Development and Initial Validation of the ONCOREUM Score to Differentiate Childhood Cancer with Arthropathy from Juvenile Idiopathic Arthritis.

OBJECTIVE: To develop and validate a weighted score, the ONCOREUM score, that aids physicians in differentiation of cancer with arthropathy from juvenile idiopathic arthritis (JIA). STUDY DESIGN: Data were extracted from the ONCOREUM Study, a multicenter, cross-sectional investigation aimed at comparing children with cancer and arthropathy to children with JIA. Three statistical approaches were applied to develop the ONCOREUM score and assess the role of each variable in the diagnosis of cancer with arthropathy, including 2 approaches based on multivariable stepwise selection (models 1 and 2) and 1 approach on a Bayesian model averaging method (model 3). The ß coefficients estimated in the models were used to assign score points. Considering that not missing a child with cancer is a mandatory clinical objective, discriminating performance was assessed by fixing sensitivity at 100%. Score performance was evaluated in both developmental and validation samples (representing 80% and 20% of the study population, respectively). RESULTS: Patients with cancer and arthropathy (49 with solid tumors and 46 with hematologic malignancies without peripheral blasts) and 677 patients with JIA were included. The highest area under the receiver operating characteristic (ROC) curve (AUC) in the validation data set was yielded by model 1, which was selected to constitute the ONCOREUM score. The score ranged from -18 to 21.8, and the optimal cutoff obtained through ROC analysis was -6. The sensitivity, specificity, and AUC of the cutoff in the validation sample were 100%, 70%, and 0.85, respectively. CONCLUSIONS: The ONCOREUM score is a powerful and easily applicable tool that may facilitate early differentiation of malignancies with articular complaints from JIA.

Association between the risk of chronification of musculoskeletal symptoms and sleep quality in Military Firefighters of the Federal District / Associação entre o risco de cronificação de sintomas musculoesqueléticos e a qualidade do sono em Bombeiros Militares no Distrito Federal

Abstract Musculoskeletal symptoms (MS) can derive from injuries or dysfunctions that affect biological tissues such as muscles, bones, and nerves, among others. Military Firefighters (MF) exercise their activities exposed to varied and complex biological conditions, in which the physical demands are intense. Shift work is another remarkable characteristic of the career, which is associated with sleep disorders. Our objective was to estimate the association between the risk of chronification of MS and sleep quality in MF with MS. Our study is a Cross-Sectional Observational Study, whose sample was composed of 753 BM from the Federal District. The analysis was performed with a Sample Characterization Questionnaire, Örebro Musculoskeletal Symptoms Screening Questionnaire (OMPSQ) and the Pittsburgh Sleep Quality Index (PSQI), answered remotely. Statistical analysis used the Spearman Correlation test, p<0.05. The correlation between OMPSQ and PSQI was rated moderate, demonstrating that sleep quality has an influence on the chronification process. The average of the evaluation of Sleep Quality through the PSQI is 8.79, indicating that military personnel present a deficient quality of sleep. There was a correlation between the PSQI score and the OMPSQ of 0.542 (p<0.001), a moderate correlation between the variables. We conclude that MF show correlation between SM and sleep quality, indicating a moderate relationship between the variables, where sleep quality explains 25% of SM. We found that most MF were classified as Low Risk for chronification of SM.

Resumo Os sintomas musculoesqueléticos (SM) podem derivar de lesões ou disfunções que afetam tecidos biológicos como músculos, ossos, nervos, entre outros. Os Bombeiros Militares (BM) exercem suas atividades expostos a condições biológicas variadas e complexas, nas quais as demandas físicas são intensas. O trabalho em turno é outra característica marcante na carreira, o qual está associado a distúrbios do sono. Nosso objetivo foi estimar a associação entre o risco de cronificação de SM e a qualidade do sono em BM com SM. Nosso estudo é um Estudo Observacional Transversal, cuja amostra foi composta por 753 BM do Distrito Federal. A análise foi realizada com um Questionário de Caracterização Amostral, Questionário Örebro de Triagem de Sintomas Musculoesqueléticos (OMPSQ) e com o Índice de Qualidade do Sono de Pittsburgh (PSQI), respondidos remotamente. A análise estatística utilizou o teste de Correlação Spearman, p<0,05. A correlação entre OMPSQ e PSQI foi classificada em moderada, demonstrando que a qualidade do sono apresenta influência no processo de cronificação. A média da avaliação da Qualidade do Sono através do PSQI é de 8,79, indicando que militares apresentam uma qualidade do sono deficitária. Houve correlação entre a pontuação no PSQI e o OMPSQ de 0,542 (p<0.001), correlação moderada entre as variáveis. Concluímos que os BM apresentam correlação entre os SM e a qualidade do sono, indicando uma relação moderada entre as variáveis, onde a qualidade de sono explica 25% dos SM. Verificamos que a maioria dos BM foram classificados como Baixo Risco de cronificação de SM.

Low Occurrence of Musculoskeletal Symptoms in Swimming? Musculoskeletal Symptoms and Sports Participation in Adolescents: Cross Sectional Study (ABCD-Growth Study).

The purpose of this paper was to identify the association between the occurrence of musculoskeletal symptoms (MS) and sports participation in adolescents. The sample included 193 adolescents (11 to 17 years of age; 131 boys and 62 girls). For this cross-sectional study, participants were categorized into four groups: "no-sports", "repetitive non-impact sports", "high-impact sports", and "odd-impact sports". A questionnaire was used, which defined MS as pain or any musculoskeletal complaint that led to restriction of current normal activities. In the entire sample, 112 adolescents reported at least one episode of MS during the recording, representing 58% of the sample. Our findings highlight that adolescents regularly engaged in odd-impact sports, such as martial arts, report a higher occurrence of MS than swimmers and adolescents who do not participate in any physical activity.

Quality of life in chronic musculoskeletal symptomatic Chilean population: secondary analysis of National Health Survey 2009-2010.

BACKGROUND: Health-related quality of life (HRQoL) is defined as the patient's perception of their health status. HRQoL can be modified by illnesses, treatments or social and health policies. Chronic musculoskeletal pain is a modifying factor of HRQoL that leads to lower quality of life, elevated suffering and disability. Knowing HRQoL in subjects reporting chronic musculoskeletal symptoms (cMSS), like pain, discomfort or swollenness lasting more than 3 months, will provide information to health teams and organizations engaged in the Chilean health system. This study aim was to determine the relationship between HRQoL and musculoskeletal symptoms measured in three different Chilean groups: [1] without symptoms; [2] with acute symptoms; and [3] with cMSS. METHODS: A secondary analysis of the 2009-10 Chilean National Health Survey (NHS) was executed to determine the relationship between HRQoL (measured with SF-12) in three MSS groups. The Chilean NHS considered a national, probabilistic, stratified and multistage sample of 5293 participants aged 15 and older; it was representative at the national, urban-rural and regional levels. A multivariate logistic regression model studied the relationship between cMSS and HRQoL, adjusted for age, sex, educational level and residence area as control variables (p < 0.05). RESULTS: Out of 5293 participants in the NHS 2009-10, 5276 subjects were included for analysis. The median age was 46 years (IQR 31-60), 59.4% women, a median of 10 years formal education (IQR 7-12) and an urban residence in 85.2% of the population of the NHS 2009-10. The observed population prevalence of people with cMSS was 42.6% (95% CI 40.4-44.9). Presence of cMSS is a risk factor for low HRQoL, exhibited both in the physical (OR 3.1 95% CI 2.7-3.5) and mental (OR 1.9 95% CI 1.6-2,) HRQoL dimensions, independent of control variables. CONCLUSIONS: Physical and mental HRQoL are affected in people with cMSS, low educational level and advanced age. This is especially seen in women. This information will facilitate assessment and treatment of cMSS as a prevalent and multidimensional health problem.

A novel combination of biallelic ALPL mutations associated with adult hypophosphatasia: A phenotype-genotype association and computational analysis study.

Hypophosphatasia (HPP) is an inherited metabolic disorder that causes defective skeletal and dental mineralization. HPP exhibits a markedly heterogeneous range of clinical manifestations caused by dysfunction of the tissue-nonspecific isozyme of alkaline phosphatase (TNSALP), resulting from loss-of-function mutations in the ALPL gene. HPP has been associated with predominantly missense mutations in ALPL, and a number of compound heterozygous genotypes have been identified. Here, we describe a case of a subject with adult-onset HPP caused by a novel combination of missense mutations p.Gly473Ser and p.Ala487Val, resulting in chronic musculoskeletal pain, myopathy, persistent fatigue, vomiting, and an uncommon dental phenotype of short-rooted permanent teeth. Pedigree and biochemical analysis indicated that severity of symptoms was correlated with levels of residual ALP activity, and co-segregated with the p.Gly473Ser missense mutation. Bioinformatic analysis to predict the structural and functional impact of each of the point mutations in the TNSALP molecule, and its potential contribution to the clinical symptoms, revealed that the affected Gly473 residue is localized in the homodimer interface and predicted to have a dominant negative effect. The affected Ala487 residue was predicted to bind to Tyr479, which is closely located the N-terminal α-helix of TNSALP monomer 2, suggesting that both changes may impair dimer stability and catalytic functions. In conclusion, these findings assist in defining genotype-phenotype associations for HPP, and further define specific sites within the TNSALP molecule potentially related to neuromuscular manifestations in adult HPP, allowing for a better understanding of HPP pathophysiology.

Prevalencia de síntomas músculo-esqueléticos de la mano en estudiantes de odontología / Prevalence of Musculoskeletal Symptoms of the Hand Among Dental Students

Resumen Introducción: Los síntomas músculo-esqueléticos de las extremidades superiores son comunes entre los trabajadores dentales debido a la exposición a factores de riesgo, como movimientos repetitivos, esfuerzos intensos de manos, y malas posturas de muñecas. A medida que los estudiantes de odontología aprenden nuevas habilidades y procedimientos durante la escuela, experimentan un aumento gradual a estos factores de riesgo. El propósito de este estudio fue determinar la prevalencia de los síntomas musculo-esqueléticos (SME) de mano y muñeca entre los estudiantes de odontología de la Universidad de Iowa. Métodos: A 35 estudiantes de primer año y 39 estudiantes de cuarto año (N = 74) se les pidió que llenaran dos cuestionarios. Resultados: La prevalencia de los SME moderados/severos de la mano dominante como entumecimiento, hormigueo y dolor entre los estudiantes de primer año fue de 0, 6 y 20%, respectivamente, comparado con el 18,15 y 36% de los estudiantes de cuarto año. Conclusiones: Los SME de la mano dominante fueron más comunes entre los estudiantes de odontología de cuarto año, en comparación con los de primer año.

Abstract Introduction: Musculoskeletal symptoms of the upper extremities are common among dental workers due to exposure to risk factors including repetition, forceful exertions of the hand, and awkward wrist postures. As dental students learn new skills and procedures during dental school, they experience a gradually increasing exposure to these risk factors. The purpose of this study was to determine the prevalence of hand and wrist musculoskeletal symptoms (MSS) among dental students of the University of Iowa. Methods: Thirty-five first year students and thirty-nine fourth year students (N=74) were asked to complete two questionnaires. Results: The prevalence of moderate/severe MSS of the dominant hand such as numbness, tingling and soreness among first year students was 0, 6 and 20% respectively compared to 18, 15 and 36% of the fourth year students. Conclusions: In this relatively small sample, MSS of the dominant hand were more common among fourth year dental students when compared to first year students.

Pain and musculoskeletal discomfort in physiotherapists of the intensive care unit and ward of a university hospital: a retrospective cohort study / Dor e desconforto musculoesquelético em fisioterapeutas da unidade de terapia intensiva e enfermaria de um hospital universitário: um estudo de coorte retrospectivo

ABSTRACT BACKGROUND AND OBJECTIVES: Both biomechanical and emotional factors may contribute to the development of work-related musculoskeletal disorders in physical therapists working at a hospital, but we still do not know if these professionals present musculoskeletal symptoms related to the sector and working time. The objective of this study was to compare the self-report of pain and musculoskeletal discomfort of the physical therapists working in the intensive care unit and ward of a university hospital and retrospectively evaluate, 12 months of work, self-report of pain and musculoskeletal discomfort of physiotherapists in these sectors. METHODS: The self-report of pain and the musculoskeletal discomfort of the 18 physical therapists working in this hospital were evaluated by the Nordic Musculoskeletal Questionnaire in the admission period (T0) and after 12 months (T1). RESULTS: No association was found between the self-report of pain and musculoskeletal discomfort and the working sector of these professionals. However, there was a temporal association between the self-report of pain and musculoskeletal complaints in the intensive care unit sector in the following regions: neck (p=0.043), shoulders (p=0.009), upper back (p=0.043), lower back (p=0.043) and hip and thigh region (p=0.027). The second shift of these professionals was not associated with pain and musculoskeletal discomfort. CONCLUSION: The self-report of pain and musculoskeletal discomfort of physical therapists of this university hospital, both in the admission period (T0) and after 12 months of work (T1) was not associated with the sector in which they work. However, after 12 months, the physical therapists working in the intensive care unit showed an increase in the amount of self-report of pain and musculoskeletal discomfort.

RESUMO JUSTIFICATIVA E OBJETIVOS: Tanto os fatores biomecânicos quanto emocionais podem contribuir para o surgimento de distúrbios osteomusculares em fisioterapeutas que atuam dentro de um hospital; porém ainda não se sabe se esses profissionais apresentam dor e desconforto musculoesquelético relacionados ao setor e ao tempo de trabalho. Os objetivos deste estudo foram comparar o autorrelato de dor e o desconforto musculoesquelético dos fisioterapeutas da unidade de terapia intensiva e enfermarias e avaliar retrospectivamente, em 12 meses de trabalho, o autorrelato de dor e desconforto musculoesquelético dos fisioterapeutas desses setores. MÉTODOS: O autorrelato de dor e o desconforto musculoesquelético dos 18 fisioterapeutas que atuam nesse hospital foi avaliado pelo Questionário Nórdico de Sintomas Osteomusculares, no período atual (T1) e comparados retrospectivamente com os dados avaliados no período admissional (T0). RESULTADOS: Não houve associação entre o autorrelato de dor e o desconforto musculoesquelético e os setores de atuação desses profissionais, porém houve uma associação temporal entre o autorrelato de dor e o desconforto musculoesquelético na unidade de terapia intensiva, nas regiões de pescoço (p=0,043), ombros (p=0,009), parte superior das costas (p=0,043), parte inferior das costas (p=0,043) e região de quadril e coxas (p=0,027). A segunda jornada de trabalho desses fisioterapeutas não se mostrou associada com a dor e o desconforto musculoesquelético. CONCLUSÃO: O autorrelato de dor e desconforto musculoesquelético de fisioterapeutas desse hospital universitário, tanto no período admissional (T0) quanto após 12 meses de trabalho (T1) não se mostrou associado com o setor de atuação desses profissionais. Depois de 12 meses, os fisioterapeutas da unidade de terapia intensiva apresentaram aumento no autorrelato de dor e desconforto musculoesquelético.

Análise ergonômica da atividade de quebra tradicional do coco babaçu no município de Itapecuru-Mirim/MA / Ergonomic analysis of the traditional babassu coconut opening in the city of Itapecuru-Mirim, Maranhão, Brazil

Resumo Objetivo: compreender a situação de trabalho das quebradeiras de coco babaçu à luz dos parâmetros da Análise Ergonômica do Trabalho (AET). Métodos: estudo observacional descritivo com mulheres quebradeiras de coco babaçu no município de Itapecuru-Mirim/MA, no período de setembro a novembro de 2014. Os dados foram coletados a partir de observações de campo, registros de imagens (fotos e vídeos), questionários e entrevistas com informantes-chave. Os instrumentos OWAS e RULA foram utilizados na AET. Resultados: riscos biomecânicos foram evidenciados na coleta, no transporte e na quebra dos cocos. Sintomas osteomusculares foram relatados por 93,5% das 275 participantes. Dores na coluna (58,4%), na região lombar (57%), no ombro direito (31,5%) e nos membros inferiores (30,1%) foram as mais referidas. As quebradeiras acreditam que tais sintomas estejam relacionados ao seu trabalho, mas a autonomia de poder decidir sobre a rotina de trabalho e a boa integração com seus pares foram identificados como elementos capazes de aliviar os efeitos da carga laboral, estimulando a satisfação pessoal e contribuindo para a continuidade dessa atividade secular. Conclusão: os resultados das avaliações das condições de saúde e trabalho, ratificados pelos relatos das informantes-chave, indicam a necessidade de mudança na atividade de quebra tradicional do coco babaçu.

Abstract Objective: to understand the work situation of babassu coconut openers through Ergonomic Work Analysis (EWA) parameters. Methods: descriptive observational study involving female babassu coconut openers in the city of Itapecuru-Mirim/MA, Brazil, from September to November 2014, using field observations, records of images (photos and videos), questionnaires and key informants interviews. OWAS and RULA instruments were used in the EWA. Results: biomechanical risks were evidenced in the coconuts collecting, transporting and opening. Musculoskeletal symptoms were reported by 93.5% of the 275 participants. Backache (58.4%), lower back pain (57%), right shoulder pain (31.5%) and lower limb pain (30.1%) were the mostly reported injuries. The openers believe that such symptoms are related to their work, but the autonomy to decide on their own work routine and the good integration with their peers were identified as elements that can mitigate the effects of work load, stimulate personal satisfaction and contribute to the continuity of this secular activity. Conclusion: the evaluations on health and work conditions, ratified by the key informants reports, indicate the need for change in the traditional babassu coconut opening.

Sintomas osteomusculares e estresse não alteram a qualidade de vida de professores da educação básica / Síntomas osteomusculares y estrés no alteran la calidad de vida de los profesores de la educación básica / Musculoskeletal symptoms and stress do not alter the quality of life of basic education teachers

RESUMO Este estudo avaliou a prevalência de sintomas osteomusculares, nível de estresse e qualidade de vida de professores do ensino básico. A amostra foi composta de 298 professores (265 mulheres e 33 homens) da educação infantil e fundamental do município de Caçador, Santa Catarina. Foram avaliados sintomas osteomusculares (Questionário Nórdico de Sintomas Osteomusculares), nível de estresse (Questionário dos Sintomas de Estresse de Lipp) e a qualidade de vida (Questionário WHOQOL-bref). Apresentaram sintomas osteomusculares 48% dos professores e 65% se afastaram das atividades diárias. Manifestaram algum nível de estresse 42% dos professores, principalmente na fase de resistência (73%) e quase-exaustão (19%). Os sintomas psicológicos predominaram sobre os físicos (p<0,05). Os escores médios dos domínios Físico (57,1) e Meio Ambiente (58,2) foram significativamente menores (p<0,001) que os domínios Psicológico (63,8) e Relações Sociais (71,2). O escore da qualidade de vida geral de 62,6 pontos classificou os professores como satisfeitos com a sua qualidade de vida. Em conclusão, a alta prevalência de sintomas osteomusculares e de estresse não altera a qualidade de vida de professores do ensino básico.

RESUMEN Este estudio evaluó la prevalencia de los síntomas osteomusculares, el nivel de estrés y la calidad de vida de profesores de la enseñanza básica. La muestra fue compuesta de 298 profesores (265 mujeres y 33 hombres) de la educación infantil y primaria del municipio de Caçador, Santa Catarina. Fueron evaluados los síntomas osteomusculares (Cuestionario Nórdico de Síntomas Osteomusculares), el nivel de estrés (Cuestionario de los Síntomas de Estrese de Lipp) y la calidad de vida (Cuestionario WHOQOL-bref). Presentaron síntomas osteomusculares el 48% de los profesores y el 65% se alejaron de las actividades diarias. Manifestaron algún nivel de estrés el 42% de los profesores, principalmente en la etapa de resistencia (el 73%) y casi-agotamiento (el 19%). Los síntomas psicológicos predominaron sobre los físicos (p < 0,05). Los puntajes promedios de los dominios Físico (57,1) y Medioambiente (58,2) fueron significativamente menores (p < 0,001) que los dominios Psicológico (63,8) y Relaciones Sociales (71,2). El puntaje de la calidad de vida general de 62,6 puntos clasificó a los profesores como satisfechos con su calidad de vida. En conclusión, la alta prevalencia de los síntomas osteomusculares y de estrés no altera la calidad de vida de los profesores de la enseñanza básica.

ABSTRACT This study assessed the prevalence of musculoskeletal symptoms, level of stress and quality of life of basic education teachers. The sample was composed of 298 teachers (265 women and 33 men) of early childhood and elementary education from Caçador, Santa Catarina, Brazil. Musculoskeletal symptoms (Nordic Musculoskeletal Questionnaire), level of stress (Lipp's Stress Symptoms Inventory) and quality of life (WHOQOL-bref Questionnaire) were evaluated. Forty-eight percent (48%) of the teachers presented musculoskeletal symptoms and 65% were absent from daily activities. Forty-two percent (42%) of the teachers presented some level of stress, mainly at the stage of resistance (73%) and near exhaustion (19%). Psychological symptoms predominated over physical symptoms (p<0.05). The average scores of the Physical (57.1) and Environmental (58.2) domains were significantly lower (p<0.001) than Psychological (63.8) and Social Relations domains (71.2). The score of 62.6 regarding the general quality of life qualified teachers as satisfied with their quality of life. In conclusion, the high prevalence of musculoskeletal symptoms and stress does not alter the quality of life of basic education teachers.

Signs and symptoms of rheumatic diseases as first manifestation of pediatric cancer: diagnosis and prognosis implications / Sinais e sintomas sugestivos de doenças reumáticas como primeira manifestação de doenças neoplásicas na infância: implicações no diagnóstico e prognóstico

ABSTRACT Objective: To assess the prevalence and describe the clinical, laboratory and radiological findings, treatment and outcome of children with cancer initially referred to a tertiary outpatient pediatric rheumatology clinic. Methods: Retrospective analysis of medical records from patients identified in a list of 250 new patients attending the tertiary Pediatric Rheumatology Clinic, Ribeirão Preto Medical School hospital, University of São Paulo, from July 2013 to July 2015, whose final diagnosis was cancer. Results: Of 250 patients seen during the study period, 5 (2%) had a cancer diagnosis. Among them, 80% had constitutional symptoms, especially weight loss and asthenia, and 60% had arthritis. Initially, all patients had at least one alteration in their blood count, lactate dehydrogenase was increased in 80% and a bone marrow smear was conclusive in 60% of patients. Bone and intestine biopsies were necessary for the diagnosis in 2 patients. JIA was the most common initial diagnosis. The definitive diagnosis was acute lymphoblastic leukemia (2 patients), M3 acute myeloid leukemia, lymphoma, and neuroblastoma (one case each). Of 5 patients studied, 3 (60%) are in remission and 2 (40%) died, one of them with prior use of steroids. Conclusion: The constitutional and musculoskeletal symptoms common to rheumatic and neoplastic diseases can delay the diagnosis and consequently worsen the prognosis of neoplasms. Initial blood count and bone marrow smear may be normal in the initial framework of neoplasms. Thus, the clinical follow-up of these cases becomes imperative and the treatment, mainly with corticosteroids, should be delayed until diagnostic definition.

RESUMO Objetivo: Avaliar a prevalência e descrever as principais manifestações clínicas, os exames complementares, o tratamento e a evolução de crianças com doenças neoplásicas atendidas inicialmente em um serviço terciário de reumatologia pediátrica. Métodos: Analisamos retrospectivamente o prontuário médico de pacientes com diagnóstico definitivo de neoplasia, identificados entre 250 casos novos atendidos no ambulatório de reumatologia pediátrica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP, de julho de 2013 a julho de 2015. Resultados: Dos 250 pacientes, cinco (2%) tiveram diagnóstico de neoplasia. Desses, 80% apresentavam sintomas constitucionais, principalmente perda de peso e astenia e 60% artrite. Inicialmente, todos apresentavam pelo menos uma série alterada no hemograma, 80% aumento da desidrogenase lática (LDH) e 60% mielograma confirmatório. Dois pacientes necessitaram de biópsia, óssea e de intestino, para o diagnóstico final. Artrite idiopática juvenil foi o diagnóstico inicial mais frequente. Os diagnósticos definitivos foram leucemia linfoide aguda (dois casos), leucemia mieloide aguda-M3, neuroblastoma e linfoma (um caso cada). Dos pacientes estudados, três (60%) estão em remissão. Dois pacientes foram a óbito (40%), um deles com uso prévio de corticoide. Conclusão: Os sintomas constitucionais e musculoesqueléticos comuns às doenças reumáticas e neoplásicas podem retardar o diagnóstico e consequentemente agravar o prognóstico das neoplasias. O hemograma inicial, assim como o mielograma, podem estar normais no quadro inicial das neoplasias. Dessa forma, o seguimento clínico evolutivo desses casos torna-se imperativo e o tratamento, principalmente com corticoides, deve ser retardado até definição diagnóstica.

Signs and symptoms of rheumatic diseases as first manifestation of pediatric cancer: diagnosis and prognosis implications.

OBJECTIVE: To assess the prevalence and describe the clinical, laboratory and radiological findings, treatment and outcome of children with cancer initially referred to a tertiary outpatient pediatric rheumatology clinic. METHODS: Retrospective analysis of medical records from patients identified in a list of 250 new patients attending the tertiary Pediatric Rheumatology Clinic, Ribeirão Preto Medical School hospital, University of São Paulo, from July 2013 to July 2015, whose final diagnosis was cancer. RESULTS: Of 250 patients seen during the study period, 5 (2%) had a cancer diagnosis. Among them, 80% had constitutional symptoms, especially weight loss and asthenia, and 60% had arthritis. Initially, all patients had at least one alteration in their blood count, lactate dehydrogenase was increased in 80% and a bone marrow smear was conclusive in 60% of patients. Bone and intestine biopsies were necessary for the diagnosis in 2 patients. JIA was the most common initial diagnosis. The definitive diagnosis was acute lymphoblastic leukemia (2 patients), M3 acute myeloid leukemia, lymphoma, and neuroblastoma (one case each). Of 5 patients studied, 3 (60%) are in remission and 2 (40%) died, one of them with prior use of steroids. CONCLUSION: The constitutional and musculoskeletal symptoms common to rheumatic and neoplastic diseases can delay the diagnosis and consequently worsen the prognosis of neoplasms. Initial blood count and bone marrow smear may be normal in the initial framework of neoplasms. Thus, the clinical follow-up of these cases becomes imperative and the treatment, mainly with corticosteroids, should be delayed until diagnostic definition.

Stretch breaks in the work setting improve flexibility and grip strength and reduce musculoskeletal complaints / Programa de ginástica laboral melhora a flexibilidade e força de preensão e reduz queixas osteomusculares em trabalhadores / Programa de gimnasia laboral mejora la flexibilidad y la fuerza de prensión y reduce las quejas musculoesqueléticas en los trabajadores

This study investigated the effect of a stretch break program (SBP) on the flexibility, strength and musculoskeletal complaints of storage (SW) and administrative (AW) sector workers. Twenty-six male workers were randomly selected: 16 workers from the storage sector and ten workers from the administrative sector. We applied the Physical Activity Questionnaire and Musculoskeletal Questionnaire and evaluated flexibility and grip strength before and after 6 months of the SBP. The SPB decreased the SW group members' complaints of paresthesias and numbness in the upper body and total body. The SPB reduced the AW group members' complaints of paresthesias and numbness in the upper body. Furthermore, the SPB improved cervical, trunk and left shoulder flexibility in the SW group and improved cervical and shoulder flexibility and grip strength in the AW group. The SBP contribute to improve flexibility and musculoskeletal complaints in the regions that are affected by higher rates of work-related injuries.

O presente estudo investigou o efeito de um programa de ginática laboral (PGL) na flexibilidade, força e sintomas osteomusculares nos trabalhadores dos setores almoxarifado (GTA) e administrativo (GTAD). Vinte e seis trabalhadores do sexo masculino foram selecionados aleatoriamente: dezesseis GTA e dez GTAD. Aplicamos os questinários de atividade física e de sintomas osteomusculares e avaliamos a flexibilidade e força de preensão manual antes e após seis meses da PGL. O PGL diminuiu o número de queixas de parestesias e dormência dos membros superiores e no corpo total no GTA. O PGL reduziu o número de queixas de parestesias e dormência dos membros superiorese no GTAD. Além disso, o PGL melhorou a flexibilidade da cervical, do tronco e do ombro esquerdo no grupo GTA e a flexibilidade da cervical e ombro e força de preensão no grupo GTAD. O PGL contribuiu para melhoria da flexibilidade e queixas osteomusculares nas regiões corporais com maiores índices de lesões provenientes do trabalho.

El presente estudio investigó el efecto de un programa de gimnasia laboral (PGL) en la flexibilidad, la fuerza y síntomas musculoesqueléticos en los sectores trabajadores de almacén (GTA) y administrativa (GTAD). Veintiséis trabajadores de sexo masculino fueron seleccionados aleatoriamente: dieciséis GTA y diez GTAD. Aplicamos las questinários de la actividad física y los síntomas musculoesqueléticos y evaluamos la flexibilidad y fuerza de presión antes y después de 6 meses de PGL. El PGL disminuyó el número de quejas por parestesias y de entumecimiento de la parte superior del cuerpo y cuerpo total en el GTA. El PGL redujo el número de quejas por parestesias y entumecimiento de los miembros superiorese en GTAD. Además, PGL mejoró la flexibilidad del cervical, el tronco y el hombro izquierdo en el grupo de GTA y flexibilidade del hombro, el cervical y la fuerza de prensión en el grupo GTAD. El PGL contribuyó a mejorar la flexibilidad y musculoesqueléticos quejas en regiones del cuerpo con las mayores tasas de lesiones de trabajo.

Síntomas músculo-esqueléticos en trabajadores operativos del área de mantenimiento de una empresa petrolera ecuatoriana / Musculoskeletal symptoms in the area of operational maintenance of an oil company workers

CONTEXTO: Al ser considerada la ergonomía como una disciplina de carácter científico, que evalúa los riesgos ergonómicos en el medio ambiente laboral, puede evitar enfermedades ocupacionales y accidentes del trabajo, contribuyendo a mejorar las condiciones laborales en una organización. OBJETIVO: Determinar la prevalencia de síntomas músculo-esqueléticos en trabajadores operativos del puesto de trabajo mantenimiento de una Empresa Petrolera Ecuatoriana. METODOLOGÍA: Se llevó a cabo un estudio transversal en 102 trabajadores de sexo masculino, correspondientes al puesto de trabajo de mantenimiento de una empresa petrolera, situada en una locación de la Provincia de Sucumbíos, durante el año 2013; la edad comprendida estuvo entre 18 y 49 años. Para la recolección de datos a cada uno de los trabajadores, previo consentimiento informado se aplicó: un Cuestionario Socio-Demográfico, una Historia Médica Ocupacional y el Cuestionario Nórdico Estandarizado. RESULTADOS: La mayor prevalencia de síntomas músculo-esqueléticos, se encuentra en el grupo de trabajadores de entre 30 y 40 años de edad, en las regiones anatómicas: espalda baja 66 (64,7%), seguido de espalda alta 44 (43,1%), cuello 38 (37,3%) y hombro 27 (26,5%), siendo los más afectados los puestos de trabajo técnico-eléctrico y técnico-mecánico. La regresión logística binaria determinó que las variables no son estadísticamente significativas y, por lo tanto, por sí solas no explican la aparición de síntomas Músculo-Esqueléticos. CONCLUSIÓN: Se concluye que existe una elevada prevalencia de síntomas músculo-esqueléticos en la población estudiada, por lo que se recomienda efectuar una evaluación ergonómica exhaustiva de los puestos de trabajo y posteriormente buscar mecanismos y estrategias de control y prevención de riesgos ergonómicos, con la finalidad de minimizar el desarrollo de lesiones músculo-esqueléticos en la población de estudio.

CONTEXT: When considered ergonomics as a scientific discipline that evaluates ergonomic hazards in the working environment, you can prevent occupational diseases and industrial accidents, helping to improve working conditions in an organization. OBJECTIVE: To determine the prevalence of musculoskeletal symptoms in workers operating as a maintenance work Ecuadorian Oil Company. METHODOLOGY: A cross-sectional study was conducted on 102 male workers, job for the maintenance of an oil company, situated in a location in the province of Sucumbíos, in 2013, the age range was between 18 and 49. To collect data for each worker, informed consent was applied: A Socio-Demographic Questionnaire an Occupational Medical History and the Standardized Nordic Questionnaire. RESULTS: The highest prevalence of musculoskeletal symptoms are in the group of workers between 30 and 40 years old, in the anatomical regions: lower back 66 (64,7%), followed by upper back 44 (43,1% ), neck 38 (37,3%) and shoulder 27 (26,5%) being the most affected stations mechanical technician and electrician work. Binary logistic regression determined that the variables are not statistically significant, and thus alone do not explain the occurrence of musculoskeletal symptoms. CONCLUSION: We conclude that there is a high prevalence of musculoskeletal symptoms in the study population, so it is recommended that a comprehensive ergonomic evaluation of jobs and then find mechanisms and strategies for control and prevention of ergonomic hazards, with the aim minimize the development of musculoskeletal injuries in the study population.

Síntomas musculoesqueléticos en conductores de buses de una institución universitaria / Musculoeskeletal symptoms in bus drivers of a university institution

Los síntomas musculoesqueléticos (SME) en conductores de buses han sido asociados a condiciones inadecuadas en su puesto de trabajo. Se determinó la ocurrencia de SME en el total de la población de conductores de buses de una universidad pública (N = 35) y se relacionó con el puesto de trabajo, la carga postural estática, edad, índice de masa corporal (IMC), jornada de trabajo y la antigüedad en el cargo. El rango de edades fue de 27 a 56 años. Se aplicaron el cuestionario estandarizado Nórdico para la determinación de los SME, un cuestionario para recoger información para caracterizar y determinar los riesgos percibidos en el puesto de trabajo y el método de la Regie National Des Usines Renault para medir la carga postural estática. La media (?± DE) de edad fue de 38,89 ±7,31 años y la del IMC de 31,4 ± 5,74 Kg/m². Los SME estuvieron asociados significativamente con el IMC (r s = 0,895; p<0,05). Hubo elevada incidencia de SME (94%), con mayor ocurrencia en cuello (69%), espalda baja (60%), espalda superior (57%) y rodillas (43%); predominó el dolor, que se ubicó mayormente en dolor fuerte y/o de fuerte intensidad en la espalda baja y rodillas. Los hallazgos pudieran estar relacionados con los riesgos presentes en el puesto de trabajo: ausencia de apoya cabeza, soporte lumbar, silla no deslizable y condiciones del ambiente laboral, vibración y ruido. No hubo asociación ni correlación entre los SME y la carga postural estática. Los resultados sugieren que las condiciones inadecuadas del puesto de trabajo, así como el IMC, predisponen a la ocurrencia de SME.

Musculoskeletal symptoms (MSDs) in bus drivers have been associated to the inadequate conditions of the work station. The occurrence of MES was determined in the total population of bus drivers of a public university (N = 35), and these were related with the work station, the posture static load, age, BMI, worked days and the number of years in the position. In this study, the age range was between 27 and 56 years. The standardize Nordic Musculoskeletal Questionnaire for the determination of the MSDs, the method of the Regie National Des Usines Renault to measure the static postural load and a questionnaire to collect information of the bus working conditions were applied. The mean (?± SD) age was 39±1.94 years and the body mass index (BMI) was 31±1.95 Kg/m². The MSDs were associated significantly to the BMI (r s=0.895 and p<0.05). There was a high incidence of MSDs (94%) with more occurrences in neck (69%), lower back (60%), superior back (57%) and knees (43%). Pain of strong intensity, located in the lower back and knees, was the main symptom. These findings can be related with the risks at the work station, such as absence of head support, lumbar support, non sliding seat and inadequate conditions of the labor environment: vibration and noise. There was neither association nor correlation of MSDs and the postural static load, or with the others variables in study. The results suggest that inadequate conditions of the work stations as well as the BMI, dominated the occurrence of MSDs.

Sintomas musculoesqueléticos em eletricistas de rede de distribuição de energia / Musculoskeletal symptoms among energy distribution network linemen

Contextualização: A presença de sintomas musculoesqueléticos em eletricistas deve ser caracterizada para auxiliar na identificação de fatores de riscos para os distúrbios osteomusculares relacionados ao trabalho (DORT) e para possibilitar implementação de medidas preventivas. Objetivo: Avaliar a ocorrência de sintomas de DORT em eletricistas de uma regional de uma empresa de distribuição de energia elétrica, verificar se existiam diferenças entre as funções exercidas quanto à proporção de trabalhadores sintomáticos, e realizar um levantamento preliminar dos principais fatores de riscos presentes. Métodos: Foram avaliados 30 eletricistas do sexo masculino (38,1±5,5 anos), divididos em três equipes conforme a função exercida (ELV=Eletricistas Linha Viva; EEM=Eletricistas Emergência/Manutenção; EC=Eletricistas Comerciais). Sintomas musculoesqueléticos foram identificados em mapa corporal, qualificados pelo Questionário McGill e quantificados por escala numérica. O questionário DASH também foi aplicado para avaliar impacto dos sintomas nos ombros na performance dos trabalhadores. Resultados: 70% dos eletricistas apresentaram ao menos um sintoma musculoesquelético nos ombros, coluna ou joelhos. A equipe ELV apresentou sintomas musculoesqueléticos em 100% dos trabalhadores e maior pontuação no questionário DASH (28±15). A equipe EEM apresentou sintomas em 67% dos trabalhadores e pontuação DASH de 8±11, e a equipe EC apresentou sintomas em 50%, mas sem sintomas nos ombros. A proporção de trabalhadores sintomáticos nos ombros estava associada à função exercida (p=0.02). Conclusões: Eletricistas avaliados apresentaram alta proporção de trabalhadores sintomáticos, que variou conforme a atividade ocupacional. Intervenções são necessárias para reduzir os riscos de DORT dentre os eletricistas avaliados.

BACKGROUND: Linemen should be evaluated regarding the presence of musculoskeletal symptoms to guide the identification of risk factors for development of work-related musculoskeletal disorders (WMSD) and to allow the implementation of preventive measures. OBJECTIVE: To assess the occurrence of WMSD symptoms among linemen working at a regional branch of an electricity distribution company, to investigate whether there were differences in the proportions of symptomatic workers among the functions performed, and to perform a preliminary survey of the main risk factors present. METHODS: Thirty male linemen (mean age 38.1±5.5 years) were evaluated, divided into three teams according to their job function (Live Line Linemen, LLL; Maintenance/Emergency Linemen, MEL; Commercial Linemen, CL). Musculoskeletal symptoms were identified on a body map, qualified using the McGill questionnaire and quantified using a numerical scale. The DASH questionnaire was also applied to evaluate the impact of the shoulder symptoms on the workers' performance. RESULTS: Seventy percent of the linemen presented at least one musculoskeletal symptom in the shoulders, back or knees. All of the LLL team presented musculoskeletal symptoms and these workers had the highest scores in the DASH questionnaire (28±15). Sixty-seven percent of the MEL team presented symptoms, and their DASH score was 8±11. Fifty percent of the CL team presented symptoms, but none of them had shoulder symptoms. The proportion of workers with shoulder symptoms was related to their job function (p=0.02). CONCLUSIONS: A high proportion of the linemen presented symptoms which varied according to the occupational activity. Interventions are needed to reduce the risk of WMSD among the linemen evaluated.

Efeitos de dois procedimentos educacionais sobre os sintomas musculoesqueléticos em trabalhadores administrativos / Effects of two educational programs on musculoskeletal symptoms in office workers

OBJETIVO: Verificar o efeito da aplicação de dois procedimentos de educação (auto-instrucional e tradicional associado às oficinas de educação) na freqüência de sintomas musculoesqueléticos percebidos. MÉTODOS: Realizou-se um estudo quase-experimental, com 94 funcionários administrativos de uma empresa pública, alocados em três grupos por amostragem aleatória simples e sem reposição, sendo um do Tradicional/Oficinas (32), um de Manual Auto-instrucional (28) e o Controle (34). Mensurou-se a freqüência de sintomas musculoesqueléticos por meio do questionário Nórdico de Sintomas Músculo-esqueléticos, no início e após 30 dias do término dos programas. Utilizou-se a estatística descritiva, a técnica de variância não-paramétrica para o modelo de medidas repetidas em três grupos independentes e o teste de Goodman. RESULTADOS: Pelos dados obtidos na comparação do pré e pós-teste, observa-se que o programa de educação baseado em tradicional e oficinas reduziu significativamente a freqüência de sintomas musculoesqueléticos, nos últimos sete dias. Nos Grupos Controle e do Manual Auto-instrucional, não se observou diferença na freqüência dos sintomas musculoesqueléticos. CONCLUSÕES: Pode-se concluir que as intervenções, principalmente o tradicional associado a oficinas, teve efeito positivo sobre as ações dos indivíduos e, apesar da complexidade de algumas medidas preventivas necessárias, houve uma diminuição dos sintomas musculoesqueléticos dos usuários no trabalho.

OBJECTIVE: To investigate the effect of applying two educational programs (one using a self-instructional approach and the other using a traditional approach similar to educational workshops), on the perceived frequency of musculoskeletal symptoms. METHODS: A quasi-experimental study was conducted in 94 office workers in a public company. The participants were divided into three groups through simple randomized sampling with no replacement. The first group (32 employees) underwent a traditional/workshop program, the second (28) used a self-instructional manual and the third (34) was a Control Group. The frequency of musculoskeletal symptoms was measured by means of the Nordic Musculoskeletal Questionnaire, at the beginning of the program and 30 days after its completion. The statistical analysis consisted of descriptive statistics, a nonparametric analysis of variance technique for a repeated measure model in three independent groups and the Goodman test. RESULTS: From the data collected in pre and post-test comparisons, it was observed that the traditional/workshop educational program significantly reduced the frequency of musculoskeletal symptoms over the final seven days. For the self-instructional manual group and control group, no difference was observed in the frequency of musculoskeletal symptoms. CONCLUSIONS: It could be concluded that the interventions, particularly the traditional approach using educational workshops, had a positive effect on the individuals' actions. Despite the complexity of some of the preventive measures needed, there was a reduction in musculoskeletal symptoms of the participants during work.