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Cunha-Miranda L.,Instituto Portugues Of Reumatologia
Acta Reumatologica Portuguesa

Introduction: Work related musculoskeletal diseases (WRMSDs) have a huge social and economic impact being a public health problem. Objectives: To determine the prevalence of WRMSDs in Portuguese active workers. Methods: A questionnaire was sent by regular mail to the occupational physician of 822 large dimension companies in Portugal (over 250 employees). This questionnaire was addressed to the physician and contemplated data on file from the occupational medical doctor of clinically relevant WRMSDs (rather than addressing workers complaints). A reply form and a telephone reminder were used to assure a higher number of respondents. Results: Of the selected 822 companies, 515 responded (response rate of 62.3%) involving a total population of 410 496 workers. The prevalence of clinically relevant WRMSD was of 5.9% (24 269 cases). The more prevalent WRMSD were back pain with a prevalence of low back pain of 2.27% (n=9310, 38.4% of total WRMSD). Dorsal pain 0.82% (n= 3379, 13.9% of total WRMSDs) and cervical pain 1.13% (n=4651, 19.2% of total WRMSD). Back pain accounts for 4.22% (n= 17340) and a total of 74.9% of all WRMSDs. Regarding the upper limb we found a prevalence of 1.61% (n= 6493). From this total, shoulder tendonitis was 0.59%(n= 2398, 9.9% of total WRMSDs), carpal tunnel syndrome 0.29% (n=1170, 4.8% of total WRMSDs), elbow tendonitis 0.29% (n=1202, 5% of total WRMSDs) and hand tendonitis 0.44% (n=1823, 7.5% of total WRMSDS). A lower prevalence was observed in the lower limbs with lower limb tendonitis of 0.08% (n=336, 0.01% of total WRMSDs). Discussion/Conclusion: Our work was representative of 11% of the working Portuguese population. We have found a prevalence of clinically relevant WRMSD of 5,9%. If we extrapolate for the total of the working population we would have 220 467 workers with WRMSDs. Our data are in conflict with national social security services regarding these diseases with much lower reported diseases that proves the inefficacy of the national reporting system. There are clear differences in our data when compared with the literature. We found a higher number of back pain, and in proportion of cervical pain, and lower numbers of upper and lower limb WRMSDs. In the upper limb we found a higher level of hand tendonitis and a decrease of elbow tendonitis and carpal tunnel syndrome. This work was a first effort to characterize WRMSDs in Portugal. Due to the study design we believe that further studies aimed for higher risk populations should be performed. Source

Non-traumatic osteonecrosis of the patella is a rare cause of knee pain that must be present in the diagnostic discussion of disability of the knee with subacute character. The author describes a case in which the characteristic images had an important role in defining the etiology of disabling knee pain, developing pathophysiological hypotheses that may have contributed to the clinical presentation, including situations of overuse of the joint. Source

Martins M.D.C.,Instituto Nacional Of Saude Dr Ricardo Jorge | Faleiro L.L.,Instituto Portugues Of Reumatologia | Fonseca A.,Instituto Nacional Of Saude Dr Ricardo Jorge
Revista Portuguesa de Cardiologia

Objective: To analyze the relationship between leptin and obesity expressed as body mass index (BMI) and certain components of the metabolic syndrome (MS) in an adult population. Methods: The study included 103 subjects, 42 men and 61 women, aged over 30 years, clinically defined as non-diabetic but with personal or family history of cardiovascular disease. All subjects underwent fasting blood measurements of leptin, insulin, glucose, glucose after ingestion of 75 g glucose, HDL cholesterol and triglycerides, and insulin resistance (IR) and BMI were calculated. Results: BMI as an index of overall adiposity was strongly associated with serum leptin. BMI rose as serum leptin levels increased from the first to the third tertile; the correlation between leptin and BMI was strong, r = 0.524 in men and r = 0.603 in women, with high statistical significance (p < 0.001 ); BMI was the best predictor of hyperleptinemia on ROC analysis, with area under the curve (AUC) = 0.81 in men and 0.84 in women. The association between leptin and obesity (BMI ≥ 30 kg/m2) showed high odds ratios (OR) in both sexes (10.11 in men, 6.00 in women) on univariate regression analysis and 9.30 in men and 8.21 in women on multivariate regression analysis. Hyperinsulinemia and IR strongly influenced hyperleptinemia. Leptin was the best predictor of IR in both sexes (AUC = 0.89 in men and 0.85 in women), and IR in men (AUC = 0.79) and hyperinsulinemia in women (AUC = 0.78) were the best predictors of hyperleptinemia after BMI. The correlations between leptin and IR, and leptin and insulinemia, were strong in both sexes. With regard to MS components, increased serum levels of the study variables were observed as leptin concentrations rose from the first to the third tertile (with the exception of HDL cholesterol, which decreased). Conclusion: Elevated serum leptin, particularly in obese individuals, should be taken as a warning sign of energy imbalance, poor diet, hyperinsulinemia, insulin resistance, or changes in other metabolic risk factors that are strongly associated with cardiovascular disease and type 2 diabetes. © 2011 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved. Source

Cunha-Miranda L.,Instituto Portugues Of Reumatologia
Acta Reumatologica Portuguesa

Objective: Portuguese data concerning general population knowledge and prevalence about neuropathicpain (NeP) are sparse and many patients remain frequently undiagnosed as this disease is still under recognized among population. This study aimed to evaluate Portuguese perception about NeP and to characterize their knowledge and information sources. Additionally, the study had the exploratory objective of determining NeP prevalence. Materials and Methods: Epidemiological, cross-sectional study of a representative sample of the Portuguese population aged 18 years old or more, by direct application of a structured question naire. Demographic data and data on knowledge and perception about NeP were collected. It was also collected data about NeP diagnosis. Descriptive analysis and a logistic regression assuming a significance level of 0.05 were performed. Results: 1072 subjects were included, 47.9% male, mean±SD age 46.4±18.6 years old. 71.3% referred never having heard about NeP. The percentage of individuals who declared to know about NeP characteristics decreased as the specificity of the theme increased:24.8% referred knowing the disease's symptoms, 23.0% knew how it is treated and 15.6% knew which situations/ pathologies can cause NeP. The three most referred symptoms of the disease were itching (42.6%),numbness (33.6%) and joint pain (31.2%). An olderage and a higher educational level were associated witha higher knowledge about this pathology. A 3.2% auto referred prevalence of NeP was observed. Conclusions: The data highlight the lack of information about NeP in Portugal. Defining multi dimensio nalstrategies to improve people's awareness about NeP might improve early diagnosis and treatment of thisvery debilitating condition. Source

Laires P.A.,Outcomes Research | Exposto F.,IMS Health | Mesquita R.,Merck And Co. | Martins A.P.,Outcomes Research | And 2 more authors.
European Journal of Health Economics

Background: Despite the widespread availability of biologics across Europe, rheumatoid arthritis (RA) patients' access to these drugs differs significantly among countries. Objectives: To compare the proportion of RA patients treated with biologics across Europe and investigate the factors that most influence it, with focus on the Portuguese case, reportedly with low access rates to biologics. Methods: The biologics' market was characterized for 15 selected European countries. Variables potentially influencing patients' access to biologics (PAB) in RA were also collected, including demographic, disease, economic, funding and biologics' market-related data. A multivariable regression model identified the factors that best explain PAB. Based on these determinants, a cluster analysis was performed to group the countries with most similar behaviour regarding PAB allowing the evaluation of Portugal's relative position among these countries. Results: The regression model (R 2 = 0.953) indicated that PAB in selected countries is explained mostly by its gross domestic product (GDP) per capita, the usage of methotrexate (MTX) and the biologics' distribution channel. Current MTX usage in Portugal shows similarity with practice from UK, France, Germany or Spain 5 years before, explaining why PAB in Portugal stood at 7 % in 2010, 12 percentage points below the average of selected countries. Conclusions: Variations in RA PAB were found across selected countries with Portugal showing the lowest proportion. GDP per capita, biologics distribution channel and consumption of MTX appear to be the best explanatory factors for these fluctuations in European countries. © 2012 Springer-Verlag. Source

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