Fear-avoidance beliefs increase perception of pain and disability in Mexicans with chronic low back pain / Crenças de medo e evitação aumentam a percepção de dor e incapacidade em mexicanos com lombalgia crônica

ABSTRACT Background: Fear-avoidance beliefs are related to the prognosis of chronicity in low back pain in subacute stages, however in chronic pain, is no clear the influence of these factors; it has been suggested that the study population can determine the magnitude of influence on disability and pain of those suffering from back pain. Currently, information does not exist in the Mexican population. Objective: To analyze the relationship between fear-avoidance beliefs with pain and disability in Mexicans with chronic low back pain; analyze potentials differences between subgroups according to the time of evolution. Methods: Cross-sectional study in Mexicans with chronic LBP aged between 18 and 45. Data were collected on general socio demographic characteristics, time of evolution, body mass index, pain, disability and fear-avoidance beliefs. Results: 33 men and 47 women, with an average age of 34.19 ± 7.65 years. Higher scores of fear-avoidance beliefs were obtained in women (47.2 ± 20.99 versus 38.5 ± 9.7; p = 0.05) and single participants (p = 0.04). A positive correlation was found between disability (r = 0.603, p < 0.001) and pain (r = 0.234, p = 0.03) with high scores of fear-avoidance beliefs. Through generalized linear models for disability, total score of the fear avoidance beliefs questionnaire showed a standardized beta coefficient of 0.603, p < 0.001 (R 2 of 0.656); for pain showed a standardized beta coefficient of 0.29, p = 0.01 (R 2 of 0.721). Conclusion: The present study suggests that there is a strong relationship between pain severity, FABQ scores, and functional disability in Mexicans with chronic LBP.

RESUMO Introdução: As crenças de medo e evitação estão relacionadas com o prognóstico da cronicidade da lombalgia nas fases subagudas; contudo, na dor crônica, não é clara a influência desses fatores. Sugeriu-se que um estudo populacional pode determinar a magnitude da influência da lombalgia sobre a incapacidade e a dor. Atualmente não há informação a esse respeito na população mexicana. Objetivo: Analisar a relação entre as crenças de medo e evitação com a dor e incapacidade em mexicanos com lombalgia crônica; analisar potenciais diferenças entre subgrupos determinados pelo tempo de evolução. Métodos: Estudo transversal em mexicanos com lombalgia crônica entre 18 e 45 anos. Coletaram-se dados sobre características sociodemográficas gerais, tempo de evolução, índice de massa corporal, dor, incapacidade e crenças de medo e evitação. Resultados: Foram estudados 33 homens e 47 mulheres com média de 34,19 ± 7,65 anos. Obtiveram-se escores de crenças de medo e evitação mais elevados em participantes do sexo feminino (47,2 ± 20,99 versus 38,5 ± 9,7; p = 0,05) e solteiros (p = 0,04). Encontrou-se uma correlação positiva entre a incapacidade (r = 0,603, p < 0,001) e a dor (r = 0,234, p = 0,03), com altas pontuações de crenças de medo e evitação. Por meio de modelos lineares generalizados para incapacidade, a pontuação total no questionário de crenças de medo e evitação mostrou um coeficiente beta padronizado de 0,603, p < 0,001 (R2 de 0,656); para a dor, mostrou um coeficiente beta padronizado de 0,29, p = 0,01 (R2 de 0,721). Conclusão: O presente estudo sugere que há uma forte relação entre a intensidade da dor, os escores no FABQ e a incapacidade funcional em mexicanos com lombalgia crônica.

Asociación entre el tiempo de permanencia en el Programa de Estancias Infantiles para niños en situación de pobreza y el nivel de desarrollo infantil / Association between time of permanence at early education program (Estancias Infantiles) and developmental level for children in situation of poverty

Resumen: Introducción: El Programa de Estancias Infantiles (PEI) se enfoca en padres de niños de 1-3 años en situación de pobreza. Incluye educación y cuidado de los niños por 8 h, 5 días por semana. El objetivo del estudio fue evaluar la asociación entre el tiempo de permanencia en el PEI y el nivel de desarrollo infantil. Métodos: Estudio transversal de base poblacional en dos estados de México. Se incluyeron todos los niños de 12-48 meses inscritos al PEI de noviembre de 2014 a enero de 2015. Se evaluó el nivel de desarrollo con la prueba EDI. Se calculó la razón de momios de prevalencia (RMP) para desarrollo normal por tiempo de estancia, ajustado por sexo, edad y discapacidad, teniendo como referencia a los niños que tenían < 30 días en el PEI. Resultados: Se incluyeron 3387 niños de 177 estancias infantiles: 53% de sexo masculino; 22.3% de 12-24 meses, 37.6% de 25-36 meses y 40.1% de 37-42 meses de edad. El RMP ajustado para desarrollo normal fue de 1.90 (IC95%:1.30-2.78) para 6-11 meses, 2.36 (IC95%:1.60-3.50) para 12-17 meses, 2.78 (IC95%:1.65-4.65) para 18-23 meses y 3.46 (2.13-5.60) para > 24 meses. Por área de desarrollo, se observó una mayor probabilidad de desarrollo normal a partir de 6 meses de estancia para lenguaje y social, y a partir de 12 meses para motor grueso, fino y conocimiento. Conclusiones: El tiempo de permanencia en el PEI a partir de 6 meses incrementa, de forma significativa y progresiva, la probabilidad de tener un desarrollo normal independiente del sexo y edad.

Abstract: Background: Early education program (EEP) was created to support parents with 1 to 3 year olds living in poverty situation in Mexico, and includes education and child daycare for 8 h five days per week. The objective of this study was to evaluate the association between length of stay in EEP and the level of development in children. Methods: Cross sectional, population-based study conducted in two Mexican states. All children aged between 12 to 48 months enrolled in EEP from November 2014 to January 2015 were included. Child Development Evaluation (CDE) test was used to screen early development in every child. Normal early development prevalence odds ratio (OR) was calculated adjusted by gender, impairment and state, using as a reference those children with less than 30 days in the program. Results: The study included 3,387 children from 177 EEP nurseries, from which 53% were male; age by group was divided in 12-24 months (22.3%), 25-36 months (37.6%) and 37-42 months (40.1%). Normal development adjusted OR by age was 1.9 (CI95%: 1.30-2.78) for 6-11 months, 2.36 (CI95%: 1.60-3.50) for 12-17 months, 2.78 (CI95%: 1.65-4.65) for 18-23 months and 3.46 (CI95%: 2.13-5.60) for >24 months. By area of development, a greater probability of having a normal result for language and social areas was observed after 6 months in the program, and for motor (both gross and fine) and knowledge areas after 12 months. Conclusion: The length of the stay in the EEP after 6 months significantly and progressively increases the probability of normal development regardless of gender and age.