Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

Background Low back pain is highly prevalent and the main cause of years lived with disability (YLDs). We present the most up-to-date global, regional, and national data on prevalence and YLDs for low back pain from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. Methods Population-based studies from 1980 to 2019 identified in a systematic review, international surveys, US medical claims data, and dataset contributions by collaborators were used to estimate the prevalence and YLDs for low back pain from 1990 to 2020, for 204 countries and territories. Low back pain was defined as pain between the 12th ribs and the gluteal folds that lasted a day or more; input data using alternative definitions were adjusted in a network meta-regression analysis. Nested Bayesian meta-regression models were used to estimate prevalence and YLDs by age, sex, year, and location. Prevalence was projected to 2050 by running a regression on prevalence rates using Socio-demographic Index as a predictor, then multiplying them by projected population estimates. Findings In 2020, low back pain affected 619 million (95% uncertainty interval 554–694) people globally, with a projection of 843 million (759–933) prevalent cases by 2050. In 2020, the global age-standardised rate of YLDs was 832 per 100 000 (578–1070). Between 1990 and 2020, age-standardised rates of prevalence and YLDs decreased by 10·4% (10·9–10·0) and 10·5% (11·1–10·0), respectively. A total of 38·8% (28·7–47·0) of YLDs were attributed to occupational factors, smoking, and high BMI. Interpretation Low back pain remains the leading cause of YLDs globally, and in 2020, there were more than half a billion prevalent cases of low back pain worldwide. While age-standardised rates have decreased modestly over the past three decades, it is projected that globally in 2050, more than 800 million people will have low back pain. Challenges persist in obtaining primary country-level data on low back pain, and there is an urgent need for more high-quality, primary, country-level data on both prevalence and severity distributions to improve accuracy and monitor change. Funding Bill and Melinda Gates Foundation

Association between malnutrition in children living in favelas, maternal nutritional status, and environmental factors

OBJECTIVE: To investigate the association of malnutrition in children living in substandard settlements (slums) of Maceió, AL, Brazil, with maternal nutritional status and environmental conditions. METHODS: Cross-sectional study involving a probability sample of 2,075 mothers (18 to 45 years) and their children (4 months to 6 years), living in the slums of the city of Maceió. First, we conducted a cluster analysis with the purpose of choosing the settlements and the administrative region of the city of Maceió with the lowest human development index. After this analysis, the 7th Administrative Region was designated for the study, including its 23 substandard settlements. Socioeconomic, demographic, anthropometric, and maternal and child health data were collected by means of household survey. The statistical analysis included the odds ratio of a child to be malnourished, and the univariate regression was used to check which maternal variables were associated with this malnutrition. RESULTS: Chronic malnutrition (-2 standard deviations/height for age) was found in 8.6% of children and was associated with mother's age and educational level, type of residence, number of rooms, flooring, water supply, and low birth weight (< 2,500 g) in children aged < 24 months. We also found an association between child malnutrition and maternal height. Such association was not observed regarding body mass index. CONCLUSIONS: The high prevalence of malnutrition observed in these settlements was related to social and environmental conditions and short maternal height, who had weight deficit or weight excess.OBJETIVO: Investigar a associação da desnutrição em crianças residentes em assentamentos subnormais (favelas) de Maceió (AL) com o estado nutricional materno e as condições socioambientais. MÉTODOS: Estudo transversal, envolvendo amostra probabilística de 2.075 mães (18 a 45 anos) e respectivos filhos (4 meses a 6 anos), moradoras nas favelas da cidade de Maceió (AL). Para escolha dos assentamentos, procedeu-se primeiramente a uma análise de clusters para eleger a região administrativa da cidade de Maceió com menor índice de desenvolvimento humano. Após essa análise, a 7ª Região Administrativa foi a designada para o estudo, com seus 23 assentamentos subnormais. Os dados socioeconômicos, demográficos, antropométricos e de saúde materno-infantil foram coletados através de inquérito domiciliar. A estatística analisou a razão de chances de uma criança ser desnutrida, e a regressão univariada foi usada para verificar quais variáveis maternas estariam associadas a essa desnutrição. RESULTADOS: A desnutrição crônica (-2 desvios padrão/altura por idade) esteve presente em 8,6% das crianças e associou-se com idade e escolaridade materna, tipo de residência, número de cômodos, revestimento de piso, origem da água e baixo peso ao nascer (< 2.500 g) em crianças com idade < 24 meses. Encontrou-se também associação entre desnutrição infantil e baixa estatura materna, que não foi observada para índice de massa corporal. CONCLUSÕES: A alta prevalência de desnutrição infantil observada nesses assentamentos esteve relacionada às condições socioambientais e à baixa estatura das mães, que apresentaram déficit ou excesso de peso.Secretaria Estadual de Saúde de AlagoasUniversidade Federal de Alagoas Faculdade de NutriçãoUniversidade Federal de São Paulo (UNIFESP) Departamento de FisiologiaUNIFESP, Depto. de FisiologiaSciEL

Portuguese translation and validation of the Braden Q scale for predicting pressure ulcer risk in pediatric patients

OBJECTIVE: To translate and culturally adapt the Braden Q scale into a Portuguese version and to test its properties (reliability and validity). METHODS: The Braden Q scale was translated and adapted according to internationally accepted methodology. The instrument was forward and back translated, and the translations were reviewed by a multidisciplinary committee. In the cultural adaptation process, three groups of ten nurses each interpreted the Brazilian version of the Braden Q scale until they fully understood the instrument. In order to evaluate the reliability of the Brazilian version, two other nurses administered the tool to pediatric ICU patients at different time points; the first nurse administered the instrument also in a second time. Statistical analysis was performed using Cronbach's α to evaluate the internal consistency of the scale, and the Spearman and intra-class correlation coefficients were calculated as a measure of reliability. RESULTS: There were no differences between scales translated by different translators during the forward and back translation process. All items of the scale culturally adapted by the 30 nurses were considered relevant. Cronbach's α for internal consistency was 0.936; intra-class correlation coefficient for intra-rater reliability was 0.995 and for inter-rater reliability was 0.998, both indicating high reliability. CONCLUSIONS: The Braden Q scale was successfully translated and adapted, and demonstrated validity and reliability.OBJETIVO: Traduzir para a língua portuguesa, adaptar ao contexto cultural brasileiro e testar as propriedades de medidas, reprodutibilidade e validade da escala de Braden Q. MÉTODOS: A escala de Braden Q foi traduzida e adaptada de acordo com metodologia aceita internacionalmente. Realizou-se tradução e tradução reversa do instrumento, intercaladas de revisões feitas por comitê multisciplinar. Na fase de adaptação cultural, três grupos de dez enfermeiras avaliaram a versão brasileira da escala de Braden Q até obter seu entendimento integral. Na validação da reprodutividade, outras duas enfermeiras aplicaram a versão brasileira em crianças internadas na UTI em tempos diferentes, sendo que a primeira enfermeira avaliou também em um segundo momento. Na análise estatística, para testar a consistência interna da escala, foi calculado o α de Crombach e, para testar a reprodutividade, o teste intraclasse e a correlação de Spearman. RESULTADOS: No processo de tradução e retrotradução, não houve diferença nas escalas feitas pelos diferentes tradutores. Na adaptação cultural realizada pelas 30 enfermeiras, todos os itens da escala foram considerados relevantes. A consistência interna testada pelo α de Crombach foi de 0,936; a correlação intraclasse da reprodutividade intraobservador foi de 0,995 e da reprodutividade interobservador foi de 0,998, ambas apontadas como excelentes. CONCLUSÕES: A escala de Braden Q foi traduzida e adaptada com sucesso, demonstrando ser válida e reprodutível.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Depression and conservative surgery for breast cancer

BACKGROUND: Depression is prevalent among women and associated with reduced quality of life, and therefore it is important to determine its incidence in adult women, especially in those with breast cancer. OBJECTIVE: To determine the occurrence of depression in women who underwent conservative surgery for breast cancer with or without breast reconstruction. METHODS: Seventy-five women aged between 18 and 65 years were enrolled. Patients had undergone conservative surgery for breast cancer with immediate breast reconstruction (n = 25) or without breast reconstruction (n = 25) at least one year before the study. The control group consisted of 25 women without cancer, but of similar age and educational level distribution as the other two groups. The Beck Depression Inventory was used to measure depression. The collected data were assessed using analysis of variance and the &#967;2 test. RESULTS: There were no significant differences between groups in age (p = 0.72) or educational level (p = 0.20). A smaller number of patients had undergone the menopause (p = 0.02) in the control group than in other groups. There were no significant differences in occurrence of depression between groups (&#967;2=9.97; p = 0.126). CONCLUSÍON: Conservative surgery for breast cancer did not affect the occurrence of depression in women, regardless of whether breast reconstruction was performed

Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050 : a systematic analysis of the global burden of disease study 2021

A full list of the GBD 2021 Low Back Pain Collaborators can be found at the end of the ArticleBackground: Low back pain is highly prevalent and the main cause of years lived with disability (YLDs). We present the most up-to-date global, regional, and national data on prevalence and YLDs for low back pain from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. Methods: Population-based studies from 1980 to 2019 identified in a systematic review, international surveys, US medical claims data, and dataset contributions by collaborators were used to estimate the prevalence and YLDs for low back pain from 1990 to 2020, for 204 countries and territories. Low back pain was defined as pain between the 12th ribs and the gluteal folds that lasted a day or more; input data using alternative definitions were adjusted in a network meta-regression analysis. Nested Bayesian meta-regression models were used to estimate prevalence and YLDs by age, sex, year, and location. Prevalence was projected to 2050 by running a regression on prevalence rates using Socio-demographic Index as a predictor, then multiplying them by projected population estimates. Findings: In 2020, low back pain affected 619 million (95% uncertainty interval 554–694) people globally, with a projection of 843 million (759–933) prevalent cases by 2050. In 2020, the global age-standardised rate of YLDs was 832 per 100 000 (578–1070). Between 1990 and 2020, age-standardised rates of prevalence and YLDs decreased by 10·4% (10·9–10·0) and 10·5% (11·1–10·0), respectively. A total of 38·8% (28·7–47·0) of YLDs were attributed to occupational factors, smoking, and high BMI. Interpretation: Low back pain remains the leading cause of YLDs globally, and in 2020, there were more than half a billion prevalent cases of low back pain worldwide. While age-standardised rates have decreased modestly over the past three decades, it is projected that globally in 2050, more than 800 million people will have low back pain. Challenges persist in obtaining primary country-level data on low back pain, and there is an urgent need for more high-quality, primary, country-level data on both prevalence and severity distributions to improve accuracy and monitor change.peer-reviewe