Neck and back muscle chains hypomobility in women with migraine

ObjectiveTo compare the mobility of neck and back flexor and extensor muscle chains in women with migraine, chronic migraine and headache-free.MethodsThis is a cross-sectional study. The muscle chain test was performed based on the theoretical assumptions of the Busquet method, in women with migraine (MG, n = 24), chronic migraine (CMG, n = 36) and headache-free (CG, n = 27). The evaluation of neck and back mobility was performed by an examiner expert in the Busquet method with the aid of cervical range of motion (CROM®) device (neck muscles) and the Tiltmeter® application (back muscles).ResultsCompared to woman headache-free, women with migraine (MD = -12° [CI95% = −19°, -5°] and chronic migraine (MD = -15° [CI95% = −21°, -8°] present reduced mobility in the neck extensor muscle chain. Also, in the back extensor muscle chain, migraine vs headache-free (MD = -9° [CI95% = −15°, -2°]) and chronic migraine vs headache-free (MD = -10° [CI95% = −16°, -4°]) and in the back flexor muscle chain, migraine vs headache-free (MD = -6° [CI95% = −10°, −0.1°]) and chronic migraine vs headache-free (MD = -7 [CI95% = −11°, -2°]), with an effect sizes varying between 1.19 e 2.38. No difference was found between groups for neck flexor muscle chain. Conclusion: Women with migraine and chronic migraine have hypomobility of the neck and back extensor muscle chains, and of the back flexor chain.     

The effectiveness of hip interventions in patients with low-back pain: A systematic review and meta-analysis

BackgroundLow-back pain (LBP) may be directly or indirectly related to impairments from the hip joint.ObjectiveTo evaluate the effectiveness of hip interventions on pain and disability in patients with LBP in the short-, medium-, and long-term.MethodsPubMed, Cochrane Library, PEDro, Web of Science, and SCOPUS databases were searched in November 2022. Randomized controlled trials involving hip-targeted interventions compared to specific low back interventions in patients with LBP were selected. The outcomes were pain intensity and disability. The quality of the studies was assessed with the risk of bias tool. GRADE was used to rate the certainty of evidence. Meta-analyses were conducted using random effects models.ResultsA total of 2581 studies were screened. Eight were included in the meta-analysis involving 508 patients with LBP. The results provided very low certainty that both hip strengthening and hip stretching improved pain (MD = -0.66; 95% CI -0.86, -0.48; I²:0%) (MD = -0.55; 95% CI -1.02, -0.08) and disability (SMD = -0.81; 95% CI -1.53, -0.10; I²: 80%) (SMD = -1.03; 95% CI -1.82, -0.25) in the short-term, respectively. No benefits were found in the medium- or long-term. The risk of bias, heterogeneity, and imprecision of the results downgraded the level of evidence.ConclusionsVery low certainty evidence suggest a positive effect of hip strengthening in isolation or combined with specific low back exercise and hip stretching combined with specific low back exercise for decreasing pain intensity and disability in the short-term, in patients with LBP.Systematic review registration numberPROSPERO CRD42022303173     

Investigating key predictors of persistent low back pain: A focus on psychological stress

AimTo investigate the degree to which psychological stress, self-reported pain scores, and pain sensitivity during an acute state of low back pain (LBP) predict the development of persistent LBP trajectories.BackgroundIdentifying which factors influence LBP trajectories is critical to understand why some individuals experience persistent LBP and to illuminate areas for nursing intervention.MethodsA secondary data analysis of a prospective study examining trajectories of LBP was conducted. The sample was comprised of 217 adults with acute-onset LBP recruited from the community and followed over 24 weeks. Variables of interest included demographic data, perceived stress scores, self-reported pain scores, and somatosensory characteristics collected within the first 4 weeks of LBP onset. The data were analyzed using non-parametric bivariate comparisons and a semi-parametric Cox proportional hazards model with interval-censoring.ResultsIndividuals with higher psychological stress scores were less likely to experience pain resolution (Hazard ratio [HR] = 0.555, 95% confidence interval [CI] = 0.36–0.85, p = 0.02). After adjustment for covariates in the final model, the analysis revealed household income (HR = 2.79, 95% CI [1.63–4.67], p < 0.001) to be the dominant predictor of LBP persistence in this sample.ConclusionHeightened psychological stress and pain severity as well as decreased pressure pain thresholds were indicated as influential factors of LBP trajectories. Household income was identified as the dominant predictor, demonstrating that individuals with a higher household income were more likely to resolve their pain. Strategies which integrate assessment of stress, self-reported pain scores, pain sensitivity, and social determinants for patients experiencing pain are needed to advance nursing care.     

Factors Associated With Exclusive Direct Breastfeeding in the First 3 Months

ObjectiveTo identify factors associated with exclusive direct breastfeeding in the first 3 months among mother and infant dyads living in the United States.DesignA secondary analysis of data collected using a cross-sectional online survey completed over a 4-month period in late 2019.ParticipantsWe recruited a convenience sample of 370 mothers with healthy full-term singleton infants between 1 and 12 weeks of age whose feeding methods consisted of direct breastfeeding at least once a day. Mothers had not returned to work/school at the time of the survey completion.MeasurementsThe questionnaire consisted of 34 questions about maternal and infant factors that influence decisions about infant feeding, professional support, and parental preferences.ResultsMothers who practiced feeding on demand (adjusted OR [aOR] = 35.76, 95% confidence interval [CI] [2.04, 500.00]) and mothers of infants 1 to 4 weeks of age (aOR = 2.74, 95% CI [1.54, 4.85]) were more likely to use exclusive direct breastfeeding. The odds of exclusive direct breastfeeding decreased with mothers who breastfed with a nipple shield while in the hospital/birth center/home (aOR = 0.13, 95% CI [0.05, 0.35]), used pacifiers (aOR = 0.31, 95% CI [0.21, 0.65]), or had perceptions of insufficient milk (aOR = 0.11, 95% CI [0.04, 0.26]).ConclusionDemand feeding and an infant’s age of 1 to 4 weeks contributed to exclusive direct breastfeeding. Lower rates of exclusive direct breastfeeding were associated with the use of nipple shields immediately after birth, pacifier use, and perceptions of insufficient milk. Further investigation is warranted to fully differentiate exclusive direct breastfeeding from exclusive breastfeeding.     

Hip passive stiffness is associated with hip kinematics during single-leg squat

IntroductionSingle-leg squat (SLS) is a test commonly used to assess lower limb function in rehabilitation. Increased hip adduction and internal rotation (IR) is associated with dynamic knee valgus, which is related to hip and knee overload. Proximal and distal factors, such as hip passive stiffness, poor hip muscle strength and excessive foot misalignment may influence hip movement. However, previous studies focus on how proximal and distal factors affected knee joint movement and did not reported the influence on hip joint.ObjectiveThis study investigated the association of hip external rotators (ER) strength, hip passive stiffness and shank-forefoot alignment (SFA) with hip adduction and IR during SLS.DesignCross-sectional study.MethodForty-six health participants of both sexes (23.47 ± 4.29 years, 60.40 ± 11.28 kg, 1.67 ± 8.9 m) had SFA, hip ER torque, hip passive stiffness and hip kinematics assessed. Multiple linear regressions were performed to identify the factors which associated with mean and peak hip adduction and IR movement during SLS.ResultsOnly hip passive stiffness was associated with mean (R² = 0.164; Confidence Interval (CI) 95% = [-0.250, −0.048]; p = 0.005) and peak (R² = 0.116; CI 95% = [-0.223, −0.210]; p = 0.019) hip IR movement.ConclusionHip passive stiffness was associated with mean and peak hip IR movement during the SLS. These results suggest that individuals with reduced hip passive stiffness may demonstrate increased hip IR movement during SLS.     

The Long-Term Prognosis in People With Recent Onset Low Back Pain From Emergency Departments: An Inception Cohort Study

Most studies investigating the course of recent-onset low back pain (LBP) included patients from primary care. We aimed to describe the prognosis in people with recent-onset LBP presenting to emergency departments (EDs) and to identify prognostic factors for nonrecovery. This inception cohort study with a 1-year follow-up recruited 600 consecutive acute LBP patients presenting to 4 EDs. The outcomes measured the days to recover from pain, recover from disability, return to previous work hours and duties, and complete recovery. Within 12 months, 73% of participants (95% confidence interval [CI] = 69–77) recovered from pain, 86% (95% CI = 82–90) recovered from disability, 79% (95% CI = 71–87) returned to previous work hours and duties, and 70% (95% CI = 66–74) completely recovered. The median recovery times were 67 days (95% CI = 54–80) to recover from pain, 37 days (95% CI = 31–43) to recover from disability, 37 days (95% CI = 25–49) to return to previous work hours and duties, and 70 days (95% CI = 57–83) to recover completely. Higher pain levels, a higher perceived risk of persistent LBP, more days of reduced activity due to LBP, more pain sites, and higher duration of LBP were associated with complete nonrecovery within 6 months.PerspectiveThis information relates to prognosis and to likely recovery times for patients with recent-onset LBP in EDs. The findings also confirm previous factors associated with poor outcomes in patients with recent-onset LBP.     

Multiple comorbidities increase the risk of death from invasive pneumococcal disease under the age of 65 years

IntroductionRisk factors for death from invasive pneumococcal disease (IPD) have not been clearly established in patients aged under 65 years. We aimed to evaluate contributions of host and bacterial factors to the risk of death from IPD in patients aged under 65 years in Japan.MethodsIn this prospective, observational, multicenter cohort study, patients with IPD (n = 581) aged 6–64 years were enrolled between 2010 and 2017. We investigated the role of host and bacterial factors in 28-day mortality.ResultsThe mortality rate increased from 3.4% to 6.2% in patients aged 6–44 years to 15.5%–19.5% in those aged 45–64 years. Multivariable analysis identified the following risk factors for mortality: age 45–64 years (hazard ratio [HR], 3.4; 95% confidence interval [CI], 1.6–6.8, p = 0.001), bacteremia with unknown focus (HR, 2.0; 95% CI, 1.1–3.7, p = 0.024), meningitis (HR, 2.1; 95% CI, 1.1–4.0, p = 0.019), underlying multiple non-immunocompromising conditions (HR, 2.6; 95% CI, 1.1–7.4, p = 0.023), and immunocompromising conditions related to malignancy (HR, 2.4; 95% CI, 1.0–5.2, p = 0.039). Pneumococcal serotype was not associated with poor outcomes.ConclusionsHost factors, including age of 45–64 years and underlying multiple non-immunocompromising conditions, are important for the prognosis of IPD. Our results will contribute to the development of targeted pneumococcal vaccination strategies in Japan.     

The relationship of childhood sexual and physical abuse with adulthood disability

ObjectiveThe aim of this study was to examine the association of childhood sexual and physical abuse with disability in adulthood, and to assess how several demographic, physical, behavioral, psychosocial, and psychiatric factors may influence this association.MethodsThis study used nationally representative cross-sectional data from 7403 people aged ≥ 16 years who participated in the 2007 Adult Psychiatric Morbidity Survey. Information on childhood sexual talk, sexual touching, sexual intercourse, and physical abuse occurring before the age of 16, and disability in activities of daily living and instrumental activities of daily living in adulthood were collected. Multivariable logistic regression analyses were conducted.ResultsAfter adjusting for age, sex, and ethnicity, we found a positive association between different types of childhood abuse and adulthood disability: sexual talk (OR 1.54; 95% CI 1.27–1.85); sexual touching (OR 1.82; 95% CI 1.49–2.22); sexual intercourse (OR 2.58; 95% CI 1.75–3.81); physical abuse (OR 2.84; 95% CI 2.20–3.68). Increasing number of types of childhood abuse was associated with increased odds of adulthood disability. The odds of adulthood disability was increased for individuals who experienced all types of childhood abuse versus no childhood abuse (OR 3.59; 95% CI 1.64–7.84). Finally, the association between any childhood abuse and adulthood disability was largely explained by anxiety disorder, number of chronic physical conditions, and loneliness.ConclusionsChildhood abuse is positively associated with adulthood disability in England. Future longitudinal studies are warranted to understand the potentially complex interplay of factors that may increase risk for disability in individuals who experienced childhood abuse.     

Characteristics Associated With People With Chronic Low Back Pain Meeting Physical Activity Guidelines and Recommendations for Sedentary Behavior: A Cross-Sectional Study

ObjectiveThe purpose of this study was to identify factors associated with meeting physical activity guidelines and sedentary recommendations in people with chronic low back pain (LBP).MethodsThis was a cross-sectional study including 171 people with chronic LBP. Trained assessors collected information regarding demographic, anthropometric, and clinical data. Physical activity levels and sedentary time were objectively measured using a tri-axial accelerometer. Participants were classified as being physically active (ie, performing at least 150 minutes of moderate or 75 minutes of vigorous physical activity per week) and sedentary (ie, more than 8 hours of time spent in sedentary activities per day). Multivariable logistic regression analyses were used to determine the association of being physically active or sedentary with the range of demographic, anthropometric and clinical variables.ResultsOur results showed that although lower body mass index (odds ratio [OR] = 0.91; 95% CI: 0.85-0.98) and higher self-reported levels of leisure time physical activity (OR = 3.46; 95% CI: 1.94-6.15) were associated with being physically active, lower self-reported levels of physical activity at work (OR = 0.56; 95% CI: 0.39-0.81) was associated with being sedentary.ConclusionOur findings showed that, in people with LBP, lower body mass index and higher levels of leisure time physical activity may be important factors for identifying those physically active. In contrast, lower levels of physical activity at work may be considered when identifying sedentary people with LBP. Future studies should consider these factors when designing interventions aiming to promote physical activity and decrease sedentary behavior in this population.     

Alcohol,Tobacco and Psychotropic Drugs Use Among a Population with Chronic Pain in Southern Spain. A Cross-Sectional Study

BackgroundSubstance use seems to be higher among populations with chronic pain.AimThe aim of this study is to examine the relationship between the quantity of alcohol, tobacco, and psychotropic drugs consumed and chronic pain among women and men.MethodLinear and logistic regression analyses were carried out using data from the 2015-2016 adults’ version of the Andalusian Health Survey which is a representative cross-sectional population-based study (n = 6,569 adults aged >16 years; 50.8% women; 49.2% men).ResultsDisabling chronic pain was statistically associated with higher tobacco consumption among men (β = –30.0, 95% confidenct interval [CI] –59.5 to –0.60; t = –2.0; p < .05). Regarding alcohol, non-disabling chronic pain and a higher quantity of alcohol consumed are statistically associated for both sexes (women: β = 30.4, 95% CI 2.3-58.6; t = 2.12; p < .05 vs. men: β = 164.2, 95% CI 24.3-340.1); t = 2.30; p < .05). For women and men, both disabling chronic pain (women: odds ratio [OR] = 8.7, 95% CI 6.0-12.7); p < .05 vs. men: OR = 3.5, 95% CI 1.5-8.2); p < .05) and non-disabling chronic pain (women: OR = 3.7, 95% CI 2.0-7.0); p <.05 vs. men: OR = 4.7, 95% CI 95% CI 1.5-14.9); p < .05) were statistically significantly associated with a higher consumption of psychotropic drugs.ConclusionsChronic pain may be related to the quantity of alcohol, tobacco, and psychotropic drugs consumed, and disability appears to be one of the factors that modulates this relationship.     

Low Somatosensory Cortex Excitability in the Acute Stage of Low Back Pain Causes Chronic Pain

Determining the mechanistic causes of complex biopsychosocial health conditions such as low back pain (LBP) is challenging, and research is scarce. Cross-sectional studies demonstrate altered excitability and organization of the somatosensory and motor cortex in people with acute and chronic LBP, however, no study has explored these mechanisms longitudinally or attempted to draw causal inferences. Using sensory evoked potential area measurements and transcranial magnetic stimulation derived map volume we analyzed somatosensory and motor cortex excitability in 120 adults experiencing acute LBP. Following multivariable regression modelling with adjustment for confounding, we identified lower primary (OR = 2.08, 95% CI = 1.22–3.57) and secondary (OR = 2.56, 95% CI = 1.37–4.76) somatosensory cortex excitability significantly increased the odds of developing chronic pain at 6-month follow-up. Corticomotor excitability in the acute stage of LBP was associated with higher pain intensity at 6-month follow-up (B = -0.15, 95% CI: -0.28 to -0.02) but this association did not remain after confounder adjustment. These data provide evidence that low somatosensory cortex excitability in the acute stage of LBP is a cause of chronic pain.PerspectiveThis prospective longitudinal cohort study design identified low sensorimotor cortex excitability during the acute stage of LBP in people who developed chronic pain. Interventions that target this proposed mechanism may be relevant to the prevention of chronic pain.     

Prognostic Indicators of Low Back Pain in Primary Care: Five-Year Prospective Study

Back pain is common and many people experience long-term problems, yet little is known about what prognostic factors predict long-term outcomes. This study's objective was to determine which factors predict short- and long-term outcomes in primary care consulters with low back pain (LBP). Analysis was carried out on 488 patients who had consulted their physician about LBP. Patients were followed up at 6 months and 5 years. Clinically significant LBP at follow-up was defined as a score of 2, 3, or 4 on the Chronic Pain Grade, indicating substantial pain and disability. Cox regression was used to estimate relative risks (RRs) with 95% confidence intervals (CIs) on 32 potential predictive factors, organized into domains (demographic, physical, psychological, and occupational). Baseline pain intensity conferred a 12% increase in risk (RR = 1.12, 95% CI = 1.03–1.20), and patients' belief that their LBP would persist conferred a 4% increase in risk (RR = 1.04, 95% CI = 1.01–1.07) for poor outcome at 6 months. Outcome at 5 years was best predicted by a model with the same factors as in the 6-month model: pain intensity increased risk by 9% (RR = 1.09, 95% CI = .997–1.20), and a belief that their LBP would persist increased risk by 6% (RR = 1.06, 95% CI = 1.03–1.09). Both predictors have the potential to be targets for clinical intervention.PerspectiveFew studies have investigated factors that predict long-term back pain. This study has shown that pain intensity experienced during a period of primary care consultation, and patients' perception about whether their back pain will persist, were significant predictors of poor outcome at 6 months and at 5 years.     

Risk Factors for Frailty in Critical Care Survivors: A secondary analysis

ObjectivesThe purpose of this study was to investigate the prevalence of frailty and its risk factors among critical care survivors who were discharged after receiving treatment in an intensive care unit.MethodsThis was a secondary analysis using data from a methodological study conducted between June and August 2018. The sample included 494 adults who had been admitted to the intensive care unit for more than 48 hours within a year. Only post-intensive care frailty was evaluated using the Kihon Checklist. The sociodemographic and intensive care-related risk factors for frailty were analysed using multivariate logistic regression.ResultsThe prevalence of frailty in the sample was 65.8%. The risk factors for frailty were female sex (adjusted odds ratio [aOR] = 1.68, 95% CI: 1.02–2.78), aged 70 years or older (aOR = 4.16, 95% CI: 2.00–8.65), unemployment (aOR = 2.41, 95% CI: 1.39–4.17) and longer ICU days (aOR = 2.29, 95% CI: 1.35–3.91). Analysis of differences in risk factors according to sex revealed that risk factors for frailty were unemployment and longer ICU length of stay for male and older age for female.ConclusionHealth care providers should be aware of frailty risk factors in female and male patients and provide patient-specific interventions for preventing frailty.     

Bidirectional Association Between Sleep Quality and Low Back Pain in Older Adults: A Longitudinal Observational Study

ObjectiveTo investigate the bidirectional relationship by determining whether baseline sleep quality predicts pain intensity and whether baseline pain intensity predicts sleep quality in older individuals with chronic low back pain (LBP).DesignA prospective longitudinal cohort study with a 6-month follow-up period.SettingCommunity.ParticipantsOlder adults with LBP aged 60 years or older (N=215).InterventionNot applicable.Main Outcome MeasuresData collection occurred at baseline and at 6 months. Pain intensity and sleep quality were measured in both time points of assessment using the numeric pain rating scale (range, 0-10) and the Pittsburg Sleep Quality Index. At baseline, we also collected information on demographic anthropometric variables, cognitive status, depression, and comorbidities. Multivariable linear regression analyses adjusted for potential covariates were performed.ResultsA total of 215 individuals with LBP were recruited. Poor sleep quality at baseline predicted high pain intensity at 6 months (β coefficient, 0.18; 95% confidence interval [CI], 0.07-0.30). High pain intensity at baseline predicted poor sleep quality 6 months later (β coefficient, 0.14; 95% CI, 0.01-0.26).ConclusionOur findings give some support to the bidirectional relationship between pain and sleep quality in older individuals with LBP. This bidirectional relationship may be used as prognostic information by clinicians when managing patients with LBP.     

Impact of Pain and Psychosocial Factors on Frailty Among Older Adults With Physical Functional Limitations: A Cross-Sectional Study

AimsThe objective of this study was to determine the prevalence of frailty and pain among older adults with physical functional limitations in China. We also assessed the impact of pain and psychosocial determinants on frailty among this vulnerable population.DesignThis study was a cross-sectional study.Setting and participantsTotally, 2,323 Chinese elders with physical functional limitation were enrolled.MethodsPhysical functioning was assessed by the Barthel Index, participants who reported “often troubled with pain” were further asked about the intensity of their pain using a 1-10 numeric rating scale, and frailty was assessed by the Assessment of frailty FRAIL scale. The impact of pain and psychosocial factors on frailty was assessed by multivariable binary logistic regression.ResultsThe prevalence of frailty and pain were 30.9% and 46.1%, respectively. Compared with subjects who reported no pain, those who reported mild (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.21-2.31), moderate (OR = 2.10, 95% CI = 1.53-2.82), or severe pain (OR = 2.31, 95% CI = 1.56-3.40) tended to be more vulnerable to frailty. Furthermore, compared with participants with positive psychosocial determinants, those with negative psychosocial determinants seemed more likely to be frail.ConclusionsThese findings suggest that the incidence of pain, negative psychosocial status, and frailty were prevalent, and the presence of pain and negative psychosocial factors increased the risk of frailty among older adults with physical functional limitation.     

Initiation of breast-feeding practice and associated factors among mothers who have infants less than 12 months of age in Debre Tabor Town,North West Ethiopia, 2021: A multicenter community-based cross-sectional study

Introductioninitiation of breastfeeding is crucial in preventing newborn deaths and influences childhood nutrition. There was limited updated evidence regarding early initiation of breast-feeding practice and associated factors among the target population in the study area.ObjectiveTo assess initiation of breastfeeding practice and its associated factors among mothers who have infants less than six months of age in, North West Ethiopia, 2020.MethodsThe Community based quantitative cross-sectional study was conducted among 405 respondents in the stud area, then data would be entered and analyzed by using SPSS version 20 statistical packages. Bivariate and multivariable logistic regression model analysis would be done. Odds ratio with 95% confidence was computed to determine the level of significance-value less than 0.05 considered as significant.ResultThis study showed that 94.7% of mothers in Debre Tabor Town practiced initiation of breastfeeding for their infants within the Less Than 12 Months of age. In multivariable analysis I n f a n t S e x, Female [AOR (95% CI) = 0.068 (0.002, 1.659), and Age of Mother 20–24 years [AOR (95% CI) = 2.33 (0.030, 17.12)], 25–29 years ((AOR = 8.20 [(95% CI: 12.212, 22.189]), and 30–34 years (AOR = 4.48 [95% CI: 0.463, 15.478], Assists (Attend) during delivery, Doctor (AOR = 0.644 [95% CI: 0.041, 10.138]) and Encourage BF by religious father (AOR = 6.669 [(95% CI: 4.27, 8.895]) were remained significantly associated with the outcome variable with at 95% CI and P- value of <0.05.Conclusionand Recommendation: The prevalence of EIBF among mother-infant pairs of less than 12 months in debre tabor town, Northwest, Ethiopia, was found to be high as compared to national and global infant and young child feeding guidelines. However; it shows improvement as compared with some previous studies in Ethiopia. I n f a n t s e x, age of mother, assists during delivery, and encourage BF by religious father were factors associated with outcome in the stud area.     

Predictors of poor haematopoietic stem cell mobilisation in patients with haematological malignancies at a South African centre

BackgroundAutologous stem cell transplant (ASCT) is an established consolidation strategy in the treatment of haematological malignancies, however poor mobilisation (PM) can contribute to patient morbidity and high resource utilisation. Identifying the incidence, risk factors for PM and engraftment outcomes are important goals in our resource limited setting.MethodsWe retrospectively analyzed patients with haematological malignancies that consecutively underwent ASCT at Groote Schuur hospital, Cape Town, South Africa from January 2013 to January 2019.Results146 patients – majority with multiple myeloma (MM)(41,8%), F:M= 1:2, underwent leukapheresis with median age of 32 years (range, 9 – 66 years). PM occurred in 25/146 (17%), mobilisation failure (MF) in 3/146 (2%) and super mobilisation (SMs) in 99/146 (68%), respectively. Risk factors for PM were: diagnosis of acute leukaemia (RR = 25, 95% CI 3.4 – 183, p = 0.002) and Hodgkin lymphoma (RR = 19, 95% CI 2.6 – 142, p = 0.004); low white cell count (WCC) at harvest (WCC < 9 × 10⁹/L (RR=4.3, 95% CI 2.3 – 8.3, p < 0.0001) and two vs one line of prior therapy (RR = 3.1, 95% CI 1.45 – 6.7, p = 0.0037). Median days to neutrophil and platelet engraftment were 14 days (95% CI 14–15 days) and 16 days (95% CI 15–16 days) respectively.ConclusionPM occurred in 17% of a contemporary South African ASCT cohort, albeit with a low MF rate (2%). There was surprisingly high rate (68%) of SMs, possibly reflective of superfluous mobilisation strategy in MM patients. We identified predictive factors for PM that will lead to enhanced cost-effective use of plerixafor.     

The Role of Workplace Bullying in Low Back Pain: A Study With Civil Servants From a Middle-Income Country

This is a cross-sectional study that analysed the association between workplace bullying and LBP. The participants were 894 judicial civil servants from Porto Alegre, southern Brazil. Workplace Bullying was measured by the Negative Acts Questionnaire (NAQ-r) and Low Back Pain by the Nordic Questionnaire for Musculoskeletal Symptoms (NQMS). Logistic Regression was used to analyse data and test hypotheses. The prevalence of LBP in the last 7 days was 50.1%, while the overall prevalence of Chronic LBP was 19.3%. Some psychosocial factors at work were strongly associated with both outcomes. Workplace bullying was strongly associated with LBP, even after adjustment for several covariates. The odds of LBP in the last 7 days among bullied workers was 1.89 (95% CI: 1.31-2.71) times higher, compared to non-bullied. Workplace bullying was also associated with chronic LBP after adjustment for sociodemographic, behavioural and some occupational factors (OR = 1.60; 95% CI: 1.05-2.44). Psychosocial factors at work, and particularly workplace bullying, were strong risk factors for LBP, in contrast to most individual factors, and dose-response patterns were showed. Positive associations between bullying and LBP raise hypotheses on causation, and the role of psychosocial factors at work are discussed. Further longitudinal studies should address these hypotheses, investigating causal paths, mechanisms and possible mediation.PerspectivesAs a psychosocial risk, workplace bullying may play a role in low back pain and can be focus of interventions to prevent LBP. Dose-response patterns on the association between workplace bullying and low back pain are discussed and hypotheses are raised. The paper addresses different ways of measuring and categorising bullying at work, in order to study the relationship between bullying and pain.