Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology.

OBJECTIVE: To describe in detail an innovative program based on telemedicine for semi-automated prioritization of referrals from Primary Care (PC) to Rheumatology, for reproducibility purposes, and to present the results of the implementation study. METHODS: The context and situation were carefully analyzed, paying attention to all processes in place, referral numbers, waiting times, and number of complementary tests prior to discharge from Rheumatology. The composition of the team, aims, users, scope, and implementation phases were defined. Eight process indicators were established and measured before and 32 months after the program implementation. RESULTS: The program, which includes IT circuits, algorithms based on response to specific guideline-based checklists, e-consultation, and appointments based on priority, was fully implemented in our health area after a pilot study in two PC centers. After implementation, 6185 rheumatology referrals showed an e-consultation response delay of 8.95 days, and to first face-to-face visit (after e-consultation) of 12.6 (previous delay before program implementation was 83.1 days). Resolution by e-consultation reached 20% (1195 patients did not need seeing the rheumatologist to have the problem solved), and 1369 patients (32%) were discharged after the first visit. The overall resolution rate was 44.0% (2564 discharges/5830 e-consultations). From a random sample of 100 visits, only 10% of patients needed additional complementary tests to make a diagnosis and decision by Rheumatology (20.9% decrease from previous period). CONCLUSION: A careful analysis of the situation and processes, with implementation of simple IT circuits, allows for the improvement of the efficiency and resolution of problems in Rheumatology.

A Systematic Mapping Study on Integration Proposals of the Personas Technique in Agile Methodologies.

Agile development processes are increasing their consideration of usability by integrating various user-centered design techniques throughout development. One such technique is Personas, which proposes the creation of fictitious users with real preferences to drive application design. Since applying this technique conflicts with the time constraints of agile development, Personas has been adapted over the years. Our objective is to determine the adoption level and type of integration, as well as to propose improvements to the Personas technique for agile development. A systematic mapping study was performed, retrieving 28 articles grouped by agile methodology type. We found some common integration strategies regardless of the specific agile approach, along with some frequent problems, mainly related to Persona modelling and context representation. Based on these limitations, we propose an adaptation to the technique in order to reduce the creation time for a preliminary persona. The number of publications dealing with Personas and agile development is increasing, which reveals a growing interest in the application of this technique to develop usable agile software.

Metacognición y autodeterminación, impulsividad e inteligencia emocional, y su relación con indicadores de bienestar y salud en adultos jóvenes

Introducción: A partir de la evidencia disponible, se infiere que variables cognitivas y motivacionales influyen sobre variables emocionales y estas a su vez influyen sobre la percepción y autorreporte de bienestar y salud, con implicaciones para la promoción y prevención. Método: Se realizó una investigación con enfoque cuantitativo, descriptiva, correlacional y con metodología de análisis explicativo, transversal, analizando los datos a través del modelado de ruta del enfoque de mínimos cuadrados parciales del modelo de ecuaciones estructurales, con el software Smart PLS versión 3.3.2., analizando consecuentemente la validez convergente y discriminante del modelo. Un total de 223 adultos jóvenes participaron, 41 hombres, (18,4%) y 182 mujeres (81,6%) con edades entre 18 a 30 años (µ= 24,26 y σ=±3,30) universitarios de pregrado o licenciatura, en Bogotá Colombia. Resultados: Se identificaron relaciones significativas entre la autodeterminación y la impulsividad e inteligencia emocional, y de estas a su vez con el bienestar psicológico y los hábitos saludables. No se identificaron relaciones significativas entre la metacognición y la impulsividad, aunque sí entre la metacognición y la inteligencia emocional. Conclusiones: Se confirma el modelo propuesto en el cual la metacognición y la autodeterminación se relacionan con la impulsividad y la inteligencia emocional y estas a su vez con el bienestar psicológico y los hábitos de vida saludable. Sobre la ausencia de relaciones entre la metacognición y la impulsividad se sugiere precisar a futuro sobre los procesos metacognitivos implicados que inciden en el control del componente emocional. Se discuten los resultados, sus implicaciones y la necesidad de considerar más determinantes simultáneamente, para la promoción de la salud.

Background: From the evidence, it is inferred the influence of cognitive or motivational variables over the emotional ones and from these on the perception and self-reported wellbeing and health, with direct implications for health promotion and prevention. Method: a quantitative approach, descriptive, correlational cross-sectional with statistical explanatory analysis investigation was conducted, analyzing the data through path modeling of the partial least squares approach of the structural equations model, by using the Smart PLS software 3.3.2 version, analyzing consequently the convergent and discriminant validity of the model. A total 223 undergraduate university young adult students was evaluated, 41 men (18,4%) and 182 women (81,6%) with ages between 18 and 30 years old (µ= 24,26 y σ=±3,30), from Bogotá Colombia participated. Results: The results allowed to significant relations between the self - determination with the impulsivity and emotional intelligence, and from these with the psychological well-being and healthy habits. There were not identified significant relations between the metacognition and the impulsivity, although there are between metacognition and emotional intelligence. Conclusions: The proposed model about the significant relations between metacognition and self-determination with impulsivity and emotional intelligence and between these and the psychological well-being and healthy habits was confirmed. The specific result related to the absence of significant relations between metacognition and the impulsivity suggest for futures research, to emphasize on the metacognitive process implicated on the emotional components. The results are discussed, its implications and the necessity to be considered more determinants for the promotion of health.

Latin American and Caribbean consensus on noninvasive central nervous system neuromodulation for chronic pain management (LAC2-NIN-CP).

INTRODUCTION: Chronic pain (CP) is highly prevalent and generally undertreated health condition. Noninvasive brain stimulation may contribute to decrease pain intensity and influence other aspects related to CP. OBJECTIVE: To provide consensus-based recommendations for the use of noninvasive brain stimulation in clinical practice. METHODS: Systematic review of the literature searching for randomized clinical trials followed by consensus panel. Recommendations also involved a cost-estimation study. RESULTS: The systematic review wielded 24 transcranial direct current stimulation (tDCS) and 22 repetitive transcranial magnetic stimulation (rTMS) studies. The following recommendations were provided: (1) Level A for anodal tDCS over the primary motor cortex (M1) in fibromyalgia, and level B for peripheral neuropathic pain, abdominal pain, and migraine; bifrontal (F3/F4) tDCS and M1 high-definition (HD)-tDCS for fibromyalgia; Oz/Cz tDCS for migraine and for secondary benefits such as improvement in quality of life, decrease in anxiety, and increase in pressure pain threshold; (2) level A recommendation for high-frequency (HF) rTMS over M1 for fibromyalgia and neuropathic pain, and level B for myofascial or musculoskeletal pain, complex regional pain syndrome, and migraine; (3) level A recommendation against the use of anodal M1 tDCS for low back pain; and (4) level B recommendation against the use of HF rTMS over the left dorsolateral prefrontal cortex in the control of pain. CONCLUSION: Transcranial DCS and rTMS are recommended techniques to be used in the control of CP conditions, with low to moderate analgesic effects, and no severe adverse events. These recommendations are based on a systematic review of the literature and a consensus made by experts in the field. Readers should use it as part of the resources available to decision-making.

Undertreatment of pain and low use of opioids in Latin America.

Pain is highly prevalent among the adult Latin American population. However, many patients with moderate to severe pain do not have access to effective pain management with opioids due to limited access to healthcare, overuse of nonopioid analgesics, regulatory barriers and lack of appropriate information about opioids. There is scarce training on use of opioids among physicians and other healthcare providers, which leads to misconceptions, mainly related to a fear of prescribing opioids. Although opioids are safe and effective drugs for the treatment of moderate to severe chronic pain, the use of opioids in Latin American nations is clearly below standards compared with developed countries.

Most Relevant Neuropathic Pain Treatment and Chronic Low Back Pain Management Guidelines: A Change Pain Latin America Advisory Panel Consensus.

Objective: Chronic pain conditions profoundly affect the daily living of a significant number of people and are a major economic and social burden, particularly in developing countries. The Change Pain Latin America (CPLA) advisory panel aimed to identify the most appropriate guidelines for the treatment of neuropathic pain (NP) and chronic low back pain (CLBP) for use across Latin America. Methods: Published systematic reviews or practice guidelines were identified by a systematic search of PubMed, the Guidelines Clearinghouse, and Google. Articles were screened by an independent reviewer, and potential candidate guidelines were selected for more in-depth review. A shortlist of suitable guidelines was selected and critically evaluated by the CPLA advisory panel. Results: Searches identified 674 and 604 guideline articles for NP and CLBP, respectively. Of these, 14 guidelines were shortlisted for consensus consideration, with the following final selections made: "Recommendations for the pharmacological management of neuropathic pain from the Neuropathic Pain Special Interest Group in 2015-pharmacotherapy for neuropathic pain in adults: A systematic review and meta-analysis.""Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society" (2007). Conclusions: The selected guidelines were endorsed by all members of the CPLA advisory board as the best fit for use across Latin America. In addition, regional considerations were discussed and recorded. We have included this expert local insight and advice to enhance the implementation of each guideline across all Latin American countries.

Ansiedad social, adicción al internet y al cibersexo: su relación con la percepción de salud / Social anxiety, Internet and Cibersex addiction: its relationship with health perception

Resumen Se realizó una investigación cuantitativa, descriptiva, correlacional de corte transversal, para describir la posible relación entre la ansiedad social, la adicción a internet y al cibersexo, con la percepción de bienestar subjetivo y de malestar físico. Participaron 214 adultos jóvenes, con edades entre los 18 y 30 años, de la ciudad de Bogotá, Colombia. Los resultados evidenciaron un nivel bajo en el comportamiento de las variables y relaciones significativas, con diferencias en función del sexo, siendo en las mujeres la relación significativa y positiva entre la adicción al internet y la adición al cibersexo con la percepción de malestar físico, y en los hombres, significativa y negativa entre la adicción al internet y al cibersexo con la percepción de bienestar subjetivo. Se discuten los resultados y sus implicaciones, para el mejoramiento del bienestar y la calidad de vida del adulto joven.

Abstract A quantitative, descriptive and correlational research was done, with Cross - sectional design, with the aim to describe the possible significant relationship between the social anxiety, internet use addiction and Cybersex addiction, with the perception of subjective well-being and physical discomfort. Participants were 214 young adults, women and men with ages between 18 to 30 years old; all of them from the city of Bogotá, Colombia. The results showed low level measures in all of the variables with significant relationships between them. Also, showed significant differences depending on gender. For women, the relationship was stronger and positive between the internet and cybersex addiction and their perception of physical discomfort, for men was stronger and negative between internet and cybersex addiction and their subjective well-being perception. The results are discussed and its implications, in order to improve the well-being and the quality of life of the young adults.

Encefalomielitis aguda diseminada viral / Acute disseminated viral encephalomyelitis

La encefalomielitis aguda diseminada (EMAD) es un trastorno neurológico caracterizado por inflamación del cerebro y médula espinal causada por un daño a la mielina, afectando al sistema nervioso central de manera difusa. Esta afección puede manifestarse de manera espontánea o secundaria a infecciones o a vacunación. La mayoría de las veces evoluciona de manera monofásica con manifestaciones clínicas inespecíficas, por lo que la sospecha diagnóstica es fundamental. La EMAD es la causa más frecuente de afectación de sustancia blanca. La incidencia es mayor en la edad prepuberal con una incidencia de aproximadamente 0,2-0,4 casos/100000 habitantes año. Tiene predominio estacional, siendo más frecuente en los meses de invierno y primavera. Afecta más a varones. A continuación presentaremos nuestra experiencia con un caso sin diagnóstico previo de esta excepcional y poco frecuente patología el cual se convirtió en un reto diagnóstico(AU)

Acute disseminated encephalomyelitis ADEM is a neurological disorder characterized by inflammation of the brain and spinal cord caused by damage to the myelin, affecting diffusely the central nervous system. This condition can appear spontaneously or secondary to infections or vaccination. Most of the time it evolves in a monophasic manner with nonspecific clinical manifestations, so that he diagnostic suspicion is fundamental. ADEM is the most frequent cause of white matter involvement. The incidence is higher in the prepubertal age with an incidence of approximately 0.2-0.4 cases / 100,000 inhabitants per year. It has a seasonal predominance, being more frequent in the winter and spring months. It affects more males. Below we present our experience with a case without previous diagnosis of this rare pathology which became a diagnostic challenge(AU)

The role of tramadol in pain management in Latin America: a report by the Change Pain Latin America Advisory Panel.

OBJECTIVE: Change Pain Latin America (CPLA) was created to enhance chronic pain understanding and develop pain management improving strategies in this region. During its seventh meeting (August 2016), the main objective was to discuss tramadol's role in treating pain in Latin America. Furthermore, potential pain management consequences were considered, if tramadol was to become more stringently controlled. METHODS: Key topics discussed were: main indications for prescribing tramadol, its pharmacological characteristics, safety and tolerability, effects of restrictions on its availability and use, and consequent impact on pain care quality. RESULTS: The experts agreed that tramadol is used to treat a wide spectrum of non-oncological pain conditions (e.g. post-surgical, musculoskeletal, post-traumatic, neuropathic, fibromyalgia), as well as cancer pain. Its relevance when treating special patient groups (e.g. the elderly) is recognized. The main reasons for tramadol's high significance as a treatment option are: its broad efficacy, an inconspicuous safety profile and its availability, considering that access to strong analgesics - mainly controlled drugs (classical opioids) - is highly restricted in some countries. The CPLA also agreed that tramadol is well tolerated, without the safety issues associated with long-term nonsteroidal anti-inflammatory drug (NSAID) use, with fewer opioid-like side effects than classical opioids and lower abuse risk. CONCLUSIONS: In Latin America, tramadol is a valuable and frequently used medication for treating moderate to severe pain. More stringent regulations would have significant impact on its availability, especially for outpatients. This could cause regression to older and frequently inadequate pain management methods, resulting in unnecessary suffering for many Latin American patients.

A psicossomática no discurso / Psychosomatic in speech / La psychosomatique dans le discours / La psicosomática en el discurso

A partir da experiência clínica realizada em um centro de reabilitação, o presente artigo põe em discussão a clínica psicanalítica com pacientes psicossomáticos num ambiente institucional orientado por um discurso médico-científico e pedagógico. Considera a hipótese de que tais pacientes colocam-se como objeto do saber das especialidades clínicas que não favorecem a invenção do inconsciente, o que possibilitaria a revelação do gozo específico no qual encontram-se fixados. Para tratar desse tema, o artigo lança mão da teoria lacaniana dos discursos, particularmente o universitário e o analítico.

From the clinical experience held in a rehabilitation center, this paper discusses the psychoanalytic treatment of psychosomatic patients in an institutional environment oriented by a medical-scientific and pedagogical discourse. It considers the hypothesis that such patients put themselves as the object of knowledge of clinical specialties that do not favor the invention of the unconsciousness, which would allow the revelation of the specific enjoyment that they are attached to. To address this issue, the study makes use of the Lacanian theory of the discourses, particularly the university and the analytical ones.

À partir de l'expérience clinique vécue dans un centre de réadaptation, cet article met en cause le traitement psychanalytique de patients psychosomatiques dans un environnement institutionnel guidé par un discours médico-scientifique et pédagogique. Il prend en considération l'hypothèse que ces patients sont considérés comme un objet de connaissance des spécialités cliniques qui ne favorisent pas l'invention de l'inconscient, ce qui permettrait la révélation de la jouissance particulière dans laquelle ils sont fixés. Pour discuter ce thème, cet article fait référence à la théorie lacanienne des discours, en particulier l'universitaire et l'analytique.

A partir de la experiencia clínica llevada a cabo en un centro de rehabilitación, este artículo debate sobre el tratamiento psicoanalítico de los pacientes psicosomáticos, en un entorno institucional, tratamiento orientado por un discurso médico-científico y pedagógico. Considera la hipótesis de que estos pacientes se presentan como un objeto del conocimiento de las especialidades clínicas que no favorecen la invención del inconsciente, lo que permitiría la revelación del goce específico en el que se establecen. Para abordar esta cuestión, el artículo hace uso de la teoría lacaniana del discurso, en especial: la universidad y la analítica.

Anhand der klinischen Erfahrung die in einem Rehabilitationszentrum gesammelt wurde, analysiert dieser Artikel die psychoanalytische Behandlung von psychosomatischen Patienten in einer institutionellen Umgebung, die auf einem medizinisch-wissenschaftlichen und pädagogischen Diskurs basiert. Wir vertreten die Ansicht, dass solche Patienten als Gegenstand des Wissens der klinischen Spezialitäten betrachtet werden. Diese Spezialitäten benachteiligen die Erfindung des Unbewussten, welche die Enthüllung des spezifischen Genusses erlauben würde, auf dem diese Patienten fixiert sind. Dieses Thema wird im Licht von Lacans Theorie des Diskurses erörtert, unter spezieller Berücksichtigung des akademischen und analytischen Diskurses.

La mal llamada medicina alternativa / The misnamed alternative medicine

La interdisciplinariedad es la que comanda el verdadero mundo de la medicina actual. Todo se complementa, por eso el término alternativo se encuentra abolido. En las clínicas de dolor ya no solo somos médicos de diversas especialidades los que hacemos parte de ellas. Así como estamos anestesiólogos, neurocirujanos, fisiatras, psiquiatras, neurólogos, internistas, paliativistas, también está el personal de enfermería, fisioterapia, terapia ocupacional, psicología, trabajo social. Estos mismos profesionales se han preparado en acupuntura, terapia neural, homeopatía, diferentes campos de la psicología, y todos ponemos nuestro grano de arena para que el paciente que sufre se pueda beneficiar de manera integral. Y no solo sufre el paciente; también lo hacen sus cuidadores, sus familiares, sus amigos y todo el entorno social que lo rodea. La acupuntura es bienvenida. Aunque poco sabemos de su mecanismo de acción real, ya sabemos algo: su manifiesta acción en el sistema nervioso central y sobre los mecanismos de control endógeno del dolor (sistema descendente) ha ido mejorando su imagen ante la comunidad científica. Es difícil evaluar su eficacia dentro de los términos de medicina basada en la evidencia ya que lograr un estudio cegado y controlado con placebo es difícil en estas circunstancias. Pero dentro de la llamada medicina basada en la experiencia y los resultados manifiestos, se demuestran hechos contundentes.

Interdisciplinarity is what commands the real world of medicine today. Everything complements each other, which is why the term alternative is abolished. In pain clinics we are no longer only physicians of various specialties who are part of them. As well as anesthesiologists, neurosurgeons, physiatrists, psychiatrists, neurologists, internists, palliativists, there are also nurses, physiotherapists, occupational therapists, psychologists, social workers. These same professionals have been trained in acupuncture, neural therapy, homeopathy, different fields of psychology, and we all do our bit so that the patient who suffers can benefit in a comprehensive manner. And it is not only the patient who suffers; so do his caregivers, his family, his friends and the whole social environment that surrounds him. Acupuncture is welcome. Although we know little about its real mechanism of action, we already know something: its manifest action on the central nervous system and on the endogenous pain control mechanisms (descending system) has been improving its image in the scientific community. It is difficult to evaluate its efficacy within the terms of evidence-based medicine since achieving a blinded, placebo-controlled study is difficult in these circumstances. But within the so called experience-based medicine and the manifest results, strong facts are demonstrated.

Latin-American guidelines for opioid use in chronic nononcologic pain.

AIM: Latin-American experts in the use of opioids in patients with chronic nononcologic pain (CNOP) have updated existing recommendations to current Latin-American reality. METHODS: Several key opinion leaders from Latin America participated in a face-to-face meeting in Guatemala (April 2015) to discuss the use of opioids in CNOP. Subgroups of experts worked on specific topics, reviewed the literature and shaped the final manuscript. RESULTS: The expert panel developed guidelines taking into consideration the utility of both opioid and nonopioid analgesics and factors pertaining to their efficacy, safety, adherence, administration and risks for abuse/addiction. CONCLUSION: Latin-American guidelines for the use of opioids in CNOP should improve pain relief and patients' quality of life by increasing access to these effective agents.

Environmental Strategies to Promote Food Intake in Older Adults: A Narrative Review.

Aging is often accompanied by lower intakes of food energy and consequent negative effects on health. To some extent this is due to declines in physiological ability, including the sensory responsiveness to regulate food intake. Fortunately, environmental factors may still influence food intake in older adults. Factors such as social facilitation, modeling, and nutrition knowledge and skills have been shown to stimulate their food intake. While environmental factors such as the eating location, portion size, food presentation, and labeling are known to influence eating behavior, their effectiveness in stimulating food intake in older persons is not well delineated. It is suggested that improving the environmental stimuli that promote food intake is a viable strategy to overcome age-related declines in nutrient intakes. This strategy is so promising that further research is warranted.

Use of Opioids in Latin America: The Need of an Evidence-Based Change.

OBJECTIVE: The subject of this publication has been focused on local considerations for facilitating regional best practice, including identifying and uniformly adopting the most relevant international guidelines on opioid use (OU) in chronic pain management. DESIGN AND SETTING: The Change Pain Latin America (CPLA) Advisory Panel conducted a comprehensive, robust, and critical analysis of published national and international reviews and guidelines of OU, considering those most appropriate for Latin America. METHODS: A PubMed search was conducted using the terms "opioid," "chronic," and "pain" and then refined using the filters "practice guidelines" and "within the last 5 years" (2007-2012). Once the publications were identified, they were selected using five key criteria: "Evidence based," "Comprehensive," "From a well-recognized source," "Current publications," and "Based on best practice" and then critically analyzed considering 10 key criteria for determining the most relevant guidelines to be applied in Latin America. RESULTS: The initial PubMed search identified 177 reviews and guidelines, which was reduced to 16 articles using the five preliminary criteria. After a secondary analysis according to the 10 key criteria specific to OU in Latin America, 10 publications were selected for critical review and discussion. CONCLUSIONS: The CPLA advisory panel considered the "Safe and effective use of opioids for chronic non-cancer pain" (published in 2010 by the NOUGG of Canada) to be valid, relevant to Latin America, practical, evidence-based, concise, unambiguous, and sufficiently educational to provide clear instruction on OU and pain management and, thus, recommended for uniform adoption across the Latin America region.

Meditation has stronger relationships with mindfulness, kundalini, and mystical experiences than yoga or prayer.

Contemplative practices can have profound effects on mindfulness and on physical and sensory and mystical experiences. Individuals who self-reported meditation, yoga, contemplative prayer, or a combination of practices and their patterns of practice were compared for mindfulness, kundalini effects, and mystical experiences. The results suggest that the amount of practice but not the pattern and social conditions of practice influences mindfulness and possibly mystical experiences. Meditation, yoga, contemplative prayer, or a combination of practices all were found to be associated with enhancements of mindfulness, kundalini effects, and mystical experiences, but meditation had particularly strong associations and may be the basis of the associations of yoga and prayer with these outcomes. The results further suggest that the primary association of contemplative practices is with the real time awareness and appreciation of sensory and perceptual experiences which may be the intermediary between disparate practices and mindfulness, kundalini effects, and mystical experiences.

Prevalence of low back pain in Latin America: a systematic literature review.

BACKGROUND: Chronic low back pain is considered as a high-impact condition that affects the working population of Latin America, with long reaching social and economic repercussions. Its true frequency is unknown due to the absence of well-designed clinical trials that use standardized definitions and criteria. OBJECTIVES: To evaluate the prevalence of chronic non-specific low back pain among the Latin American population. STUDY DESIGN: A systematic review of chronic non-specific low back pain in Latin America. SETTING: Meeting of Change Pain Latin America, Mexico. METHODS: Data sources included relevant literature identified through searches of published studies between August 30, 2002, and August 30, 2012, in 7 electronic databases: Cochrane BVS, Pubmed, Medline, Lilacs, Scielo, Hinari, and MedCarib. Publications dealing with low back pain of a post-traumatic, infectious, or malignant origin were excluded. Two reviewers selected in an independent manner all eligible studies using the MOOSE checklist and extracted data on both prevalence and risk factors associated with low back pain. A narrative synthesis of the results was drafted, which was later validated by a panel of clinical experts on pain. RESULTS: Twenty-eight studies were included in the review, comprising a total of 20,559 subjects from 7 countries in the region. Four of these studies, with significant methodological differences between them, measured the frequency of chronic low back pain with results that varied from 4.2% to 10.1%. Four studies are part of the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) program reports, and were pooled and analyzed separately because of their particular design. Their prevalence estimations varied between 1.8% and 11.3%. The remaining 20 studies evaluated a total population of 6,992 subjects, and found a prevalence of low back pain of 31.3%. Based on an epidemiological model constructed on both times to resolution and low back pain recurrence rates, the prevalence of chronic low back pain in Latin America was estimated to be around 10.5%. Some risk factors reported by the authors are long working hours with the worker in the sitting position, obesity and overweight, pregnancy, smoking, advanced age, lifting and carrying heavy loads, domestic work, sedentary lifestyles, and duration of current employment. A subgroup analysis of the population under study yielded an estimated prevalence of low back pain of 16.7% for the population exposed to a lower number of risk factors and 65% for the higher risk subgroup. In this review, we made an exhaustive search of studies evaluating the epidemiology of chronic low back pain in the Latin America region. LIMITATIONS: The large topographic and chronologic variability in definitions of low back pain, interviewer bias, and subject selection bias. CONCLUSIONS: Despite the sparse information and the methodological heterogeneity of the studies, pooled results allowed for an indirect estimation of the prevalence of low back pain in the region that was pretty consistent with the published results obtained from other settings. New studies need to be carried out to supplement and overcome the methodological weaknesses of those previously conducted.

Overweight and obese humans overeat away from home.

The built environment has been implicated in the development of the epidemic of obesity. We investigated the differences in the meal patterns of normal weight vs. overweight/obese individuals occurring at home vs. other locations. The location of meals and their size in free-living participants were continuously recorded for 7 consecutive days. Study 1: 81 males and 84 females recorded their intake in 7-day diet diaries and wore a belt that contained a GPS Logger to record their location continuously for 7 consecutive days. Study 2: 388 males and 621 females recorded their intake in diet diaries for 7 consecutive days. In both studies, compared to eating at home, overweight/obese participants ate larger meals away from home in both restaurants and other locations than normal weight participants. Overweight/obese individuals appear to be more responsive to environmental cues for eating away from home. This suggests that the influence of the built environment on the intake of overweight/obese individuals may contribute to the obesity epidemic.

Set points, settling points and some alternative models: theoretical options to understand how genes and environments combine to regulate body adiposity.

The close correspondence between energy intake and expenditure over prolonged time periods, coupled with an apparent protection of the level of body adiposity in the face of perturbations of energy balance, has led to the idea that body fatness is regulated via mechanisms that control intake and energy expenditure. Two models have dominated the discussion of how this regulation might take place. The set point model is rooted in physiology, genetics and molecular biology, and suggests that there is an active feedback mechanism linking adipose tissue (stored energy) to intake and expenditure via a set point, presumably encoded in the brain. This model is consistent with many of the biological aspects of energy balance, but struggles to explain the many significant environmental and social influences on obesity, food intake and physical activity. More importantly, the set point model does not effectively explain the 'obesity epidemic'--the large increase in body weight and adiposity of a large proportion of individuals in many countries since the 1980s. An alternative model, called the settling point model, is based on the idea that there is passive feedback between the size of the body stores and aspects of expenditure. This model accommodates many of the social and environmental characteristics of energy balance, but struggles to explain some of the biological and genetic aspects. The shortcomings of these two models reflect their failure to address the gene-by-environment interactions that dominate the regulation of body weight. We discuss two additional models--the general intake model and the dual intervention point model--that address this issue and might offer better ways to understand how body fatness is controlled.

The control of food intake of free-living humans: putting the pieces back together.

The control of food intake has been studied using reductionism; by separately investigating environmental, physiological, and genetic variables. The general model of intake regulation attempts to reassemble the pieces into an organized whole. It postulates that intake is influenced by sets of both physiological factors which have negative feedback loops to intake and environmental factors which do not. Data and behavioral genetic analysis on a number of environmental, psychological, dietary, and social variables demonstrate that they have large impacts on the intake of free-living humans in their everyday environments and their magnitude and impact on intake are influenced by heredity. Recent evidence of built environment influences on activity and intake further indicate the profound influence of environmental circumstances on both intake and expenditure. A computer simulation of the general model of intake regulation demonstrates that the model predicts different maintained levels of intake and body weight depending upon the external environment and that change in the environment can produce new sustained levels. It is suggested that eating is influenced by a myriad of physiological and non-physiological factors and that total intake results from the integral of their influences. It is concluded that recombining the components broken down in the reductionistic process results in a functional whole that can well describe human behavior in natural environments. The paper represents an invited review by a symposium, award winner or keynote speaker at the Society for the Study of Ingestive Behavior [SSIB] Annual Meeting in Portland, July 2009.

When, how much and what foods are eaten are related to total daily food intake.

Intake in the morning is associated with a reduction in the total intake for the day, while intake at night is associated with greater overall daily intake. These associations are macronutrient specific, with morning carbohydrate intake associated with reduced daily carbohydrate intake, morning fat intake associated with reduced daily fat intake and morning protein intake associated with reduced daily protein intake. Since different types of foods contain differing proportions of macronutrients, the present study investigated the associations of different types of foods ingested at various times of day with total daily and macronutrient intakes. The intakes of 388 male and 621 female free-living individuals reported in 7 d diet diaries were reanalysed. The intakes of twenty-four different types of foods and seven different drinks occurring during the morning (04.00-10.29 hours), afternoon (10.30-16.59 hours) and evening (17.00-02.00 hours) were identified and related to overall daily intakes. Dairy foods, ice cream, beef, other meats, potatoes, pastry, nuts, chips and snacks, condiments, alcohol and soda were significantly associated with higher total intake over the day, while fruit, soup, breakfast cereal, pasta, pizza, water, coffee/tea and diet soda were either not associated or were associated with lower overall intake. Dietary energy density appeared to mediate the associations between particular foods and beverages and overall energy intake. This suggests that eating low-density foods in the morning and avoiding high-density foods at night might aid in reducing overall intake and may be useful in dietary interventions for overweight and obesity.