Musculoskeletal symptoms in nursing students: concept analysis / Sintomatologia musculoesquelética em estudantes de enfermagem: uma análise de conceito / Sintomatología musculoesquelética en estudiantes de enfermería: un análisis de concepto

ABSTRACT Objective: to analyze the musculoskeletal symptomatology concept in undergraduate nursing students through Rodgers' evolutionary method. Method: An integrative review of the literature was performed for the identification and selection of ten articles. A concept analysis was performed according to Rodgers' evolutionary method. Article search was performed using the EBOSCO Host platform, Virtual Health Library and Google scholar for the years from 2004 to 2018. Results: Based on the 3 elements of Rodgers model we found: 1) substitute terms and related concepts, where musculoskeletal disorders and musculoskeletal symptoms were highlighted; 2) as essential attributes of the concept we highlight pain and discomfort, as well as, measurement using the Nordic Musculoskeletal Questionnaire; and 3) risk factors were identified as antecedents, and the consequences were the impact on students' lives. Conclusions: This study contributes to the knowledge and clarification of the concept of musculoskeletal symptomatology in nursing students.

RESUMO Objetivo: Analisar o conceito de sintomatologia musculoesquelética nos estudantes de licenciatura em enfermagem segundo o método evolucionário de Rodgers. Método: Foram incluídos dez artigos através de uma revisão integrativa da literatura para identificação e seleção dos artigos. Análise de conceito foi pelo método evolucionário de Rodgers para análise dos dados. Os artigos pesquisados na plataforma Host EBOSCO, na Biblioteca Virtual de Saúde e no Google Scholar de 2004 a 2018. Resultados: Com base no método de Rodgers, foi possível a identificação: 1) termos substitutos e conceitos relacionados, onde foram destacados os distúrbios musculoesqueléticos e os sintomas musculoesqueléticos; 2) como atributos essenciais do conceito destacamos, dor e desconforto, bem como mensuração pelo Questionário Nórdico-Musculoesquelético; e 3) os fatores de risco foram identificados como antecedentes e o impacto na vida dos estudantes como consequências. Conclusão: Este estudo contribuiu para o conhecimento e esclarecimento do conceito de sintomatologia musculoesquelética em estudantes de enfermagem.

RESUMEN Objetivo: Analizar el concepto de sintomatología musculoesquelética en los estudiantes de enfermería según el método evolutivo de Rodgers. Método: Se incluyeron diez artículos. Hecho una revisión integrativa de la literatura para identificación y selección de los artículos. Análisis de concepto según el método evolutivo de Rodgers. Los artículos fueron recogidos en la plataforma Host EBOSCO, en la Biblioteca Virtual de Salud y en Google Scholar de 2004 a 2018. Resultados: Con base en el método de Rodgers, fue posible la identificación: 1) términos substitutos y conceptos relacionados, donde fueron destacados los disturbios musculoesqueléticos y los síntomas musculoesqueléticos; 2) como atributos esenciales del concepto destacamos, dolor e incomodidad, así como la medición por el Cuestionario Nórdico-Musculoesquelético; 3) los factores de riesgo se identificaron como antecedentes y el impacto en la vida de los estudiantes como consecuencia. Conclusión: Este estudio contribuye al conocimiento y clarificación del concepto de sintomatología musculoesquelética en estudiantes de enfermería.

Sonographic Findings of Common Musculoskeletal Diseases in Patients with Diabetes Mellitus

Diabetes mellitus (DM) can accompany many musculoskeletal (MSK) diseases. It is difficult to distinguish the DM-related MSK diseases based on clinical symptoms alone. Sonography is frequently used as a first imaging study for these MSK symptoms and is helpful to differentiate the various DM-related MSK diseases. This pictorial essay focuses on sonographic findings of various MSK diseases that can occur in diabetic patients.

Validación del cuestionario para graduación de dolor crónicoen pacientes chilenos con patología musculoesquelética / Validation of the graduation of chronic pain in patients with chilean musculoskeletal pathology

Introducción: el dolor crónico es una condición que afecta a 1 de cada 5 personas en el mundo, comprometiendo diferentes áreas de la calidad de vida. El cuestionario para graduación de dolor crónico (CGDC) fue desarrollado como una forma de evaluar y monitorear a estos pacientes, con altos niveles de fiabilidad y validez. Objetivos: Desarrollar una versión española del CGDC, adaptado culturalmente a Chile y determinar su validez y fiabilidad, en el Hospital Clínico de la Universidad de Chile. Material y métodos: El cuestionario fue traducido y adaptado culturalmente de acuerdo a las recomendaciones internacionales. Se aplicó SF-36 v2.0 en 130 pacientes condolor musculoesquelético crónico (más de 6 meses). La fiabilidad se calculó con Alfa de Cronbach y el índice de validez se evaluó mediante la comparación de las respuestas de la CGDC para cada categoría con las subescalas del SF-36 v.2. Resultados: La versión chilena de la CGDC fue válida. Se obtuvieron altos niveles de confiabilidad con alfa de Cronbach> 0,7. Se observaron correlaciones significativas del SF -36,especialmente con las subescalas que tienen alta capacidad de medir el dolor y la salud física (p <0,01). Conclusiones: Los resultados presentados aquí confirman la fiabilidad y validez de la versión chilena del CGDC en la evaluación de pacientes con dolor musculoesquelético crónico.

Introduction: chronic pain is a condition that affectss 1 in every 5 people in the world, compromising different areas of quality of life. The Chronic Pain Graded questionnaire (CPG) was developed as a form to assess and monitor these patients, with high levels of reliability and validity. Objectives: To develop a spanish version of the chronic pain graded questionnaire, culturally adapted to Chile determine its reliability and convergent construct validity , in the University of Chile Clinical Hospital. Materials and Methods: The chronic pain graded questionnaire was translated and culturally adapted accordingt o international recommendations. It was applied with SF -36 v2.0 questionnaire in 130 patients with chronic musculoskeletal pain (more than 6 months). The reliability was calculated with de Alpha the Cronbach Index and de validity was assessed by comparing the responses of the CPG for each category with the subscales of SF-36 v.2. Results: The Chilean version of the CBDC was valid. High levels of reliability was obtained with Cronbach’s alpha > 0.7. Compared with the SF -36 significant correlations were observed, especially with the SF -36 subscales having high ability to measure pain and physical health ( P < 0.01). Conclusions: The results presented here confirm the reliability and validity of the Chilean version of the chronic pain graded questionnaire in the evaluation of patients with chronic musculoskeletal pain.

Revisión bibliográfica: factores de riesgo en patologías musculoesqueléticas / Bibliographic review: risk factors on musculoskeletal diseases

Introducción: las enfermedades musculoesqueléticas tienen elevada prevalencia y alto impacto socio económico sobre el bienestar de la población y la productividad económica de un país. En Chile, este grupo de patologías constituyen la principal causade enfermedades profesionales y con mayores tasas anuales de licencias médicas laborales, aún cuando se considera que estas enfermedades, en la actualidad, estarían siendo subnotificadas. Independiente del origen de la enfermedad, el dolor y la impotencia funcional son los principales síntomas en este grupo de patologías, al conducir el diagnóstico y tratamiento y guiar la indicación de reposo y reintegro laboral. En su fisiopatología interactúanfrecuentemente una serie de riesgos personales y ambientales, entre los que se encuentran factores de riesgo laborales, siendo reconocidas algunas de estas patologías entre el listado deenfermedades profesionales de la Organización Internacional del Trabajo. Sin intención de saldar el debate sobre el origen de este grupo de patologías, sino con el fin de aportar evidencia ala discusión sobre la compleja interacción entre sus factores de riesgo, presentamos una revisión bibliográfica sobre enfermedades osteomusculares observadas con frecuencia en la población. Metodología: Se seleccionaron 11 patologías musculoesqueléticas de diagnóstico frecuente en población económicamente activa y que generan ausentismo laboral: Cervicalgia, Dorsalgia, Epicondilitis, Lumbago Mecánico, Quiste Sinovial, Tendinitis Aquiliana, TendinitisBicipital, Tendinitis del Manguito Rotador, Tendinitis Rotuliana, Tenosinovitis de De Quervain, Síndrome del Túnel Carpiano. Se realizó una revisión de la literatura registrada en las principales bases de datos a nivel internacional y una búsqueda manual de estudios referenciados en los artículos principales...

Introduction: musculoskeletal diseases have highprevalence and socioeconomic impact on population’swellbeing and countries’ economic productivity. In Chile,this group of pathologies constitute the main cause ofprofessional diseases, with the highest working leaveperiods annual rate, even though it is considered that thisdiseases are being subnotified. Independent of diseaseorigin, pain and functional impotence are main symptomson this group of pathologies, conducting its diagnosis andtreatment, and guiding the indication of rest and return towork. In its pathophysiology several personal and ambientrisks interact, with occupational risk factors in-between,being some of the diseases recognized on the InternationalWork Organization’s list of Professional Diseases. Withoutintention of settle the debate about the origin of thisgroup of diseases, but with intention of contribute withevidence to the discussion of the complex interactionbetween its risk factors, we present a bibliographic reviewof musculoskeletal diseases observed with frequency.Methodology: 11 musculoskeletal diseases of frequentdiagnosis on economically active population that produceworking absenteeism were selected: Cervicalgia, Dorsalgia,Epicondylitis, Low back pain, Synovial Cyst, AchillesTendinitis, Bicipital Tendinitis, Rotator Cuff Tendinitis,Patellar Tendinitis, De Quervain Tenosynovitis and CarpalTunnel Syndrome. A literature review registered on maininternational databases was performed, and a manualsearch of studies cited on main articles...

Preoperative Nutritional Status of the Surgical Patients in Jeju

BACKGROUND: To assess the preoperative nutritional status of patients with various disorders and to provide data for pre- and postoperative patient management plans, particularly in the elderly. There is no published information on age-matched and disease-matched preoperative nutritional/immunologic status for orthopedic patients, especially in the elderly, in Jeju. METHODS: In total, 331 patients with four categories of orthopedic conditions were assessed: 92 elective surgery patients, 59 arthroplasty patients, 145 patients with fractures, and 35 infection patients. Malnutrition was defined as body mass index (BMI) below 18 kg/m2 of expected body weight (below 20% of normal), serum albumin/globulin ratio below 1.5 (normal range, 1.5 to 2.3), albumin level below 3.5 g/dL, total lymphocyte count below 1,500 cells/mm3, and lymphocyte/monocyte ratio below 5 versus 1. RESULTS: In 92 elective surgery patients, the average BMI was 23 kg/m2, hemoglobin was 15 g/dL, lymphocytes (2,486 cells)/monocytes (465 cells) ratio was 6.1, and the albumin (4.4 g/dL)/globulin (2.5 g/dL) ratio as a protein quotient was 1.7. Among the 59 hip and knee arthroplasty patients, the average BMI was 25 kg/m2, hemoglobin was 12 g/dL, lymphocytes (2,038 cells)/monocytes (391 cells) ratio was 6.6, and albumin (4.1 g/dL)/globulin (2.4 g/dL) ratio was 1.6. No subject showed malnutrition. Among the 145 fracture patients, the average BMI was 23 kg/m2. The hemoglobin level was 13 g/dL, monocytes (495 cells)/lymphocytes (1,905 cells) ratio was 1 versus 4.6, and albumin (4.1 d/gL)/globulin (2.5 d/gL) ratio was 1.6. However, both ratios decreased after 70 years of age. Among the 17 of 35 infection patients, albumin levels were below 3.5 g/dL, the average BMI was 22 kg/m2, lymphocytes (1,532 cells)/monocytes (545 cells) ratio was 2.4 versus 1, and albumin (3.0 g/dL)/globulin (3.3 g/dL) ratio was 0.9, while in 18 patients albumin levels were over 3.5 g/dL, the average BMI was 22 kg/m2, hemoglobin was 12 g/dL, lymphocytes (1,998 cells)/monocytes (583 cells) ratio was 3 versus 1, and albumin/globulin ratio was 1.4. Thus, in the infection group, approximately 50% of the patients showed poor nutrition and immunosuppression. CONCLUSIONS: It was found that nutritional and immune condition deteriorated gradually to some degree in elderly patients over 60 years of age.

Z-lengthening of the Achilles Tendon with Transverse Skin Incision

BACKGROUND: The risk of various complications after Achilles tendon lengthening is mainly related to the length of surgical exposure and the lengthening method. A comprehensive technique to minimize the complications is required. METHODS: The treatment of Achilles tendon tightness in 57 patients (95 ankles) were performed by using a short transverse incision on a skin crease of the heel and by Z-lengthening of the tendon. In the severe cases, two or three transverse incisions were required for greater lengthening of the tendon, and a serial cast or Ilizarov apparatus was applied for the gradual correction. The results of these 95 ankles were compared to those of 18 ankles, which underwent percutaneous sliding lengthening, and to the 19 ankles, which received Z-lengthening with a medial longitudinal incision. RESULTS: The functional and cosmetic satisfaction was achieved among those who underwent the tendon lengthening with the new technique. The mean American Orthopaedic Foot & Ankle Society (AOFAS) score improved from 56.1 to 81.8. The second operations to correct recurrence were performed in the two cerebral palsy patients. CONCLUSIONS: The new technique has a low rate of complications such as scarring, adhesion, total transection, excessive lengthening, and recurrence of shortening. The excellent cosmesis and the short operation time are the additional advantages.

Fatores associados à duração dos benefícios por incapacidade: um estudo de coorte / Factors associated with duration of disability benefits: a cohort study

OBJETIVO: Analisar fatores associados à duração dos benefícios por incapacidade por doenças musculoesqueléticas na região cervical e/ou em membros superiores relacionadas ao trabalho. MÉTODOS: Estudo de coorte ambispectivo com 563 trabalhadores segurados do Regime Geral da Previdência Social que receberam benefício por incapacidade temporária por doenças musculoesqueléticas da região cervical e membros superiores relacionadas ao trabalho em Salvador, BA, em 2008. Os dados provieram de um inquérito conduzido pela Auditoria Regional do Instituto Nacional do Seguro Social e de registros administrativos. Foram analisadas variáveis sociodemográficas, relacionadas ao trabalho, características do agravo e aspectos relacionados ao seguro social. Os fatores associados ao tempo até a cessação do benefício foram identificados com técnicas de análise de sobrevida. RESULTADOS: Posição socioeconômica baixa (RR = 1,29; IC95% 1,02;1,64), idade abaixo de 39 anos (RR = 1,23; IC95% 1,03;1,47), reposição de renda pelo Instituto Nacional do Seguro Social < 100% (RR = 1,24; IC95% 1,04;1,47) e expectativa alta de retorno ao trabalho (RR = 1,20; IC95% 1,00;1,44) são as categorias relacionadas com maior taxa de cessação do benefício e sua menor duração. CONCLUSÕES: Fatores não estritamente médicos, como posição socioeconômica, idade, expectativa relativa ao retorno ao trabalho e nível de reposição de renda pelo Instituto Nacional do Seguro Social parecem influenciar a duração do benefício. Essas hipóteses deverão ser testadas posteriormente com estudos confirmatórios para aprimorar o entendimento do processo de determinação da incapacidade para o trabalho.

OBJECTIVE: To analyze factors associated with the duration of disability benefits due to work-related upper-limb musculoskeletal disorders. METHODS: Ambispective cohort study conducted with 563 insured workers from the General Social Security System who received temporary disability benefits due to work-related upper-limb musculoskeletal disorders in the city of Salvador, Northeastern Brazil, in 2008. The data came from an inquiry performed by the Regional Audit of the National Social Security Institute and from administrative records. Sociodemographic and work-related variables were analyzed, as well as characteristics of the health problem and aspects related to social security. Factors associated with time until the cessation of the benefit were identified through survival analysis techniques. RESULTS: Low socioeconomic position (RR=1.29; 95% CI 1.02; 1.64), age below 39 years (RR=1.23; 95% CI 1.03; 1.47), income replacement by the National Social Security Institute < 100% (RR=1.24; 95% CI 1.04; 1.47) and high expectation of returning to work (RR=1.20; 95% CI 1.00; 1.44) are the categories related to higher rate of cessation of the benefit and with its shorter duration. CONCLUSIONS: Factors that are not strictly medical, like socioeconomic position, age, expectation of returning to work and level of income replacement by the National Social Security Institute, seem to influence the benefit's duration. These hypotheses need to be tested with further confirmatory studies in order to improve the understanding of the process of determining incapacity for work.

Effect of Preexisting Musculoskeletal Diseases on the 1-Year Incidence of Fall-related Injuries / 예방의학회지

OBJECTIVES: People who have chronic diseases, as well as gait imbalance or psychiatric drug use, may be susceptible to injuries from falls and slips. The purpose of this study was to evaluate the effect of musculoskeletal diseases on incidental fall-related injuries among adults in Korea. METHODS: We analyzed data from the 4th Korea National Health and Nutrition Examination Survey (2007-2009), which are national data obtained by a rolling survey sampling method. The 1-year incidence of fall-related injuries was defined by health service utilization within the last year due to injury occurring after a slip and fall, and musculoskeletal diseases included osteoarthritis, rheumatoid arthritis, osteoporosis, and back pain. To evaluate the effects of preexisting musculoskeletal diseases, adults diagnosed before the last year were considered the exposed group, and adults who had never been diagnosed were the unexposed group. RESULTS: The weighted lifetime prevalence of musculoskeletal disease was 32 540 per 100 000 persons. Musculoskeletal diseases were associated with a higher risk of fall-related injury after adjustment for sex, age, residence, household income, education, occupation, visual disturbance, paralysis due to stroke, and medication for depression (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.03 to 1.93). As the number of comorbid musculoskeletal diseases increased, the risk of fall-induced injuries increased (p-value for trend <0.001). In particular, patients who had any musculoskeletal condition were at much higher risk of recurrent fall-related injuries (OR, 6.20; 95% CI, 1.06 to 36.08). CONCLUSIONS: One must take into account the risk of fall-related injuries and provide prevention strategies among adults who have musculoskeletal diseases.

Prevalência da lombalgia e sua associação com atividades domésticas em gestantes do município de Itabuna, Bahia / Prevalence of lower back pain and its association with household chores in pregnant women in the city of Itabuna, Bahia / Prevalencia del dolor lumbar y su asociación con las actividades domésticas en mujeres embarazadas en la ciudad de Itabuna, Bahia

Na gravidez, a lombalgia apresenta uma alta incidência, sendo considerada pela população em geral como uma alteração normal e esperada entre as gestantes. O objetivo deste artigo é, por meio do estudo epidemiológico, calcular a prevalência da lombalgia em gestantes do município de Itabuna, Bahia, investigando a relação da lombalgia gestacional com as atividades domésticas. Foi realizado um estudo descritivo de uma amostra de 124 gestantes assistidas pelo programa de atendimento pré-natal das Unidades Básicas de Saúde.A prevalência de dor lombar nessa amostra foi de 48,2por cento. As principais características da lombalgia gestacional eram dor de intensidade moderada, que se agravava com o avanço da gravidez e com as atividades domésticas e melhorava com o repouso. As atividades domésticas eram realizadas por 78 (62,9por cento) gestantes estudadas e a execução dessa tarefa foi fator intensificador da dor na maioria dos casos e de limitação funcional em alguns; a atividade de lavar roupa foi responsável pelo maior índice de queixas dolorosas (22,6por cento).Conclui-se que, o fato de a lombalgia ser um acometimento frequente entre essa população,há a necessidade de programas educacionais que visem à atenuação ou mesmo prevenção dessa alteração, a fim de proporcionar maior conforto à gestante e evitar o aparecimento de maiores complicações musculoesqueléticas.

In pregnancy, lower back pain has a high incidence and it is considered by common sense as a normal and expected change among pregnant women. The aim of this article is, by means of an epidemiological study, to calculate the prevalence of lower back pain in pregnant women in the city of Itabuna, Bahia, investigating the relationship between lower back pain in pregnancy and household chores. A study was conducted with a sample of 124 pregnant women attending the program of prenatal care of the Basic Health Unit. The prevalence of lower back pain in this sample was 48.2percent. The main features of lower back pain during pregnancy were of moderate intensity that worsens with advancing pregnancy and domestic activities, and improves with rest. The household chores are done by 78 (62.9percent) women studied and this task was an enhancer of pain in most cases and of functional limitation in some; doing the laundry was responsible for the higher rate of complaints ofpain (22.6percent). This study concluded that as lower back pain is a frequent complaint among this population, educational programs are needed, aiming the mitigation or prevention of this amendment in order to provide greater comfort to pregnant women and prevent the emergence of major musculoskeletal complications.

En el embarazo, el dolor lumbar presenta una alta incidencia, siendo considerada por la población en general como un cambio normal y esperado entre lãs gestantes. El propósito de este artículo es, mediante el estudio epidemiológico, calcular la prevalencia del dolor lumbar en gestantes en la ciudad de Itabuna, Bahía, investigando la relación del dolor lumbar durante la gestación con las tareas domésticas. Se realizó un estúdio descriptivo con una muestra de 124 mujeres embarazadas atendidas por el programa de atención prenatal de las Unidades Básicas de Salud. La prevalencia del dolor lumbar en esta muestra fue de 48,2por ciento. Las principales características del dolor lumbar del embarazo fueron dolor de intensidad moderada, el cual se agrava con el avanzo del embarazo y las actividades domésticas, y mejora con el reposo. Las actividades domésticas son realizadas por 78 gestantes estudiadas (62,9por ciento) y la ejecución de esa tarea fue el factor potenciador del dolor em la mayoría de los casos y, en algunas, limitación funcional; la actividad del lavado de ropas fue responsable por el mayor índice de quejas relacionadas al dolor (22,6por ciento). Se concluye que, el hecho de que la lumbalgia sea una alteración común en esta población, hay una necesidad de programas educativos dirigidos a mitigarla, o incluso prevenirla, con el fin de brindar mayorcomodidad a la gestante y evitar la aparición de complicaciones músculoesqueléticas mayores.

Application of Botulinum toxin Type A: An arsenal in dentistry.

An extremely effective way of preventing damage to and enhancing treatment of dental hard tissues and restorations would be to ''de-programme'' the muscles responsible for excessive destructive forces and other gnathological-related diseases. The new paradigm is the intramuscular injection of Botulinum toxin type A (BOTOX) into the affected muscles. It is a natural protein produced by anaerobic bacterium, Clostridium botulinum. The toxin inhibits the release of acetylcholine (ACH), a neurotransmitter responsible for the activation of muscle contraction and glandular secretion, and its administration results in reduction of tone in the injected muscle. There are seven distinct serotypes of Botulinum toxin, viz., A, B, C, D, E, F, and G, which differ in their potency, duration of action, and cellular target sites. This paper describes the different applications of BOTOX in dentistry.

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.

Prescription Pattern of NSAIDs and the Prevalence of NSAID-induced Gastrointestinal Risk Factors of Orthopaedic Patients in Clinical Practice in Korea

This is a cross-sectional observational study undertaken to explore the current prescription pattern of non-steroidal anti-inflammatory drugs (NSAIDs) and the prevalence of NSAID-induced gastrointestinal (GI) risk factors of orthopaedic patients in real clinical practice in Korea. Study cohort included 3,140 orthopaedic outpatients at 131 hospitals and clinics between January 2008 and August 2008. A self-administered questionnaire was completed by each patient and physician. A simplified risk scoring scale (the Standardized Calculator of Risk for Events; SCORE) was used to measure patients' risk for GI complications. The pattern of NSAIDs prescription was identified from medical recordings. Forty-five percents of the patients belonged to high risk or very high risk groups for GI complications. The cyclooxygenase-2 enzyme (COX-2) selective NSAID showed a propensity to be prescribed more commonly for high/very high GI risk groups, but the rate was still as low as 51%. In conclusion, physician's considerate prescription of NSAIDs with well-understanding of each patient's GI risk factors is strongly encouraged in order to maximize cost effectiveness and to prevent serious GI complications in Korea. Other strategic efforts such as medical association-led education programs and application of Korean electronic SCORE system to hospital order communication system (OCS) should also be accompanied in a way to promote physician's attention.

Dolor crónico en hemodializados: prevalencia, severidad y estrategias de afrontamiento / Chronic pain in hemodialysis patients: prevalence, severity and coping strategies

El dolor es un aspecto relevante y escasamente estudiado en los pacientes hemodializados. Las estrategias de afrontamiento son vitales para enfrentar el dolor. Se evaluó la prevalencia y severidad del dolor crónico, comorbilidad y estrategias de afrontamiento en pacientes en Hemodiálisis del Hospital Clínico de la Pontificia Universidad Católica de Chile. Para ello, se aplicó la Versión Corta de McGill para dolor(SF-MPQ), con Escala Analógica Visual (VAS) y el Cuestionario para Estrategias de Afrontamiento al Dolor (CAD) a 39 mujeres y 51 hombres, conformándose tres grupos según percentiles de edad. Para el análisis se empleó el SPSS versión 16 para Windows. La prevalencia de dolor crónico fue de 70 por ciento, la causa más frecuente fue el musculoesquelético, con 60,31 por ciento. La severidad no tuvo relación con las causas. Para VAS, el promedio fue 6,92 cms y presentó correlaciones altas con las dimensiones sensorial, afectiva y total. El 39,68 por ciento experimentó dolor moderado y el 53,96 por ciento, severo. La media para Pain Rating Index (PRI) fue 16,68 (Dt. 8,949) y para el Present PAin Intensive (PPI) 0,81 (Dt. 0,998). Las mujeres presentaron puntuaciones superiores para ambas dimensiones, más altas en el grupo entre 45-70 años. El análisis multivariado para dolor y comorbilidad mostró independencia con hipertensión y no significación para diabetes. La estrategia de afrontamiento mas empleada fue autoafirmación (media 16,82 por ciento), seguida de búsqueda de información (14,42 por ciento) y distracción (11,77 por ciento). La catarsis es la menos utilizada. En conjunto, las dimensiones del afrontaiento, hombres y mujeres se comportan diferente, básicamente en religión y catarsis, con valores superiores en mujeres, pero no en cuanto a grupos de edad. Por la elevada prevalencia, severidad y el tipo de afrontamiento, el dolor y la psicoterapia para su enfrentamiento deben incluirse en el manejo de pacientes hemdializados.

Enfermedades músculo esqueléticas en población hipertensa y su asociación con obesidad: un estudio transversal en laRegión Metropolitana, Chile / Musculo and skeletal diseases in hypertensive subjects and their association with obesity: a cross sectional study in the Region Metropolitana, Chile

Antecedentes: Los hipertensos presentan elevada prevalencia de obesidad lo que puede predisponer para el desarrollo de enfermedades músculo-esqueléticas (EME). Actualmente se desconoce la magnitud de estas patologías en población hipertensa chilena. Objetivo: Determinar prevalencia de EME en hipertensos bajo control en el programa de salud cardiovascular de la Región Metropolitana y su posible asociación con obesidad. Método: Estudio transversal en una muestra aleatoria simple (n = 1194 sujetos) a partir del universo (N = 391.129) distribuida en 52 comunas de Santiago. Se registró diagnóstico de EME (CIE10, códigos MM00-99), edad, sexo, presión arterial, índice de masa corporal (IMC), obesidad (IMC ³ 30 kg/m2) y carga psicológica. La asociación con obesidad se exploró a través de regresión logística estimando odds ratio (OR) con intervalos de confianza al 95% (IC95%). Resultados: La prevalencia de EME fue 36,5% (39,9% mujeres y 28,3% hombres, p<0.01). En ambos sexos las patologías más frecuentes fueron lumbago, artrosis de rodilla y artralgias. La asociación de EME y obesidad presentó un OR crudo de 1,09 (1,06-1,19) en hombres y de 1,24 (1,22-1,26) en mujeres; luego de ajuste multivariante el OR fue de 1,19 (1,15-1,23) y 1,49 (1,46-1,52) respectivamente. Conclusiones: Además de la edad, sexo femenino y carga psicológica, la obesidad aparece como un factor de riesgo para EME en población hipertensa. La elevada prevalencia observada enfatiza la necesidad de acentuar el control de peso, incluir el ejercicio físico y brindar acceso a la kinesioterapia en la atención primaria chilena.

Background: Hypertensive subjects frequently are obese, which may lead to development of muscular and skeletal diseases (MSD). There is no data regarding the frequency of this complications in Chile. Aim: to determine the prevalence of MSD in hypertensive subjects being followed by the Cardiovascular Health Program in the Region Metropolitana; to determine the association of MSD to obesity in those subjects. Methods: Cross sectional study using a simple random sample of 1194 subjects from the population of 391,129 hypertensives distributed in 52 municipalities in Santiago, Chile. Diagnosis of MSD was established according to CIE 10 codes MM00-99). Age, sex, blood pressure, body mass index and psychological burden were determined. Obesity was defined as IMC ³ 30 kg/m2). Association of MSD with obesity was explored using logistic regression and OR with 95% confidence intervals (95% CI). Results: The prevalence of obesity was 36.5% (39.0% in women, 28.3% in males, p<0.01). In both sexes, lumbar pain, knee osteoarthritis and joint pain were the most common forms of MSD. OR for the association of MSD and obesity was 1.09 (95% CI 1.06-1.19) in males and 1.24 (1.22-1.26) in females. After multivariate adjustment the respective OR became 1.19 (1.15-1.23) and 1.49 (1.46-1.52). Conclusion: In addition to age, female sex and psychological burden, obesity is an independent risk factor for MSD en hypertensive patients. These findings stress the need for better weight control in hypertensives. Physical exercise and physical therapy should be helpful in the primary care of this population.

Prevalência de hipermobilidade articular e sintomas álgicos em trabalhadores industriais / Prevalence of joint hypermobility and algic symptoms in industry workers

Hipermobilidade articular é a capacidade de desempenhar movimentos articulares com amplitude maior quea normal. Sua importância atual está associada à gênese da dor musculoesquelética, uma vez que seu diagnóstico precoce previne disfunções articulares. O presente estudo determinou a prevalência de hipermobilidade articular e queixas musculoesqueléticas em 100 trabalhadores industriais de ambos os sexos,com idade entre 18 e 67 anos. Utilizou-se o método de Beighton et al. e questionário fechado para determinaçãode hipermobilidade articular e dor musculoesquelética. Hipermobilidade articular foi encontrada em 1,9% dos funcionários da indústria moveleira e em 27,7% dos da indústria têxtil; destes, respectivamente, 100% e84,6% apresentaram dor. A estimativa da prevalência e a detecção precoce da hipermobilidade articular e desuas co-morbidades têm grande importância na prevenção de doenças ocupacionais.

Alterações músculo-esqueléticas em mulheres com dor pélvica crônica (DPC) / Musculoskeletal disorders in women with chronic pelvi pain (CPP)

Algia pélvica crônica é definida como dor localizada na região inferior do abdômen ou da pelve com duração superior a seis meses. Sua etiologia é multifatorial e as causas ósteo-musculares (principalmente das dores na pelve, quadril, coluna lombar e membros inferiores) devem ser salientadas, pois geralmente são negligenciadas no atendimento. Na literatura são discutidas alterações músculo-esqueléticas observadas em mulheres com queixa de dores pélvidas sem diagnóstico de doenças ginecológicas; nestes casos é possível que estas alterações sejam a causa primária da dor. Entretanto, as alterações músculo-esqueléticas também podem surgir devido a postura antálgica por tempo prolongado, adotada por mulheres com doenças que levam a dor crônica (p.ex., pacientes com endometriose). O papel da fisioterapia é avaliar as condições posturais e músculo-esqueléticas que afetam o equilíbrio pélvico gerando dor nesta região. A fisioterapia, inserida na equipe multiprofissional que atende a mulher com queixa álgica, contribui para esclarecer a causa destes sintomas e atua sinergicamente nas afecções ginecológicas que geram distúrbios ósteo-musculares; isto favorece a diminuição da dor e a melhora na qualidade de vida destas pacientes

Dolor y sueño: dos variables biológicas siempre presentes / Pain and sleep: two biological present conditions

El dolor constituye una entidad psicobiológica tan importante que se le conoce como el quinto signo vital. Junto al dolor, también se alteran otras entidades biológicas, denominadas "comorbilidades", una de ellas es el sueño. Al interactuar estas dos entidades, comprometen la capacidad biológica y conductual del individuo otorgándole una peor calidad de vida. Resulta indispensable reconocer y tratar las alteraciones del sueño que ocurren tanto en dolor agudo como crónico. Una de las formas de entender las alteraciones del sueño es mediante una polisomnografía. Este artículo de revisión pretende analizar la emergente literatura médica que reconoce y describe esta problemática relación sueño-dolor.

The pain is an important psychobiology condition, called the five vital sign. The sleep is other biology condition or "comorbilities". When these two vital condition, pain and sleep interact, the biological and behavioral capacity of the patient is compromised, given the worse live quality. An important consideration in understanding the sleep disturbances found in acute and chronic pain relates to their measurements. The polysomnography is the standard for defining sleep and its disturbances. This articles review the emergent medical literature about this complex pain-sleep nexus.

Doença reumatóide do adulto ou artrite reumatóide? Aspectos clínicos e laboratoriais / Adult's rheumatoid disease or rheumatoid arthritis? Clinicals and laboratorials aspects

O autor chama atenção para o nome doença reumatóide, com o objetivo de lembrar que essa enfermidade também se manifesta em outras estruturas que não as articulações. Faz considerações sobre sua etiologia e patogenia. Descreve as principais manifestações articulares. Descreve também as várias manifestações sistêmicas, como vasculites, envolvimentos pleuropulmonar, cardíaco, gastrointestinal, hematológico e outros