Fábio Araújo

Trends in cardiovascular diseases and cancer mortality in 45 countries from five continents (1980-2010)

Background Cardiovascular diseases (CVD) and cancer are worldwide main causes of death with mortality trends varying across countries with different levels of economic development. Design and methods We analysed trends in CVD and cancer mortality for 37 European countries, five high-income non-European countries and four leading emerging economies (BRICS) using data from the World Health Organization database for the period 1980–2010. Results In high-income countries, CVD mortality trends are characterized by steep declines over the last decades, while a downward trend in cancer mortality started more recently and was less pronounced. This resulted in the gradual convergence of the CVD and cancer mortality rates, and the latter are already higher in some countries. The absolute number of CVD deaths decreased in most settings, while cancer deaths increased in nearly all countries. Among the BRICS, China and South Africa share a similar pattern of no meaningful variation in both CVD and cancer age-standardized mortality rates and an increase in the overall number of deaths by these causes. Brazil presents trends similar to those of high-income countries, except for the still increasing number of CVD deaths. Conclusions The substantial decreases in CVD mortality over the last decades have overcome the impact of the growth and ageing of populations in the overall number of deaths, while stabilization in the number of cancer deaths was observed only in some of the high-income countries.

Sagittal standing posture, back pain, and quality of life among adults from the general population: a sex-specific association.

Study Design. A prospective radiographical study of sagittal standing posture among adults consecutively recruited from the general population. Objective. To analyze the relation of suboptimal sagittal standing posture with back pain and health-related quality of life in general adult males and females. Summary of Background Data. Clinical studies have shown the association of sagittal standing posture with pain and reduced quality of life, but this relation has not been assessed in the general adult population. Methods. As part of the EPIPorto population-based study of adults, 178 males and 311 females were evaluated. Age, education, and body mass index were recorded. Radiographical data collection consisted of 36-in. standing sagittal radiographs. Creation of 3 groups for individual spinopelvic parameters was performed (low, intermediate, or high), and 1 of 4 sagittal types of postural patterns attributed to each participant (Roussouly classification). Back pain prevalence and severity were assessed on the basis of self-reported data and health-related quality of life using 2 main components of the 36-Item Short Form Health Survey. Results. In males, differences in back pain severity were observed only among pelvic tilt/pelvic incidence ratio groups. Females presenting high pelvic incidence and sacral slope exhibited higher odds of severe back pain than those with intermediate values (adjusted odds ratios = 2.21 and 2.15; 95% confidence interval, 1.24–3.97 and 1.21–3.86; respectively). Sagittal vertical axis showed the largest differences in physical quality of life of females: high group had 8.8 lower score than the low group (P < 0.001), but this result lost statistical significance after adjustment for age, education, and body mass index. Conclusion. Sagittal standing posture was not consistently associated with quality of life measures in males. Increased pelvic incidence and sacral slope may be involved in causing severe back pain among females. Monitoring sagittal postural parameters has limited usefulness as a screening tool for causes of unspecific musculoskeletal symptoms in the general adult population. Level of Evidence: 3

Patterns and Consequences of Multimorbidity in the General Population: There is No Chronic Disease Management Without Rheumatic Disease Management

To identify empirical model‐based patterns of multimorbidity from chronic noncommunicable diseases in the general population, with a focus on the contribution of rheumatic and musculoskeletal diseases (RMDs), and to quantify their association with adverse health outcomes.

Osteoarthritis medical labelling and health-related quality of life in the general population

BackgroundOsteoarthritis is the most common chronic joint disease. In the absence of an effective medical treatment and due to the chronic nature of this condition, an osteoarthritis medical diagnosis may finally result in decreased health-related quality of life. Therefore, the aim of this study was to measure the impact of the osteoarthritis medical labelling on physical and mental health-related quality of life.MethodsSubjects (n = 1132, 58.7% women) were approached as participants of an urban population-based cohort (EPIPorto). Self-reported information on previous diagnosis of knee, hip or hand osteoarthritis was obtained and rheumatologists established knee, hip or hand osteoarthritis clinical diagnosis in symptomatic individuals. Physical and mental dimensions of health-related quality of life were evaluated using the self-administered Medical Outcomes Study: 36-Item Short Form Survey. Crude and adjusted linear regression coefficients (beta) and the corresponding 95% confidence intervals (95% CI) were computed to estimate the associations between being labelled as an osteoarthritis case and health-related quality of life.ResultsRegardless of disease medical labelling, individuals with osteoarthritis scored significantly lower physical health-related quality of life when compared to those without joint disease (kneeunexposed: beta = −5.3, 95% CI: −7.6, −3.1; kneeexposed: beta = −6.0, 95% CI: −8.4, −3.7; hipunexposed: beta = −6.0, 95% CI: −9.8, −2.3; hipexposed: beta = −11.0, 95% CI: −15.6, −6.4; handunexposed: beta = −4.3, 95% CI: −6.5, −2.0; handexposed: beta = −4.3, 95% CI: −6.6, −2.1). The same was not observed regarding mental health-related quality of life. Among subjects with clinically confirmed osteoarthritis, the medical labelling of this joint disease was not significantly associated to health-related quality of life.ConclusionsThe labelling of knee, hip and hand osteoarthritis diagnosis may not add specific benefit to osteoarthritis patients in terms of its capability to improve health-related quality of life.

Defining Patterns of Sagittal Standing Posture in School-Aged Girls and Boys

Background Sagittal postural patterns are associated with back pain in adolescents and adults. However, it is unknown if postural patterns are already observable during childhood. This would confirm childhood as a key period for posture differentiation and thus for chronic pain etiology. Objective We aimed to identify and describe postural patterns in school-aged girls and boys. Design This was a cross-sectional study. Methods Eligible children were evaluated at age 7 in the population-based birth cohort Generation XXI, Portugal. Posture was assessed through right-side photographs during habitual standing with retro-reflective markers placed on body landmarks. We defined postural patterns from trunk, lumbar and sway angles using model-based clusters and associations with anthropometric measures were assessed by multinomial logistic regression. Results Posture was evaluated in 1147 girls and 1266 boys. Three postural patterns were identified: “Sway” (26.9%), “Flat” (20.9%) and “Neutral to Hyperlordotic” (52.1%) in girls; “Sway to Neutral” (58.8%), “Flat” (36.3%) and “Hyperlordotic” (4.9%) in boys. In girls, higher body mass index was associated with a Sway pattern (vs. Flat, OR=1.21; 95% CI: 1.12-1.29), while in boys, body mass index was higher in the Hyperlordotic pattern (vs. Flat, OR=1.30; 95% CI: 1.17-1.44). Limitations Photogrammetry as a non-invasive method for posture assessment may have introduced some postural misclassification. Conclusions Postural patterns in seven-year-old children were consistent with those previously found in adults, suggesting childhood as a sensitive period for posture differentiation. Sagittal morphology differed between genders, emphasizing gender-specific biomechanical loads during habitual upright position even in prepubertal ages.

The population impact of rheumatic and musculoskeletal diseases in relation to other non-communicable disorders: comparing two estimation approaches

The aim of this study was to quantify the population impact of rheumatic and musculoskeletal diseases (RMDs) with other non-communicable diseases (NCDs), using two complementary strategies: standard multivariate models based on global burden of disease (GBD)-defined groups vs. empirical mutually exclusive patterns of NCDs. We used cross-sectional data from the Portuguese Fourth National Health Survey (n = 23,752). Six GBD-defined groups were included: RMDs, chronic obstructive pulmonary disease or asthma, cancer, depression, diabetes or renal failure, and stroke or myocardial infarction. The empirical approach comprised the patterns “low disease probability”, “cardiometabolic conditions”, “respiratory conditions” and “RMDs and depression”. As recommended by the outcome measures in rheumatology (OMERACT) initiative, health outcomes included life impact, pathophysiological manifestations, and resource use indicators. Population attributable fractions (PAF) were computed for each outcome and bootstrap confidence intervals (95% CI) were estimated. Among GBD-defined groups, RMDs had the highest impact across all the adverse health outcomes, from frequent healthcare utilization (PAF 7.8%, 95% CI 6.2–9.3) to negative self-rated health (PAF 18.1%, 95% CI 15.4–20.6). In the empirical approach, patterns “cardiometabolic conditions” and “RMDs and depression” had similar PAF estimates across all adverse health outcomes, but “RMDs and depression” showed significantly higher impact on chronic pain (PAF 8.9%, 95% CI 7.6–10.3) than the remaining multimorbidity patterns. RMDs revealed the greatest population impact across all adverse health outcomes tested, using both approaches. Empirical patterns are particularly interesting to evaluate the impact of RMDs in the context of their co-occurrence with other NCDs.