparability of future surveys in Latin America and the Caribbean, which would in turn help improve information on workers' heath in the region.

Descriptive Epidemiology of Somatising Tendency: Findings from the CUPID Study.

Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait.

Classification of neck/shoulder pain in epidemiological research: a comparison of personal and occupational characteristics, disability, and prognosis among 12,195 workers from 18 countries.

To inform case definition for neck/shoulder pain in epidemiological research, we compared levels of disability, patterns of association, and prognosis for pain that was limited to the neck or shoulders (LNSP) and more generalised musculoskeletal pain that involved the neck or shoulder(s) (GPNS). Baseline data on musculoskeletal pain, disability, and potential correlates were collected by questionnaire from 12,195 workers in 47 occupational groups (mostly office workers, nurses, and manual workers) in 18 countries (response rate = 70%). Continuing pain after a mean interval of 14 months was ascertained through a follow-up questionnaire in 9150 workers from 45 occupational groups. Associations with personal and occupational factors were assessed by Poisson regression and summarised by prevalence rate ratios (PRRs). The 1-month prevalence of GPNS at baseline was much greater than that of LNSP (35.1% vs 5.6%), and it tended to be more troublesome and disabling. Unlike LNSP, the prevalence of GPNS increased with age. Moreover, it showed significantly stronger associations with somatising tendency (PRR 1.6 vs 1.3) and poor mental health (PRR 1.3 vs 1.1); greater variation between the occupational groups studied (prevalence ranging from 0% to 67.6%) that correlated poorly with the variation in LNSP; and was more persistent at follow-up (72.1% vs 61.7%). Our findings highlight important epidemiological distinctions between subcategories of neck/shoulder pain. In future epidemiological research that bases case definitions on symptoms, it would be useful to distinguish pain that is localised to the neck or shoulder from more generalised pain that happens to involve the neck/shoulder region.

An icon-based interview for the assessment of occupational pesticide exposure in a case-control study of childhood leukemia.

An icon-calendar interview form (ICF) for a case-control study of childhood leukemias and parental exposures to pesticides is described. It includes calendar sheets, icons for life events, crops, jobs, regions, non-agricultural jobs, application techniques and personal protection, markers for durations of exposure patterns, and checklists of pesticides. The ICF collects monthly data from two years before birth until diagnosis of cancer (index children) or until either the interview date or age 15 (controls). Data ascertainment was easy in 62% of interviews, moderately easy in 32%, and difficult in 6%. Seventy-eight subjects delivered data on specific pesticides with pesticide checklists, which improved identification of pesticides. ICF performs satisfactorily for crops, tasks, and other determinants of exposure. Data on pesticides will be further improved by introducing external data use on different crops, time periods, and regions, and by exposure modeling for 27 pesticides.

Calidad de vida relacionada a la salud en niños y adolescentes con enfermedad celiaca / Health related quality of life in celiac children and adolescents

INTRODUCCIÓN: La dieta libre de gluten (DLG) de por vida es el tratamiento de la enfermedad celiaca (EC). Sien do una dieta restrictiva, impone limitaciones en la vida diaria y puede repercutir en la calidad de vida relacionada a la salud (CVRS). Nuestro objetivo fue evaluar la CVRS de pacientes celíacos en DLG, la concordancia entre pacientes-cuidador/a, y comparar la situación local con experiencias internacionales. PACIENTES Y MÉTODO: Se evaluaron pacientes de 8-18 años en DLG > 6 meses (37 diadas). Se les aplicó el "Celiac Disease Dutch Questionnaire" (CDDUX), que evalúa en 2 cuestio narios (uno al niño y otro al cuidador/padre), tres áreas: i) el tener EC, ii) la comunicación con otros y iii) la dieta. Se evaluó la confiabilidad, la dimensionalidad, y la consistencia interna mediante el coeficiente de Cronbach. RESULTADOS: Más del 50% de los pacientes y cuidadores reportan bien/ muy bien en las sub-escalas "tener enfermedad" y "dieta libre de gluten"; "comunicación" mostró altos porcentajes de mal/muy mal. No hubo diferencias significativas en la CVRS percibida por pacientes y cuidadores (global y sub-escala). Sí las hubo al analizar las respuestas de las/los cuida dores, que asignaron mejores puntajes a los pacientes varones (p = 0,022) y a quienes seguían DLG de manera no estricta (p = 0,049). La concordancia entre pacientes y cuidadores fue 39,2%. DISCUSIÓN: La CVRS de los pacientes evaluados aparece como satisfactoria, de las mejores reportadas en latinoamericana. El manejo de "tener EC" y la necesidad de mantener una "DLG" influyen menos en la CVRS que el tener que comunicarse con otros acerca de la enfermedad. La concordancia encontrada sugiere que la percepción del cuidador/a no refleja necesariamente lo que percibe el paciente.

INTRODUCTION: The lifelong gluten-free diet (GFD) is the treatment of celiac disease (CD). Being a restrictive diet, it limits daily life and can impact on the health-related quality of life (HRQoL). Our objective was to assess HRQoL of celiac patients on a GFD, the concordance between patients - caregivers, and to compare the local results with international data. PATIENTS AND METHOD: Patients aged 8-18 years on a GFD for >6months (37 dyads) were evaluated. The "Celiac Disease Dutch Questionnaire" (CDDUX) was applied, which evaluates in two questionnaires (one applied to the child and another one to the caregiver/parent), three areas: i) having CD, ii) communication with others, and iii) the diet. Reliability, dimensionality, and internal consistency were assessed using the Cronbach coefficient. RESULTS: More than 50% of patients and caregivers reported "well/very well" on sub-scales "having CD" and "GFD"; "communication" showed high percentages of "bad/very bad". Although there were no significant differences in HRQoL (global and subscale) perceived by patients and caregivers, there were when analyzing the answers of caregivers, who assigned better scores to boys (p=0.022) and to patients maintaining a non-strict GFD (p=0.049). Concordance between patients and caregivers was 39.2%. DISCUSSION: HRQoL of the assessed celiac children was satisfactory, among the best repor ted in Latin America. "Having CD" and the need for a "GFD" have less influence on HRQoL than "communication" with others about the disease. The concordance found suggests that the caregivers' perception does not necessarily reflect what patients perceive.

Disabling musculoskeletal pain in working populations: is it the job, the person, or the culture?

To compare the prevalence of disabling low back pain (DLBP) and disabling wrist/hand pain (DWHP) among groups of workers carrying out similar physical activities in different cultural environments, and to explore explanations for observed differences, we conducted a cross-sectional survey in 18 countries. Standardised questionnaires were used to ascertain pain that interfered with everyday activities and exposure to possible risk factors in 12,426 participants from 47 occupational groups (mostly nurses and office workers). Associations with risk factors were assessed by Poisson regression. The 1-month prevalence of DLBP in nurses varied from 9.6% to 42.6%, and that of DWHP in office workers from 2.2% to 31.6%. Rates of disabling pain at the 2 anatomical sites covaried (r = 0.76), but DLBP tended to be relatively more common in nurses and DWHP in office workers. Established risk factors such as occupational physical activities, psychosocial aspects of work, and tendency to somatise were confirmed, and associations were found also with adverse health beliefs and group awareness of people outside work with musculoskeletal pain. However, after allowance for these risk factors, an up-to 8-fold difference in prevalence remained. Systems of compensation for work-related illness and financial support for health-related incapacity for work appeared to have little influence on the occurrence of symptoms. Our findings indicate large international variation in the prevalence of disabling forearm and back pain among occupational groups carrying out similar tasks, which is only partially explained by the personal and socioeconomic risk factors that were analysed.

Patterns of multisite pain and associations with risk factors.

To explore definitions for multisite pain, and compare associations with risk factors for different patterns of musculoskeletal pain, we analysed cross-sectional data from the Cultural and Psychosocial Influences on Disability (CUPID) study. The study sample comprised 12,410 adults aged 20-59 years from 47 occupational groups in 18 countries. A standardised questionnaire was used to collect information about pain in the past month at each of 10 anatomical sites, and about potential risk factors. Associations with pain outcomes were assessed by Poisson regression, and characterised by prevalence rate ratios (PRRs). Extensive pain, affecting 6-10 anatomical sites, was reported much more frequently than would be expected if the occurrence of pain at each site were independent (674 participants vs 41.9 expected). In comparison with pain involving only 1-3 sites, it showed much stronger associations (relative to no pain) with risk factors such as female sex (PRR 1.6 vs 1.1), older age (PRR 2.6 vs 1.1), somatising tendency (PRR 4.6 vs 1.3), and exposure to multiple physically stressing occupational activities (PRR 5.0 vs 1.4). After adjustment for number of sites with pain, these risk factors showed no additional association with a distribution of pain that was widespread according to the frequently used American College of Rheumatology criteria. Our analysis supports the classification of pain at multiple anatomical sites simply by the number of sites affected, and suggests that extensive pain differs importantly in its associations with risk factors from pain that is limited to only a small number of anatomical sites.

The CUPID (Cultural and Psychosocial Influences on Disability) study: methods of data collection and characteristics of study sample.

BACKGROUND: The CUPID (Cultural and Psychosocial Influences on Disability) study was established to explore the hypothesis that common musculoskeletal disorders (MSDs) and associated disability are importantly influenced by culturally determined health beliefs and expectations. This paper describes the methods of data collection and various characteristics of the study sample. METHODS/PRINCIPAL FINDINGS: A standardised questionnaire covering musculoskeletal symptoms, disability and potential risk factors, was used to collect information from 47 samples of nurses, office workers, and other (mostly manual) workers in 18 countries from six continents. In addition, local investigators provided data on economic aspects of employment for each occupational group. Participation exceeded 80% in 33 of the 47 occupational groups, and after pre-specified exclusions, analysis was based on 12,426 subjects (92 to 1018 per occupational group). As expected, there was high usage of computer keyboards by office workers, while nurses had the highest prevalence of heavy manual lifting in all but one country. There was substantial heterogeneity between occupational groups in economic and psychosocial aspects of work; three- to five-fold variation in awareness of someone outside work with musculoskeletal pain; and more than ten-fold variation in the prevalence of adverse health beliefs about back and arm pain, and in awareness of terms such as "repetitive strain injury" (RSI). CONCLUSIONS/SIGNIFICANCE: The large differences in psychosocial risk factors (including knowledge and beliefs about MSDs) between occupational groups should allow the study hypothesis to be addressed effectively.