Job satisfaction evaluation in low back pain: a literature review and tools appraisal.

UNLABELLED: Among occupational risk factors of recurrence, chronicity and no return to work in low back pain, poor job satisfaction is the only high evidence-based factor. OBJECTIVE: To find out any validated questionnaire usable to assess job satisfaction in low back pain patients, both in clinical practice and research setting. METHOD: A systematic literature search on Pubmed and Cochrane library databases and un-indexed literature was made. "Job satisfaction" and "low back pain" keywords were used. Only English and French relevant articles were retained. A double assessment was made of listed questionnaires according to psychometric properties and daily practice use. RESULTS: Among the 40 articles retained only four used a validated questionnaire. Among the 12 different questionnaires, only two are validated in their English version (Job Descriptive Index [JDI] and the Work Environment Scale [WES]) and one in its French Version (JDI). Because they are time consuming, use these questionnaires in daily practice seems difficult. CONCLUSION: Based on literature review and questionnaire heterogeneity, at this time, there is no reference job satisfaction questionnaire. For daily practice, global job satisfaction visual analog scale could be useful. For research and intervention, JDI is more suitable despite its validity is still questionable.

Predictive factors of rituximab response in rheumatoid arthritis: results from a French university hospital.

OBJECTIVE: To study the influence of several factors (rheumatoid factor [RF], anti-cyclic citrullinated peptide [anti-CCP], serum Ig level, and Epstein-Barr virus [EBV] load) on clinical response to rituximab (RTX) after 6 months in rheumatoid arthritis (RA) patients. METHODS: Sixty-four patients receiving RTX (two 1-gm doses 2 weeks apart) for active RA were prospectively included. RF, anti-CCP, gamma globulin level, and EBV load were assessed prior to the first RTX cycle. Clinical responses were analyzed 6 months after RTX initiation using the European League Against Rheumatism criteria. Univariate and multivariate analyses were performed to identify factors associated with RTX response at 6 months. RESULTS: The mean disease duration was 16.4 years and 46 patients (71.9%) had already received at least 1 anti-tumor necrosis factor agent prior to RTX. At 6 months, 46 patients (71.9%) had a good to moderate response to RTX. Anti-CCP positivity was associated with a good to moderate response (odds ratio [OR] 4, 95% confidence interval [95% CI] 1.04-15.5; P = 0.04). RF positivity (P = 0.26) and positive initial EBV load (P = 0.16) were not associated with a good to moderate response. Hyperimmunoglobulin was correlated with a poorer response to RTX than normal Ig levels (OR 0.04, 95% CI 0.005-0.28; P = 0.002). CONCLUSION: Anti-CCP positivity was a predictor of good to moderate response to RTX in RA patients. On the other hand, high Ig levels were associated with a poorer outcome in contrast to previous findings. Further support from larger studies is necessary so as to optimize the management of the RA patients with high Ig levels.

[Transversal fractures in spinal ankylosis: a case series of 17 patients]. / Fractures transversales du rachis ankylosé : une série de 17 cas.

PURPOSE: Transverse fractures of the spine are rare. They occur in ankylosed spine and may lead to neurological complications. We report a series of 18 cases observed in 17 patients with ankylosing spondylitis (AS). The objective of this study were to describe the clinical, diagnostic and therapeutic features of our series and to compare our results with those of the literature. METHODS: We conducted a retrospective study from 1975 to 2008 in the neurosurgery and rheumatology departments of the university hospital (CHU) of Clermont-Ferrand. RESULTS: Eighteen transverse spine fractures were documented in 17 patients (one female patient had two fractures of the lumbar vertebrae). The 13 male and four female patients included in this series had a mean age of 57.4 ± 17.2 years and AS for a mean time of 21.3 ± 12 years (5-40). All patients had spinal ankylosis with a "bamboo" spine appearance. The reasons for hospital admission were suspicion of AS flare (n=10) and suspected traumatic fracture (n=8). Trauma, in most cases minor, was noted in 15 patients. Fourteen patients presented with mechanical spinal pain and three had both mechanical and inflammatory pain. Three patients experienced severe pain on mobilization. Two patients had pyramidal syndrome. The mean time to diagnosis of the fracture was 6.8 ± 8.4 weeks (0-22). The fracture was located in cervical spine (n=2), dorsal spine (n=8) and lumbar spine (n=8). It was transdiscal and transcorporeal in nine cases each. Standard radiographs (n=18) identified the fracture in nine cases. The fracture was demonstrated in all CT-scan (n=13). Magnetic resonance imaging (MRI) (n=6) showed the fracture in five cases and epidural hematoma in one. Eleven patients had orthopedic treatment and six underwent surgery. Outcome was favorable in 16 patients. One paraplegic patient died of pulmonary embolism. CONCLUSION: Transverse fractures of the spine are rare and diagnosis should be considered in a patient with AS and ankylosed spine who presented mechanical spine pain following even minor trauma. If standard radiographs are normal, further investigations should be performed using MRI, CT-scan, or both.

Effects of a 2-hour run on metabolic economy and lower extremity strength in men and women.

Changes in running economy, or the oxygen cost of running at a given submaximal speed (ml/m/kg), during prolonged exercise have been well described in men but not in women. Lower extremity strength changes associated with prolonged exercise have never been addressed. We examined changes in running economy and strength following a 2-hour run in eight men and eight women. Knee and hip strength were measured pre- and post-running. Peak oxygen consumption (VO2peak) and oxygen consumption at ventilatory threshold were determined. Subjects then ran for 2 hours at an intensity which elicited ventilatory threshold (68.7% vs. 66.6% of VO2peak for men and women, p = 0.5). Water was ingested at a rate of 0.5% of body weight each half hour. Oxygen uptake (VO2) and respiratory exchange ratio were measured initially and at 1 and 2 hours. Body weight declined in the men (p = 0.001) but not in the women (p = 0.12). Running economy decreased in the men (p < 0.001) but not in the women (p = 0.084). At 2 hours of running, knee flexion and extension strength declined significantly in the men only (effect of gender x time, p < 0.014), but hip flexion, abduction, and adduction strength declined in both genders. Decreased knee extensor/flexor strength was evident in men only, while decreased hip strength was independent of gender. We conclude that 2 hours of running produced changes in knee strength and running economy in men only.

Systemic effects of ingesting varying amounts of a commercial carbohydrate beverage postexercise.

OBJECTIVE: Although the role of postexercise carbohydrate intake in the replenishment of muscle glycogen is well established, large amounts of carbohydrate may affect other systems which are recovering from exercise as well. METHODS: We varied the timing and amount of a commercial glucose polymer/fructose (CHO) beverage ingested postexercise in 2 groups of 8 normotensive men following 1 hour of cycling exercise. In Study A the subjects ingested 1 L of a 200 g CHO solution or 1 L of water (W) immediately postexercise. The participants in Study B consumed 1 L of a 1.5 g/kg CHO solution, or W, immediately and 2 hours postexercise. RESULTS: Recovery systolic blood pressure was elevated after 200 g CHO as compared to water, but not after 1.5 g/kg CHO. Diastolic blood pressure was decreased, while heart rate, insulin and glucose increased following both doses of CHO. Despite the potassium (K) content of the beverages, serum K decreased in Study A and B, while a trend was noted following CHO for decreased urinary K excretion at 2 hours and for increased sodium excretion at 4 hours in Study B. Post CHO aldosterone declined more rapidly than after W, and urine volumes were decreased compared to W in both studies 2 hours after CHO. CONCLUSIONS: We speculate that hyperinsulinemia contributed to the rapid decline in K and aldosterone by creating a flux of K to the intracellular space. It appears that CHO ingestion postexercise results in systemic effects that are related to the amount and timing of CHO consumed.

Sucrose ingestion following exercise: selected cardiovascular, hormonal, renal, and metabolic effects.

Carbohydrates, frequently consumed following exercise for glycogen resynthesis, have been shown to have other systemic effects in resting men. We examined the effects of postexercise sucrose (a disaccharide carbohydrate) ingestion on the renal, cardiovascular, and sympathetic nervous systems. Eight men consumed 1 l of water (W) or 1 l of a 200 g sucrose solution (S) following 1 hour of bicycle exercise at 70% heart rate reserve. Measurements were made during 2 hours of recovery. Heart rate and systolic blood pressure were elevated following S as compared to W (p < 0.009, p < 0.04, respectively). Diastolic blood pressure was lower after S (p < 0.04) and mean blood pressure did not differ between beverages. Plasma and urinary catecholamines decreased similarly after exercise regardless of treatment. After S insulin (p = 0.0019) and glucose (p = 0.0036) were increased but serum aldosterone (p = 0.0083) and potassium (p = 0.0285) responses were lower. No differences were observed for plasma renin activity. Urine volume and kaliuresis were less after S (p = 0.03, p = 0.03). A 24% increase in metabolic rate (p = 0.002) and increased respiratory exchange ratio (p = 0.02) after S were observed. Systemic effects of sucrose ingestion following exercise include cardiovascular, renal, endocrine, and metabolic changes.

Blood pressure responses to sucrose ingestion in four rat strains.

Among four strains examined, spontaneously hypertensive rats (SHR) show a marked (20 mm Hg, P less than .01) systolic blood pressure elevation (SBP), Sprague-Dawley (SD) and Wistar-Kyoto (WKY) rats developed a moderate elevation (8 mm Hg, P less than .01), and a normotensive Wistar rat (WAM) had a lesser SBP elevation (6 mm Hg, P = NS) after excess sucrose ingestion. The SBP elevations found in SHR were noted at 2 and 4 weeks after starting the dietary treatments. Corresponding with SBP changes, plasma renin activity (PRA), aldosterone, and neuropeptide Y (NPY) concentrations all decreased with the high sucrose-low protein diet compared to the low sucrose-high protein diet, while circulating insulin levels were unchanged. Although norepinephrine (NE) and epinephrine (E) excretion tended to be higher in the rats eating the high sucrose-low protein food, the differences were not statistically significant. The differences in these parameters could influence the SBP in SHR, SD, and WKY, but virtually similar qualitative and quantitative blood and urinary findings were found in WAM, a strain of rat that showed no significantly increased SBP. Removing one kidney increases the CHO-induced SBP response of WKY to levels comparable to those seen in SHR, converting a moderate responder to a highly sensitive one. We conclude that under well-controlled conditions there are obvious differences in the SBP response to the macronutrients in the diets of various rat strains and that SHR possess some intrinsic mechanism(s), most likely associated with renal metabolism, which make this strain more sensitive to refine CHO-induced SBP elevations.