The bidirectional association between chronic musculoskeletal pain and sleep-related problems: a systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis synthesizes the evidence on prospective bidirectional associations between sleep-related problems (SRP) and chronic musculoskeletal pain (CMP). METHODS: A literature search for cohort studies available in the PubMed, Scopus, Web of Science, PsycINFO and Cochrane Library databases as of 19 July 2022 was performed. Pooled odds ratios and effect sizes were calculated through random effects meta-analysis. Subgroup and meta-regression analyses were performed to explore differences by follow-up time, proportion of each sex and mean age. The Meta-analysis Of Observational Studies in Epidemiology guidelines were strictly followed. RESULTS: Twenty studies with a total of 208 190 adults (aged 34.4-71.7 years) were included, with 17 of them being used in the meta-analysis. Individuals with SRP at baseline had a 1.79-fold higher incidence (odds ratio [OR] = 1.79; 95% CI: 1.55, 2.08; I2 = 84.7%; P < 0.001) and a 2.04-fold higher persistence (OR = 2.04; 95% CI: 1.42, 2.94; I2 = 88.5%; P < 0.005) of CMP than those without SRP. In the subgroup analysis of the association between SRP and CMP, the longer the follow-up time of the studies, the higher the heterogeneity between them. In the corresponding meta-regression, no significant effect was observed for follow-up time, sex proportion or age. Individuals with CMP at baseline had a 2.02-fold higher incidence of SRP (OR = 2.02; 95% CI: 1.62, 2.53; I2 = 90.0%; P < 0.001) than those without CMP. CONCLUSION: This study provides robust evidence concerning the longitudinal association between SRP and incidence-persistence of CMP in adults. In addition, the available prospective studies support the existence of a bidirectional relationship between CMP and SRP. PROSPERO REGISTRATION NUMBER: CRD42020212360.

Physiotherapy work process in primary health care in a Brazilian municipality: qualitative study.

OBJECTIVE: The aim of this study was to analyze the work process of physiotherapists in primary health care (PHC) and the repercussions of work management practices. METHODS: A qualitative study that used semi-structured interviews with nineteen physiotherapists, two management physiotherapists and a coordinator of PHC in municipality in Southern Brazil. Data were analyzed using the methodological framework of discourse analysis. RESULTS: Through the analyzed speeches, the work routine of physiotherapists working in basic health units in the municipality studied mainly involves individual care, group activities and home visits. The diversity of this routine is influenced by management, work teams, the characteristics of the assisted population and the professional profile of the physiotherapist. Measures that enhanced work effectiveness were the increase in the number of physiotherapists in the city over the years, effective interprofessional relationships, the possibility of working in a single health unit, and monthly meetings for continuing education. Among the weaknesses presented were the low effectiveness of the orthopedics protocol adopted in the municipality, poor access to secondary care, lack of knowledge about the physiotherapist's functions in PHC and limitations in infrastructure and financial resources. CONCLUSION: Physiotherapy in primary care has been consolidated in the studied city, with effective management actions and increased access to professional, having a positive impact on resolving health conditions sensitive to this level of care.

Burnout and Long-term Sickness Absence From the Teaching Function: A Cohort Study.

Background: The present objective was to verify whether burnout (emotional exhaustion [EE], depersonalization [DP] and low professional efficacy [PE]) is a risk factor for long-term sickness absence (LTSA; ≥30 consecutive days) from the teaching role. Methods: This was a prospective cohort study with two years of follow-up that investigated 509 elementary and high-school teachers. Burnout was identified by Maslach Burnout Inventory. Poisson regression with robust variance was used to adjust for possible confounders. Results: The incidence of LTSA was 9.4%. High EE levels were associated with LTSA in the crude analysis, but the association lost statistical significance after adjustments (for sex, age, perception of work-life balance, general self-rated health, chronic pain and depression). High DP levels were associated with this outcome, even after all adjustments (relative risk = 1.80; 95% confidence interval: 1.05-3.09). Low PE levels were not related to LTSA. Conclusion: The results reinforce the need to improve teachers' work conditions to reduce burnout, particularly DP, and its consequences.

Bidirectional associations between chronic low back pain and sleep quality: A cohort study with schoolteachers.

AIMS: Although both chronic low back pain (cLBP) and sleep problems are prevalent among active workers, the relation between these variables is not well established. This study aimed to examine the bidirectional association between cLBP and sleep in schoolteachers. METHODS: The Pittsburgh Sleep Quality Index (PSQI) and cLBP were self-reported by 530 schoolteachers in Londrina, Brazil, at baseline and after 2 years of follow-up. Generalized estimating equations were adjusted for sociodemographic, lifestyle and mental health variables. RESULTS: Poor sleep quality at baseline was associated with cLBP at follow-up after adjusting for sociodemographic and lifestyle variables (OR=1.61; 95% confidence interval [95% CI]=1.06, 2.47). Changes in the PSQI score over time were also associated with a higher likelihood of cLBP at follow-up (OR=1.13; 95% CI=1.07, 1.20 for each 1-point increase in the PSQI score), regardless of mental health condition. cLBP at baseline was associated with worse sleep quality at follow-up after adjusting for sociodemographic and lifestyle variables (OR=1.56; 95% CI=1.02, 2.37). The presence of cLBP also changed the PSQI score over time (ß coefficient=1.153; 95% CI=0.493, 1.814). CONCLUSIONS: Worse sleep quality was prospectively and bidirectionally associated with cLBP. Concretely, changes in PSQI values after 2 years of follow-up increased the likelihood of reporting cLBP, and baseline cLBP was associated with sleep quality worsening (i.e., higher score in the PSQI). Mental health conditions such as self-rated health, depression and anxiety play a relevant confounding role in the bidirectional associations between sleep and chronic low back pain.

Association Between Chronic Pain and Leisure Time Physical Activity and Sedentary Behavior in Schoolteachers.

Chronic pain (CP) is a public health problem with harmful social and individual effects, and its relationships with physical activity (PA) and sedentary behaviors are unclear. This study examined the relationship between CP and PA and time spent watching television as an indicator of leisure time sedentary behavior, and explored the effects of major confounding factors. The information was obtained between 2012 and 2013 from individual interviews with 943 teachers from public schools in Londrina, Brazil. Statistical analysis was performed in 2014 using a logistic regression model adjusted for sociodemographic, lifestyle, depression, and working conditions variables. The prevalence of CP was 31.9%. No statistically significant association was observed between PA and CP. In the adjusted analyses, CP was associated with time > 60 minutes/day spent watching television (odds ratio [OR] = 1.39, 95% confidence interval [CI] 1.03, 1.89) on weekdays. In analyses stratified according to body areas affected by CP, only pain in the lower limbs was associated with more time watching television (OR = 1.62, 95% CI 1.06, 2.47). Watching television on a weekday for > 60 minutes is a sedentary behavior associated with a greater likelihood of teachers having chronic pain, especially in the lower limbs. This association was observed independently of the main confounders such as sex, age, leisure time physical activity, depression and working conditions.

Papiloesfinteroplastia: sus complicaciones / Sphincteroplasty: its complications

Se analizan 282 casos de papiloesfinteroplastias por litiasis coledociana (82,26%), papilitis (10,63%) y litiasis residual (6,38%). La morbilidad fue del 8,86% (25 casos) debiendo destacarse que 11 pacientes presentaron una fístula duodenal postoperatoria. Fallecieron 9 pacientes (3,5%), 5 de ellos por pancreatitis aguda postoperatoria

Papiloesfinteroplastia: sus complicaciones / Sphincteroplasty: its complications

Se analizan 282 casos de papiloesfinteroplastias por litiasis coledociana (82,26%), papilitis (10,63%) y litiasis residual (6,38%). La morbilidad fue del 8,86% (25 casos) debiendo destacarse que 11 pacientes presentaron una fístula duodenal postoperatoria. Fallecieron 9 pacientes (3,5%), 5 de ellos por pancreatitis aguda postoperatoria (AU)