Mechanisms for reducing low back pain: a mediation analysis of a multifaceted intervention in workers in elderly care

Purpose A multifaceted workplace intervention consisting of participatory ergonomics, physical training, and cognitive–behavioural training (CBT) has shown effectiveness for reducing low back pain (LBP). However, the mechanisms of action underlying these intervention components are not well understood. Methods This was a mediation analysis of a cluster-randomised controlled trial of a multifaceted intervention in 420 workers in elderly care. Mediation analysis was carried out via structural equation modelling. Potential mediators investigated were: fear-avoidance beliefs, perceived muscle strength, use of assistive devices at work and perceived physical exertion at work. LBP outcomes assessed were: days with LBP, LBP intensity and days with bothersome LBP. Results There were no significant indirect effects of the intervention on LBP outcomes. There were significant effects of the intervention on both fear-avoidance measures [β = − 0.63, 95% CI (1.23, 0.03); β = − 1.03, 95% CI (− 1.70, − 0.34)] and the use of assistive devices [β = − 0.55, 95% CI (− 1.04, − 0.05)], but not on perceived muscle strength [β = − 0.18, 95% CI (− 0.50, 0.13)] or physical exertion [β = − 0.05, 95% CI (− 0.40, 0.31)]. The only potential mediator with a significant effect on LBP outcomes was physical exertion, which had a significant effect on LBP intensity [β = 0.14, 95% CI (0.04, 0.23)]. Conclusions A multifaceted intervention consisting of participatory ergonomics, physical training, and CBT was able to decrease fear-avoidance beliefs and increase use of assistive devices in the workplace. However, these changes did not explain the effect of any of the intervention components on days with LBP, LBP intensity and days with bothersome LBP

Yo-Yo IR2 test e teste de margaria: validade, confiabilidade e obtenção da frequência cardíaca máxima em jogadores jovens de futebol

Os objetivos do presente estudo foram: i) avaliar a validade de constructo do Yo-Yo Intermittente Recovery Test Level 2 (Yo-Yo IR2) e do teste de Margaria (TM) com o desempenho em alta intensidade de exercício durante jogos oficiais em jogadores de futebol; ii) verificar a confiabilidade (teste-reteste) dos dois testes; iii) comparar os valores da frequência cardíaca máxima (FCM) obtida nesses protocolos e em jogo. Dezoito jogadores (média ± DP; idade 14 ± 0,8 anos, estatura 172 ± 9cm, peso 64,3 ± 8,5kg) pertencentes à mesma equipe foram avaliados em teste-reteste nos referidos protocolos e no percentual de tempo de permanência acima de 85% da FCM individual (PTP>85%FCM) em dois jogos oficiais do Campeonato Mineiro Infantil. Uma alta correlação foi encontrada entre o desempenho no Yo-Yo IR2 e PTP>85%FCM (rs = 0,71; p 85%FCM (rs = 0,44; p = 0,06). O Yo-Yo IR2 se mostrou mais variável e menos reprodutível (CV = 11%; CCI [95% IC] = 0,38) do que TM (CV = 1%; CCI [95% IC] = 0,93). O maior valor de FCM (p < 0,001) ocorreu no jogo (202 ± 8bpm). A FCM no Yo-Yo IR2 (194 ± 4bpm) foi menor (p < 0,006) do que TM (197 ± 6bpm). Conclui-se que o Yo-Yo IR2 pode ser considerado mais válido para predizer a manutenção de alta intensidade de exercício em jogo que é uma importante medida de desempenho no futebol. Porém, há necessidade de padronização rigorosa entre os procedimentos de avaliação para estabilidade da medida. A FCM deve ser observada em diversas situações, principalmente competitiva, para possibilitar que ocorra o maior valor individual

The pharmacokinetics of escitalopram in patients with hepatic impairment

The effect of hepatic impairment on the pharmacokinetics of escitalopram was determined by means of nonlinear mixed effect modeling, considering both the Child-Pugh classification (and its components) and cytochrome P450 2C19 (CYP2C19) activity. Twenty-four subjects were grouped according to their Child-Pugh score as healthy, with mild hepatic impairment or with moderate hepatic impairment. The subjects were administered a single oral dose of escitalopram 20 mg, and blood was sampled up to 168 hours after dosage. The serum concentration of escitalopram was determined and the pharmacokinetics assessed by nonlinear mixed effect modeling. The CYP2C19 activity was measured from the urinary excretion ratio of S/R-mephenytoin. All subjects tolerated the treatment well, and no serious adverse events were reported. Predicted mean area under the curve from zero to infinity (AUCinf) values were 51% and 69% higher for patients with mild and moderate hepatic impairment (Child-Pugh classification), respectively, compared with healthy subjects. The best-fitting model showed an influence of CYP2C19 activity on clearance and body weight on the volume of distribution for escitalopram. CYP2C19 activity is a better predictor of escitalopram clearance than is Child-Pugh classification