**4. Discussion**

Program for the Control of Rheumatic Diseases (COPCORD). In the first case, people liv‐ ing in urban area had less prevalence of MSK diseases, in comparison to the people in rural area. In the second case, the musculoskeletal complaints were more frequent in Turks than in

In United States (US), several papers have been published on this topic, especially on immi‐ grant population. In this sense, Schulz et al. [5] describes that the back symptoms and wrist/ hand symptoms were reported by over 35% of Latino workers. In the same way, Rosenbaum et al. [6] identifies that upper body musculoskeletal and low back pain are common in immi‐ grant Latino workers and may negatively impact long‐term health and contribute to occupa‐ tional health disparities. Xiao et al. [8] and Cartwright et al. [9] describe the Latino population

In Latin American (LA), previous studies have shown that people belonging to an indig‐ enous group are associated with the prevalence of rheumatic disease as the rheumatoid arthritis (RA) [28]. Due to the presence in LA of indigenous groups, all countries and their condition of vulnerability, not only socioeconomic but also ethnic, were created the Latin American Group for the Study of Rheumatic Diseases in Original Populations (Grupo Latino Americano De estudio de Enfermedades Reumáticas en Pueblos Originarios; GLADERPO). The main objective was to carry out epidemiological, anthropological and genetic studies, thus fulfilling with intervention processes in the affected populations. Studies are currently being carried out in several indigenous populations of Argentina, Mexico and Venezuela [29]. In 2016, "The Clinical Rheumatology Journal" published a supplement with informa‐ tion about the Maya‐Yucateco, Mixtec, Chontal and Rarámuri populations from Mexico; Warao, Kari'ña and Chaima from Venezuela; and Qom from Argentina [29]. The design of the studies, including samplings, case definition and methodology, was the same. The methodology was that proposed by COPCORD. Overall, low back pain, osteoarthritis (OA) and rheumatic regional pain syndromes (RPPS) were the most prevalent rheumatic diseases across all populations. Among the inflammatory rheumatic diseases, RA was the most prevalent, especially in the Qom community (2.4%) [22]. There were variations in the prevalence of certain diseases among different populations. The low back pain was more prevalent in the Qom community (19.8%) [22] and the OA in the Chontal community (32.1%) [24]. Variations were not related to the design of the study but to the characteristics of the populations and environmental factors, that is to say, heavy loads in Chontales ver‐ sus Rarámuris or Maya‐Yucateco in people not exposed to the same environment [20–23, 26, 27]. These results give information on working and socioeconomic conditions in these

2. Synthesis and interpretation of qualitative studies: Few researches have been conducted based on social impacts associated with MSDs so far. Most outcome studies in occupational health have been focused on workers' compensation (WC), insurance payments, provision of medical services, return‐to‐work time and other direct insurance and employment‐related measures [30]. Unfortunately, there has been little research studying the impact on the social and family environment of the workers affected, as well as the indirect economic conse‐ quences. These complex interactions create significant difficulties for researchers attempting

Caucasians, both living in identical environment.

as a vulnerable group for MSDs.

214 Occupational Health

populations.

to study the social consequences of MSDs.

It is extremely important to study in‐depth the closely related social and cultural aspects. Only traditional social variables have been studied that are only the tip of the iceberg. Multilevel analysis (e.g., individuals, social environment, health system, employers, type of work, insur‐ ance) should be incorporated for study between MSDs and vulnerable groups [35].

The constant migration of vulnerable groups to developed countries and precarious work must be taken into account in the analysis of MSDs.

The approach to this problem should be through the qualitative methods. These can serve to contextualize quantitative data providing means of cross‐validation and what is termed by social scientists as triangulation, that is, the use of different approaches, by the conceptual, meth‐ odological or data collecting, to study the same problem in order to optimize the understanding of underlying mechanisms, work activity and environment, relationships, and solutions.

The incorporation of the COPCORD methodology should be of great help because it would assist the health system in the appropriate selection and application of resources, as well as the decision making in the system, demonstrating that the major worldwide problems of rheumatic complaints and disability are not just relevant to the elderly populations of devel‐ oped countries, but also to the vulnerable populations living in poorer conditions [36].
