Prevalência, fatores associados e limitações relacionados ao problema crônico de coluna entre adultos e idosos no Brasil / Prevalencia, factores asociados y limitaciones relacionadas con el problema crónico de columna entre adultos y ancianos en Brasil / Prevalence, associated factors, and limitations related to chronic back problems in adults and elderly in Brazil

O objetivo foi analisar aspetos epidemiológicos do problema crônico de coluna no Brasil e estudar a associação entre a prevalência do problema crônico de coluna e fatores demográficos, socioeconômicos, estilo de vida e condições de saúde. Utilizam-se microdados da Pesquisa Nacional de Saúde (PNS) de 2013. Os indicadores epidemiológicos foram: prevalência, tempo vivido com problema crônico de coluna, ciclo vital (de adulto jovem até idoso), impacto nas limitações da Vida Diária e idade média do início dos sintomas, segundo sexo e faixa etária. Para analisar a desigualdade do problema crônico de coluna segundo características socioeconômicas e fatores de risco realiza-se modelo de regressão logística multivariada, por etapa do ciclo vital, tendo como variável dependente a presença de problema crônico de coluna e como independentes: sexo, escolaridade, área de residência, raça/cor, autoavaliação da saúde, tipo de doença crônica, ídice de massa corporal (IMC) e atividade física. A prevalência de problema crônico de coluna no Brasil foi de 18,5%, sendo maior entre mulheres do que entre homens (21,1%; IC95%: 20,2-21,9). A idade média de início do problema crônico de coluna é 35 anos. Encontrou-se associação entre problema crônico de coluna e menor nível educacional, má autoavaliação da saúde e presença da maioria das doenças crônicas consideradas. Local de residência, IMC, idade e raça/cor estiveram fracamente ou não associados. A prevalência de problema crônico de coluna estabiliza aos 50 anos, mas a severidade da limitação aumenta em idades mais avançadas. A alta prevalência, similar a outros países, e o impacto nas condições de vida revelam a necessidade de estudos epidemiológicos sobre problema crônico de coluna. Resultados sugerem que a promoção e prevenção do problema crônico de coluna devem ser intensificadas, especialmente antes dos 50 anos de idade, considerando-se o acentuado envelhecimento populacional do país.

El objetivo fue analizar aspectos epidemiológicos del problema crónico de columna en Brasil y estudiar la asociación entre la prevalencia del problema crónico de columna y factores demográficos, socioeconómicos, estilo de vida y condiciones de salud. Se utilizan microdatos de la Encuesta Nacional de Salud (PNS) de 2013. Los indicadores epidemiológicos fueron: prevalencia, tiempo vivido con problema crónico de columna, ciclo vital (desde la etapa de adulto joven a incluso anciano), impacto en las limitaciones de la vida diaria y edad media del inicio de los síntomas, según sexo y franja de edad. Para analizar la desigualdad del problema crónico de columna, según características socioeconómicas y factores de riesgo, se realiza un modelo de regresión logística multivariada, por etapa del ciclo vital, teniendo como variable dependiente la presencia de problema crónico de columna y como independientes: sexo, escolaridad, área de residencia, raza/color, autoevaluación de la salud, tipo de enfermedad crónica, índice de masa corporal (IMC) y actividad física. La prevalencia de problema crónico de columna en Brasil fue de un 18,5%, siendo mayor entre mujeres que entre hombres (21,1%; IC95%: 20,2-21,9). La edad media de inicio del problema crónico de columna es 35 años. Se encontró una asociación entre problema crónico de columna y un menor nivel educacional, mala autoevaluación de la salud y una presencia de la mayoría de las enfermedades crónicas consideradas. Lugar de residencia, IMC, edad y raza/color estuvieron escasamente o no asociados. La prevalencia de problema crónico de columna se estabiliza a los 50 años, pero la severidad de la limitación aumenta en edades más avanzadas. La alta prevalencia, similar a otros países, y el impacto en las condiciones de vida revelan la necesidad de estudios epidemiológicos sobre problema crónico de columna. Los resultados sugieren que la promoción y prevención del problema crónico de columna deben ser intensificadas, especialmente antes de los 50 años de edad, considerándose el acentuado envejecimiento poblacional del país.

The objective was to analyze the epidemiological characteristics of chronic back problems in Brazil and study the association between their prevalence and demographic and socioeconomic factors, lifestyle, and health conditions. The study used micro-data from the Brazilian National Health Survey (PNS), 2013. The epidemiological indicators were: prevalence, time with chronic back problems, life cycle (from young adults to the elderly), limitations in activities of daily living, and mean age at onset of symptoms, according to sex and age bracket. In order to analyze inequality in chronic back problems according to socioeconomic characteristics and risk factors, a multivariate logistic regression model was used, based on life cycle stages, with the presence of chronic back problems as the dependent variable and the following independent variables: sex, schooling, area of residence, race/color, self-rated health, types of chronic diseases, body mass index (BMI), and physical activity. Prevalence of chronic back problems in Brazil was 18.5%, and was higher in women than in men (21.1%; 95%CI: 20.2-21.9). Mean age at onset of chronic back problems was 35 years. There was an association between chronic back problems and lower schooling, poor self-rated health, and presence of the majority of the selected chronic diseases. Area of residence, BMI, age, and race/color were weakly associated or not associated with chronic back problems. Prevalence of chronic back problems stabilized at 50 years of age, but the severity of limitations increased at older ages. As in other countries, high prevalence and the impact on living conditions revealed the need for epidemiological studies on chronic back problems in Brazil. The results suggest that health promotion and the prevention of chronic back problems should be intensified, especially before 50 years of age, considering the on-going population aging in Brazil.

[Prevalence of life-time back pain in Iran: a systematic review and meta-analysis]

Nowadays, Back pain as a multi-causal phenomenon is considered a major problem in most communities. It may be caused as a result of psychological, social and ergonomic factors. There is no precise statistical report on the prevalence of back pain in Iran. The aim of this study was to estimate the life-time prevalence of back pain in Iran using systematic review and meta-analysis. Twenty research papers on the prevalence of low-back pain using "back-pain prevalence" as the key words were obtained from the databases such as Magiran, MEDLIBE, SID, Google scholar and databases in English such as Pubmed and Scopus. Data analysis was performed by using meta-analysis [random model effects]. Heterogeneity among the studies was assessed by means of I[2] test. The estimated prevalence of life-time back pain in our study with a sample size of 5670 patients obtained from 20 papers was 51%[95% CI: 40.1-61.8]. Prevalence of lifetime back pain among the medical staff with an average of 54.6% [95% CI: 42.9-66.3] was more than the prevalence of other social groups. The highest and lowest prevalence rates of back pain were observed in Mazandaran Province and southern parts of Iran, with an average of 84/1% and 13%, respectively. The highest prevalence rate was observed in the age range of 15 to 45 years with an average of 54.2% [95% CI: 6.42-65.9]. The results of this study indicated that back pain must be considered a social problem. Therefore the health authorities are expected to inform people through the mass media in order to prevent back pain and decrease its prevalence

Effects of an educational back care program on Brazilian schoolchildren's knowledge regarding back pain prevention / Efeitos de um programa educacional de cuidados com a coluna sobre o nível de conhecimento de escolares brasileiros quanto à prevenção de dor na coluna vertebral

BACKGROUND: Children are often exposed to ergonomic risk factors at school. Thus, the school is a potential environment for developing musculoskeletal disorders and implementing back care programs. OBJECTIVES: To evaluate the effect of an educational program on schoolchildren's knowledge regarding back pain prevention. METHODS: 392 students from 4th to 8th grade from a Brazilian state school took part in the study; 114 students (30%) were evaluated at follow-up. The back care program included pre- and post-intervention assessments and a follow-up assessment, as well as theoretical and practical lessons. The time interval between the pre- and post-intervention assessments was 9 weeks, and between the post-intervention and follow-up assessments, it was 2 years. Statistical analysis included non-parametric ANOVA tests. Significance level was set at 5% (p<0.05). RESULTS: There was a significant increase (p<0.001) between pre- (3.6±2.9) and postintervention (7.5±2.2) scores and a significant decrease in the follow-up score (5.1±2.5). However, the follow-up score was still significantly higher (p<0.001) than the pre-intervention score. The rate of correct answers in the post-intervention assessment increased for all questions, and some of them were still high at follow-up. Significant differences were identified for the comparison between grades, with the 8th grade being significantly different from the other grades. CONCLUSION: The back care program showed an increase in the level of knowledge of Brazilian schoolchildren. Two years after the intervention, students still retained ergonomic concepts. Although the program has limitations, theoretical knowledge acquisition is the first step towards adopting healthy postural habits to prevent back pain.

CONTEXTUALIZAÇÃO: As crianças estão expostas a um conjunto de fatores de risco ergonômicos na fase escolar. Tais fatores tornam a escola um ambiente propício ao desenvolvimento de alterações musculoesqueléticas, assim como para a implementação de programas de cuidados com a coluna vertebral. OBJETIVO: Avaliar os efeitos de um programa educacional de cuidados com a coluna sobre o nível de conhecimento de escolares brasileiros quanto à prevenção de dor na coluna vertebral. MÉTODOS: Trezentos e noventa e dois estudantes da 4ª à 8ª série de uma escola estadual participaram do estudo, sendo que 114 deles (30%) foram avaliados no follow up. O programa foi composto por avaliações pré, pós-intervenção e follow up, por aulas teóricas e práticas. O intervalo entre as avaliações pré e pós-intervenção foi de nove semanas e, entre a avaliação pré e o follow up, foi de dois anos. A análise estatística incluiu ANOVA não-paramétrica e o nível de significância foi de 5%. RESULTADOS: Houve diferença significativa no nível de conhecimento (pfollow up (5,1±2,5), sendo que a pontuação no follow up foi significativamente superior à do pré-teste. Foi encontrada diferença significativa entre as séries, sendo que a 8ª série atingiu pontuação maior que as demais (p CONCLUSÃO: O programa preventivo proporcionou aumento no nível de conhecimento dos estudantes, mesmo após dois anos de sua implementação. Embora o programa tenha limitações, a aquisição de conhecimento é o primeiro passo para a adoção de hábitos posturais saudáveis para a prevenção de dores na coluna vertebral.

[Comparison of effectiveness of different methods of changing position on back pain intensity and comfort level of patients after coronary angiography: a randomized clinical trial]

Angiography is the most common invasive method to assess coronary artery. Back pain is a common complication after coronary angiography among patients after coronary angiography that is associated with immobility and restricted positioning. This study compared the effectiveness of three changing position methods in bed on back pain severity and comfort level of patients after coronary angiography. This study is a clinical trial carried out in angiography ward of Valiasre Hospital in Qom, Iran, in 2009. 75 patients undergoing angiography were randomly divided into three equal groups. The first group received the usual care after angiography, remaining supine and flat for 6 hours with the affected leg kept straight. In the second group, patients' positions were changed hourly for 6 hours, varying between semi-Fowler's [up to15° or 30° or 45°] positions. In the third group, patients' positions were changed hourly for 6 hours, varying between supine, right side-lying and left side-lying. The data were collected by a questionnaire including demographic characteristics, visual analog scale of pain and comfort. Data were analyzed by chi-square test, Kolmogorov-Smirnov test, Loon statistics, Kruskal-Wallis, ANOVA, and repeated measures analysis of variance. Pain intensity in the second and third groups was significantly lower than the first group at 2, 4, and 6 hours after angiography [p<0.05]; moreover, the discomfort level in the second and third groups was significantly lower than the first group at 2, 4, and 6 hours after angiography and the following morning [p<0.05]. The study findings showed that changing position in bed can prevent post angiographic patients, back pain and promote their physical comfort

[Percutaneous vertebroplasty for pain relief in patients with osteoporotic spine fractures]

Percutaneous vertebroplasty [PVP] is an interventional radiology technique where pathological vertebral bodies are filled with acrylic cement. This method is used to strengthen the vertebral body and reduce pain in certain diseases involving the vertebrae such as osteoporosis. To evaluate PVP in symptomatic osteoporotic vertebral fractures after failure of conservative management. Between November 2008 to December 2009, PVP was performed for osteoporotic vertebral fractures in 12 consecutive patients in a single institution. Medium term [3 days and 15 days post PVP] and long term follow up [1 month and 3 months post PVP] consisted in the evaluation of residual or secondary pain using Huskisson's visual analogue scale. A total of 20 vertebrae were treated. Mean follow up was 80 days [30-90 days]. Significant symptomatic improvement [p=0.002] was noted with pre PVP pain score of 7.4 [ +/- 1.6], 3 days post PVP score of 4.1 [ +/- 2.1], 15 days post PVP score of 1.8 [ +/- 1.1], 1 month post PVP score of 1.22 [ +/- 1.06] and 3 months post PVP score of 1.4 [ +/- 1.14]. PVP appears to be an effective technique in the treatment of symptomatic osteoporotic vertebral fractures with approximately 94% of satisfactory results in the short and medium term period

Prevalência de dor músculo esquelética e percepção de hábitos posturais entre estudantes do ensino fundamental / Prevalence of musculoskeletal pain and perception of postural habits among primary school students

O objetivo desta pesquisa foi identificar a prevalência de dores nas costas pregressa associada a situações de vida diária e prevalência de dor músculo esquelética atual por local do corpo e percepção dos hábitos posturais entre estudantes. Foram estudados120 escolares, de 7 a 11 anos, sendo 58 do sexo masculino e 59 do sexo feminino de uma Escola Fundamental da Cidade de São Paulo. Foi aplicado um questionário em sala de aula sob a supervisão de uma fisioterapeuta. Resultados: a prevalência de dores nas costas pregressa foi de 61% aumentando com a idade e associada asituações de vida diária principalmente no transporte de mochila escolar. A prevalência de dor músculo esquelética atual foi: costas (34%), nuca (30%) e pés (29%), predominando no sexo masculino. Quanto a percepção dos hábitos posturais, o índice de respostascorretas dos alunos foi superior para o jeito de sentar comparado ao jeito de abaixar, transportar a mochila escolar e posição dos pés. Concluindo: a presença de dor músculo esquelética entre escolares foi alta, sugerindo a necessidade da elaboração de um programa de educação postural.

The aim of was to identify the prevalence of previous back pain associated to daily life situations and the prevalence of current musculoskeletal pain according to body location and the perception of postural habits among students. It was developed between 120 schoolchildren from an Elementary School in Sao Paulo, aged from 7 to 11 years-old. They were 58 male 59 female. A questionnaire was applied in the classrooms under the supervision of a physical therapist. Results: the prevalence of previous back pain was of 61%, and increased with age and was associated to daily life situations mainly as carrying a backpack. The prevalence of current musculoskeletal pain was: back (34%), neck (30%) and feet (29%), predominantly among male students. Regarding theperception of postural habits, the percentage of correct answers was higher for the correct way of sitting against the way of bending, carrying the backpack and feet position. Conclusion: the presence of musculoskeletal pain was high, suggesting the need to developan education program postural among the Elementary School Students.

Awareness among Indian dentist regarding the role of physical activity in prevention of work related musculoskeletal disorders.

Background: The prevalence of work-related musculoskeletal complaints in dentists is high and the past two decades have witnessed a sharp rise in the incidence of various disorders. The prevalence of musculoskeletal pain ranges between 64% and 93%. The most effected regions have been back and neck. Various studies have been done to record stress levels and health-related behaviors of dentists in other countries but limited data is available among the Indian dentists. Materials and Methods: Therefore a questionnaire survey was carried out among 102 Indian dentists belonging to different fields having at least one musculoskeletal disorder in last 6 months. Results: The total sample consists of 80 males and 22 females. Out of the 102 over 97 of dentists had sought medical advice for these disorders during the previous 06 months and 74 of them also consulted the physiotherapist for exercises and ergonomic advice. The number of sessions taken for regular physical exercises was minimum 6 till 44 the most. The percentage of improvement in symptoms varied between 20% and 80%. Conclusions: A significant direct correlation between the number of sessions taken for physical activity and the self-perceived improvement in the symptoms was found using the Pearson correlation test. The work-related musculoskeletal disorders among dentists not only decrease their efficiency but also is a major concern among them. Self-awareness and benefits of regular exercise is the need of the hour.

[Effects of change positioning on vascular complications and comfort in patients undergoing heart catheterization]

Coronary heart diseases are increasing and one of the gold standards for diagnosis is coronary angiography [CA]. Bed rest after CA may cause back pain. Since, there are a few studies about change position effects on reducing back pain and patients comfort during bed rest after CA in Iran, the study was designed to explore these effects in Taleghani hospital patients [2006-2007]. This clinical trial was conducted on 130 patients hospitalized for coronary angiography. Each Patient was assigned randomly to either the control group, which remained is supine position 6 hours of bed rest after CA, or experimental group. The experimental group changed position hourly, varying between supine, elevated to 3o degrees and semi position [elevated to 45 degrees] during the first 6 hours after coronary angiography. Checklist and numeric pain intensity scale were used for data collection. None of patients developed bleeding, haematoma and arterial thrombosis, so there was no significant difference between two groups. There was significantly less pain intensity of back pain [P<0.001] and nausea [P<0.01] in experimental group. Urinary difficulty, Groin and leg pain were lower in the experimental group but they were not significantly different between the two groups. Changing positions in bed without increased vascular complications may cause reduced back pain; and promote physical comfort among patients who had undergone coronary angiography

Factors leading to the Computer Vision Syndrome: an issue at the contemporary workplace

INTRODUCTION: Vision and eye related problems are common among computer users, and have been collectively called the Computer Vision Syndrome (CVS). METHODS: An observational study in order to identify the risk factors leading to the CVS was done. Twenty-eight participants answered a validated questionnaire, and had their workstations examined. The questionnaire evaluated personal, environmental, ergonomic factors, and physiologic response of computer users. The distance from the eye to the computers' monitor (A), the computers' monitor height (B), and visual axis height (C) were measured. The difference between B and C was calculated and labeled as D. Angles of gaze to the computer monitor were calculated using the formula: angle=tan(-1)(D/ A). Angles were divided into two groups: participants with angles of gaze ranging from 0 degrees to 13.9 degrees were included in Group 1; and participants gazing at angles larger than 14 degrees were included in Group 2. Statistical analysis of the evaluated variables was made. RESULTS: Computer users in both groups used more tear supplements (as part of the syndrome) than expected. This association was statistically significant (p<0.10). Participants in Group 1 reported more pain than participants in Group 2. Associations between the CVS and other personal or ergonomic variables were not statistically significant. CONCLUSIONS: Our findings show that most important factor leading to the syndrome is the angle of gaze at the computer monitor. Pain in computer users is diminished when gazing downwards at angles of 14 degrees or more. The CVS remains an under estimated and poorly understood issue at the workplace. The general public, health professionals, the government, and private industries need to be educated about the CVS

Avaliação da postura corporal dos trabalhadores de enfermagem na movimentação de pacientes acamados / Evaluation of the corporal posture of the nursing workers in the movement of patients in bed

A movimentação de pacientes no leito, é um procedimento que requer grande esforço físico e utilização de boa mecânica corporal pelo pessoal de enfermagem, afim de prevenir-lhes problemas de dores nas costas. Reconhecendo a importância da movimentação e posicionamento, para promover segurança e conforto ao paciente, e diante das queixas dos profissionais, descritas na literatura, este trabalho tem por objetivos: identificar e analisar as posturas assumidas pelos trabalhadores de enfermagem e, identificar as facilidades e dificuldades encontradas durante a execução da referida atividade. Através da técnica de observação direta foram filmados, através de vídeo tape, trinta procedimentos de movimentação de paciente no leito executados por trabalhadores de enfermagem de uma clínica ortopédica de um hospital universitário. Os resultados evidenciaram que os trinta procedimentos foram executados ao longo de 197,41 minutos e que a postura corporal mais freqüentemente assumida foi coluna inclinada, braço com cotovelo abaixo da bancada, pernas extensão (53,76%). De acordo com os princípios da mecânica corporal e da ergonomia, tal postura é considerada penosa ao homem, devido às agressões músculo-esqueléticas e à sobrecarga física que acarreta. Os trabalhadores apontaram os aspectos: pequeno espaço (58,82%), elevada carga física (52,94%) e falta de pessoal (47,06%) como as principais dificuldades encontradas na execução da movimentação de paciente no leito, corroborando com os achados da literatura, caracterizando essa atividade como penosa, também apontaram que o uso da técnica adequada para movimentar o paciente (35,29%), o uso do lençol (35,29%) e o espaço adequado da enfermaria (23,52%), como aspectos que facilitariam a execução do procedimento.

The patients' movement in bed, is a procedure that demand great physical effort and use of good corporal mechanics for the nursing personnel, relative of preventing them back pain problems. Recognizing the importance of the movement and positioning, to promote safety and comfort to the patient, and before the professionals' complaints, described in the literature, this work has for objectives: to identify and analyzer the postures assumed by the nursing workers and identify the means and difficulties found during the execution of the referred activity. Through the technique of direct observation they were filmed, through videotapes, thirty procedures of patient's movement in the bed executed by nursing workers of an orthopedic clinic of an university hospital. The results evidence that the thirty procedures were executed along 197,41 minutes and that the corporal postures more frequently assumed they were, in respect to back, arms and legs, back inclined/arms with elbow down of row of seats/legs extension (53,76%). In agreement with the beginnings of the corporal mechanics and of the ergonomics, such postures are considered painful to the man, due to the muscle-skeletal aggressions and to the physical overload that they cart. The workers aimed the aspects little space (58,82%), physical load (52,94%) and absence of the personal (47,06%), as the main difficulties found in the execution of patient's movement in the bed, corroborating with the discoveries of the literature, characterizing that activity as painful. They pointed: the adequate technique (36,29%), used of sheet (35,29%) and space adequate (23,52%), as aspects that would facilitate the execution of the proceduer.

Lombalgia: magnitude do problema / Low back pain: magnitude of the problem

Resumo: A lombalgia representa hoje uma verdadeira epidemia, atingindo principalmente os países industrializados, com repercussöes socioeconômicas importantes. Estima-se nos EUA cerca de 9 milhöes de pessoas afetadas, 2,5 milhöes de incapacitadas; destas, metade torna-se incapacitade cronicamente. A populaçäo economicamente ativa é a faixa etária mais acometida, sendo a lombalgia uma das principais causas de afastamento do trabalho, além de ser a segunda causa de procura de serviços médicos. Embora se evoluçäo benigna e com 90 (por cento) de cura entre duas e quatro semanas, independente da forma de tratamento, estimam-se gastos de 50 milhöes de dolares anuais com a lombalgia nos EUA. Novos estudos epidemológicos säo necessários para se esclarecer melhor sua etiologia, história natural e fatores relacionadoscom o seu desenvolvimento, além de se desenvolver novas estratégias de prevençäo. Somente dessa forma será possível melhorar o seu tratamento, dimin uindo assim os custos e as lesöes iatrogênicas.

Ergonomics in dental practice

Dentistry particularly the practice of general dentistry is a high risk profession for the development of musculoskeletal disorders as it requires high visual demands which result in the adoption of fixed postures. The aims of this paper are; firstly to highlight the extent of musculoskeletal problems related to the dental professionals in different parts of the world and secondly to describe the term ergonomics in dental practice and finally, to emphasize the management with specific and general recommendations. It is hoped that the paper will help dental professionals to adopt correct postures, which will enhance their working capacity to work in a pain free environment to deliver quality dental care to their patients

A coluna vertebral dos trabalhadores: alteraçöes da coluna relacionadas com o trabalho / The spine of the workers: spine alterations related with the work

Esta exposiçäo visa apresentar alguns pontos importantes sobre a coluna vertebral e procura oferecer subsídios para pensarmos nossos próprios conhecimentos sobre o assunto. A primeira parte cita dois estudos sobre as várias causas de lombalgia, enfatizando a importância dos aspectos psicológicos. Na segunda parte, säo comentadas onze pesquisas internacionais sobre radiologia e biomecânica, destacando-se aspectos tais como vibraçäo e flexibilidade. Também apresenta um novo tipo de contraçäo muscular denominado isoinercial, bem como constata a controvérsia entre dois autores de renome, acerca da correta postura de levantamento de pesos. A terceira e última parte, mostra uma experiência nacional em termos de prevençäo de lombalgia, baseada em dez principios de ergonomia bem como, comenta dois trabalhos quanto ao tratamento global de pacientes com patologia lombares