Costs and consequences of chronic pain due to musculoskeletal disorders from a health system perspective in Chile

Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain. Background: Chronic pain is a prevalent and distressing condition caused by an unceasing pain lasting more than 3 months or a pain that persists beyond the normal healing time. There is evidence of inadequate management partly explained by the unawareness regarding the magnitude of the problem. Objectives: To estimate the annual expected costs and consequences of chronic pain caused by musculoskeletal diseases from the health system perspective in Chile. Methods: A Markov cohort model was built to represent chronic pain and estimate expected costs and consequences over 1-year time horizon. Transition probabilities were obtained through expert elicitation. Consequences examined were: years lost to disability (YLD), depression, anxiety, and productivity losses. Direct health care costs were estimated using local sources. Probabilistic sensitivity analysis was performed to characterize second-order uncertainty. Results: The annual expected cost due to musculoskeletal chronic pain was estimated in USD $1387.2 million, equivalent to 0.417$94 million (Bayesian credibility interval 95% $49.1-$156.26). Productivity losses were also important cost, although early retirement and presenteeism were not measured. Chronic pain causes 137,037 YLDs. Conclusion: Chronic pain is not only an important cause of disability but also responsible for high social and financial burden in Chile. Public health programs focused on managing chronic pain may decrease burden of disease and possibly reduce costs.

Modifiable risk factors associated with prediabetes in men and women: A cross-sectional analysis of the cohort study in primary health care on the evolution of patients with prediabetes

Background: Prediabetes is a high-risk state for diabetes development, but little is known about the factors associated with this state. The aim of the study was to identify modifiable risk factors associated with the presence of prediabetes in men and women. Methods: Cohort Study in Primary Health Care on the Evolution of Patients with Prediabetes (PREDAPS-Study) is a prospective study on a cohort of 1184 subjects with prediabetes and another cohort of 838 subjects without glucose metabolism disorders. It is being conducted by 125 general practitioners in Spain. Data for this analysis were collected during the baseline stage in 2012. The modifiable risk factors included were: smoking habit, alcohol consumption, low physical activity, inadequate diet, hypertension, dyslipidemia, and obesity. To assess independent association between each factor and prediabetes, odds ratios (ORs) were estimated using logistic regression models. Results: Abdominal obesity, low plasma levels of high-density lipoprotein cholesterol (HDL-cholesterol), and hypertension were independently associated with the presence of prediabetes in both men and women. After adjusting for all factors, the respective ORs (95% Confidence Intervals) were 1.98 (1.41-2.79), 1.88 (1.23-2.88) and 1.86 (1.39-2.51) for men, and 1.89 (1.36-2.62), 1.58 (1.12-2.23) and 1.44 (1.07-1.92) for women. Also, general obesity was a risk factor in both sexes but did not reach statistical significance among men, after adjusting for all factors. Risky alcohol consumption was a risk factor for prediabetes in men, OR 1.49 (1.00-2.24). Conclusions: Obesity, low HDL-cholesterol levels, and hypertension were modifiable risk factors independently related to the presence of prediabetes in both sexes. The magnitudes of the associations were stronger for men than women. Abdominal obesity in both men and women displayed the strongest association with prediabetes. The findings suggest that there are some differences between men and women, which should be taken into account when implementing specific recommendations to prevent or delay the onset of diabetes in adult population

Different Alternatives to Assess the Burden of Disease Using Attributable Fraction on a Disability Variable: The Case of Pain and Chronic Musculoskeletal Disorders in Chile.

ObjectivesTo estimate the burden of disease through 4 complementary procedures to years lived with disability (YLDs) using the concept of attributable fraction and including analysis of subdomains of disability.MethodsWe explored the burden on disability for 7 common musculoskeletal disorders (CMD) using the 2009 to 2010 Chilean National Health Survey, which included the Community Oriented Programme for the Control of Rheumatic Disease Core Questionnaire to identify cases with CMD, and an 8-domain questionnaire for health state descriptions. We calculated the proportion of disability attributable to pain in the general population and people with CMD. We also estimated the burden of CMD expressed as YLD and as the proportion of the disability in the general population attributable to people with CMD, with a particular focus in the pain domain of disability. Second order of uncertainty around point estimations was also characterized.ResultsPain domain of disability accounted for 23.4% of the total disability in the general population, and between 20% (fibromyalgia) to 27.1% (osteoarthritis of the hip) in people with some of the selected CMD. People with chronic musculoskeletal pain accounted for 21.2% of total disability from general population, which generated 1.2 million of YLD (6679 YLD/100 000 inhabitants). Chronic low back pain and osteoarthritis of the knee were in the top position of specific CMDs, explaining the highest national burden.ConclusionPain is an essential component of disability in people with CMD and also in the general population. The approach used can be easily applied to other health conditions and other domains of disability

Ética e educação clássica: virtude e felicidade no justo meio Ethics and classical education: virtue and happiness in the golden mean

O presente estudo debruça-se sobre a interface do problema educativo com a problemática da ética, compreendendo a pedagogia com a arte/ciência voltada para a busca do bem educar/instruir/formar. Para tanto, o texto mobilizará conceitos da concepção ética da Aristóteles; e, na atmosfera mental da Grécia clássica, recorre-se ao termo específico grego e transdisciplinar na origem: paideia. A seguir, este ensaio procura pontuar alguns aspectos da concepção iluminista a propósito do tema, valendo-se da noção kantiana de imperativo categórico, a qual teria sido precedida pelo parecer de Rousseau, segundo o qual a vontade - e não a razão - seria a marca distintiva do gênero humano no ambiente natural. A idéia de Piaget de uma ética da reciprocidade também é aqui mobilizada. Abordando diacronicamente a temática, serão analisados conceitos de autores clássicos no debate da relação entre educação e ética, com destaque para o sentido conferido por Hanna Arendt para a autoridade como critério distintivo da relação assimétrica entre o educador (as gerações adultas de maneira geral) e os estudantes (ou as novas gerações). Arendt defende, como conceito e pressuposto operatório, a dimensão necessariamente conservadora do ato educativo: compete ao educador preservar do mundo as novas gerações e preservar o mundo das novas gerações - para que estas não destruam o suporte e o acervo cultural acumulados.<br>The present study is an in-depth discussion of the interface between educational and ethical problems, understanding pedagogy as the art/science aiming at good education/instruction/training. For this purpose, the text will summon concepts from Aristotle's ethics. Immersed in Classical Greek Thought, it will attempt to rescue a term which is originally interdisciplinary - paideia. Next, this essay tries to highlight some aspects of the illuminist concept of the theme, taking advantage of the Kantian notion of categoric imperative, which had been preceeded by Rousseau's opinion asserting that will - and not reason - would be the distinctive feature of the human race in a natural environment. Piaget's idea of reciprocity ethics is also evoked here. Through a diachronic approach of the theme, concepts of classical authors who have debated the relationship between ethics and education will be analyzed, focusing on the sense Hanna Arendt conferred to authority as a distinctive criteria of the asymmetric relationship between educators (adult generations) and students (new generations). As an operating concept and assumption, Arendt advocates that the educational act necessarily entails a conservative dimension: the mission of educators is to protect the new generations from the world and the world from the new generations - so that they do not to destroy the accumulated supports and cultural heritage