Factors Associated With Scoliosis in Schoolchildren: a Cross-Sectional Population-Based Study

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Abstract

Background

The present study aimed to investigate the prevalence of scoliosis and to analyze the factors associated with scoliosis in schoolchildren aged between 7 and 17 years.

Methods

This is a cross-sectional and quantitative study with stratified random selection of public school students in the city of Santa Cruz, Brazil. The presence of scoliosis was examined, as well as the flexibility of the posterior muscle chain, socioeconomic characteristics, anthropometry, lifestyle habits, sexual maturation, and ergonomics of school furniture. In order to identify factors associated with scoliosis, the variables were divided in biological, socioeconomic, lifestyle, and ergonomic factors, and crude and adjusted prevalence ratios (PRs) were estimated by means of Poisson regression analysis.

Results

Two hundred and twelve pupils participated in this study (mean age 11.61 years, 58% female). The prevalence of scoliosis was 58.1% ( n = 123) and associated with female sex (PR 2.54; 95% CI, 1.33–4.86) and age between 13 and 15 years (PR 5.35; 95% CI, 2.17–13.21). Sleeping in a hammock was inversely associated with scoliosis (PR 0.44; 95% CI, 0.23–0.81).

Conclusions

Scoliosis seems to be positively associated with female sex and age between 13 and 15 years, whereas the habit of sleeping in a hammock is negatively associated with the onset of scoliosis.

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Most cited references 15

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Epidemiology, evidenced-based medicine, and evidence-based public health.

M Jenicek (1997)

Evidence-Based Medicine (EBM) is heralded as a new paradigm of medicine. Is it? What is its link to epidemiology? Does an evidence-based (EB) approach apply also to other health sciences and to public health in particular? What has epidemiology already achieved in these domains, and what remains to be done? What should our priorities be in the coming years? The EB approach is essential in all health sciences at two levels: for problem solving, and for decision making. It applies to all health sciences, be it medicine, nursing, public health, or others. Many epidemiological principles, methods and techniques are put into good use in EBM. The EB "movement" is attractive in it's use of clearly defined procedures, generalizing (not always explicitly) the application of good epidemiologic principles, methods, and techniques. Epidemiology must now contribute to the evaluation of the practice of an EB approach. If one does not have access to a good medical library nor information technology does the EBM paradigm still hold? Hence, clinical and public health guidelines will benefit first from the EBM approach, then daily practice of EBM will follow, conditions permitting. In public health, the challenges of the EB practice are not equally spread across health protection, different levels of disease prevention, and health promotion. The latter represents the most challenging task for epidemiology at any step of EB approach. Epidemiology, if successful in this domain, may help to build an EB health promotion. An Evidence-Based Public Health paradigm may be considered.

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A review of the trunk surface metrics used as Scoliosis and other deformities evaluation indices

Petros Patias, Theodoros Grivas, Angelos Kaspiris … (2010)

Background Although scoliosis is characterized by lateral deviation of the spine, a 3D deformation actually is responsible for geometric and morphologic changes in the trunk and rib cage. In a vast related medical literature, one can find quite a few scoliosis evaluation indices, which are based on back surface data and are generally measured along three planes. Regardless the large number of such indices, the literature is lacking a coherent presentation of the underlying metrics, the involved anatomic surface landmarks, the definition of planes and the definition of the related body axes. In addition, the long list of proposed scoliotic indices is rarely presented in cross-reference to each other. This creates a possibility of misunderstandings and sometimes irrational or even wrong use of these indices by the medical society. Materials and methods It is hoped that the current work contributes in clearing up the issue and gives rise to innovative ideas on how to assess the surface metrics in scoliosis. In particular, this paper presents a thorough study on the scoliosis evaluation indices, proposed by the medical society. Results More specifically, the referred indices are classified, according to the type of asymmetry they measure, according to the plane they refer to, according to the importance, and relevance or the level of scientific consensus they enjoy. Conclusions Surface metrics have very little correlation to Cobb angle measurements. Indices measured on different planes do not correlate to each other. Different indices exhibit quite diverging characteristics in terms of observer-induced errors, accuracy, sensitivity and specificity. Complicated positioning of the patient and ambiguous anatomical landmarks are the major error sources, which cause observer variations. Principles that should be followed when an index is proposed are presented.

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Adolescent idiopathic scoliosis (AIS), environment, exposome and epigenetics: a molecular perspective of postnatal normal spinal growth and the etiopathogenesis of AIS with consideration of a network approach and possible implications for medical therapy

R Burwell, Peter H Dangerfield, Alan Moulton … (2011)

Genetic factors are believed to play an important role in the etiology of adolescent idiopathic scoliosis (AIS). Discordant findings for monozygotic (MZ) twins with AIS show that environmental factors including different intrauterine environments are important in etiology, but what these environmental factors may be is unknown. Recent evidence for common chronic non-communicable diseases suggests epigenetic differences may underlie MZ twin discordance, and be the link between environmental factors and phenotypic differences. DNA methylation is one important epigenetic mechanism operating at the interface between genome and environment to regulate phenotypic plasticity with a complex regulation across the genome during the first decade of life. The word exposome refers to the totality of environmental exposures from conception onwards, comprising factors in external and internal environments. The word exposome is used here also in relation to physiologic and etiopathogenetic factors that affect normal spinal growth and may induce the deformity of AIS. In normal postnatal spinal growth we propose a new term and concept, physiologic growth-plate exposome for the normal processes particularly of the internal environments that may have epigenetic effects on growth plates of vertebrae. In AIS, we propose a new term and concept pathophysiologic scoliogenic exposome for the abnormal processes in molecular pathways particularly of the internal environment currently expressed as etiopathogenetic hypotheses; these are suggested to have deforming effects on the growth plates of vertebrae at cell, tissue, structure and/or organ levels that are considered to be epigenetic. New research is required for chromatin modifications including DNA methylation in AIS subjects and vertebral growth plates excised at surgery. In addition, consideration is needed for a possible network approach to etiopathogenesis by constructing AIS diseasomes. These approaches may lead through screening, genetic, epigenetic, biochemical, metabolic phenotypes and pharmacogenomic research to identify susceptible individuals at risk and modulate abnormal molecular pathways of AIS. The potential of epigenetic-based medical therapy for AIS cannot be assessed at present, and must await new research derived from the evaluation of epigenetic concepts of spinal growth in health and deformity. The tenets outlined here for AIS are applicable to other musculoskeletal growth disorders including infantile and juvenile idiopathic scoliosis.

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Author and article information

Journal

Journal ID (nlm-ta): J Epidemiol

Journal ID (iso-abbrev): J Epidemiol

Journal ID (publisher-id): JE

Title: Journal of Epidemiology

Publisher: Japan Epidemiological Association

ISSN (Print): 0917-5040

ISSN (Electronic): 1349-9092

Publication date (Electronic): 5 March 2015

Publication date (Electronic preprint): 19 January 2015

Publication date Collection: 2015

Volume: 25

Issue: 3

Pages: 212-220

Affiliations

[1 ]Physiotherapy, Graduate Program at the Mid-West State University, Paraná, Brazil

[2 ]Graduate Physiotherapist from the Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil

[3 ]Multidisciplinary Maternal and Child Residency at Hospital Ana Bezerra, Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil

[4 ]Physiotherapy; Doctoral student at the Brasília University, Federal District, Brazil

[5 ]Physiotherapy, Graduate Program at the Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil

Author notes

Address for correspondence. Marina Pegoraro Baroni, Physiotherapy, Graduate Program at the Mid-West State University, Voluntários da Pátria Street, 1705, apt 403, Centro, Cascavel, Paraná 85812-160, Brazil (e-mail: marinapegoraro@ 123456hotmail.com ).

Article

Publisher ID: JE20140061

DOI: 10.2188/jea.JE20140061

PMC ID: 4340998

PubMed ID: 25716134

SO-VID: cc734208-3c74-4711-b8a4-592ce6b21770

License:

This is an open access article distributed under the terms of Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Factors Associated With Scoliosis in Schoolchildren: a Cross-Sectional Population-Based Study

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Abstract

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Cardiovascular Innovations and Applications

Most cited references 15

Epidemiology, evidenced-based medicine, and evidence-based public health.

A review of the trunk surface metrics used as Scoliosis and other deformities evaluation indices

Adolescent idiopathic scoliosis (AIS), environment, exposome and epigenetics: a molecular perspective of postnatal normal spinal growth and the etiopathogenesis of AIS with consideration of a network approach and possible implications for medical therapy

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