Barriers to Lose Weight from the Perspective of Children with Overweight/Obesity and Their Parents: A Sociocultural Approach

Introduction. There are not enough studies about the barriers to lose weight from the perspective of children and their parents. Methods. Children and adolescents diagnosed with overweight/obesity in the Department of Endocrinology and their parents were invited to participate in a series of focus group discussions (FGD). Twenty-nine children 10–16 years old and 22 parents participated in 7 focus groups; 2 mothers and 2 adolescents participated in depth interviews. All interviews were recorded, transcribed, and analyzed through grounded theory. Results. Parents went to the hospital only when their children presented any obesity complication; for them, overweight was not a health problem. Parents referred to lack of time to supervise about a healthy diet and exercise; besides, the same parents, relatives, friends, and the mass media encourage the consumption of junk food. Children accepted eating a lot, not doing exercise, skipping meals, and not understanding overweight consequences. Both, parents and children, demanded support to do the time recommended for exercise inside the schools. They also suggested getting information from schools and mass media (TV) about overweight consequences, exercise, and healthy food by health workers; they recommended prohibiting announcements about junk food and its sale. Conclusions. The barriers detected were lack of perception of being overweight, its identification as a disease and its consequences, lack of time to supervise a healthy lifestyle, and a big social influence to eat junk food

Características socio-demográficas asociadas a la presencia de dolor músculo-esquelético, en Cuenca-Ecuador.

OBJETIVO: Determinar las características socio-demográficas asociadas a la presencia de dolor músculo-esquelético (MSQ) en personas mayores de 18 años que viven en el Cantón Cuenca. PACIENTES Y MÉTODOS: Estudio transversal analítico, realizado en sujetos del área rural y urbana, mayores de 18 años, utilizando la metodología COPCORD (Community Oriented Program for the Control of Rheumatic Diseases), adaptada para Ecuador. Se identificaron a los individuos con síntomas reumáticos, casa por casa. La revisión para confirmar el diagnóstico realizó un médico Reumatólogo. El análisis estadístico fue univariado y multivariado. RESULTADOS: Participaron 2 500 personas encuestadas, el 59.6% correspondió al sexo femenino, con una edad promedio de 42.8 años, el 25.5% de los participantes realizaban actividades domésticas. El dolor MSQ se presentó en el 32.2% de las personas, el cual se asoció significativamente a vivir en el área rural, tener menor escolaridad, ingresos económicos por debajo de 340 dólares, carga física mayor de 8 libras, mayor discapacidad funcional y el cocinar con leña en el sector rural. CONCLUSIÓN: El dolor MSQ tiene un alta prevalencia en la población de Cuenca, Ecuador; produciendo discapacidad especialmente en el área rural. Se asocia con menor nivel de escolaridad, ingresos económicos bajos y mayor carga física.To determine the socio-demographic characteritics associated with the precence of musculoskeletal pain (MSK)in people over 18 years who are Living en Cuenca

Physical Function Assessment of a Mayan Population Living With Osteoarthritis: The Importance of Considering Different Aspects of Functioning

Objectives: To assess the physical function of people living with osteoarthritis in a Maya-Yucateco rural community from 3 perspectives and explore factors associated with the presence of disability. Design: Physical function and social, physical, psychological, and behavioral factors were evaluated in all adults detected with hand, hip, and/or knee osteoarthritis (n = 144) through a Community-Oriented Program for the Control of Rheumatic Diseases–based census in the Mayan community of Chankom, Yucatán. All cases fulfilled the American College of Rheumatology criteria. Physical function was assessed from 3 perspectives: hypothetical or “what people think they can do” (Health Assessment Questionnaire-Disability Index [HAQ-DI]), experimental or “what people could do in standardized conditions” (6-minute walk test [6MWT] + the Functional Dexterity Test) and enacted or “what people actually do” (personal care, work, and leisure activities’ self-report). Results: About 80% of participants reported “mild” disability (HAQ-DI ≤ 1) in the hypothetical function perspective, whereas average experimental function scores were low (6MWT: 206 m, Functional Dexterity Test: 64 seconds), and 78% of participants reported problems with enacted function (ie, work). Pain was significantly associated with disability in the hypothetical perspective (odds ratio [OR] = 3 [95% confidence interval [CI]: 1-4]); levels of wealth (β = 5 [95% CI: 1-9]) and muscle strength (β = 54 [95% CI: 20-87]) were significantly associated with functioning in the experimental perspective; and lower levels of self-efficacy (OR = 12 [95% CI: 6-27]) and physical activity (OR = 12 [95% CI: 6-27]) were significantly associated with work disability in the enacted function perspective. Conclusions: People living with osteoarthritis in Chankom show important issues when assessing physical function at the experimental and enacted perspectives, which could have been overlooked if only the hypothetical perspective was considered. Different factors were associated with different physical function perspectives and all should be addressed to decrease disability in this community

Prevalence of disability in patients with musculoskeletal pain and rheumatic diseases in a population from Cuenca, Ecuador

Objective: The aim of this study was to determine the prevalence of disability in patients with musculoskeletal pain and rheumatic diseases in Cuenca, Ecuador. Methods: We performed a cross-sectional analytical study with randomized sampling in 4877 subjects, from urban and rural areas. COPCORD (Community Oriented Program for Control of Rheumatic Diseases)- validated questionnaire was administered house-to-house to identify subjects with nontraumatic musculoskeletal pain and rheumatic diseases. The subjects were assessed by rheumatologists for diagnostic accuracy, and the Health Assessment Questionnaire Disability Index was administered to assess functional capacity. A logistic regression analysis was conducted to determine the association of rheumatic diseases with functional disability. Results: Functional disability was found in 221 subjects (73.1% women), with mean age 62 (SD, 18.2)years, residing in rural areas (201 [66.5%]), with education of 6.9 (SD, 5.3)years, and of low income (77 [47.2%]). The value of HAQ-DI was a mean of 0.2 (0-2.9). The real prevalence of physical disability was 9.5%. Moderate and severe disability predominated in activities such as kneeling (4.9% and 3.3%), squatting (4.8% and 2.7%), and leaning to pick up objects (3.7% and 0.9%), respectively. Rheumatic diseases associated with physical disabilities were knee osteoarthritis (95 [31.4%]) and hand osteoarthritis (69 [22.8%]), mechanical low-back pain (43 [14.2%]), fibromyalgia (27 [9.5%]), and rheumatoid arthritis (11 [3.6%]; P < 0.001). Conclusions: Physical disability was associated with older age, female sex, rural residence, lower education, and lower income. Moderate and severe disability predominated in the dimensions of kneeling, squatting, and picking up objects. Rheumatic diseases associated with disabilitywere hand and knee osteoarthritis, back pain, fibromyalgia, and rheumatoid arthritis. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved

The impact of arthritis on the physical function of a rural Maya-Yucateco community and factors associated with its prevalence: a cross sectional, community-based study

This study aims to evaluate the impact of arthritis on the physical function of people living in a Maya-Yucateco rural community and to assess the association of known modifiable risk factors with the prevalence of overall arthritis and its main types (osteoarthritis and rheumatoid arthritis). Using a cross-sectional, community-based census design, data collected from the adult population (≥18 years) of the Municipality of Chankom, Yucatán, México, were analyzed (n = 1523). Participants’ physical function was assessed using a culturized version of the health assessment questionnaire disability index. Social, physical, and behavioral factors linked to overall arthritis, osteoarthritis, and rheumatoid arthritis, were assessed through the “Community-Oriented-Program-for-the-Control-of-Rheumatic-Diseases [COPCORD]” questionnaire. A physiatrist and a rheumatologist confirmed all osteoarthritis and rheumatoid arthritis cases using the American College of Rheumatology criteria. Arthritis was confirmed in 169 cases (22 %, 95 % confidence interval (CI) 19–25) of those assessed for musculoskeletal symptoms (n = 779): osteoarthritis = 144, rheumatoid arthritis = 17, and non-specific arthritis = 8. Arthritis was associated with a higher prevalence of disability after controlling for age, gender, and number of comorbidities (odds ratio = 4.0, 95 % CI 3.0–6.0). Higher level of wealth was associated with lower arthritis prevalence (odds ratio = 0.9, 95% CI 0.8–0.9). Higher body mass index was associated with higher hip and/or knee osteoarthritis prevalence (odds ratio = 1.1, 95 % CI 1.03–1.1). Arthritis is highly associated with disability in the Mayan people living in Chankom. The prevalence of arthritis in Chankom is associated with social factors, such as people’s level of wealth, while the prevalence of low-extremity osteoarthritis is associated with people’s body mass index

“There are still a lot of things that I need”: a qualitative study exploring opportunities to improve the health services of First Nations People with arthritis seen at an on-reserve outreach rheumatology clinic

Background: Arthritis is a highly prevalent disease and leading cause of disability in the Indigenous population. A novel model of care consisting of a rheumatology outreach clinic in an on-reserve primary healthcare center has provided service to an Indigenous community in Southern Alberta since 2010. Despite quality assessments suggesting this model of care improves accessibility and is effective in meeting treatment targets, substantial improvements in patient-reported outcomes have not been realized. Therefore, the objective of this study was to explore the experiences of Indigenous persons with arthritis and healthcare providers involved in this model of care to inform the development of health service improvements that enhance patient outcomes. Methods: This was a narrative-based qualitative study involving a purposeful sample of 32 individuals involved in the Indigenous rheumatology model of care. In-depth interviews were conducted to elicit experiences with the existing model of care and to encourage reflections on opportunities to improve it. A two-stage analysis was conducted. The first stage aimed to produce a narrative synthesis of concepts through a dialogical method comparing people with arthritis and health providers’ narratives. The second stage involved a collective effort to synthesize concepts and propose specific recommendations to improve the quality of the current model of care. Triangulation, through participant checking and discussion among researchers, was used to increase the validity of the final recommendations. Results: Ten Indigenous people with arthritis lived experience, 14 health providers and 8 administrative staff were interviewed. One main overarching theme was identified, which reflected the need to provide services that improve people’s physical and mental functioning. Further, the following specific recommendations were identified: 1) enhancing patient-provider communication, 2) improving the continuity of the healthcare service, 3) increasing community awareness about the presence and negative impact of arthritis, and 4) increasing peer connections and support among people living with arthritis. Conclusions: Improving the quality of the current Indigenous rheumatology model of care requires implementing strategies that improve functioning, patient-provider communication, continuity of care, community awareness and peer support. A community-based provider who supports people while navigating health services could facilitate the implementation of these strategies.Medicine, Faculty ofNon UBCMedicine, Department ofRheumatology, Division ofReviewedFacult

Validación del cuestionario COPCORD para detección de enfermedades reumáticas CUENCA - ECUADOR

Objetivo: Validar la adaptación cultural del ins-trumento (Community Orientade Programm in the Rheumatic Diseases) COPCORD para de-tectar malestares músculo-esqueléticos y en-fermedades reumáticas en la población del cantón Cuenca.Metodología: Validación transcultural del cues-tionario COPCORD y aplicación en la comuni-dad, para identificar síntomas reumáticos. Un médico reumátologo revisó a las personas para definir el diagnóstico.Se realizó análisis estadístico descriptivo de cada una de la variables; se midió el alfa de Chronbach, análisis de prueba de tamizaje (sensibilidad, especificidad, valor predictivo positivo y curvas roc). Resultados: Participaron 201 personas, 106 del área urbana y 95 del área rural. El 67,6% co-rrespondió a mujeres con una edad promedio 50,3 años, con escolaridad 7,5 años. El 57,7% reportó dolor músculo-esquelético, con una in-tensidad de 5,8 por EVA; al comparar el cues-tionario COPCORD con la evaluación clínica del reumatólogo, se observó una sensibilidad del 83,72, especificidad de 61,14%, razón de verosimilitud de 2,18 y área bajo la curva de 0,72; con una alfa de Cronbach de 0,7 para las características del dolor y 0,9 para capaci-dad funcionalObjective: To validate the cultural adaptation of the instrument (Community Orientate Pro-gram in the Rheumatic Diseases) COPCORD to detect musculoskeletal pain and rheumatic diseases in the population of Cuenca.Methodology: A COPCORD transcultural ques-tionnaire validation and its application were made in the community to identify rheumatic symptoms. A rheumatologist doctor checked people to define the diagnosis. A descriptive statistical analysis of each variable was per-formed. Chronbach alpha, analysis screening test (sensitivity, specificity, and positive predic-tive value and roc curves) was measured.Results: A total of 201 people participated, 106 in urban areas and 95 in rural areas. The 67.6% were women with an average age of 50.3 years with 7.5 years in school. The 57.7% reported musculoskeletal pain with an inten-sity of 5.8 for VSA. Comparing the COPCORD questionnaire with the clinical assessment of the rheumatologist an 83.72% of sensitivity, was observed, specificity of 61.14%, probability of 2.18 and area under the curve of 0.72; with a Cronbach’s alpha of 0.7 for pain characteris-tics and 0,9 for functional capacity.Conclusion: The COPCORD questionnaire is valid for using in rural and urban populations in Ecuador; it demonstrated good performance as a screening test