Low back pain in beauty salons professionals in the city of Fortaleza-CE.

Introduction: Low back pain can be defined as pain below the ribs and above the upper gluteal line. Objectives: The study aimed to analyze low back pain in professionals from beauty salons in the city of Fortaleza, state of Ceará. Methods: Descriptive, quantitative-qualitative, transversal, non-probabilistic research in the snowball modality, conducted between June and August 2021 in the José Walter neighborhood. Two sociodemographic questionnaires and the Quebec Back Pain Disability scale were applied, which seeks to assess how pain affects the participants' daily lives. Results: Forty-two professionals were interviewed, of which 32 women (76.2%), with a mean age of 39.45 ± 10.99 years. Women were more likely to have an onset of low back pain and to live with pain for a longer time compared to men, in addition to these professionals having a significant overload for the hours worked. 52% of respondents showed significant clinical changes, mainly in relation to stand up for 20-30 minutes (16.7%), sit in a chair for several hours (14.3%), walk several kilometers (19%), carry two bags with groceries (14.3%) and lift and carry a heavy suitcase (28.6%). Conclusions: It was evidenced that low back pain may be related to personal or environmental factors, with a sedentary lifestyle, length of service and working hours as strong indications for the onset of low back pain, with impairment in daily tasks.

Introdução: A dor lombar pode ser definida como uma dor abaixo das costelas e acima da linha glútea superior. Objetivos: Analisar a dor lombar em profissionais de salões de beleza na cidade de Fortaleza, estado do Ceará. Métodos: Tratou-se de pesquisa descritiva, qualiquantitativa, transversal, não probabilística na modalidade bola de neve, realizada entre os meses de junho e agosto de 2021 no bairro José Walter. Foram aplicados dois questionários sociodemográficos e a escala de Quebec Back Pain Disability, que busca avaliar como a dor afeta a vida diária dos participantes. Resultados: Quarenta e dois profissionais foram entrevistados, sendo 32 mulheres (76,2%), com média de idade de 39,45±10,99 anos. O sexo feminino demonstrou ter maior predisposição para o aparecimento da dor lombar, convivendo com a dor por mais tempo em relação aos homens, além dessas profissionais apresentarem uma sobrecarga significativa para as horas trabalhadas. Dos entrevistados, 52% apresentaram mudanças clínicas significativas, principalmente em relação a ficar em pé por 20 a 30 minutos (16,7%), sentar-se em uma cadeira por várias horas (14,3%), caminhar vários quilômetros (19%), carregar duas sacolas de compras (14,3%) e levantar e carregar uma mala pesada (28,6%). Conclusões: Evidenciou-se que a dor lombar pode estar relacionada a fatores pessoais ou ambientais, sendo o sedentarismo, o tempo de profissão e as horas trabalhadas fortes indícios para o aparecimento da dor lombar, com comprometimento das tarefas diárias.

Epidemiology of Injuries and Their Implications in Jiu-Jitsu Practitioners: An Integrative Systematic Review.

Objective To investigate the epidemiology of injury types among jiu-jitsu practitioners, as well as the incidence regarding different skill and experience levels, through the question: "What are the characteristics and prevalence of musculoskeletal injuries in Jiu-Jitsu practitioners?". Methods Since the beginning of the study, in August 2020, we conducted a search on the MEDLINE, LILACS, and SciELO electronic databases. We included cross-sectional studies published between 2018 and 2023 on the epidemiology of the types of injuries among jiu-jitsu practitioners that compared their incidence regarding different levels of ability and experience. Two independent researchers performed the data extraction and assessed the risk of bias. Results Seven studies were included. The common outcomes involved 2,847 jiu-jitsu practitioners. A high prevalence in the knee joint and chest and rib areas was reported. Considering the difference in experience level among the practitioners, we could observe that most of the individuals included were beginners. Among the age groups observed, male practitioners older than 30 years of age were the ones who presented the highest rate of musculoskeletal injury, especially during training sessions. Conclusion There is a high prevalence of musculoskeletal injuries among jiu-jitsu practitioners. The most affected anatomical segments are the knee joint, the chest, and the rib region, followed by the shoulder joint. The related factors change according to certain variables, being more common during training in male individuals over 30 years of age and beginners in the sport.

Therapeutic Approaches for the Prevention of Upper Limb Repetitive Strain Injuries in Work-Related Computer Use: A Scoping Review.

PURPOSE: To explore and describe therapeutic approaches for the prevention of upper limb (UL) repetitive strain injuries (RSI) amongst computer users in the twenty-first century. METHODS: A scoping review was conducted using the method described by Arksey and O'Malley, further enhanced by Levac et al. to ensure rigor, validity and reliability during analysis. Key concepts pertaining to the research question have been mapped, following comprehensive searches of relevant electronic databases namely EBSCOHost (Academic Search Premier, CINAHL, eBook Collection, E-Journals, Health Source-Consumer Edition, Health Sources-Nursing/Academic Edition and MEDLINE), PUBMED and Google Scholar. The identified studies have been presented in a descriptive numerical summary to address the research aim. RESULTS: From the 577 studies initially identified, 58 studies were eligible for inclusion in the scoping review after abstract and full text screening. Strategies for the prevention of UL RSIs in computer users were categorised into overarching types of intervention as well as the factors which contribute towards sustained implementation of prevention strategies. Using ergonomic equipment was the most prevalent approach during intervention, breaks and rest periods were found to be the less common intervention offered to prevent RSIs. The majority of the studies noted personal worksite adjustments, including adjustments of the chair, back rest, lumbar support, handles or any arm support to the individual as a strategy to prevent UL RSIs. In high income countries the use of ergonomic equipment was the most common type of approach during intervention, in middle income countries stretches were the most common therapeutic intervention strategy and in low-income countries there was an even distribution between a number of different therapeutic interventions aimed at preventing RSIs. CONCLUSIONS: The review provides an overview of approaches and a comprehensive baseline for identifying further research required to generate prevention approaches. The information within the review may be used to impact company practice, policy and decision making in terms of developing prevention strategies.

Musculoskeletal symptoms in Primary Health Care professionals / Sintomas osteomusculares em profissionais da Atenção Primária à Saúde / Síntomas musculoesqueléticos en profesionales de Atención Primaria de Salud

Background and Objectives: musculoskeletal diseases affect the musculoskeletal system and have multifactorial causes, with a higher risk of developing in some work activities. This study aimed to analyze the occurrence of musculoskeletal symptoms in Primary Health Care professionals. Methods: a comparative study among healthcare professionals from two municipalities. A structured questionnaire containing sociodemographic and professional variables and the Nordic Musculoskeletal Questionnaire were applied. Results: a total of 429 healthcare professionals have participated; 85 (19.8%) from municipality A and 344 (80.2%) from municipality B. There was no difference in the percentage of professionals with musculoskeletal symptoms between the municipalities (p>0.05). The main pain complaints in the last 12 months were for the lumbar region (56.2%), neck/cervical (48.4%), shoulders (44.7%), back/thoracic region (35.3%) and ankles/foot (31.7%). The lowest rates of pain complaints were for elbows (10.5%) and forearms (14.6%). In the last 12 months, 203 (48.7%) professionals avoided their daily activities of working, at-home service or leisure/pastime due to musculoskeletal problems/symptoms. Conclusion: Primary Health Care professionals from the studied municipalities reported main complaints of musculoskeletal symptoms, in the last 12 months, in the lumbar region, neck/cervical, shoulders, dorsal/thoracic region and ankles/foot. The regions with the fewest complaint rates were elbows and forearms. There were no significant differences in the number of professionals with complaints of musculoskeletal symptoms between the municipalities. This study provides new knowledge by contributing with information that can guide the planning and implementation of actions to promote health and prevent musculoskeletal disorders in Primary Health Care workers.(AU)

Justificativa e Objetivo: as doenças osteomusculares afetam o sistema osteomuscular e possuem causas multifatoriais, com maior risco de desenvolvimento em algumas atividades laborais. Este estudo objetivou analisar a ocorrência de sintomas osteomusculares em profissionais da Atenção Primária à Saúde. Métodos: estudo comparativo entre profissionais de saúde de dois municípios. Foi aplicado um questionário estruturado contendo variáveis sociodemográficas e profissionais, e o Questionário Nórdico de Sintomas Osteomusculares. Resultados: participaram 429 profissionais, sendo 85 (19.8%) do município de pequeno porte e 344 (80,2%) do município de grande porte. Não houve diferença nos porcentuais de profissionais com sintomas osteomusculares entre os municípios (p>0,05). As principais queixas de dor, nos últimos 12 meses, foram para a região lombar (56,2%), pescoço/cervical (48,4%), ombros (44,7%), região dorsal/torácica (35,3%) e tornozelos/pés (31,7%). Os menores índices de queixas de dor foram para os cotovelos (10,5%) e antebraços (14,6%). Nos últimos 12 meses, 203 (48,7%) profissionais evitaram as atividades diárias de trabalho, serviço doméstico ou lazer/passatempo, em decorrência de problemas/sintomas osteomusculares. Conclusão: os profissionais da Atenção Primária à Saúde relataram queixas de sintomas osteomusculares, nos últimos 12 meses, na região lombar, no pescoço/cervical, ombros, região dorsal/torácica e tornozelos/pés. As regiões com menores queixas foram os cotovelos e antebraços. Não houve diferenças significativas do número de profissionais com queixas de sintomas osteomusculares entre os municípios. O estudo agrega novos conhecimentos, ao contribuir com informações capazes de direcionar o planejamento e a implementação de ações de promoção da saúde e prevenção de lesões osteomusculares nos trabalhadores da Atenção Primária à Saúde.(AU)

Justificación y Objetivos: las enfermedades musculoesqueléticas afectan al sistema musculoesquelético y tienen causas multifactoriales, con un mayor riesgo de desarrollarse en algunas actividades laborales. Este estudio tuvo como objetivo analizar la aparición de síntomas musculoesqueléticos en profesionales de Atención Primaria de Salud. Métodos: un estudio comparativo entre profesionales de la salud de dos municipios. Se aplicó un cuestionario estructurado que contiene variables sociodemográficas y profesionales, y el Cuestionario Nórdico de Síntomas Musculoesqueléticos. Resultados: participaron 429 profesionales; 85 (19.8%) del municipio A y 344 (80,2%) del municipio B. No hubo diferencias en el porcentaje de profesionales con síntomas musculoesqueléticos entre los municipios (p>0,05). Las mayores quejas de dolor, en los últimos 12 meses, fueron para la región lumbar (56,2%), el cuello/cervical (48,4%), los hombros (44,7%), la espalda/región torácica (35,3%) y los tobillos/pies (31,7%). Las tasas más bajas de quejas de dolor se dieron en los codos (10,5%) y los antebrazos (14,6%). En los últimos 12 meses, 203 (48,7%) profesionales evitaron las actividades diarias de trabajo, servicio doméstico u ocio/pasatiempo debido a problemas/síntomas musculoesqueléticos. Conclusión: los profesionales de la Atención Primaria de Salud de los municipios estudiados relatan las mayores quejas de síntomas osteomusculares, en los últimos 12 meses, en la región lumbar, cuello/región cervical, hombros, región dorsal/torácica y tobillos/pies. Las regiones con menos quejas fueron los codos y los antebrazos. No hubo diferencias significativas en el número de profesionales con quejas de síntomas musculoesqueléticos entre los municipios. El estudio añade nuevos conocimientos al contribuir con información capaz de dirigir la planificación y la implementación de acciones para promover la salud y prevenir los trastornos musculoesqueléticos en los trabajadores de la Atención Primaria de Salud.(AU)

Epidemiology of Injuries and Their Implications in Jiu-Jitsu Practitioners: An Integrative Systematic Review / Epidemiologia das lesões e suas implicações em praticantes de jiu-jitsu: Uma revisão sistemática integrativa

Abstract Objective To investigate the epidemiology of injury types among jiu-jitsu practitioners, as well as the incidence regarding different skill and experience levels, through the question: "What are the characteristics and prevalence of musculoskeletal injuries in Jiu-Jitsu practitioners?". Methods Since the beginning of the study, in August 2020, we conducted a search on the MEDLINE, LILACS, and SciELO electronic databases. We included cross-sectional studies published between 2018 and 2023 on the epidemiology of the types of injuries among jiu-jitsu practitioners that compared their incidence regarding different levels of ability and experience. Two independent researchers performed the data extraction and assessed the risk of bias. Results Seven studies were included. The common outcomes involved 2,847 jiu-jitsu practitioners. A high prevalence in the knee joint and chest and rib areas was reported. Considering the difference in experience level among the practitioners, we could observe that most of the individuals included were beginners. Among the age groups observed, male practitioners older than 30 years of age were the ones who presented the highest rate of musculoskeletal injury, especially during training sessions. Conclusion There is a high prevalence of musculoskeletal injuries among jiu-jitsu practitioners. The most affected anatomical segments are the knee joint, the chest, and the rib region, followed by the shoulder joint. The related factors change according to certain variables, being more common during training in male individuals over 30 years of age and beginners in the sport.

Resumo Objetivo Investigar a epidemiologia dos tipos de lesões entre praticantes de jiu-jitsu e sua incidência em diferentes níveis de habilidade e experiência por meio da questão: "Quais as características e a prevalência das lesões musculoesqueléticas em praticantes de jiu-jitsu?" Métodos Desde o início do estudo, em agosto de 2020, foram pesquisados os bancos de dados MEDLINE, LILACS e SciELO. Foram incluídos estudos transversais, publicados entre 2018 e 2023, que investigaram a epidemiologia dos tipos de lesões ocorridas entre praticantes de jiu-jitsu e compararam sua incidência em diferentes níveis de habilidade e experiência. Para tanto, dois pesquisadores independentes realizaram a extração dos dados e avaliaram o risco de viés. Resultados Sete estudos foram incluídos. Os resultados comuns envolveram 2.847 praticantes de jiu-jitsu. Houve uma alta prevalência de lesão na articulação do joelho e nas áreas do tórax e das costelas. Considerando a diferença de nível de experiência entre os praticantes, pôde-se observar que a maioria dos indivíduos incluídos eram iniciantes. Entre as faixas etárias observadas, homens acima de 30 anos de idade foram os que mais apresentaram lesões musculoesqueléticas, principalmente durante os treinos. Conclusão Houve uma alta prevalência de lesões musculoesqueléticas entre os praticantes de jiu-jitsu. Os segmentos anatômicos mais acometidos foram a articulação do joelho, o tórax e a região das costelas, seguidos da articulação do ombro. Os fatores relacionados mudaram de acordo com algumas variáveis, sendo mais comuns durante o treinamento em indivíduos do sexo masculino com mais de 30 anos e iniciantes na modalidade.

Work-related musculoskeletal disorders in dockworkers. Systematic review and meta-analysis.

BACKGROUND: Dockworkers are exposed to physical overloads that can contribute to the development of musculoskeletal disorders, leading to functional disability and absenteeism. OBJECTIVE: to map, critically appraise, and synthesize the available evidence on the prevalence of musculoskeletal diseases associated with port occupational activities. METHODS: A comprehensive search was conducted in structured and unstructured databases in August 2023, with no date or language restriction, to identify observational studies evaluating the prevalence of musculoskeletal disorders in dockworkers' occupational activity. The risk of bias was assessed using validated tools based on the included study designs. Data from studies were pooled in meta-analyses. The certainty of the evidence was assessed using the GRADE approach. RESULTS: We identified 12 analytical cross-sectional studies involving 7821 participants in ports of five countries. Most studies (75%) had a moderate methodological quality according to the Joanna Briggs Institute tool. Considering the overall worker categories and any musculoskeletal disorders, the meta-analysis showed a prevalence of 58% (95% Confidence Interval [95% CI] 37% to 78%), with degenerative spinal diseases 42% (95% CI -0.6% to 91%) and low back pain 36% (95% CI 21% to 50%) being the most prevalent conditions. Symptoms were predominantly in foremen and stevedores. The certainty of the evidence was very low. CONCLUSIONS: Musculoskeletal disorders seem prevalent among dockworkers, mainly degenerative spinal diseases and low back pain. Studies with greater methodological consistency are still needed to validate these hypotheses and assist in decision-making for implementing preventive and informational policies in maritime port management organizations. PROSPERO registry CRD42021257677.

Intervenções no trabalho para prevenção de distúrbios musculoesqueléticos: revisão sistemática de ensaios randomizados / Workplace interventions to prevent musculoskeletal disorders: a systematic review of randomized trials

Resumo Objetivo: investigar os efeitos de intervenções no ambiente laboral para prevenção de distúrbios musculoesqueléticos. Métodos: revisão sistemática que incluiu ensaios randomizados, individuados ou comunitários, que investigaram efeitos de intervenções no trabalho para prevenir distúrbios musculoesqueléticos, relatados em artigos publicados entre 2015 e 2020 e indexados nas bases de dados: Lilacs, Medline/Pubmed, PEDro e Web of Science. Os estudos foram categorizados conforme a modalidade de intervenção e avaliados quanto à qualidade metodológica. Resultados: dos 58 estudos selecionados, 15 atenderam satisfatoriamente aos critérios de qualidade, abordando diferentes modalidades de exercícios físicos e/ou abordagem cognitivo-comportamental, aplicadas de forma única ou combinada; nenhum estudo abordou intervenções organizacionais. Apesar da heterogeneidade de intervenções e desfechos, exercícios físicos realizados nos locais de trabalho resultaram em diminuição da dor musculoesquelética, do uso de analgésicos e do afastamento do trabalho por distúrbios musculoesqueléticos, no entanto, combinados às intervenções comportamentais não mostraram os resultados esperados. Os resultados com a Ergonomia Participativa ratificaram o papel fundamental dos trabalhadores na realização de intervenções em seus ambientes de trabalho. Conclusão: apesar de benefícios observados, salienta-se que os estudos revisados não produziram evidências consolidadas acerca das intervenções mais eficazes para prevenir distúrbios musculoesqueléticos entre trabalhadores.

Abstract Objective: to investigate the effects of workplace interventions aiming to prevent musculoskeletal disorders. Methods: systematic review that included randomized, individual or community trials, which investigated the effects of workplace interventions aiming to prevent musculoskeletal disorders, reported in articles published between 2015 and 2020 and indexed in the following databases: Lilacs, Medline/Pubmed, PEDro, and Web of Science. Studies were categorized according to the type of intervention and evaluated in terms of methodological quality. Results: of all 58 studies selected, 15 satisfactorily met the quality criteria, addressing different types of physical exercise and/or cognitive-behavioral approaches, applied alone or in combination. No study addressed organizational interventions. Despite the heterogeneity of interventions and outcomes, physical exercises performed in the workplace led to reduction in musculoskeletal pain, use of analgesics, and absence from work due to musculoskeletal disorders; however, combined with behavioral interventions, they did not show the expected results. The results with participatory ergonomics confirmed the critical role of workers in performing interventions in the workplace. Conclusion: despite the benefits observed, the studies reviewed did not produce consolidated evidence about the most effective interventions to prevent musculoskeletal disorders among workers.

Work-related musculoskeletal disorders in vulnerable populations: what are the most common body parts affected?

BACKGROUND: Studies investigating vulnerable populations have shown that work-related musculoskeletal disorders have a negative impact on quality of life. However, no study has examined the body regions commonly affected by work-related musculoskeletal disorders in vulnerable populations. OBJECTIVE: To describe the body regions commonly affected by work-related musculoskeletal disorders in vulnerable populations. METHODS: Cross-sectional study. We used the ABEP questionnaire, the World Health Organization Quality of Life, the Nordic Musculoskeletal Disorders Questionnaire, the Perceived Stress Scale, and a self-report questionnaire to determine morning-evening in human circadian rhythms (chronotype assessment). To reduce the possibility of information bias, we provided prior training in the use of the instruments and created an electronic database that was filled out in duplicate (in cases of disagreement, a third researcher was consulted). We tested the normality of the data using the Shapiro-Wilk test. RESULTS: The sample consisted of 132 participants, but there was a sample loss of 41.6% (final sample n = 77). We observed the predominance of those who worked from 6 to 8 h/day, rest of 1 h during the working day, from 1 to 10 years of service and only 1 employment relationship. Regarding the quality of life, we observed a worse result in the domain related to the environment, as well as a stress level of 15.43 (± 7.52) with a maximum of 30. Finally, we observed the presence of pain self-reported by the artisanal fishermen in several regions of the body, lumbar being the most mentioned. CONCLUSION: The neck, shoulders, arms, elbows, forearms, wrists, back, lumbar spine, and lower limbs are the most common parts of the body affected by work-related musculoskeletal disorders in artisanal fishermen.

Validity of "OfficeCheck": A self-musculoskeletal assessment tool for screening work-related musculoskeletal disorders in office workers.

BACKGROUND: Early self-assessment for work-related musculoskeletal disorders (WMSDs) is crucial in preventing severe symptoms and long-term consequences. Accessible tools are necessary for proactive management. OBJECTIVE: To validate the OfficeCheck web application as a screening tool to classify office workers as capable of self-management for specific symptoms of WMSDs or requiring professional consultation. METHODS: This study was conducted to determine the criterion-related validity of OfficeCheck using physical therapy assessment as the reference standard. In total, 223 office workers who work with a computer more than two hours a day with or without symptoms of WMSDs participated in this study. All of them were classified by self-assessment on the OfficeCheck process flow (Kappa = 0.841) and physical therapy assessment, respectively. For statistical analysis, classification numbers were calculated for sensitivity, specificity, false positive rate (FPR), false negative rate (FNR), positive predictive value (PPV), and negative predictive value (NPV). RESULTS: A total of 223 workers with a mean age of 38.9±9.0 years and mean body mass index (BMI) of 24.3±5.2 kg/m2 were illustrated. The most common areas of complaint were neck/upper back and lower back/hip. The results indicated that OfficeCheck had high sensitivity (95.1%), low specificity (42.0%), low PPV (38.0%), and high NPV (95.8%). The FPR was 58.0% and the FNR was 4.9%. CONCLUSION: OfficeCheck was found to have high sensitivity to classify office workers as capable of self-management for specific symptoms of WMSDs or requiring professional consultation. The use of OfficeCheck is thus recommended for self-detection and management to stop the consequences of WMSDs.

Use of Smartphones as a Risk Factor for the Development of Morbidities in the Wrist and Fingers.

Objective To investigate the long-term use of smartphones as a risk factor for the development of morbidities in the wrist and fingers. Methods The present is a descriptive, exploratory study with a quantitative approach based on injury prevalence among one hundred smartphone users of a private university in the state of Pernambuco, Northeastern Brazil. We applied a semi-structured questionnaire and the Boston Carpal Tunnel Questionnaire (BCTQ), as well as the Visual Analog Scale (VAS) and the Finkelstein, Phalen, reverse Phalen, and Tinel signal tests on the wrist. Results The average of the sample was of 22.73 years, with a prevalence of single, right-handed female participants. Most of them had been using smartphones for 5 to 10 years, and 85% reported discomfort in the wrist and fingers while using the device, with numbness as the most prevalent symptom. Most clinical tests were negative, and the Finklestein test showed greater positivity. The BCTQ is composed of a symptom severity scale (S scale) and a functional status scale (F scale): the overall score on the S scale was of 1.61, indicating mild to moderate symptoms, and the F scale revealed that the symptoms did not affect functionality. Conclusion There was a significant correlation between the length of use of smartphones and discomfort in the wrist and fingers; as such, smartphones are a risk factor for the development of morbidities.

Influence of Surface Geometry on Palm and Fist Contact Pressure Distribution During Strikes With the Hand in Automotive Assembly.

The increase in repetitive strain injuries to the hand underscores the need for assessing and preventing musculoskeletal overuse associated with hand-intensive tasks. This study investigates the risk of overload injuries in soft tissue structures of the hand by analyzing the pressure distribution and location of peak pressure in the hand during snap-fit connection assembly in the automotive industry. The influence of the surface geometry of automotive trim components the pressure distribution and force imparted during strikes with the palm and the fist are investigated in a cohort of 30 subjects with extensive experience installing trim parts with snap-fit connections. Using the palm or fist (ulnar hand side) of the dominant hand, the subjects struck a simulation device with a flat, rounded, or edged surface geometry. The average peak force applied was 600 N (±122 N), nearly 3 times the force required to overcome the technical resistance of the snap-fit connector (220 N). Fist strikes exerted a 40% higher mean peak pressure and 18% higher mean pressure than did palm strikes. The pressure distribution in the region of the thenar eminence and soft tissue of the ulnar side of the hand did not differ between fist strikes on flat and edged surfaces. Considering the delicate anatomy of the hand, especially the hypothenar muscles on the ulnar side, assembling connection claps using the fist instead of the palm may prevent repetitive blunt trauma to the sensitive blood vessels and nerves in the palm.

Prevalência de distúrbios osteomusculares relacionadosao trabalho em agricultores do Oeste do Paraná / Prevalence of work-related osteomuscular disordersin farmers of western Paraná

Os distúrbios osteomusculares relacionados ao trabalho (DORT) podem afetar articulações, músculos, tendões, ligamentos e nervos periféricos e são comuns na agricultura devido à sobrecarga de trabalho, esforços excessivos e repetitivos e adoção de posturas inadequadas para a realização das atividades. O objetivo deste estudo é apresentar a prevalência de DORT, a intensidade e características da dor, além de descrever as categorias e ferramentas de trabalho de agricultores da Região Oeste do Paraná. Foi realizado um estudo observacional transversal com uma amostra representativa dos agricultores associados ao sindicato da região. Para coleta de dados utilizou-se um questionário sociodemográfico, um formulário sobre categorias e ferramentas de trabalho, a Escala Visual Analógica de dor, o Questionário Nórdico de Sintomas Osteomusculares e o questionário de McGill para caracterização da dor. Participaram do estudo 144 agricultores, com predomínio do sexo masculino (63,89%) e faixa etária entre 18 e 47 anos (73,61%). A prevalência de DORT nos agricultores foi de 100% e as regiões mais acometidas foram as partes inferior e superior das costas com 59,72% e 43,75% respectivamente. A intensidade da dor foi moderada em 50,69% e do tipo enjoada em 89,58% dos participantes. A atividade de cultivo de grãos está presente em 57,64% dos indivíduos e o uso de motosserra e maquinário agrícola foram as ferramentas mais citadas durante o labor. Os achados apontam a necessidade urgente de intervenção terapêutica e preventiva aos trabalhadores e contribuem ao avanço científico da área. Além de tratar os DORT, mostram-se imprescindíveis adaptações ergonômicas no trabalho dos agricultores.

Work-related musculoskeletal disorders (WRMD) can affect joints, muscles, tendons, ligaments and peripheral nerves and are common in agriculture due to work overload, excessive and repetitive efforts and the adoption of inappropriate postures to perform activities. The objective of this study is to present the prevalence of WRMD, the intensity and characteristics of pain, in addition to describing the categories and work tools of farmers in the western region of Paraná. A cross-sectional observational study was carried out with a representative sample of farmers associated with the worker ́s union in the region. For data collection, we used a sociodemographic questionnaire, a form on categories and work tools, the visual analogue pain scale, the Nordic questionnaire on musculoskeletal symptoms and the McGill questionnaire for pain characterization. A total of 144 farmers participated in the study, with a predominance of males (63.89%) aged between 18 and 47 years old (73.61%). The prevalence of WRMDs in farmers was 100% and the most affected body regions were the lower and upper back with 59.72% and 43.75% respectively. Pain intensity was moderate in 50.69% and nausea type in 89.58% of participants. Grain cultivation activity was present in 57.64% of individuals and the use of chainsaws and agricultural machinery were the most cited tools used during work. The findings point to the urgent need for therapeutic and preventive intervention to these land workers and can contribute to the scientific advancement of the area. Besides treating WRMDs, ergonomic adaptations in the work of farmers are essential.

Use of Smartphones as a Risk Factor for the Development of Morbidities in the Wrist and Fingers / Uso de smartphones como fator de risco para o desenvolvimento de morbidades no punho e nos dedos*

Abstract Objective To investigate the long-term use of smartphones as a risk factor for the development of morbidities in the wrist and fingers. Methods The present is a descriptive, exploratory study with a quantitative approach based on injury prevalence among one hundred smartphone users of a private university in the state of Pernambuco, Northeastern Brazil. We applied a semi-structured questionnaire and the Boston Carpal Tunnel Questionnaire (BCTQ), as well as the Visual Analog Scale (VAS) and the Finkelstein, Phalen, reverse Phalen, and Tinel signal tests on the wrist. Results The average of the sample was of 22.73 years, with a prevalence of single, right-handed female participants. Most of them had been using smartphones for 5 to 10 years, and 85% reported discomfort in the wrist and fingers while using the device, with numbness as the most prevalent symptom. Most clinical tests were negative, and the Finklestein test showed greater positivity. The BCTQ is composed of a symptom severity scale (S scale) and a functional status scale (F scale): the overall score on the S scale was of 1.61, indicating mild to moderate symptoms, and the F scale revealed that the symptoms did not affect functionality. Conclusion There was a significant correlation between the length of use of smartphones and discomfort in the wrist and fingers; as such, smartphones are a risk factor for the development of morbidities.

Resumo Objetivo Investigar o uso de smartphones em longo prazo como fator de risco para o desenvolvimento de morbidades no nível do punho e dos dedos. Métodos Realizou-se um estudo descritivo, exploratório, de abordagem quantitativa, para a obtenção de medidas de prevalência com cem acadêmicos usuários de smartphones de uma faculdade privada localizada no sertão de Pernambuco. Foram aplicados um questionário semiestruturado e o Questionário de Síndrome doTúnel do Carpo de Boston (Boston Carpal Tunnel Questionnaire, BCTQ, na sigla em inglês), além da Escala Visual Analógica (EVA) e dos testes de Finkesltein, Phalen, Phalen reverso, e sinal de Tinel no punho. Resultados A idade média da amostra foi de 22,73 anos, com prevalência de solteiros, de destros, e do sexo feminino. O tempo de uso do smartphone indicado pela maioria dos participantes era entre 5 e 10 anos, e 85% da amostra relatou já ter sentido desconforto no punho e nos dedos durante o uso do aparelho, sendo a dormência o sintoma mais prevalente. Com relação aos testes clínicos, houve prevalência de resultados negativos, e o de Finklestein apresentou maior positividade. Quanto ao BCTQ, dividido em duas escalas, uma de gravidade dos sintomas (escala G) e uma de estado funcional (escala F), a média geral das pontuações foi de 1,61 na escala G, o que indica sintomas de leve a moderados, já a escala F revelou que os sintomas não afetavam a funcionalidade. Conclusão Foi possível observar uma correlação significativa entre o tempo de uso dos smartphones e a presença de desconforto no punho e nos dedos, o que indica que se trata de um fator de risco para o desenvolvimento de morbidades.

The Effectiveness of Workplace Musculoskeletal Injury Risk Factor Screening Tools for Reducing Injury: A Systematic Review.

INTRODUCTION: Musculoskeletal injury (MSI) contributes to global health burdens. Effective MSI prevention is necessary. MSI risk factor screening tools can be used by employers to identify and mitigate occupational hazards. Rigorous synthesis of the effectiveness of these tools has not taken place. We synthesized literature on effectiveness of MSI risk factor screening tools for reducing injury through informing prevention interventions. MATERIALS AND METHODS: A literature search of Medline, Embase, Cochrane Library (Trials), CINAHL, Scopus and PsycINFO databases was performed. Included studies required an analytic design, used an MSI risk factor screening tool to inform an intervention in a working-age population and reported an outcome of MSI development, injury or compensation/work absence. Data extraction and study quality rating (Downs and Black criteria) were completed. Studies were sub-categorized as having used a single MSI screening tool (single-tool) to inform an injury prevention intervention or involving multiple simultaneous screening tools (multiple-tool). Study outcomes were synthesized when possible. RESULTS: Eighteen articles representing fourteen studies met our inclusion criteria. No high-quality studies were identified (maximum Downs and Black score of 19). Studies did not employ previously validated tools but instead, typically, those purpose-built for a single use. The results were inconsistent both when using tools alone and in combination with other tools. Outcome measure heterogeneity precluded meaningful meta-analysis. CONCLUSIONS: There is limited evidence regarding use of MSI risk factor screening tools for preventing injury. Rigorous studies that utilize previously validated tools are needed.

Ultrasonographic Measurement of Median Nerve Cross-Sectional Area in Evaluating Carpal Tunnel Release Outcomes.

PURPOSE: Earlier research has explored carpal tunnel release (CTR) surgery outcomes using electrodiagnostic tests (EDX). However, evaluation of the median nerve before and after CTR by ultrasound (US) is understudied. This study aimed to establish the outcomes of CTR by EDX and US, and examine the correlation between the clinical improvement and US after CTR. METHODS: The sample consisted of 172 wrists that underwent CTR. Pain was assessed using the visual analog scale (VAS). The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), including the symptom severity and function subscales, was applied before and 3 months after CTR. The proximal and distal cross-sectional areas (CSAs) of the median nerve were measured using US, and EDX was performed before and 3 months after CTR. RESULTS: Patients had mean preoperative and postoperative VAS scores of 7.7 ± 1.2 and 1.7 ± 1.2, respectively. The mean preoperative and postoperative proximal CSA measurements were 16.4 ± 4.5 mm2 and 12.1 ± 3.9 mm2, respectively. The mean preoperative and postoperative distal CSA measurements were 13.6 ± 3.7 mm2 and 11.0 ± 3.1 mm2, respectively. A significant improvement was observed in VAS, BCTQ, and EDX 3 months after CTR. A weak, positive correlation was observed between the improvement in the BCTQ symptom severity and function subscales and CSAs following CTR. CONCLUSIONS: The results of this study demonstrate that preoperative median nerve CSA values may be used in evaluating CTR outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Altered regional 3D shear wave velocity patterns in youth competitive alpine skiers suffering from patellar tendon complaints - a prospective case-control study.

Patellar tendon (PT) complaints are frequent throughout the population, with increased occurrence in athletes and, particularly, in youth competitive alpine skiers. Timely detection and treatment might improve prospects of recovery. Diagnostic modalities in clinical use to date rely on pain symptoms, manual palpation, and potentially, magnetic resonance imaging (MRI); however, MRI-based imaging yields limited sensitivity. Quantitatively measuring the morphological and mechanical properties of PTs by means of B-mode ultrasound and shear wave elastography (SWE), instead, may allow improved diagnosis or even early detection. We performed B-mode scans and three-dimensional ultrasound shear wave velocity (SWV) mapping and MRI of the PT in 106 youth skiers. A prospective one-year survey on health problems combined with clinical assessments served to categorize symptomatic and asymptomatic youth skiers. Skiers suffering from distal or proximal tendon complaints showed lower SWV in the respective tendon region than asymptomatic skiers (p = 0.035 and p = 0.019, respectively). Youth skiers with distal tendon complaints additionally exhibited decreased SWV in the proximal region compared to asymptomatic counterparts (p = 0.020). Cross-validated analysis of retrospective prediction indicated sensitivity and specificity in detecting tendon complaints in the range of 0.606-0.621 and 0.536-0.650, respectively. MRI detected distal tendon complaints with a sensitivity of 0.410 (12/29) but failed to detect any proximal cases. This study agrees with the most recent literature in that SWE holds promise as a valuable adjunct modality for the diagnosis of PT complaints or even the detection of subclinical prestages. However, to evaluate its prospective predictive value, long-term studies are warranted.Highlights Patellar tendon complaints are a frequent complaint in athletes, particularly in youth competitive alpine skiers, but timely quantitative detection of related tendon properties remains challenging.Quantitative B-mode US and three-dimensional ultrasound shear wave elastography assessments and magnetic resonance imaging were performed in youth competitive alpine skiers.Three-dimensional shear wave elastography was able to discern symptomatic from asymptomatic patellar tendons both in the distal and proximal tendon regions, whereas magnetic resonance imaging failed to detect any proximal cases.

Analysis of the articular load on the lower limbs during backflip / Análise da carga articular nos membros inferiores durante o backflip / Análisis de la carga articular en los miembros inferiores durante el backflip

ABSTRACT Introduction: Sports injuries restrict the acquisition of optimal results and represent a great threat to the athlete's physical health, lower limb injuries being the most prominent, mainly those caused by landing. Objective: Use biomechanics to analyze the joint load of the lower limbs during the landing process in the gymnastics backflip, establishing movement control and reducing the risk of lower limb injury. Methods: The male athletes of the National Gymnastics Team were selected as the research objects, and the three-dimensional backflip (BS) motion trajectory was completed after the landing process was completed, the vertical ground reaction force (VGRF) after landing and the lower limb muscle electromyography (EMG) after landing was collected, and the human multi-body system model and the landing platform model of the landing action were completed with the help of the system simulation software. Results: Statistics show that gymnasts train more intensively during competition or daily training, performing more than 200 landings per week, a factor that increases the risk of injuries during the backflip in athletes. Conclusion: The lower limb joint load of the landing action in gymnastics backflip is high, which will cause a certain risk of injury, and specific measures can be taken to control it. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Lesões esportivas restringem a aquisição dos resultados ótimos e representam uma grande ameaça à saúde física do esportista, sendo as lesões nos membros inferiores as mais proeminentes, majoritariamente as causadas pela aterrissagem. Métodos: Os atletas masculinos da Equipe Nacional de Ginástica foram selecionados como objetos de pesquisa, e a trajetória de movimento tridimensional do backflip (BS) foi completada após a conclusão do processo de aterrissagem, a força vertical de reação ao solo (VGRF) após a aterrissagem e a eletromiografia do músculo do membro inferior (EMG) após a coleta do pouso, e o modelo do sistema humano de multicorpos e o modelo da plataforma de aterrissagem da ação de aterrissagem foram completados com a ajuda do software de simulação do sistema. Resultados: As estatísticas mostram que os ginastas treinam mais intensamente durante a competição ou no treinamento diário, efetuando mais de 200 aterrissagens semanais, fator que aumenta o risco de lesões durante o backflip nos atletas. Conclusão: A carga articular dos membros inferiores da ação de aterrissagem no backflip da ginástica é alta, o que causará um certo risco de ferimentos, e medidas específicas podem ser tomadas para controlá-lo. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Las lesiones deportivas limitan la obtención de resultados óptimos y representan una gran amenaza para la salud física del deportista, siendo las lesiones en los miembros inferiores las más destacadas, principalmente las causadas por el aterrizaje. Objetivo: Utilizar la biomecánica para analizar la carga articular de los miembros inferiores durante el proceso de aterrizaje en el backflip gimnástico, estableciendo el control del movimiento y reduciendo el riesgo de lesiones en los miembros inferiores. Métodos: Se seleccionaron como objetos de investigación los atletas masculinos del Equipo Nacional de Gimnasia, y se completó la trayectoria de movimiento tridimensional del backflip (BS) tras el proceso de aterrizaje, se recogió la fuerza de reacción vertical del suelo (VGRF) tras el aterrizaje y la electromiografía (EMG) de los músculos de las extremidades inferiores tras el aterrizaje, y se completó el modelo del sistema multicuerpo humano y el modelo de la plataforma de aterrizaje de la acción de aterrizaje con la ayuda del software de simulación de sistemas. Resultados: Las estadísticas muestran que los gimnastas entrenan más intensamente durante la competición o el entrenamiento diario, realizando más de 200 aterrizajes a la semana, un factor que aumenta el riesgo de lesión durante el backflip en los atletas. Conclusión: La carga de la articulación del miembro inferior en la acción de aterrizaje en el backflip de gimnasia es elevada, lo que provocará un cierto riesgo de lesión, y se pueden tomar medidas específicas para controlarla. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Percepção de sintomas osteomusculares e sua repercussão nas atividades de vida diária em intérpretes de língua de sinais / Musculoskeletal symptoms perception and its impact on language interpreters' daily lives

Resumo Objetivo: analisar a percepção de sintomas osteomusculares e sua repercussão nas atividades de vida diária referidas por intérpretes da língua brasileira de sinais (libras). Métodos: pesquisa qualitativa de natureza descritiva-analítica, utilizando a análise de conteúdo categorial temática. Foi aplicado questionário sociodemográfico e realizada entrevista semiestruturada com 12 profissionais intérpretes de libras, atuantes nas redes de ensino nos níveis fundamental, médio e superior do município de Goiânia, convidados via redes sociais, no primeiro semestre de 2021. Resultados: foram identificadas três categorias temáticas: percepção álgica, percepção de cansaço e atividades de vida diária. Os profissionais estavam trabalhando remotamente devido à pandemia da doença COVID-19, cujo regime permitiu uma flexibilização do processo de trabalho com aulas on-line, eventos, palestras e congressos a partir do domicílio do trabalhador. Houve um aumento expressivo da demanda física e psicológica, devido ao aumento das atividades a serem cumpridas e por estarem ausentes os limites entre ambiente de "trabalho" e "casa". Conclusão: os participantes apresentaram percepções negativas em todos os aspectos avaliados, evidenciando a existência de sobrecarga na atuação como intérprete de língua de sinais.

Abstract Objective: to analyze the perception of musculoskeletal symptoms and their repercussion in the activities of daily living reported by professional Brazilian sign language interpreters (LIBRAS). Methods: descritive-analytical qualitative research, using thematic categorical content analysis. We used a sociodemographic questionnaire and a semi-structured interview with 12 professional LIBRAS interpreters, working in the primary, secondary, and superior education in the municipality of Goiânia. They were invited via social media, in the first half of 2021. Results: we identified three thematic categories: pain perception, perception of tiredness, and activities of daily living. The professionals were working remotely due to the COVID-19 pandemic. This allowed flexibility in the work schedule, with online classes, events, lectures, and congresses participation from the worker's home. Conclusion: the participants had negative perceptions in all aspects evaluated, evidencing an overload in acting as a sign language interpreter in educational activities.

Prevalence of low back pain and work-related musculoskeletal disorders in Brazilian domestics and cleaners: 2013 and 2019 National Health Survey.

Introduction: Low back pain and work-related musculoskeletal disorders are two of the leading causes of absenteeism worldwide. Objectives: To determine the prevalence and predictive factors of low back pain and work-related musculoskeletal disorders in Brazilian domestics and cleaners. Methods: This population-based cross-sectional study used data from the 2013 and 2019 National Health Survey (Pesquisa Nacional de Saúde), involving a total of 8,160 workers. The prevalence of low back pain and work-related musculoskeletal disorders was calculated based on adjusted prevalence ratio by Poisson regression and 95%CI. Results: The prevalence of lowback pain was 19.1% in 2013 and 20.6% in 2019, while the prevalence of musculoskeletal disorders was 2.2% in 2013 and 2.4% in 2019. Low back pain was associated with older age (prevalence ratio: 1.74; 95%CI 1.44-2.09), poor or very poor self-rated health (prevalence ratio: 2.10; 95%CI 1.76-2.50), holding a prepaid health plan (prevalence ratio: 1.27; 95%CI 1.09-1.47), and moderately severe (prevalence ratio: 2.27; 95%CI 1.84-2.80) or severe (prevalence ratio: 2.32; 95%CI 1.77-3.04) depressive symptoms. Musculoskeletal disorders affected domestics less frequently (prevalence ratio: 0.53; 95%CI 0.40-0.72) and were associated with women (prevalence ratio: 2.50; 95%CI 1.34-4.66), adults (40-59 years) (prevalence ratio: 1.79; 95%CI 1.26-2.55), holding a prepaid health plan (prevalence ratio: 2.31; 95%CI 1.63-3.26), and the presence of moderately severe (prevalence ratio: 4.00; 95%CI 2.34-6.86) or severe (prevalence ratio: 3.63; 95%CI 1.77-7.46) depressive symptoms. Conclusions: Brazilian domestics and cleaners need interventions and improvements in health care given the prevalence of low back pain and musculoskeletal disorders as well as their association with depression.

Introdução: Lombalgia e distúrbios osteomusculares relacionadas ao trabalho são duas das principais causas de absenteísmo no mundo. Objetivos: Determinar a prevalência e fatores preditivos da lombalgia e distúrbios osteomusculares relacionados ao trabalho em trabalhadores domésticos e faxineiros brasileiros. Métodos: Este estudo transversal populacional coletou dados da Pesquisa Nacional de Saúde, realizada nos anos de 2013 e 2019, totalizando uma amostra de 8.160 trabalhadores. A prevalência da lombalgia e distúrbios osteomusculares relacionados ao trabalho autorreferidos foi calculada pela razão de prevalência ajustada pelo modelo de regressão de Poisson e IC95%. Resultados: A prevalência de lombalgia foi de 19,1% em 2013 e 20,6% em 2019; e de distúrbios osteomusculares foi de 2,2% em 2013 e 2,4% em 2019. A lombalgia esteve associada aos indivíduos idosos (razão de prevalência: 1,74; IC95% 1,44-2,09), com percepção baixa ou muito baixa a respeito da sua saúde (razão de prevalência: 2,10; IC95% 1,76-2,50), com plano de saúde (razão de prevalência: 1,27; IC95% 1,09-1,47) e com sintomas depressivos moderadamente graves (razão de prevalência: 2,27; IC95% 1,84-2,80) ou graves (razão de prevalência: 2,32; IC95% 1,77-3,04). A presença de distúrbios osteomusculares foi menor nos trabalhadores domésticos (razão de prevalência: 0,53; IC95% 0,40-0,72); e esteve associada ao sexo feminino (razão de prevalência: 2,50; IC95% 1,34-4,66), adultos (40-59 anos) (razão de prevalência: 1,79; IC95% 1,26-2,55), ter plano de saúde (razão de prevalência: 2,31; IC95% 1,63-3,26) e presença de sintomas depressivos moderadamente graves (razão de prevalência: 4,00; IC95% 2,34-6,86) ou graves (razão de prevalência: 3,63; IC95% 1,77-7,46). Conclusões: Trabalhadores domésticos e faxineiros necessitam de intervenções, melhorias na saúde e adaptação dos ambientes de trabalho dada a prevalência de lombalgia e distúrbios osteomusculares e associações com a depressão.

Occupational risks and musculoskeletal complaints among industrial workers: a cross-sectional study.

Introduction: Work-related musculoskeletal disorders result from the overuse of the musculoskeletal system and insufficient time for the structures to recover. They are generally characterized by chronic pain, paresthesia, feeling of heaviness and fatigue, especially in the upper extremities, concomitantly or not, with an insidious onset. Objectives: To characterize musculoskeletal complaints and occupational risks in workers with work-related musculoskeletal disorders. Methods: A cross-sectional observational study of 60 participants in a Workers' Health Reference Center with clinical and imaging diagnosis of work-related musculoskeletal disorders. The instrument used contained 30 questions about individual factors, occupational risks, and musculoskeletal abnormalities. The results were analyzed descriptively, and the chi-square test was used to assess associations with a significance level at p < 0.05. Data analysis was performed using BioEstat 5®. Results: Most participants were men (66.7%) working in the industrial sector. The most common complaint was pain (100%) in the shoulders (43.8%) and lumbar spine (22%), and the most common abnormalities were tendinopathies and intervertebral disc disorders. The following risk factors were identified: 8-hour workday (80%); repetitive gestures (86.7%); twisting (58.3%); bending (61.7%); standing (66.7%); manual work (96.7%); and 10-30 kg of weight handled (35%). Conclusions: A large number of workers exposed to biomechanical and organizational risks report musculoskeletal pain. Employers should check working conditions and adjust them, investing in health promotion and protection actions to effectively reduce the occurrence of these disorders.

Introdução: Os distúrbios osteomusculares relacionados ao trabalho são decorrentes da utilização excessiva do sistema osteomuscular e da falta de tempo para recuperação dessas estruturas. Geralmente, são caracterizados por dor crônica, parestesia, sensação de peso e fadiga, sobretudo em membros superiores, concomitantes ou não, de aparecimento insidioso. Objetivos: Caracterizar as queixas osteomioarticulares e os riscos ocupacionais em trabalhadores portadores de distúrbios osteomusculares relacionados ao trabalho. Métodos: Estudo observacional com análise transversal, realizado com 60 participantes em um Centro de Referência em Saúde do Trabalhador, com diagnóstico clínico e de imagem dos distúrbios osteomusculares relacionados ao trabalho. O instrumento utilizado continha 30 questões sobre fatores individuais, riscos ocupacionais e alterações osteomusculares. Foram realizadas análises descritivas e, para avaliar as associações, foi utilizado o teste qui-quadrado, considerando nível de significância p < 0,05. As análises foram realizadas no programa BioEstat 5®. Resultados: A amostra foi majoritariamente masculina (66,7%) e do setor industrial. A queixa mais relatada foi a dor (100%) nos ombros (43,8%) e região lombar da coluna (22%), e as alterações mais encontradas foram tendinopatias e transtornos nos discos vertebrais. Alguns fatores de risco identificados foram: jornada de trabalho de 8 horas (80%); realizar gestos repetitivos (86,7%); torções (58,3%); deslocamentos (61,7%); adotar a posição bípede (ortostática) do corpo (66,7%); trabalho manual (96,7%); transporte de peso entre 10 e 30 kg (35%). Conclusões: Um grande número de trabalhadores expostos a riscos biomecânicos e organizacionais relata dores musculoesqueléticas. Cabe aos empresários verificar as condições de trabalho e ajustá-las, investindo em ações de promoção e proteção à saúde, para efetivamente reduzir a ocorrência desses distúrbios.