Disability prevalent conditions in women

Women and men can have the same illnesses, but with different prevalence and reactions to symptoms.

OBJECTIVE

This study aimed to emphasize that distinct traits between men and women require a different approach for each of them.

METHODS

PubMed and Google Scholar were searched using the following terms: Disability Evaluations, Women's health, Osteoporosis, Osteoarthritis, and Lymphedema, Pregnancy.

RESULTS/CONCLUSION

Disease management can go beyond the symptoms, assessing the long-term consequences and possibly the disabilities they can generate, compromising the quality of life of the person, his/her family members, and eventually caregivers.

Generating evidence and understanding the treatment of osteoarthritis in Brazil: a study through Delphi methodology

OBJECTIVES

This study aimed to provide evidence for understanding how to treat osteoarthritis (OA) in our country. Therefore, it was necessary to match information and investigations related to the treatment of the disease from the three main types of specialists involved: physiatrists, orthopedists and rheumatologists.

METHODS

The authors acted as a scientific advisory committee. From the initial discussions, a structured questionnaire was developed for use with a group of specialists on OA using the Delphi technique. The questionnaire was sent to 21 experts appointed by the authors, and the results obtained were critically analyzed and validated.

RESULTS

The prevalence of OA was 33% in Brazil, corresponding to one-third of the individuals in the reference population, which included individuals over 25 years of age. Another significant finding was that most patients did not receive any form of treatment in the early stages of OA.

CONCLUSION

The committee pointed to the need for early intervention and that the available medicinal resources can fulfil this important role, as is the case with SYSADOA treatments. Glucosamine-based medicinal products with or without chondroitin could also fulfill this need for early treatment. The other generated evidence and included investigations were then grouped together and are the subject of this publication.

PROFILE OF PATIENTS WITH OSTEOPOROTIC FRACTURES AND FACTORS THAT DECREASE PREVENTION

Objective:

To evaluate the epidemiological profile of patients with osteoporotic fractures compared to patients with osteoarthritis (OA) and identify factors that diminish adherence to secondary prevention.

Methods:

A total of 108 patients with osteoporotic fractures (OF) were compared to 86 patients with OA.

Results:

Patients in the OF group were older (p < 0.001); had a lower body mass index (p < 0.001); were less literate (p = 0.012); were more frequently Caucasian (p = 0.003); were less frequently married (p < 0.001); experienced more falls, cognitive deficiency, previous fractures, old fracture, falls in the last year, and fall fractures; needed more help and took more medicine for osteoporosis (p < 0.05); and showed less pathology in the feet, muscle weakness, less vitamin D intake, and lower Katz & Lawton scores (p < 0.001). Factors that increased the chance of nonadherence included older age (p = 0.020), falls (p = 0.035), cognitive deficiency (p = 0.044), and presence of depression/apathy/confusion (p < 0.001).

Conclusion:

Patient age, ethnicity, marital status, previous falls, foot pathologies, muscle weakness, previous fractures, use of vitamin D, use of osteoporosis drugs, and lower Katz & Lawton scale score defined the OF group. Factors that increased the chance of nonadherence included older age, sedative use, cognitive disorders, and symptoms of depression/apathy/confusion. Level of Evidence III, Case-control.

Double-blind, randomized, double-dummy clinical trial comparing the efficacy of ketorolac trometamol and naproxen for acute low back pain

Background

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common type of medication used in the treatment of acute pain. Ketorolac trometamol (KT) is a nonnarcotic, peripherally acting nonsteroidal anti-inflammatory drug with analgesic effects comparable to certain opioids.

Objective

The aim of this study was to compare the efficacy of KT and naproxen (NA) in the treatment of acute low back pain (LBP) of moderate-to-severe intensity.

Patients and methods

In this 10-day, Phase III, randomized, double-blind, double-dummy, noninferiority trial, participants with acute LBP of moderate-to-severe intensity as determined through a visual analog scale (VAS) were randomly assigned in a 1:1 ratio to receive sublingual KT 10 mg three times daily or oral NA 250 mg three times daily. From the second to the fifth day of treatment, if patient had VAS >40 mm, increased dosage to four times per day was allowed. The primary end point was the reduction in LBP as measured by VAS. We also performed a post hoc superiority analysis.

Results

KT was not inferior to NA for the reduction in LBP over 5 days of use as measured by VAS scores (P=0.608 for equality of variance; P=0.321 for equality of means) and by the Roland–Morris Disability Questionnaire (P=0.180 for equality of variance test; P=0.446 for equality of means) using 95% confidence intervals. The percentage of participants with improved pain relief 60 minutes after receiving the first dose was higher in the KT group (24.2%) than in the NA group (6.5%; P=0.049). The most common adverse effects were heartburn, nausea, and vomiting.

Conclusion

KT is not inferior in efficacy and delivers faster pain relief than NA.

[2008 official positions of the Brazilian Society for Clinical Densitometry--SBDens]

With the evolution of bone densitometry, differences in technologies, acquisition techniques, reference databases, reporting methods, diagnostic criteria and terminology have developed and the International Society for Clinical Densitometry (ISCD) periodically holds Position Development Conferences, the latest in 2007. The Brazilian Society for Clinical Densitometry (SBDens), with support from many Brazilian societies interested in bone health, gathered numerous specialists to discuss the ISCD proposals and to evaluate the validity of the extension of those norms to Brazilian population. The SBDens reunion of consensus made a very useful document to help the understanding and interpretation of bone densitometry and other methods of bone assessment.

[Osteoporosis and exercise]

Osteoporosis is the most frequent metabolic alteration affecting bones, being one of the most common diseases in women after menopause. It can be defined as a clinical condition in which there is significant bone loss with a reduction in bone mass beyond that which is considered normal for patient's age and sex, risking the integrity of the bone structure, diminishing its resistance and causing fractures of the affected bones, even at minimum effort. Bone loss is an inevitable consequence of aging and it is responsible for a high level of morbidity. It is considered a silent disease until the first fractures. The prevention is extremely important as well as the rehabilitation and drug treatment. The exercises are necessary, not only preventing the osteoporosis itself but also preventing the falls that can provoke bone fractures.

[Evaluation of isokinetic trunk flexion and extension in normal sportsman and sedentary people]

It was studied two groups: Group 1: 13 male voluntaries, competition sportsman, mean age: 25 +/- 2.1 years (18-30): Group 2: 17 male voluntaries, sedentary, mean age: 31.2 years (23-46). All the voluntaries was evaluated by the CYBEX 6000, TEF (trunk flexion extension) module. The parameters analyzed were: peak torque, total work and average power (absolute values and corrected by the body weight) and the flexion/extension relation. All the tests were performed at the speed of 60 and 120 degrees per second. The peak torque absolute values at 60 and 120 degrees were higher in Group 1 than Group 2 (p < 0.05), in flexion and extension movement. At the corrected date by the body weight, this relation remained the same, at 60 degrees, for flexion and extension and for extension at 120 degrees (p < 0.05), but the flexion at 120 degrees is not different in both groups. The peak torque angle is the same for extensor tests at both speed, but is different for the flexor test, at 60 degrees. The total work performed was better in the Group 1 at 60 degrees during the flexion (p < 0.05) and during the extension in both tested speed. At the corrected values the work is the same at flexion and at extension is higher only at 120 degrees (p < 0.05). At the average power of flexion movement there is a difference at the absolute values, that was not seen at the body weight corrected date. The difference between average power of the extension, in both speeds was significant at 60 and 120 degrees. The relation between flexor and extensor: Group 1: peak torque 80% at 60 degrees, total work and average power is nearly 100%; Group 2: peak torque, total work and average power is closed to 100%, at 60 degrees. The flexor muscles values are light higher than the extensor muscles, that means the abdominal muscles are stronger than the spine erector muscles. At 120 degrees this tendency is more clear and the relation is 120-125% and at the sedentary group this relation is higher: 150-165%.

[Physiatric treatment of pain in osteoarthrosis]

The osteoarthrosis is a disease of high incidence in the population affecting chiefly middle-aged women. The chronic pain is the main cause of incapacity and may be responsible for the secondary articular alterations in theses patients. This paper reviews the physiopathology and the treatment of the pain in osteoarthrosis.