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Hertel E, Arendt-Nielsen L, Olesen AE, Andersen MS, Petersen KKS. Quantitative sensory testing, psychological factors, and quality of life as predictors of current and future pain in patients with knee osteoarthritis. Pain 2024; 165:1719-1726. [PMID: 38381930 DOI: 10.1097/j.pain.0000000000003194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/08/2024] [Indexed: 02/23/2024]
Abstract
ABSTRACT Substantial interindividual variability characterizes osteoarthritis (OA) pain. Previous findings identify quantitative sensory testing (QST), psychological factors, and health-related quality of life as contributors to OA pain and predictors of treatment outcomes. This exploratory study aimed to explain baseline OA pain intensity and predict OA pain after administration of a nonsteroidal anti-inflammatory drug in combination with paracetamol for 3 weeks. The Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score was used to estimate OA pain presentation. One hundred one patients were assessed at baseline and follow-up using QST (pressure pain thresholds and temporal summation of pain [TSP]), symptoms of depression and anxiety, pain catastrophizing scales (PCSs), and health-related quality of life. Linear regression with backward selection identified that PCS significantly explained 34.2% of the variability in baseline KOOS pain, with nonsignificant contributions from TSP. Pain catastrophizing score and TSP predicted 29.3% of follow-up KOOS pain, with nonsignificant contributions from symptoms of anxiety. When assessed separately, PCS was the strongest predictor (32.2% of baseline and 24.1% of follow-up pain), but QST, symptoms of anxiety and depression, PCS, and quality of life also explained some variability in baseline and follow-up knee OA pain. Further analyses revealed that only TSP and PCS were not mediated by any other included variables, highlighting their role as unique contributors to OA pain presentation. This study emphasizes the importance of embracing a multimodal approach to OA pain and highlights PCS and TSP as major contributors to the baseline OA pain experience and the OA pain experience after OA treatment.
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Affiliation(s)
- Emma Hertel
- Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Department of Materials and Production, Aalborg University, Aalborg, Denmark
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Estrup Olesen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark
| | - Michael Skipper Andersen
- Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | - Kristian Kjær-Staal Petersen
- Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Department of Materials and Production, Aalborg University, Aalborg, Denmark
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Gheisary Z, Hoja I, Liu J, Papagerakis P, Weber LP, Fenton M, Katselis GS, Lieffers JRL, Papagerakis S. Association of Sleep Quality and General, Mental, and Oral Health with Lifestyle Traits (Dietary Intake, Smoking Status) in Arthritis: A Cross-Sectional Study from the Canadian Community Health Survey (CCHS). Nutrients 2024; 16:2091. [PMID: 38999838 PMCID: PMC11243648 DOI: 10.3390/nu16132091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Arthritis is associated with health challenges. Lifestyle traits are believed to influence arthritis development and progression; however, data to support personalized treatment regimens based on holistic lifestyle factors are missing. This study aims to provide a comprehensive list of associations between lifestyle traits and the health status of individuals with arthritis in the Canadian population, using binary logistic regression analysis on data from the Canadian Community Health Survey, which includes 104,359 respondents. Firstly, we explored the association between arthritis and various aspects of health status including self-reported lifestyle factors. Secondly, we examined the associations between self-reported dietary intake and smoking status with general, mental, and oral health, and sleep disturbance among individuals both with and without arthritis. Our analysis revealed that individuals with arthritis reported considerably poorer general, mental, and oral health, and poorer sleep quality compared to those without arthritis. Associations were also found between self-reported dietary intake and various measures of health status in individuals with arthritis. Smoking and exposure to passive smoking were associated not only with arthritis but also with compromised sleep quality and poorer general, mental, and oral health in people with and without arthritis. This study highlights the need for personalized and holistic approaches that may include a combination of dietary interventions, oral health improvements, sleep therapies, and smoking cessation for improved arthritis prevention and care.
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Affiliation(s)
- Zohre Gheisary
- Department of Biochemistry, Microbiology, and Immunology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada;
| | - Ibrahim Hoja
- Laboratory of Precision Oral Health and Chronobiology, Faculty of Dentistry, Laval University, Dental Medicine Pavilion, 2420, rue de la Terrasse, Quebec City, QC G1V 0A6, Canada; (I.H.); (P.P.)
- Health Sciences, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada
| | - Juxin Liu
- Department of Mathematics and Statistics, College of Arts and Science, University of Saskatchewan, 106 Wiggins Road, Saskatoon, SK S7N 5E6, Canada;
| | - Petros Papagerakis
- Laboratory of Precision Oral Health and Chronobiology, Faculty of Dentistry, Laval University, Dental Medicine Pavilion, 2420, rue de la Terrasse, Quebec City, QC G1V 0A6, Canada; (I.H.); (P.P.)
| | - Lynn P. Weber
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK S7N 5B4, Canada;
| | - Mark Fenton
- Division of Respirology, Critical Care, and Sleep Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada;
| | - George S. Katselis
- Department of Medicine, Canadian Centre for Rural and Agricultural Health, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada;
| | - Jessica R. L. Lieffers
- College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada
| | - Silvana Papagerakis
- Laboratory of Precision Oral Health and Chronobiology, Faculty of Dentistry, Laval University, Dental Medicine Pavilion, 2420, rue de la Terrasse, Quebec City, QC G1V 0A6, Canada; (I.H.); (P.P.)
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Yu H, Tao R, Zhou J, Su J, Lu Y, Hua Y, Jin J, Pei P, Yu C, Sun D, Chen Z, Li L, Lv J. Temporal change in multimorbidity prevalence, clustering patterns, and the association with mortality: findings from the China Kadoorie Biobank study in Jiangsu Province. Front Public Health 2024; 12:1389635. [PMID: 38699413 PMCID: PMC11064014 DOI: 10.3389/fpubh.2024.1389635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/18/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives The characteristics of multimorbidity in the Chinese population are currently unclear. We aimed to determine the temporal change in multimorbidity prevalence, clustering patterns, and the association of multimorbidity with mortality from all causes and four major chronic diseases. Methods This study analyzed data from the China Kadoorie Biobank study performed in Wuzhong District, Jiangsu Province. A total of 53,269 participants aged 30-79 years were recruited between 2004 and 2008. New diagnoses of 15 chronic diseases and death events were collected during the mean follow-up of 10.9 years. Yule's Q cluster analysis method was used to determine the clustering patterns of multimorbidity. A Cox proportional hazards model was used to estimate the associations of multimorbidity with mortalities. Results The overall multimorbidity prevalence rate was 21.1% at baseline and 27.7% at the end of follow-up. Multimorbidity increased more rapidly during the follow-up in individuals who had a higher risk at baseline. Three main multimorbidity patterns were identified: (i) cardiometabolic multimorbidity (diabetes, coronary heart disease, stroke, and hypertension), (ii) respiratory multimorbidity (tuberculosis, asthma, and chronic obstructive pulmonary disease), and (iii) mental, kidney and arthritis multimorbidity (neurasthenia, psychiatric disorders, chronic kidney disease, and rheumatoid arthritis). There were 3,433 deaths during the follow-up. The mortality risk increased by 24% with each additional disease [hazard ratio (HR) = 1.24, 95% confidence interval (CI) = 1.20-1.29]. Compared with those without multimorbidity at baseline, both cardiometabolic multimorbidity and respiratory multimorbidity were associated with increased mortality from all causes and four major chronic diseases. Cardiometabolic multimorbidity was additionally associated with mortality from cardiovascular diseases and diabetes, with HRs of 2.64 (95% CI = 2.19-3.19) and 28.19 (95% CI = 14.85-53.51), respectively. Respiratory multimorbidity was associated with respiratory disease mortality, with an HR of 9.76 (95% CI = 6.22-15.31). Conclusion The prevalence of multimorbidity has increased substantially over the past decade. This study has revealed that cardiometabolic multimorbidity and respiratory multimorbidity have significantly increased mortality rates. These findings indicate the need to consider high-risk populations and to provide local evidence for intervention strategies and health management in economically developed regions.
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Affiliation(s)
- Hao Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Department of Noncommunicable Chronic Disease and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Ran Tao
- Department of Noncommunicable Chronic Disease and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jinyi Zhou
- Department of Noncommunicable Chronic Disease and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jian Su
- Department of Noncommunicable Chronic Disease and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yan Lu
- Department of Noncommunicable Chronic Disease Control and Prevention, Suzhou City Center for Disease Control and Prevention, Suzhou, China
| | - Yujie Hua
- Department of Noncommunicable Chronic Disease Control and Prevention, Suzhou City Center for Disease Control and Prevention, Suzhou, China
| | - Jianrong Jin
- Department of Noncommunicable Chronic Disease Control and Prevention, Wuzhong District Center for Disease Control and Prevention, Suzhou, China
| | - Pei Pei
- Peking University Center for Public Health, Epidemic Preparedness and Response, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health, Epidemic Preparedness and Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, Beijing, China
| | - Dianjianyi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health, Epidemic Preparedness and Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health, Epidemic Preparedness and Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health, Epidemic Preparedness and Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, Beijing, China
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Tan GJ, Kioh SH, Mat S, Tan MP, Chan SHL, Lee JMY, Tan YW. Psychosocial Determinants of Knee Osteoarthritis Progression: Results from the Promoting Independence in Our Seniors with Arthritis Study. Ann Geriatr Med Res 2023; 27:346-352. [PMID: 37899274 PMCID: PMC10772335 DOI: 10.4235/agmr.23.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/11/2023] [Accepted: 10/24/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is a common cause of physical disability among older adults. While established risk factors for knee OA include age and increased body weight, few studies have examined psychosocial risk factors or progression of knee OA. METHODS The Promoting Independence in our Seniors with Arthritis study recruited participants aged 65 years and over from orthopedic outpatients and community engagement events. Participants were invited to annual visits during which knee OA symptoms were assessed with the Knee Injury and Osteoarthritis Outcome Score (KOOS), social network using the 6-item Lubben Social Network Scale and anxiety and depression using the Hospital Anxiety and Depression scale. Knee OA worsening was defined by a 5% reduction in mean KOOS scores at the last visit compared to the first visit. RESULTS Data were available from 148 participants, mean age 66.2±6.5 years and 74.1% female, of whom 28 (18.9%) experienced OA worsening over a median follow-up period of 29 months. Univariate analyses revealed that age, sex, height, grip strength, and social network were associated with OA worsening. Social network remained statistically significantly associated with OA worsening after adjustment for age and sex difference (odds ratio=0.924; 95% confidence interval, 0.857-0.997). The relationship between social network and OA worsening were attenuated by both depression and handgrip strength at baseline. CONCLUSION Psychological status and muscle strength may be modifiable risk factors for social network which may in turn prevent knee OA worsening and should be targeted in future intervention studies.
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Affiliation(s)
- Guo Jeng Tan
- Department of General Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Sheng Hui Kioh
- Department of Chiropractic, Centre Of Complementary and Alternative Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Sumaiyah Mat
- Centre for Health Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Department of General Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | | | | | - Yee Wen Tan
- Department of Anaesthesiology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
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Amirzada M, Buczak-Stec E, König HH, Hajek A. Multimorbidity patterns in the German general population aged 40 years and over. Arch Gerontol Geriatr 2023; 114:105067. [PMID: 37257215 DOI: 10.1016/j.archger.2023.105067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
AIM The aim of this study was to identify and describe multimorbidity patterns among middle-aged and older community-dwelling individuals in Germany. Moreover, we aimed to determine potential gender differences in multimorbidity patterns. METHODS We analysed data from the most recent (sixth) wave (2017) of the large nationally representative German Ageing Survey (DEAS). Altogether n = 6,554 individuals participated, mean age was 62.0 (ranging from 43 to 92 years). Latent Class Analysis was performed to identify multimorbidity patterns, based on 13 chronic conditions and diseases. Multimorbidity was defined as the presence of at least two chronic conditions. RESULTS Altogether, 53.3% of individuals were multimorbid. We identified and clinically described five multimorbidity patterns: the relatively healthy class (45.1%), the high morbidity class (10.8%), the arthrosis/inflammatory/mental illnesses class (20.6%), the hypertension-metabolic illness class (21.7%), and the cardiovascular/cancer class (1.7%). Our analysis revealed that women compared to men have higher relative risk (IRR = 1.61, 95% CI 1.25-2.06) of being in the arthrosis/inflammatory/mental illnesses class, compared to the relatively healthy class. Furthermore, we found that, depending on which multimorbidity pattern individuals belong to, they differ greatly in terms of socio-demographic factors, health behaviour, and lifestyle factors. CONCLUSIONS We showed that the many chronic diseases cluster in a non-random way. Five clinically meaningful multimorbidity patterns were identified. Gender differences were apparent only in one class, namely in the arthrosis/inflammatory/mental illnesses class.
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Affiliation(s)
- Massuma Amirzada
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany.
| | - Elżbieta Buczak-Stec
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany
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Spijker JJA, Rentería E. Shifts in Chronic Disease Patterns Among Spanish Older Adults With Multimorbidity Between 2006 and 2017. Int J Public Health 2023; 68:1606259. [PMID: 37920847 PMCID: PMC10618995 DOI: 10.3389/ijph.2023.1606259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
Objectives: To investigate changes in multimorbidity patterns among Spanish older adults. Methods: Data come from the Spanish National Health Survey (ENSE) for individuals aged 60-89 years (2006: n = 9,758; 2017: n = 8,535). Prevalence rates and relative risks of 20 chronic conditions are estimated for the multimorbidity (3+ chronic conditions) sample, along with observed-to-expected prevalence of three-way disease combinations. Principal component and cluster analyses identify multimorbidity patterns and track temporal changes. Results: Overall, multimorbidity remained stable [2006: 59.6% (95% CI: 58.7%-60.6%); 2017: 60.3% (CI: 59.3%-61.3%)], except at older ages. Women exhibited higher multimorbidity prevalence, but sex differences declined by five percentage points. Low-high education differences widened by three percentage points. In 2017 most individuals living with multimorbidity experienced hypertension (63.4%), osteoarthrosis (62.4%) and chronic back pain (55.9%). These chronic conditions also dominate the most common triadic combinations. Multimorbid men also saw increases in cholesterol and diabetes. Conclusion: Multimorbidity trends and the most common combination of diseases can help plan healthcare for an ageing population. Sex and socioeconomic differences pose additional public health challenges as women and deprived populations tend to have more health complexities.
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Fuller-Thomson E, Marshall DJ, Moses M, Abudiab S. Flourishing mental health despite disabling chronic pain: Findings from a nationally representative sample of Canadians with arthritis. PLoS One 2023; 18:e0291722. [PMID: 37819867 PMCID: PMC10566723 DOI: 10.1371/journal.pone.0291722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/05/2023] [Indexed: 10/13/2023] Open
Abstract
This study aims to determine the prevalence of, and factors associated with, the "absence of psychiatric disorders" (APD) and "complete mental health" (CMH) among individuals with arthritis who report disabling chronic pain. There are three aspects of CMH: a) APD; b) happiness and/or life satisfaction in the past month on a daily or almost daily basis, and c) high levels of psychological and social well-being. A secondary analysis of a nationally representative sample (n = 620) of individuals with arthritis who report chronic and debilitating pain was conducted. Data were drawn from the Canadian Community Health Survey-Mental Health. The results of this study indicate that many people with arthritis who are living with disabling chronic pain are free of psychiatric disorders (76%) and are in CMH (56%). Factors associated with higher odds of APD and CMH among the sample include having a confidant, being free from insomnia, and having no lifetime history of major depressive disorder and/or generalized anxiety disorder. White respondents were almost 3-fold more likely to be in a state of CMH compared to racialized individuals. Respondents in the top 50% of household incomes were almost 4-fold more likely to be APD compared to the lowest 10%. In conclusion, many individuals with arthritis have excellent mental health despite disabling pain. Clinicians should be attuned to the mental health of their patients, with particular focus on those who may be more vulnerable to adverse mental health outcomes, such as racialized individuals, those in impoverished households, and those who lack social support.
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Affiliation(s)
- Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Institute for Life Course & Aging, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Denise J. Marshall
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Matthew Moses
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Sally Abudiab
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
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Awad NB, Axon DR. Characteristics Associated with Good Self-Perceived Mental Health among United States Adults with Arthritis. Behav Sci (Basel) 2022; 12:bs12080256. [PMID: 36004827 PMCID: PMC9405205 DOI: 10.3390/bs12080256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 01/27/2023] Open
Abstract
Mental health disorders are prevalent among United States (US) adults with arthritis. Yet, little is known about characteristics associated with mental health among US adults with arthritis. This retrospective cross-sectional study used 2019 Medical Expenditures Panel Survey data to assess the association between multiple personal characteristics and mental health status among US adults with arthritis. Hierarchical logistic regression models modeled associations between personal characteristics and mental health status. Model 1 included predisposing factors, model 2 included predisposing and enabling factors, while model 3 included predisposing, enabling, and need factors. The a priori alpha level was 0.05. Analyses accounted for the complex survey design and were weighted to produce national estimates. Among 28,512 individuals, 4984 met the inclusion criteria. Of these, 4181 had good mental health (85.5%, 95% confidence interval (CI) = 84.3%, 86.7%). The following characteristics were associated with good mental health status in the final adjusted model: age 18–64 vs. ≥65 (adjusted odds ratio (AOR) = 0.29, 95% CI = 0.12, 0.71), Midwest vs. West census region (AOR = 5.17, 95% CI = 1.63, 16.46), no degree vs. higher than high school education (AOR = 0.34, 95% CI = 0.12, 0.92), and high school diploma vs. higher than high school education (AOR = 0.40, 95% CI = 0.18, 0.86). In conclusion, this study suggests such characteristics may be targeted to help improve mental health among this population. Additional efforts are needed to help satisfy the unmet need for mental healthcare among this population.
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Illeez OG, Oktay KNK, Aktas I, Ozkan FU, Nazligül T, Begoglu FA, Kaysin MY, Atici A, Akpinar P. Comparison of the effects of duloxetine and pregabalin on pain and associated factors in patients with knee osteoarthritis. Rev Assoc Med Bras (1992) 2022; 68:377-383. [PMID: 35442367 DOI: 10.1590/1806-9282.20211047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/07/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the effects of duloxetine and pregabalin primarily on pain and functional status in patients with knee osteoarthritis and secondarily on quality of life, depression, anxiety, and sleep disturbance. METHODS A total of 66 patients with knee osteoarthritis were randomized to use duloxetine or pregabalin. Patients were evaluated by Visual Analog Scale, Neuropathic Pain Diagnostic Questionnaire, Western Ontario and McMaster University Osteoarthritis Index, Short Form-36, Beck Depression Inventory, Beck Anxiety Inventory, and Pittsburg Sleep Quality Index before the treatment and after 4 and 12 weeks of treatment. RESULTS Improvements occurred in Visual Analog Scale, Neuropathic Pain Diagnostic Questionnaire, Western Ontario and McMaster University Osteoarthritis Index, Short Form-36 (with an exception of the mental health subgroup scores in duloxetine-treated group), Beck Depression Inventory, and Beck Anxiety Inventory scores in both groups from 4 weeks after baseline. Pittsburg Sleep Quality Index total scores and SF-36 mental health subgroup scores started to improve on the 4th and 12th weeks in pregabalin- and duloxetine-treated groups, respectively. CONCLUSION Osteoarthritis pain, a complex outcome with nociceptive and neuropathic components, leads to central sensitization in a chronic phase. Using centrally acting drugs in the control of pain and associated symptoms would increase the probability of treatment success.
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Affiliation(s)
- Ozge Gulsum Illeez
- University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
| | - Kubra Neslihan Kurt Oktay
- Yeditepe University Faculty of Medicine, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
| | - Ilknur Aktas
- University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
| | - Feyza Unlu Ozkan
- University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
| | - Tuba Nazligül
- University of Health Sciences, Van Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Van, Turkey
| | - Feyza Akan Begoglu
- University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
| | - Meryem Yilmaz Kaysin
- University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
| | - Arzu Atici
- University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
| | - Pinar Akpinar
- University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
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Mohd Yusuf SY, Md-Yasin M, Mohd Miswan MF. Does Less Pain Predict Better Quality of Life among Malaysian Patients with Mild–Moderate Knee Osteoarthritis? Clin Pract 2022; 12:219-230. [PMID: 35447854 PMCID: PMC9031927 DOI: 10.3390/clinpract12020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022] Open
Abstract
This study aims to identify the relationship between knee functional status and Health-Related QoL (HRQoL) in mild to moderate knee osteoarthritis (OA) patients and to ascertain which subdomain of knee functional status best predicts good HRQoL. A cross-sectional study was conducted in an orthopaedic clinic of a tertiary hospital in Malaysia. Patients aged 40–75 years old with mild–moderate primary knee OA were recruited. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and SF-36 questionnaires were used to measure knee functional status and HRQoL, respectively. Subdomains of KOOS include “function in daily living”, “function in recreational activities”, “pain”, “symptom”, and “knee-specific quality of life”. Subdomains for SF-36 are Physical Component Summary (PCS) and Mental Component Summary (MCS). Overall, 290 patients fulfilled the inclusion criteria of the study, with a mean age of 66.8 years old (±7.06). Majority were female (57.6%) and Malay (79.7%). The relationships between all KOOS and HRQoL subdomains were significant. “Pain” contributed most towards better physical HRQoL ((PCS) Adj. B (95% CI); 0.063 (0.044, 0.169)), while “function in daily living” contributed most towards better mental HRQoL ((MCS) Adj. B (95% CI); 0.624 (0.478, 0.769)). Thus, better HRQoL was related to better pain control and improved “function in daily living” in these patients.
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Affiliation(s)
- Salma Yasmin Mohd Yusuf
- Department of Primary Care Medicine, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh 47000, Malaysia;
| | - Mazapuspavina Md-Yasin
- Department of Primary Care Medicine, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh 47000, Malaysia;
- Correspondence: ; Tel.: +60-19-356-4020
| | - Mohd Fairudz Mohd Miswan
- Department of Orthopaedic, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh 47000, Malaysia;
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11
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Health, Psychological and Demographic Predictors of Depression in People with Fibromyalgia and Osteoarthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063413. [PMID: 35329109 PMCID: PMC8950397 DOI: 10.3390/ijerph19063413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023]
Abstract
Depression is common in people with fibromyalgia (FM) and osteoarthritis (OA) and has been linked to adverse health outcomes in these conditions. The purpose of this study was to examine differences in predictors of depression among individuals with FM and OA using a range of health, demographic, and psychological variables. Of the total 963 participants, 600 were diagnosed with FM, and 363 with OA. The Quality of Well-Being Scale (QWB) was used to assess health status. The Fibromyalgia Impact Questionnaire (FIQ) and the Arthritis Impact Measurement Scale (AIMS) were used to measure disease-specific impact. Additionally, participants completed self-efficacy and helplessness assessments. Depression was measured using the Center for Epidemiological Studies Scale (CES-D). The results of a moderated linear regression showed that higher depression scores were associated with lower health status and a greater condition impact, especially in the FM group. Self-efficacy and helplessness predicted depression in both groups, but more strongly in FM. White participants with OA were more depressed than their non-White counterparts, while the opposite was true for FM. These findings indicate that improving health status and psychological well-being might alleviate depression in both FM and OA.
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Roomes D, Abraham L, Russell R, Beck C, Halsby K, Wood R, O'Brien M, Massey L, Burton K. Quantifying the Employer Burden of Persistent Musculoskeletal Pain at a Large Employer in the United Kingdom: A Non-interventional, Retrospective Study of Rolls-Royce Employee Data. J Occup Environ Med 2022; 64:e145-e154. [PMID: 34941604 PMCID: PMC8887851 DOI: 10.1097/jom.0000000000002468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To quantify the burden of work-relevant persistent musculoskeletal (MSK) pain to a large UK employer. METHODS A retrospective, longitudinal, analytical cohort study using linked Rolls-Royce data systems. Cases were employees with a MSK-related referral to occupational health; controls were age-, sex-, and job role-matched employees without such a referral. Outcomes were compared during 12 months' follow-up. RESULTS Overall, 2382 matched case-control pairs were identified (mean age: 46 y; 82% male). Cases took 39,200 MSK-related sickness absence days in total (equating to £50 million in sickness absence costs). Cases took significantly more all-cause sickness absence days than controls (82,341 [£106 million] versus 19,628 [£26 million]; P < 0.0001). CONCLUSIONS Despite access to extensive occupational health services, the burden of work-relevant persistent MSK pain remains high in Rolls-Royce. There is a clear need to better understand how to effectively reduce this burden.
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Affiliation(s)
- David Roomes
- Rolls-Royce plc, Derby, UK (Dr Roomes); Pfizer Ltd, Tadworth, UK (Ms Abraham, Dr Russell, Dr Beck, Dr Halsby); Adelphi Real World, Bollington, UK (Mr Wood, Ms O'Brien, Ms Massey); University of Huddersfield, Huddersfield, UK (Dr Burton)
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13
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Racial Disparities in Health Risk Indicators Reported by Alabamians Diagnosed with COPD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189662. [PMID: 34574587 PMCID: PMC8470414 DOI: 10.3390/ijerph18189662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/01/2021] [Accepted: 09/09/2021] [Indexed: 12/27/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a growing public health problem in the southern United States, particularly in Alabama. However, very little is known about specific health risk factors disproportionately impacting Alabamians with COPD. We conducted a latent class analysis of 2015–2019 Behavioral Risk Factor Surveillance System data from 4057 Alabamians with COPD (White = 2947, Black = 873, Other = 237). Eighteen risk indicators were examined across three health-related domains: (1) comorbidities, (2) limited healthcare access, and (3) substance use/abuse. Racial disparities between Black and white Alabamians with COPD were assessed using configural similarity analysis. Findings showed that almost one-third (31%) of Alabamians with COPD were in the high-risk class for eight comorbidities, and nearly one-half (48.88%) belonged to the high-risk class for limited healthcare access. Black Alabamians with COPD who did not have health insurance were much more likely to be at high risk for limited healthcare access (94.44%) when compared to their counterparts with insurance (5.56%), χ2(df = 2) = 1389.94, p < 0.0001. Furthermore, the proportion of high-risk, uninsured Black Alabamians with COPD (94.44%) substantially exceeded the percentage of high-risk, uninsured white Alabamians with COPD (59.70%). Most Alabamians with COPD (82.97%) were at low risk for substance use/abuse. Future research should explore new mechanisms for facilitating better healthcare access among high-risk Alabamians living with COPD and other prevalent comorbidities. Greater attention should be focused on Black Alabamians with COPD who cannot afford adequate health insurance.
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Valentini Neto J, Fisberg RM, Ribeiro SML. Association between joint diseases and common mental disorders in women at ages related to menopause: Data from the São Paulo City Health Survey, SP, Brazil. Exp Gerontol 2021; 152:111436. [PMID: 34098011 DOI: 10.1016/j.exger.2021.111436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To investigate the association between joint diseases (JD) and common mental disorders (CMD) in women at ages related to menopause. STUDY DESIGN Cross-sectional, population-based study (São Paulo City Health Survey, SP, Brazil). The sample was composed of 1191 women, 40 years and older. MAIN PARAMETERS INVESTIGATED Dependent variable (outcome): Presence of CMD, investigated by the Self Reporting Questionnaire-20 (SRQ-20). INDEPENDENT VARIABLES Presence of JD; other self-reported chronic conditions different from JD (OCC); age categories (40-45, 46-50, 51-55, 56-60, 61+ years old); Adjusting variables: years of formal education and ethnicity (skin color), used as proxies of socioeconomic status. The associations were investigated using simple and multiple logistic regression models. MAIN RESULTS The prevalence of CMD was 30.4%, and JD was 21.4%. Considering only the women presenting CMD, the prevalence of JD was 31.6%. The final regression model showed an independent association between JD and CMD (OR = 1.998; p < 0.001), age between 56 and 60 years (OR = 0.542; p = 0.018), and having three OCC (OR = 2.696; p = 0.027). CONCLUSIONS Our data showed that JD in women of the ages related to menopause was significantly and independently associated with CMD. Interestingly, the 56 to 60 years' age interval showed a very particular feature, with opposite association's direction, which demands further investigations.
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Affiliation(s)
| | | | - Sandra Maria Lima Ribeiro
- Public Health School, University of São Paulo, Brazil; School of Arts, Science and Humanities, University of São Paulo, Brazil.
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15
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Nikiphorou E, Santos EJF, Marques A, Böhm P, Bijlsma JW, Daien CI, Esbensen BA, Ferreira RJO, Fragoulis GE, Holmes P, McBain H, Metsios GS, Moe RH, Stamm TA, de Thurah A, Zabalan C, Carmona L, Bosworth A. 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis. Ann Rheum Dis 2021; 80:1278-1285. [PMID: 33962964 PMCID: PMC8458093 DOI: 10.1136/annrheumdis-2021-220249] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/26/2022]
Abstract
Background An important but often insufficient aspect of care in people with inflammatory arthritis (IA) is empowering patients to acquire a good understanding of their disease and building their ability to deal effectively with the practical, physical and psychological impacts of it. Self-management skills can be helpful in this regard. Objectives To develop recommendations for the implementation of self-management strategies in IA. Methods A multidisciplinary taskforce of 18 members from 11 European countries was convened. A systematic review and other supportive information (survey of healthcare professionals (HCPs) and patient organisations) were used to formulate the recommendations. Results Three overarching principles and nine recommendations were formulated. These focused on empowering patients to become active partners of the team and to take a more proactive role. The importance of patient education and key self-management interventions such as problem solving, goal setting and cognitive behavioural therapy were highlighted. Role of patient organisations and HCPs in promoting and signposting patients to available resources has been highlighted through the promotion of physical activity, lifestyle advice, support with mental health aspects and ability to remain at work. Digital healthcare is essential in supporting and optimising self-management and the HCPs need to be aware of available resources to signpost patients. Conclusion These recommendations support the inclusion of self-management advice and resources in the routine management of people with IA and aim to empower and support patients and encourage a more holistic, patient-centred approach to care which could result in improved patient experience of care and outcomes.
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Affiliation(s)
- Elena Nikiphorou
- Rheumatology Department, King's College Hospital, London, UK .,Centre for Rheumatic Diseases, King's College London, London, UK
| | - Eduardo José Ferreira Santos
- Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal.,Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Portugal
| | - Andrea Marques
- Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal.,Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Portugal
| | - Peter Böhm
- German League against Rheumatism, Bonn, Germany
| | - Johannes Wj Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Claire Immediato Daien
- Lapeyronie Hospital, CHU Montpellier, and Inserm U1046, CNRS UMR 9214, Montpellier University, Montpellier, France
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal.,Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Portugal
| | - George E Fragoulis
- First Department of Internal Medicine, Propaedeutic Clinic, Athens, Greece
| | - Pat Holmes
- National Rheumatoid Arthritis Society, Maidenhead, UK
| | - Hayley McBain
- School of Health Sciences, City, University of London, London, UK
| | - George S Metsios
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall, UK.,Department of Nutrition and Dietetics, University of Thessaly, Trikala, Thessaly, Greece
| | - Rikke Helene Moe
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Departent of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - Ailsa Bosworth
- National Rheumatoid Arthritis Society, Littlewick Green, UK
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16
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Tavares DRB, Moça Trevisani VF, Frazao Okazaki JE, Valéria de Andrade Santana M, Pereira Nunes Pinto AC, Tutiya KK, Gazoni FM, Pinto CB, Cristina Dos Santos F, Fregni F. Risk factors of pain, physical function, and health-related quality of life in elderly people with knee osteoarthritis: A cross-sectional study. Heliyon 2020; 6:e05723. [PMID: 33376818 PMCID: PMC7758370 DOI: 10.1016/j.heliyon.2020.e05723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/09/2020] [Accepted: 12/10/2020] [Indexed: 10/26/2022] Open
Abstract
Data on the precise mechanisms of the complex interactions of factors related to clinical impact of knee osteoarthritis (KOA) in the elderly population remain limited. To find predictors that explain pain intensity, physical function, and quality of life in elderly KOA subjects, we performed a cross-sectional analysis of the baseline data from a randomized trial. The trial included 104 subjects (aged ≥60) with KOA pain and dysfunctional endogenous pain-inhibitory system activity assessed by conditioned pain modulation (CPM). Three multiple linear regression models were performed to understand the independent predictors of Brief Pain Inventory (BPI), WOMAC function subscale (WOMACFunc), and SF-12 physical subscale (SF12-PCS). Model 1 showed that BPI pain score was predicted by low CPM response, high von-Frey light touch threshold, worse radiological severity as indexed by Kellgren-Lawrence grade (KL), high von-Frey punctate pain intensity and high levels of anxiety (adjusted R2 = 27.1%, F (6,95) = 7.27, P < 0.0001). In model 2, von-Frey light touch threshold, KL, depressive symptoms indexed by Beck Depression Inventory (BDI), level of sleepiness and pain pressure threshold were risk factors for SF12-PCS (adjusted R2 = 31.9%, F (5,96) = 10.5, P < 0.0001). Finally, model 3 showed that WOMACFunc was predicted by BDI, KL and BPI (adjusted R2 = 41%, F (3,98) = 24.42, P < 0.0001). Our data provides an interesting framework to understand the predictors of KOA pain in the elderly and highlights how its related outcomes are affected by disease-specific factors, somatosensory dysfunction and emotional factors.
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Affiliation(s)
- Daniela Regina Brandão Tavares
- Department of Geriatrics and Gerontology, Federal University of São Paulo, São Paulo, SP, Brazil.,Department of Evidence-Based Medicine, Brazilian Cochrane Centre, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Virginia Fernandes Moça Trevisani
- Department of Evidence-Based Medicine, Brazilian Cochrane Centre, Federal University of São Paulo, São Paulo, SP, Brazil.,Department of Rheumatology, Santo Amaro University, São Paulo, SP, Brazil
| | - Jane Erika Frazao Okazaki
- Department of Evidence-Based Medicine, Brazilian Cochrane Centre, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | - Ana Carolina Pereira Nunes Pinto
- Department of Evidence-Based Medicine, Brazilian Cochrane Centre, Federal University of São Paulo, São Paulo, SP, Brazil.,Department of Physical Therapy, University of Pittsburgh, Fullbright Program, USA
| | - Karina Kuraoka Tutiya
- Department of Geriatrics and Gerontology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Fernanda Martins Gazoni
- Department of Geriatrics and Gerontology, Federal University of São Paulo, São Paulo, SP, Brazil.,Department of Evidence-Based Medicine, Brazilian Cochrane Centre, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Camila Bonin Pinto
- Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Felipe Fregni
- Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Morabito DM, Mathes BM, Schmidt NB. The Impact of Two Brief Web-Based Psychological Interventions on Functional Outcomes. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10144-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Bayes-Marin I, Sanchez-Niubo A, Egea-Cortés L, Nguyen H, Prina M, Fernández D, Haro JM, Olaya B. Multimorbidity patterns in low-middle and high income regions: a multiregion latent class analysis using ATHLOS harmonised cohorts. BMJ Open 2020; 10:e034441. [PMID: 32690500 PMCID: PMC7371222 DOI: 10.1136/bmjopen-2019-034441] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 05/17/2020] [Accepted: 05/27/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Our aim was to determine clusters of non-communicable diseases (NCDs) in a very large, population-based sample of middle-aged and older adults from low- and middle-income (LMICs) and high-income (HICs) regions. Additionally, we explored the associations with several covariates. DESIGN The total sample was 72 140 people aged 50+ years from three population-based studies (English Longitudinal Study of Ageing, Survey of Health, Ageing and Retirement in Europe Study and Study on Global Ageing and Adult Health) included in the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project and representing eight regions with LMICs and HICs. Variables were previously harmonised using an ex-post strategy. Eight NCDs were used in latent class analysis. Multinomial models were made to calculate associations with covariates. All the analyses were stratified by age (50-64 and 65+ years old). RESULTS Three clusters were identified: 'cardio-metabolic' (8.93% in participants aged 50-64 years and 27.22% in those aged 65+ years), 'respiratory-mental-articular' (3.91% and 5.27%) and 'healthy' (87.16% and 67.51%). In the younger group, Russia presented the highest prevalence of the 'cardio-metabolic' group (18.8%) and England the 'respiratory-mental-articular' (5.1%). In the older group, Russia had the highest proportion of both classes (48.3% and 9%). Both the younger and older African participants presented the highest proportion of the 'healthy' class. Older age, being woman, widowed and with low levels of education and income were related to an increased risk of multimorbidity. Physical activity was a protective factor in both age groups and smoking a risk factor for the 'respiratory-mental-articular'. CONCLUSION Multimorbidity is common worldwide, especially in HICs and Russia. Health policies in each country addressing coordination and support are needed to face the complexity of a pattern of growing multimorbidity.
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Affiliation(s)
- Ivet Bayes-Marin
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Albert Sanchez-Niubo
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Laia Egea-Cortés
- Center of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Hai Nguyen
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Matthew Prina
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Daniel Fernández
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Serra Húnter fellow. Department of Statistics and Operations Research, Polytechnic University of Catalonia, Barcelona, Spain
| | - Josep Maria Haro
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
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Abstract
OBJECTIVE Anxiety disorders are among the most frequent mental disorders and are associated with a range of short- and long-term impairments and disabilities. Relatively little is known about anxiety disorders in patients with somatic diseases, and the present literature review highlights the current research in this field, data about prevalences of anxiety disorders in patients with somatic diseases, and the effectiveness of interventions. This article also introduces a comprehensive model of inpatient treatment and summarizes the evidence pertinent to this approach. METHODS A narrative review is presented with regard to prevalence and treatment of anxiety disorders in patients with somatic diseases. The effects of inpatient treatment are illustrated based on a case report. RESULTS This review indicates that anxiety disorders are more common in patients with somatic diseases, with prevalence estimates ranging from 2.5% to 55%, than in the general population. Several outpatient treatment options exist, with substantial support for the effectiveness of cognitive behavioral therapy, psychodynamic therapy, and pharmacotherapy. We also provide evidence in support of psychosomatic inpatient treatment for patients with anxiety disorders that are comorbid with somatic diseases. CONCLUSIONS Anxiety disorders are common in patients with somatic diseases, and several effective treatment options exist, including cognitive behavioral therapy and pharmacological interventions. We also provide support for the effectiveness of inpatient treatment with unique opportunities for multidisciplinary psychosomatic treatment of anxiety disorders with comorbid somatic diseases.
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Affiliation(s)
- Michaela Henning
- From the Department of Psychosomatic Medicine and Psychotherapy (Henning, Subic-Wrana, Wiltink, Beutel), University Medical Center, Mainz; and Department of Psychosomatics and Psychotherapy (Henning), University Hospital Cologne, University of Cologne, Cologne, Germany
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20
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Helminen EE, Arokoski JP, Selander TA, Sinikallio SH. Multiple psychological factors predict pain and disability among community-dwelling knee osteoarthritis patients: a five-year prospective study. Clin Rehabil 2020; 34:404-415. [PMID: 31965830 DOI: 10.1177/0269215519900533] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To identify predictors of long-term pain and disability in knee osteoarthritis. DESIGN A longitudinal cohort study of five years. SETTING Primary care providers. SUBJECTS In all, 108 patients (mean age = 63.6 years, standard deviation (SD) = 7.2 years) with knee pain (⩾40 mm on a 100 mm visual analogue scale in the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index pain scale) and radiographic grading (Kellgren-Lawrence: 2-4) of knee osteoarthritis who participated in a randomized controlled trial. MAIN MEASURES Disease-specific pain and functioning were assessed using the corresponding WOMAC subscales. Generic functioning was assessed by the RAND-36 subscales for function and physical and mental component summary scores. Possible baseline predictors for these outcomes were (1) demographic and disease-related variables and (2) psychological variables of mood (anxiety, depression), pain-related cognitions (pain self-efficacy, pain catastrophizing, kinesiophobia), and positive resource factors (life satisfaction, sense of coherence). RESULTS Multivariate linear mixed model analyses revealed that minimal anxiety at baseline predicted significantly better results for pain (WOMAC, P = 0.019) and function (WOMAC, P = 0.001, RAND-36 function P = 0.001). High pain self-efficacy predicted significantly better scores in RAND-36 function (P = 0.006), physical (P = 0.004) and mental (P = 0.001) component summaries. Pain catastrophizing predicted higher pain (P = 0.015), whereas fear of movement predicted poorer functioning in RAND-36 physical (P = 0.016) and mental (P = 0.009) component summaries. Those satisfied with life reported higher scores in RAND-36 function (P = 0.002) and mental component summary (P = 0.041). A low number of comorbidities predicted significantly better results in pain (WOMAC P = 0.019) and function (WOMAC P = 0.033, RAND-36 P = 0.009). CONCLUSION Anxiety, pain-related cognitions, and psychological resources predict symptoms in knee osteoarthritis in the long term.
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Affiliation(s)
- Eeva-Eerika Helminen
- Mental Health and Substance Abuse, Social Services and Health Care, City of Helsinki, Helsinki, Finland
| | - Jari Pa Arokoski
- Department of Physical Medicine and Rehabilitation, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Sanna H Sinikallio
- School of Educational Sciences and Psychology, University of Eastern Finland, Kuopio, Finland
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21
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Karp JF, Zhang J, Wahed AS, Anderson S, Dew MA, Fitzgerald K, Weiner DK, Albert S, Gildengers A, Butters M, Reynolds CF. Improving Patient Reported Outcomes and Preventing Depression and Anxiety in Older Adults With Knee Osteoarthritis: Results of a Sequenced Multiple Assignment Randomized Trial (SMART) Study. Am J Geriatr Psychiatry 2019; 27:1035-1045. [PMID: 31047790 PMCID: PMC6739151 DOI: 10.1016/j.jagp.2019.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/27/2019] [Accepted: 03/18/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Older adults with knee osteoarthritis (OA) and comorbid subsyndromal depressive symptoms are at elevated risk for incidental major depression or anxiety disorders. Using an indicated prevention paradigm, the authors conducted a sequenced multiple assignment randomized trial (SMART) to: 1) evaluate the effect of cognitive behavioral therapy (CBT) and physical therapy (PT), together with the temporal ordering of these interventions, on patient-reported global impression of change (P-GIC), mood, anxiety, and pain; and 2) compare the strategies' impact on incidence of common psychiatric disorders over 12-months. METHODS This intervention development trial compared four adaptive strategies delivered in two stages (each up to 8 weeks), contrasted with enhanced usual care (EUC). The strategies were CBT followed by an increased dose of CBT (CBT-CBT), CBT followed by PT (CBT-PT), PT followed by an increased dose of PT (PT-PT), and PT followed by CBT (PT-CBT). Participants (n = 99) were aged 60 years and older and met clinical criteria for knee OA and subthreshold depression. Response was defined as at least "much better" on the P-GIC. Participants were assessed quarterly for 12 months for incidence of psychiatric disorders. RESULTS Stage 1 response was higher for PT (47.5%) compared to CBT (20.5%). Non-responders receiving an additional dose of the same intervention experienced a response rate of 73%, higher than for switching to a different intervention. All strategies were superior to EUC (5%). Although not powered to detect effects on disorders, neither intervention strategy nor response status affected 12-month incidence of depression and anxiety disorders. CONCLUSION As response rates were similar for PT-PT and CBT-CBT, it may be dose and not type of these interventions that are necessary for clinical benefit. For non-responders, this finding may guide providers to stay the clinical course for up to 12 weeks before switching. These results support future trials of SMART designs in late-life depression prevention.
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Affiliation(s)
- Jordan F. Karp
- Department of Psychiatry,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Jun Zhang
- Department of Biostatistics, Graduate School of Public Health,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Abdus S. Wahed
- Department of Biostatistics, Graduate School of Public Health,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Stewart Anderson
- Department of Biostatistics, Graduate School of Public Health,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Mary Amanda Dew
- Department of Psychiatry,University of Pittsburgh and University of Pittsburgh School of Medicine,Department of Biostatistics, Graduate School of Public Health,University of Pittsburgh and University of Pittsburgh School of Medicine,Epidemiology,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Kelley Fitzgerald
- School of Health and Rehabilitation Sciences,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Debra K. Weiner
- Department of Psychiatry,University of Pittsburgh and University of Pittsburgh School of Medicine,Department of Medicine,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Steve Albert
- Behavioral and Community Health Sciences,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Ari Gildengers
- Department of Psychiatry,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Meryl Butters
- Department of Psychiatry,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Charles F. Reynolds
- Department of Psychiatry,University of Pittsburgh and University of Pittsburgh School of Medicine
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Stellefson M, Paige SR, Barry AE, Wang MQ, Apperson A. Risk factors associated with physical and mental distress in people who report a COPD diagnosis: latent class analysis of 2016 behavioral risk factor surveillance system data. Int J Chron Obstruct Pulmon Dis 2019; 14:809-822. [PMID: 31040659 PMCID: PMC6462160 DOI: 10.2147/copd.s194018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction Challenges associated with COPD increase patients’ risk of physical immobility and emotional distress, perpetuating a cycle of symptomatic living that hinders patients’ self-management and adherence to a treatment regimen. There is limited evidence available on how discrete behavioral and health risk factors contribute to the physical and mental distress experienced by people living with COPD. Purpose This secondary data analysis of 2016 Behavioral Risk Factor Surveillance System (BRFSS) sought to identify subgroups of people with COPD who were at the highest risk for physical and mental distress. Methods We selected 16 relevant risk indicators in four health-related domains – 1) health risk behaviors, 2) lack of preventive vaccinations, 3) limited health care access, and 4) comorbidities – as predictors of physical and mental health-related quality of life (HRQoL) in the COPD population. Latent class modeling (LCM) was applied to understand how various health-related indicators in these four health domains influenced reports of physical and/or mental distress. Results The majority of BRFSS respondents who reported a COPD diagnosis experienced physical (53.76%) and/or mental (58.23%) distress in the past 14 days. Frequent physical and mental distress were more common in females with COPD in the 45–64 years age group, who were also identified as white and in the lower socioeconomic group. Respondents with intermediate- to high-risk behaviors, intermediate to multiple comorbidities, limited access to health care, and intermediate to low use of preventive vaccinations were more likely to report frequent physical distress compared to the low-risk respondents. Similarly, respondents with high-risk behaviors, intermediate to multiple comorbidities, and low use of preventive vaccinations were more likely to report frequent mental distress than the low-risk group. Discussion This analysis of updated 2016 BRFSS data identified high-risk Americans with COPD who could benefit from disease management and secondary/tertiary health promotion interventions that may improve HRQoL. Future research should address noted disparities in risk factors, particularly among low socioeconomic populations living with COPD.
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Affiliation(s)
- Michael Stellefson
- Department of Health Education & Promotion, East Carolina University, Greenville, NC, USA,
| | - Samantha R Paige
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Adam E Barry
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Min Qi Wang
- Department of Behavioral and Community Health, University of Maryland, College Park, MD, USA
| | - Avery Apperson
- Department of Health Education & Promotion, East Carolina University, Greenville, NC, USA,
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Costa CDS, Flores TR, Wendt A, Neves RG, Tomasi E, Cesar JA, Bertoldi AD, Ramires VV, Nunes BP. Inequalities in multimorbidity among elderly: a population-based study in a city in Southern Brazil. CAD SAUDE PUBLICA 2018; 34:e00040718. [PMID: 30484558 DOI: 10.1590/0102-311x00040718] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/14/2018] [Indexed: 11/21/2022] Open
Abstract
Lower socioeconomic level is positively related to multimorbidity and it is possible that the clustering of health conditions carries the same association. The aim of this study was to identify prevalence of multimorbidity and clusters of health conditions among elderly, as well the underlying socioeconomic inequalities. This was a cross-sectional population-based study carried out with 60-year-old individuals. Multimorbidity was defined as the presence of 2+, 3+, 4+ or 5+ health conditions in the same individual. Schooling levels and the National Economic Index were used to investigate inequalities in the prevalence of multimorbidities among elderly. Slope and concentration indexes of inequality were used to evaluate absolute and relative differences. A factorial analysis was performed to identify disease clusters. In every ten older adults, about nine, eight, seven and six presented, respectvely, 2+, 3+, 4+ and 5+ health conditions. Three clusters of health conditions were found, involving musculoskeletal/mental/functional disorders, cardiometabolic, and respiratory factors. Higher inequalities were found the higher amount of health conditions (5+), when considering economic level, and for 3+, 4+ and 5+, when considering educational level. These findings show high multimorbidity prevalence among elderly, highlighting the persistence of health inequalities in Southern Brazil. Strategies by the health services need to focus on elderly at lower socioeconomic levels.
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Affiliation(s)
| | | | - Andrea Wendt
- Universidade Federal de Pelotas, Pelotas, Brasil
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Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ustün TB. The WHO World Mental Health (WMH) Surveys. ACTA ACUST UNITED AC 2018. [PMID: 21132091 DOI: 10.1055/s-0038-1671923] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The paper presents an overview of the WHO World Mental Health (WMH) Survey Initiative and summarizes recent WMH results regarding the prevalence and societal costs of mental disorders. The WMH surveys are representative community surveys that were carried out in 28 countries throughout the world aimed at providing information to mental health policy makers about the prevalence, burden, and unmet need for treatment of common mental disorders. Results show that mental disorders are commonly occurring in all participating countries. The inter-quartile range (IQR: 25(th)-75(th) percentiles) of lifetime DSM-IV disorder prevalence estimates (combining anxiety, mood, disruptive behavior, and substance disorders) is 18.1-36.1%. The IQR of 12-month prevalence estimates is 9.8-19.1%. Analysis of age-of-onset reports shows that many mental disorders begin in childhood-adolescence and have significant adverse effects on subsequent role transitions. Adult mental disorders are found in the WMH data to be associated with high levels of role impairment. Despite this burden, the majority of mental disorders go untreated. Although these results suggest that expansion of treatment could be cost-effective from both the employer perspective and the societal perspective, treatment effectiveness trials are needed to confirm this suspicion. The WMH results regarding impairments are being used to target several such interventions.
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25
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Hay E, Dziedzic K, Foster N, Peat G, van der Windt D, Bartlam B, Blagojevic-Bucknall M, Edwards J, Healey E, Holden M, Hughes R, Jinks C, Jordan K, Jowett S, Lewis M, Mallen C, Morden A, Nicholls E, Ong BN, Porcheret M, Wulff J, Kigozi J, Oppong R, Paskins Z, Croft P. Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundOsteoarthritis (OA) is the most common long-term condition managed in UK general practice. However, care is suboptimal despite evidence that primary care and community-based interventions can reduce OA pain and disability.ObjectivesThe overall aim was to improve primary care management of OA and the health of patients with OA. Four parallel linked workstreams aimed to (1) develop a health economic decision model for estimating the potential for cost-effective delivery of primary care OA interventions to improve population health, (2) develop and evaluate new health-care models for delivery of core treatments and support for self-management among primary care consulters with OA, and to investigate prioritisation and implementation of OA care among the public, patients, doctors, health-care professionals and NHS trusts, (3) determine the effectiveness of strategies to optimise specific components of core OA treatment using the example of exercise and (4) investigate the effect of interventions to tackle barriers to core OA treatment, using the example of comorbid anxiety and depression in persons with OA.Data sourcesThe North Staffordshire Osteoarthritis Project database, held by Keele University, was the source of data for secondary analyses in workstream 1.MethodsWorkstream 1 used meta-analysis and synthesis of published evidence about effectiveness of primary care treatments, combined with secondary analysis of existing longitudinal population-based cohort data, to identify predictors of poor long-term outcome (prognostic factors) and design a health economic decision model to estimate cost-effectiveness of different hypothetical strategies for implementing optimal primary care for patients with OA. Workstream 2 used mixed methods to (1) develop and test a ‘model OA consultation’ for primary care health-care professionals (qualitative interviews, consensus, training and evaluation) and (2) evaluate the combined effect of a computerised ‘pop-up’ guideline for general practitioners (GPs) in the consultation and implementing the model OA consultation on practice and patient outcomes (parallel group intervention study). Workstream 3 developed and investigated in a randomised controlled trial (RCT) how to optimise the effect of exercise in persons with knee OA by tailoring it to the individual and improving adherence. Workstream 4 developed and investigated in a cluster RCT the extent to which screening patients for comorbid anxiety and depression can improve OA outcomes. Public and patient involvement included proposal development, project steering and analysis. An OA forum involved public, patient, health professional, social care and researcher representatives to debate the results and formulate proposals for wider implementation and dissemination.ResultsThis programme provides evidence (1) that economic modelling can be used in OA to extrapolate findings of cost-effectiveness beyond the short-term outcomes of clinical trials, (2) about ways of implementing support for self-management and models of optimal primary care informed by National Institute for Health and Care Excellence recommendations, including the beneficial effects of training in a model OA consultation on GP behaviour and of pop-up screens in GP consultations on the quality of prescribing, (3) against adding enhanced interventions to current effective physiotherapy-led exercise for knee OA and (4) against screening for anxiety and depression in patients with musculoskeletal pain as an addition to current best practice for OA.ConclusionsImplementation of evidence-based care for patients with OA is feasible in general practice and has an immediate impact on improving the quality of care delivered to patients. However, improved levels of quality of care, changes to current best practice physiotherapy and successful introduction of psychological screening, as achieved by this programme, did not substantially reduce patients’ pain and disability. This poses important challenges for clinical practice and OA research.LimitationsThe key limitation in this work is the lack of improvement in patient-reported pain and disability despite clear evidence of enhanced delivery of evidence-based care.Future work recommendations(1) New thinking and research is needed into the achievable and desirable long-term goals of care for people with OA, (2) continuing investigation into the resources needed to properly implement clinical guidelines for management of OA as a long-term condition, such as regular monitoring to maintain exercise and physical activity and (3) new research to identify subgroups of patients with OA as a basis for stratified primary care including (i) those with good prognosis who can self-manage with minimal investigation or specialist treatment, (ii) those who will respond to, and benefit from, specific interventions in primary care, such as physiotherapy-led exercise, and (iii) develop research into effective identification and treatment of clinically important anxiety and depression in patients with OA and into the effects of pain management on psychological outcomes in patients with OA.Trial registrationCurrent Controlled Trials ISRCTN06984617, ISRCTN93634563 and ISRCTN40721988.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme and will be published in full inProgramme Grants for Applied Research Programme; Vol. 6, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elaine Hay
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Krysia Dziedzic
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Nadine Foster
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - George Peat
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Danielle van der Windt
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bernadette Bartlam
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Milisa Blagojevic-Bucknall
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - John Edwards
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Emma Healey
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Melanie Holden
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Rhian Hughes
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Kelvin Jordan
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Sue Jowett
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Andrew Morden
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Elaine Nicholls
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bie Nio Ong
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Mark Porcheret
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jerome Wulff
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jesse Kigozi
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Raymond Oppong
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Zoe Paskins
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Peter Croft
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
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Kelley GA, Kelley KS, Callahan LF. Community-deliverable exercise and anxiety in adults with arthritis and other rheumatic diseases: a systematic review with meta-analysis of randomised controlled trials. BMJ Open 2018; 8:e019138. [PMID: 29455165 PMCID: PMC5855450 DOI: 10.1136/bmjopen-2017-019138] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND/PURPOSE Given conflicting findings, the purpose of this study was to use the meta-analytic approach to examine the effects of exercise (aerobic, strength training or both) on anxiety in adults with arthritis and other rheumatic diseases (AORD). METHODS Randomised controlled exercise intervention trials ≥4weeks in adults ≥18 years of age with osteoarthritis, rheumatoid arthritis or fibromyalgia were included. Studies were located by searching eight electronic databases, cross-referencing and expert review. Dual selection and data abstraction of studies were performed. Hedge's standardised effect size (ES) was calculated for each result and pooled using the recently developed inverse heterogeneity model. Two-tailed z-alpha values ≤0.05 and non-overlapping 95% CI were considered statistically significant. Heterogeneity was estimated using Q and I2 with alpha values ≤0.10 for Q considered statistically significant. Small-study effects were examined using funnel plots and Egger's regression test. In addition, the number needed to treat (NNT), percentile improvement and meta-regression were conducted. RESULTS Of the 639 citations screened, 14 studies representing 926 initially enrolled participants (539 exercise, 387 control) met the criteria for inclusion. Length of training (mean±SD) averaged 15.8±6.7 weeks, frequency 3.3±1.3 times per week and duration 28.8±14.3 min per session. Overall, statistically significant reductions in anxiety were found (exercise minus control changes ES=-0.40, 95% CI -0.65 to -0.15, tau2=0.14; Q=40.3, P=0.0004; I2 =62.8%). The NNT was 6 with a percentile improvement of 15.5% and an estimated 5.3 million inactive US adults with AORD improving their anxiety if they started exercising regularly. Statistically significant small-study effects were observed (P<0.0001). CONCLUSIONS Exercise is associated with reductions in anxiety among adults with selected types of AORD. However, a need exists for additional, well-designed, randomised controlled trials on this topic. PROSPERO REGISTRATION NUMBER CRD42016048728.
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Affiliation(s)
- George A Kelley
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Kristi S Kelley
- Department of Biostatistics, School of Public Health, Robert C Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Leigh F Callahan
- Departments of Social Medicine and Orthopaedics, Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
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Svärd T, Lakovaara M, Pakarinen H, Haapea M, Kiviranta I, Lammentausta E, Jurvelin J, Tervonen O, Ojala R, Nieminen M. Quantitative MRI of Human Cartilage In Vivo: Relationships with Arthroscopic Indentation Stiffness and Defect Severity. Cartilage 2018; 9:46-54. [PMID: 29219019 PMCID: PMC5724675 DOI: 10.1177/1947603516684592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the association of cartilage defect severity, as determined by the International Cartilage Repair Society (ICRS) grading with indentation stiffness and T2 relaxation time of magnetic resonance imaging (MRI), a biomarker for the integrity of articular cartilage. Design Twenty-one patients scheduled for arthroscopic were included in the study. Prior to arthroscopy, subjects underwent quantitative MRI of articular cartilage, namely T2 relaxation time mapping at 1.5 T. Within 2 months, subjects underwent arthroscopy, which also included ICRS grading and measurement of arthroscopic indentation stiffness. Arthroscopic evaluations and T2 mapping at anterior, central, and posterior medial and lateral femoral condyles were correlated using a colocalization scheme. Differences in Young's modulus, as derived by indentation tests, and T2 times between ICRS grades were analyzed using Mann-Whitney's U or Kruskal-Wallis H tests. The correlation between modulus and T2 times was analyzed using Spearman's rank correlation coefficients. Results Modulus and T2 showed significant topographical variation. In the anterior region of interest (ROI) on the medial condyle the modulus showed a negative association with ICRS grade ( P = 0.040) and the T2 times were longer in ICRS grade 2 compared with grades 0 and 1 ( P = 0.047). Similar, but nonsignificant associations were found in the central ROI on the medial condyle. No significant correlations were observed between the indentation modulus and T2 times. Conclusions Cartilage degeneration is identified both with mechanical indentation and T2 mapping in MRI. However, in this study, indentation stiffness and T2 relaxation time in vivo, were not associated.
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Affiliation(s)
- Tuomas Svärd
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Oulun lääni, Finland,Tuomas Svärd, Department of Diagnostic Radiology, Oulu University Hospital, POB 50, Oulu, Oulun lääni 90029, Finland.
| | | | - Harri Pakarinen
- Department of Orthopaedic Surgery, Oulu University Hospital, Oulu, Oulun lääni, Finland
| | - Marianne Haapea
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Oulun lääni, Finland,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Oulun lääni, Finland
| | - Ilkka Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Oulun lääni, Finland
| | - Jukka Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Osmo Tervonen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Oulun lääni, Finland,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Oulun lääni, Finland,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Oulun lääni, Finland
| | | | - Miika Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Oulun lääni, Finland,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Oulun lääni, Finland,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Oulun lääni, Finland
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28
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Kanavaki AM, Rushton A, Efstathiou N, Alrushud A, Klocke R, Abhishek A, Duda JL. Barriers and facilitators of physical activity in knee and hip osteoarthritis: a systematic review of qualitative evidence. BMJ Open 2017; 7:e017042. [PMID: 29282257 PMCID: PMC5770915 DOI: 10.1136/bmjopen-2017-017042] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
UNLABELLED Physical activity (PA), including engagement in structured exercise, has a key role in the management of hip and knee osteoarthritis (OA). However, maintaining a physically active lifestyle is a challenge for people with OA. PA determinants in this population need to be understood better so that they can be optimised by public health or healthcare interventions and social policy changes. OBJECTIVES The primary aim of this study is to conduct a systematic review of the existing qualitative evidence on barriers and facilitators of PA for patients with hip or knee OA. Secondary objective is to explore differences in barriers and facilitators between (1) lifestyle PA and exercise and (2) PA uptake and maintenance. METHODS Medline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Scopus, Grey literature and qualitative journals were searched. Critical Appraisal Skills Programme-Qualitative checklist and Lincoln and Guba's criteria were used for quality appraisal. Thematic synthesis was applied. FINDINGS Ten studies were included, seven focusing on exercise regimes, three on overall PA. The findings showed a good fit with the biopsychosocial model of health. Aiming at symptom relief and mobility, positive exercise experiences and beliefs, knowledge, a 'keep going' attitude, adjusting and prioritising PA, having healthcare professionals' and social support emerged as PA facilitators. Pain and physical limitations; non-positive PA experiences, beliefs and information; OA-related distress; a resigned attitude; lack of motivation, behavioural regulation, professional support and negative social comparison with coexercisers were PA barriers. All themes were supported by high and medium quality studies. Paucity of data did not allow for the secondary objectives to be explored. CONCLUSION Our findings reveal a complex interplay among physical, personal including psychological and social-environmental factors corresponding to the facilitation and hindrance of PA, particularly exercise, engagement. Further research on the efficacy of individualised patient education, psychological interventions or social policy change to promote exercise engagement and lifestyle PA in individuals with lower limb OA is required. TRIAL REGISTRATION NUMBER CRD42016030024.
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Affiliation(s)
- Archontissa M Kanavaki
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), University of Birmingham, Birmingham, UK
| | - Nikolaos Efstathiou
- Nursing, Institute of Clinical Sciences, Medical School, University of Birmingham, Birmingham, UK
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Asma Alrushud
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- Department of Health Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Rainer Klocke
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Abhishek Abhishek
- Academic Rheumatology Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
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Helminen EE, Sinikallio SH, Valjakka AL, Väisänen-Rouvali RH, Arokoski JP. Determinants of pain and functioning in knee osteoarthritis: a one-year prospective study. Clin Rehabil 2017; 30:890-900. [PMID: 27496698 PMCID: PMC4976658 DOI: 10.1177/0269215515619660] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 11/02/2015] [Indexed: 11/28/2022]
Abstract
Objective: To identify predictors of pain and disability in knee osteoarthritis. Design: A one-year prospective analysis of determinants of pain and functioning in knee osteoarthritis. Study setting: Primary care providers in a medium-sized city. Patients: A total of 111 patients aged from 35 to 75 with clinical symptoms and radiographic grading (Kellgren-Lawrence 2–4) of knee osteoarthritis who participated in a randomized controlled trial. Main measures: The outcome measures were self-reported pain and function, which were recorded at 0, 3 and 12 months. Disease-specific pain and functioning were assessed using the pain and function subscales of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. Generic physical and mental functioning were assessed using the RAND-36 subscales for function, and physical and mental component summary scores. Possible baseline predictors for these outcomes were 1) demographic, socioeconomic and disease-related variables, and 2) psychological measures of resources, distress, fear of movement and catastrophizing. Results: Multivariate linear mixed model analyses revealed that normal mood at baseline measured with the Beck Anxiety Inventory predicted significantly better results in all measures of pain (WOMAC P=0.02) and function (WOMAC P=0.002, RAND-36 P=0.002) during the one-year follow-up. Psychological resource factors (pain self-efficacy P=0.012, satisfaction with life P=0.002) predicted better function (RAND-36). Pain catastrophizing predicted higher WOMAC pain levels (P=0.013), whereas fear of movement (kinesiophobia) predicted poorer functioning (WOMAC P=0.046, RAND-36 P=0.024). Conclusions: Multiple psychological factors in people with knee osteoarthritis pain are associated with the development of disability and longer term worse pain.
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Affiliation(s)
- Eeva-Eerika Helminen
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Finland Psychiatry, Department of Social Services and Health Care, City of Helsinki Health Care, Finland
| | - Sanna H Sinikallio
- School of Educational Sciences and Psychology, University of Eastern Finland, Finland
| | - Anna L Valjakka
- Department of Psychiatry, Addiction Psychiatry Outpatient Clinic, Kuopio University Hospital, Finland
| | | | - Jari Pa Arokoski
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Finland Institute of Clinical Medicine, University of Eastern Finland, Finland
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30
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Mallen CD, Nicholl BI, Lewis M, Bartlam B, Green D, Jowett S, Kigozi J, Belcher J, Clarkson K, Lingard Z, Pope C, Chew-Graham CA, Croft P, Hay EM, Peat G. The effects of implementing a point-of-care electronic template to prompt routine anxiety and depression screening in patients consulting for osteoarthritis (the Primary Care Osteoarthritis Trial): A cluster randomised trial in primary care. PLoS Med 2017; 14:e1002273. [PMID: 28399129 PMCID: PMC5388468 DOI: 10.1371/journal.pmed.1002273] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 02/20/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study aimed to evaluate whether prompting general practitioners (GPs) to routinely assess and manage anxiety and depression in patients consulting with osteoarthritis (OA) improves pain outcomes. METHODS AND FINDINGS We conducted a cluster randomised controlled trial involving 45 English general practices. In intervention practices, patients aged ≥45 y consulting with OA received point-of-care anxiety and depression screening by the GP, prompted by an automated electronic template comprising five questions (a two-item Patient Health Questionnaire-2 for depression, a two-item Generalized Anxiety Disorder-2 questionnaire for anxiety, and a question about current pain intensity [0-10 numerical rating scale]). The template signposted GPs to follow National Institute for Health and Care Excellence clinical guidelines for anxiety, depression, and OA and was supported by a brief training package. The template in control practices prompted GPs to ask the pain intensity question only. The primary outcome was patient-reported current pain intensity post-consultation and at 3-, 6-, and 12-mo follow-up. Secondary outcomes included pain-related disability, anxiety, depression, and general health. During the trial period, 7,279 patients aged ≥45 y consulted with a relevant OA-related code, and 4,240 patients were deemed potentially eligible by participating GPs. Templates were completed for 2,042 patients (1,339 [31.6%] in the control arm and 703 [23.1%] in the intervention arm). Of these 2,042 patients, 1,412 returned questionnaires (501 [71.3%] from 20 intervention practices, 911 [68.0%] from 24 control practices). Follow-up rates were similar in both arms, totalling 1,093 (77.4%) at 3 mo, 1,064 (75.4%) at 6 mo, and 1,017 (72.0%) at 12 mo. For the primary endpoint, multilevel modelling yielded significantly higher average pain intensity across follow-up to 12 mo in the intervention group than the control group (adjusted mean difference 0.31; 95% CI 0.04, 0.59). Secondary outcomes were consistent with the primary outcome measure in reflecting better outcomes as a whole for the control group than the intervention group. Anxiety and depression scores did not reduce following the intervention. The main limitations of this study are two potential sources of bias: an imbalance in cluster size (mean practice size 7,397 [intervention] versus 5,850 [control]) and a difference in the proportion of patients for whom the GP deactivated the template (33.6% [intervention] versus 27.8% [control]). CONCLUSIONS In this study, we observed no beneficial effect on pain outcomes of prompting GPs to routinely screen for and manage comorbid anxiety and depression in patients presenting with symptoms due to OA, with those in the intervention group reporting statistically significantly higher average pain scores over the four follow-up time points than those in the control group. TRIAL REGISTRATION ISRCTN registry ISRCTN40721988.
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Affiliation(s)
- Christian D. Mallen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
- NIHR Collaboration for Leadership in Applied Health Research and Care West Midlands, Keele, United Kingdom
- * E-mail:
| | - Barbara I. Nicholl
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Bernadette Bartlam
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Daniel Green
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Sue Jowett
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Jesse Kigozi
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - John Belcher
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Kris Clarkson
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Zoe Lingard
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Christopher Pope
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Carolyn A. Chew-Graham
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
- NIHR Collaboration for Leadership in Applied Health Research and Care West Midlands, Keele, United Kingdom
| | - Peter Croft
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Elaine M. Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
- NIHR Collaboration for Leadership in Applied Health Research and Care West Midlands, Keele, United Kingdom
| | - George Peat
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
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Depression and inflammatory arthritis are associated in both Western and Non-Western countries: Findings from the World Health Survey 2002. J Psychosom Res 2017; 92:49-54. [PMID: 27998512 DOI: 10.1016/j.jpsychores.2016.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 11/22/2016] [Accepted: 11/26/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Epidemiological studies have linked arthritis to depression. However, it remains unclear to what degree the association between arthritis and depression extends to low income countries and whether it can be replicated for inflammatory arthritis (IA). We aimed to address these knowledge gaps based on a large multi-national sample. METHODS Cross-sectional data was drawn from the 2002 World Health Survey. IA was defined as reports of either a diagnosis or treatment of arthritis and morning stiffness for >30min. Self-reported depression was defined as positive if participants reported its prior diagnosis or treatment or if they were classified as suffering from a major depressive episode by a seven-item screening instrument. Multivariable logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the entire sample and stratified by sex and continent. RESULTS The odds of IA was 2.6-fold increased in those with depression compared to those without (OR=2.64, 95% CI 2.18-3.21) in the entire sample. This association was observed in both men (OR=3.06, 95% CI 2.19-4.27) and women (OR=2.50, 95% CI 1.95-3.21). Similar associations were found on the continent level, but were generally stronger for the Americas and Asia compared to Africa and Europe. CONCLUSIONS Although our definition of IA was limited by the use of self-reported morning stiffness, this study suggests that there is a positive association between inflammatory arthritis and depression in Western and Non-Western countries, suggesting that this relationship represents a universal phenomenon.
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Walker V, Perret-Guillaume C, Kesse-Guyot E, Agrinier N, Hercberg S, Galan P, Assmann KE, Briançon S, Rotonda C. Effect of Multimorbidity on Health-Related Quality of Life in Adults Aged 55 Years or Older: Results from the SU.VI.MAX 2 Cohort. PLoS One 2016; 11:e0169282. [PMID: 28033414 PMCID: PMC5199105 DOI: 10.1371/journal.pone.0169282] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/14/2016] [Indexed: 12/31/2022] Open
Abstract
Introduction Multimorbid chronic diseases are usually considered separately in trials. Here, we aimed to describe overall multimorbidity patterns in adults aged 55 years or older and assess their effect on health-related quality of life (HRQoL). Methods We used data for 5,647 participants included in the SUpplémentation en VItamines et Minéraux AntioXydants 2 (SU.VI.MAX 2) population-based trial. HRQoL was assessed by the French versions of the Medical Outcome Study Short Form 36 and the Duke Health Profile. An exploratory factor analysis was used to determine multimorbidity patterns, and a multimorbidity score for each resulting pattern was calculated. Adjusted multiple linear regression was used to examine the association between the identified multimorbidity and HRQoL scores by gender and for each age group (55–59, 60–64, 65–69, ≥ 70 years). Results More than 63% of the sample reported two or more chronic conditions (from 55.8% for those 55–59 years to 74.4% for those ≥ 70 years). Multimorbidity was more common among women than men (67.3% vs 60%). Two different multimorbidity patterns were identified. Pattern A was represented mainly by mental illness and bone impairments. Pattern B was represented mainly by cardiovascular and metabolic disorders. After adjusting for covariates, a high pattern A score was associated with reduced HRQoL for the physical and mental components of each HRQoL questionnaire, and a high pattern B score was associated with reduced HRQoL for only the physical component of each questionnaire. These multimorbidity scores affected HRQoL differently by age group. Conclusion Our study used a novel methodological approach to account for multimorbidity patterns in determining the link with chronic conditions. These multimorbidity scores (counted and weighted) can be used in clinical research to control for the effect of multimorbidity on patients’ HRQoL and may be useful for clinical practice. Clinical Trial Registration Clinicaltrial.gov (number NCT00272428).
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Affiliation(s)
- Valentin Walker
- EA4360 APEMAC, University of Lorraine, University Paris Descartes, Nancy, France
| | - Christine Perret-Guillaume
- EA4360 APEMAC, University of Lorraine, University Paris Descartes, Nancy, France
- Department of Gerontology, CHRU de Brabois, Nancy, France
| | - Emmanuelle Kesse-Guyot
- Equipe de Recherche en Epidémiologie Nutritionnelle, Centre d’Epidémiologie et Statistiques Paris Cité, Université Paris 13, Inserm (U1153), Inra (U1125), COMUE Sorbonne-Paris-Cité, Bobigny, France
| | - Nelly Agrinier
- EA4360 APEMAC, University of Lorraine, University Paris Descartes, Nancy, France
- CIC-1433 Epidémiologie Clinique, Inserm, CHRU Nancy, Nancy, France
| | - Serge Hercberg
- Equipe de Recherche en Epidémiologie Nutritionnelle, Centre d’Epidémiologie et Statistiques Paris Cité, Université Paris 13, Inserm (U1153), Inra (U1125), COMUE Sorbonne-Paris-Cité, Bobigny, France
- Département de Santé Publique, Hôpital Avicenne, Bobigny, France
| | - Pilar Galan
- Equipe de Recherche en Epidémiologie Nutritionnelle, Centre d’Epidémiologie et Statistiques Paris Cité, Université Paris 13, Inserm (U1153), Inra (U1125), COMUE Sorbonne-Paris-Cité, Bobigny, France
| | - Karen E. Assmann
- Equipe de Recherche en Epidémiologie Nutritionnelle, Centre d’Epidémiologie et Statistiques Paris Cité, Université Paris 13, Inserm (U1153), Inra (U1125), COMUE Sorbonne-Paris-Cité, Bobigny, France
| | - Serge Briançon
- EA4360 APEMAC, University of Lorraine, University Paris Descartes, Nancy, France
- CIC-1433 Epidémiologie Clinique, Inserm, CHRU Nancy, Nancy, France
- * E-mail:
| | - Christine Rotonda
- EA4360 APEMAC, University of Lorraine, University Paris Descartes, Nancy, France
- CIC-1433 Epidémiologie Clinique, Inserm, CHRU Nancy, Nancy, France
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Sharma A, Kudesia P, Shi Q, Gandhi R. Anxiety and depression in patients with osteoarthritis: impact and management challenges. Open Access Rheumatol 2016; 8:103-113. [PMID: 27843376 PMCID: PMC5098683 DOI: 10.2147/oarrr.s93516] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Anxiety and depression are common psychological comorbidities that impact the quality of life (QoL) of patients. In this systematic review, we 1) determined the impact of anxiety and depression on outcomes in patients with osteoarthritis (OA) and 2) summarized unique challenges these comorbidities present to current OA management. Patients and methods A systematic literature search was performed using the OVID Medline and EMBASE databases until April 2016. Full-text research articles published in English from the year 2000 onward with a sample size of >100 were included in this review. Eligible research articles were reviewed and the following data were extracted: study author(s), year of publication, study design, and key findings. Results A total of 38 studies were included in the present review. The present study found that both anxiety and/or depression were highly prevalent among patients with OA. Patients with OA diagnosed with these comorbidities experienced more pain, had frequent hospital visits, took more medication, and reported less optimal outcomes. Management strategies in the form of self-care, telephone support, audio/video education programs, and new pharmacotherapies were reported with favorable results. Conclusion Anxiety and depression adversely impact the QoL of patients with OA. Physicians/caregivers are highly recommended to consider these comorbidities in patients with OA. Ultimately, a holistic individualized management approach is necessary to improve patient outcomes.
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Affiliation(s)
- Anirudh Sharma
- Division of Genetics and Development, Krembil Research Institute
| | - Prtha Kudesia
- Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Qian Shi
- Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Rajiv Gandhi
- Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
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Tegethoff M, Stalujanis E, Belardi A, Meinlschmidt G. Chronology of Onset of Mental Disorders and Physical Diseases in Mental-Physical Comorbidity - A National Representative Survey of Adolescents. PLoS One 2016; 11:e0165196. [PMID: 27768751 PMCID: PMC5074457 DOI: 10.1371/journal.pone.0165196] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/08/2016] [Indexed: 01/10/2023] Open
Abstract
Background The objective was to estimate temporal associations between mental disorders and physical diseases in adolescents with mental-physical comorbidities. Methods This article bases upon weighted data (N = 6483) from the National Comorbidity Survey Adolescent Supplement (participant age: 13–18 years), a nationally representative United States cohort. Onset of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition lifetime mental disorders was assessed with the fully structured World Health Organization Composite International Diagnostic Interview, complemented by parent report. Onset of lifetime medical conditions and doctor-diagnosed diseases was assessed by self-report. Results The most substantial temporal associations with onset of mental disorders preceding onset of physical diseases included those between affective disorders and arthritis (hazard ratio (HR) = 3.36, 95%-confidence interval (CI) = 1.95 to 5.77) and diseases of the digestive system (HR = 3.39, CI = 2.30 to 5.00), between anxiety disorders and skin diseases (HR = 1.53, CI = 1.21 to 1.94), and between substance use disorders and seasonal allergies (HR = 0.33, CI = 0.17 to 0.63). The most substantial temporal associations with physical diseases preceding mental disorders included those between heart diseases and anxiety disorders (HR = 1.89, CI = 1.41 to 2.52), epilepsy and eating disorders (HR = 6.27, CI = 1.58 to 24.96), and heart diseases and any mental disorder (HR = 1.39, CI = 1.11 to 1.74). Conclusions Findings suggest that mental disorders are antecedent risk factors of certain physical diseases in early life, but also vice versa. Our results expand the relevance of mental disorders beyond mental to physical health care, and vice versa, supporting the concept of a more integrated mental-physical health care approach, and open new starting points for early disease prevention and better treatments, with relevance for various medical disciplines.
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Affiliation(s)
- Marion Tegethoff
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland
- * E-mail:
| | - Esther Stalujanis
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland
| | - Angelo Belardi
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland
| | - Gunther Meinlschmidt
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
- Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany
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Torvik FA, Reichborn-Kjennerud T, Gjerde LC, Knudsen GP, Ystrom E, Tambs K, Røysamb E, Østby K, Ørstavik R. Mood, anxiety, and alcohol use disorders and later cause-specific sick leave in young adult employees. BMC Public Health 2016; 15:702. [PMID: 27488425 PMCID: PMC4972995 DOI: 10.1186/s12889-016-3427-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental disorders strongly influence work capability in young adults, but it is not clear which disorders that are most strongly associated with sick leave, and which diagnoses that are stated on the sick leave certificates. Better knowledge of the impairments associated with different mental disorders is needed for optimal planning of interventions and prioritization of health services. In the current study, we investigate the prospective associations between eight mood, anxiety, and alcohol use disorders, and later sick leave granted for mental, somatic, or any disorder. METHODS Lifetime mental disorders were assessed by structured diagnostic interviews in 2,178 young adults followed for eight years with registry data on sick leave. Relative risk ratios were estimated for the associations between each mental disorder and the different forms of sick leave. RESULTS All included diagnoses were associated with later sick leave. In adjusted analyses, major depressive disorder and generalized anxiety disorder were the strongest predictors of sick leave granted for mental disorders, whereas social anxiety disorder and specific phobia were the strongest predictors of sick leave granted for somatic disorders. Specific phobia and major depressive disorder had the highest attributable fractions for all-cause sick leave. CONCLUSIONS Mood and anxiety disorders constituted independent risk factors for all cause sick leave, whereas alcohol use disorders seemed to be of less importance in young adulthood. Disorders characterised by distress were most strongly associated with sick leave granted for mental disorders, whereas disorders characterised by fear primarily predicted sick leave granted for somatic conditions. A large part of all sick leave is related to specific phobia, due to the high prevalence of this disorder. The impairment associated with this common disorder may be under-acknowledged, and it could decrease work capacity among individuals with somatic disorders. This disorder has good treatment response and may be overlooked as a target for interventions aimed at prevention of sick leave.
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Affiliation(s)
- Fartein Ask Torvik
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
| | - Ted Reichborn-Kjennerud
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
- University of Oslo, Institute of Clinical Medicine, P.O. Box 1171, Blindern, 0318 Oslo Norway
| | - Line C. Gjerde
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
- University of Oslo, Department of Psychology, Section of Health, Developmental and Personality Psychology, P.O. Box 1094, Blindern, 0317 Oslo Norway
| | - Gun Peggy Knudsen
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
| | - Eivind Ystrom
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
- University of Oslo, Department of Psychology, Section of Health, Developmental and Personality Psychology, P.O. Box 1094, Blindern, 0317 Oslo Norway
- University of Oslo, School of Pharmacy, PharmacoEpidemiology and Drug Safety Research Group, P.O. Box 1094, Blindern, 0317 Oslo Norway
| | - Kristian Tambs
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
| | - Espen Røysamb
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
- University of Oslo, Department of Psychology, Section of Health, Developmental and Personality Psychology, P.O. Box 1094, Blindern, 0317 Oslo Norway
| | - Kristian Østby
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
| | - Ragnhild Ørstavik
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
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Fuller-Thomson E, Ramzan N, Baird SL. Arthritis and suicide attempts: findings from a large nationally representative Canadian survey. Rheumatol Int 2016; 36:1237-48. [DOI: 10.1007/s00296-016-3498-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
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Prescription trajectories and effect of total hip arthroplasty on the use of analgesics, hypnotics, antidepressants, and anxiolytics. Pain 2016; 157:643-651. [DOI: 10.1097/j.pain.0000000000000414] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Associations between DSM-IV mental disorders and subsequent onset of arthritis. J Psychosom Res 2016; 82:11-16. [PMID: 26944393 PMCID: PMC4884652 DOI: 10.1016/j.jpsychores.2016.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/24/2015] [Accepted: 01/17/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We investigated the associations between DSM-IV mental disorders and subsequent arthritis onset, with and without mental disorder comorbidity adjustment. We aimed to determine whether specific types of mental disorders and increasing numbers of mental disorders were associated with the onset of arthritis later in life. METHOD Data were collected using face-to-face household surveys, conducted in 19 countries from different regions of the world (n=52,095). Lifetime prevalence and age at onset of 16 DSM-IV mental disorders were assessed retrospectively with the World Health Organization (WHO) Composite International Diagnostic Interview (WHO-CIDI). Arthritis was assessed by self-report of lifetime history of arthritis and age at onset. Survival analyses estimated the association of initial onset of mental disorders with subsequent onset of arthritis. RESULTS After adjusting for comorbidity, the number of mood, anxiety, impulse-control, and substance disorders remained significantly associated with arthritis onset showing odds ratios (ORs) ranging from 1.2 to 1.4. Additionally, the risk of developing arthritis increased as the number of mental disorders increased from one to five or more disorders. CONCLUSION This study suggests links between mental disorders and subsequent arthritis onset using a large, multi-country dataset. These associations lend support to the idea that it may be possible to reduce the severity of mental disorder-arthritis comorbidity through early identification and effective treatment of mental disorders.
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Lao CK, Chan YM, Tong HHY, Chan A. Underdiagnosis of depression in an economically deprived population in Macao, China. Asia Pac Psychiatry 2016; 8:70-9. [PMID: 26293902 DOI: 10.1111/appy.12208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 07/28/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previous literature revealed an association between low income and depression. Despite the availability of effective treatments, depression is often underdiagnosed and undertreated. This study was designed to evaluate the prevalence of depressive symptoms and their impact on health-related quality of life (HRQoL) in a low-income population in Macao. METHODS This cross-sectional study targeted the adult beneficiaries of local food bank program. The program was established to provide food assistance to the residents who had low income but were ineligible for government financial assistance. All data were collected through interview and questionnaires. The Patient Health Questionnaire (PHQ-9) was used for assessing depressive symptoms. Information about depression diagnosis was obtained by the self-report method. HRQoL levels were measured by the 12-item Short-Form Health Survey, Version 2.0. RESULTS A total of 272 study participants were included for analysis. Based on the PHQ-9 scores, 27.6% of the participants suffered from moderate to severe depressive symptoms. Among them, 76% were not diagnosed with depression. Those with moderate to severe depressive symptoms had significantly lower levels of HRQoL (P < 0.001). Anxiety disorders (OR = 9.71, 95% CI = 2.36-40.06), migraine (OR = 3.88, 95% CI = 1.55-9.73), and poor to fair self-rated health (OR = 6.30, 95% CI = 1.95-20.40) were the independent factors associated with moderate to severe depressive symptoms. DISCUSSION Underdiagnosis of depression was prevalent in this low-income population. There is a need to raise their awareness of mental disorders and improve their access to mental health services.
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Affiliation(s)
- Cheng-Kin Lao
- School of Health Sciences, Macao Polytechnic Institute, Macao
| | - Yok-Man Chan
- School of Health Sciences, Macao Polytechnic Institute, Macao
| | | | - Alexandre Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
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Njeru JW, DeJesus RS, St Sauver J, Rutten LJ, Jacobson DJ, Wilson P, Wieland ML. Utilization of a mental health collaborative care model among patients who require interpreter services. Int J Ment Health Syst 2016; 10:15. [PMID: 26933447 PMCID: PMC4772682 DOI: 10.1186/s13033-016-0044-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/13/2016] [Indexed: 12/28/2022] Open
Abstract
Background Immigrants and refugees to the United States have a higher prevalence of depression compared to the general population and are less likely to receive adequate mental health services and treatment. Those with limited English proficiency (LEP) are at an even higher risk of inadequate mental health care. Collaborative care management (CCM) models for depression are effective in achieving treatment goals among a wide range of patient populations, including patients with LEP. The purpose of this study was to assess the utilization of a statewide initiative that uses CCM for depression management, among patients with LEP in a large primary care practice. Methods This was a retrospective cohort study of patients with depression in a large primary care practice in Minnesota. Patients who met criteria for enrollment into the CCM [with a provider-generated diagnosis of depression or dysthymia in the electronic medical records, and a Patient Health Questionnaire-9 (PHQ-9) score ≥10]. Patient-identified need for interpreter services was used as a proxy for LEP. Rates of enrollment into the DIAMOND (Depression Improvement Across Minnesota, Offering A New Direction) program, a statewide initiative that uses CCM for depression management were measured. These rates were compared between eligible patients who require interpreter services versus patients who do not. Results Of the 7561 patients who met criteria for enrollment into the DIAMOND program during the study interval, 3511 were enrolled. Only 18.2 % of the eligible patients with LEP were enrolled into DIAMOND compared with the 47.2 % of the eligible English proficient patients. This finding persisted after adjustment for differences in age, gender and depression severity scores (adjusted OR [95 % confidence interval] = 0.43 [0.23, 0.81]). Conclusions Within primary care practices, tailored interventions are needed, including those that address cultural competence and language navigation, to improve the utilization of this effective model among patients with LEP.
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Affiliation(s)
- Jane W Njeru
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA ; Robert D and Patricia E Kern Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Ramona S DeJesus
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA ; Robert D and Patricia E Kern Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Jennifer St Sauver
- Robert D and Patricia E Kern Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA ; Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
| | - Lila J Rutten
- Robert D and Patricia E Kern Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA ; Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
| | - Patrick Wilson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
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Davillas A, Benzeval M, Kumari M. Association of Adiposity and Mental Health Functioning across the Lifespan: Findings from Understanding Society (The UK Household Longitudinal Study). PLoS One 2016; 11:e0148561. [PMID: 26849046 PMCID: PMC4744034 DOI: 10.1371/journal.pone.0148561] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/19/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Evidence on the adiposity-mental health associations is mixed, with studies finding positive, negative or no associations, and less is known about how these associations may vary by age. OBJECTIVE To examine the association of adiposity -body mass index (BMI), waist circumference (WC) and percentage body fat (BF%)- with mental health functioning across the adult lifespan. METHODS Data from 11,257 participants (aged 18+) of Understanding Society: the UK Household Longitudinal Study (waves 2 and 3, 5/2010-7/2013) were employed. Regressions of mental health functioning, assessed by the Mental Component Summary (MCS-12) and the General Health Questionnaire (GHQ-12), on adiposity measures (continuous or dichotomous indicators) were estimated adjusted for covariates. Polynomial age-adiposity interactions were estimated. RESULTS Higher adiposity was associated with poorer mental health functioning. This emerged in the 30s, increased up to mid-40s (all central adiposity and obesity-BF% measures) or early 50s (all BMI measures) and then decreased with age. Underlying physical health generally accounted for these associations except for central adiposity, where associations remained statistically significant from the mid-30s to 50s. Cardiovascular, followed by arthritis and endocrine, conditions played the greatest role in attenuating the associations under investigation. CONCLUSIONS We found strong age-specific patterns in the adiposity-mental health functioning association that varied across adiposity measures. Underlying physical health had the dominant role in attenuating these associations. Policy makers and health professionals should target increased adiposity, mainly central adiposity, as it is a risk factor for poor mental health functioning in those aged between mid-30s to 50 years.
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Affiliation(s)
- Apostolos Davillas
- Institute for Social and Economic Research (ISER), University of Essex, Colchester, United Kingdom
| | - Michaela Benzeval
- Institute for Social and Economic Research (ISER), University of Essex, Colchester, United Kingdom
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Meena Kumari
- Institute for Social and Economic Research (ISER), University of Essex, Colchester, United Kingdom
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Garin N, Koyanagi A, Chatterji S, Tyrovolas S, Olaya B, Leonardi M, Lara E, Koskinen S, Tobiasz-Adamczyk B, Ayuso-Mateos JL, Haro JM. Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study. J Gerontol A Biol Sci Med Sci 2015; 71:205-14. [PMID: 26419978 DOI: 10.1093/gerona/glv128] [Citation(s) in RCA: 383] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/22/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Population ageing challenges health care systems due to the high prevalence and impact of multimorbidity in older adults. However, little is known about how chronic conditions present in certain multimorbidity patterns, which could have great impact on public health at several levels. The aim of our study was to identify and describe multimorbidity patterns in low-, middle-, and high-income countries. METHODS We analyzed data from the Collaborative Research on Ageing in Europe project (Finland, Poland, and Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, and South Africa). These cross-sectional studies obtained data from 41,909 noninstitutionalized adults older than 50 years. Exploratory factor analysis was performed to detect multimorbidity patterns. Additional adjusted binary logistic regressions were performed to identify associations between sociodemographic factors and multimorbidity. RESULTS Overall multimorbidity prevalence was high across countries. Hypertension, cataract, and arthritis were the most prevalent comorbid conditions. Two or three multimorbidity patterns were found per country. Several patterns were identified across several countries: "cardio-respiratory" (angina, asthma, and chronic obstructive pulmonary disease), "metabolic" (diabetes, obesity, and hypertension), and "mental-articular" (arthritis and depression). CONCLUSIONS A high prevalence of multimorbidity occurs in older adults across countries, with low- and middle-income countries gradually approaching the figures of richer countries. Certain multimorbidity patterns are present in several countries, which suggest that common underlying etiopathogenic factors may play a role. Deeper understanding of these patterns may lead to the development of preventive actions to diminish their prevalence and also give rise to new, comprehensive approaches for the management of these co-occurring conditions.
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Affiliation(s)
- Noe Garin
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigacions Biomèdiques Sant Pau (IIB Sant Pau), Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain. Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Somnath Chatterji
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
| | - Stefanos Tyrovolas
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Beatriz Olaya
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy
| | - Elvira Lara
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Seppo Koskinen
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Jose Luis Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain. Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain. Department of Psychiatry, Universidad Autónoma de Madrid, Spain
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
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One-year trajectories of depression and anxiety symptoms in older patients presenting in general practice with musculoskeletal pain: A latent class growth analysis. J Psychosom Res 2015; 79:195-201. [PMID: 26070405 DOI: 10.1016/j.jpsychores.2015.05.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Distinguishing transient from persistent anxiety and depression symptoms in older people presenting to general practice with musculoskeletal pain is potentially important for effective management. This study sought to identify distinct post-consultation depression and anxiety symptom trajectories in adults aged over 50years consulting general practice for non-inflammatory musculoskeletal pain. METHODS Self-completion questionnaires, containing measures of anxiety and depressive symptoms, age, gender, pain status, coping and social status were mailed within 1week of the consultation and at 3, 6 and 12months. Latent class growth analysis was used to identify anxiety and depression symptoms trajectories, which were ascertained with cut-off score ≥8 on Hospital Anxiety and Depression Scale subscales. Associations between baseline characteristics and cluster membership were examined using multivariate multinomial logistic regression analysis (the 3-step approach). RESULTS Latent class growth analyses determined a 3-cluster anxiety model (n=499) and a 3-cluster depression model (n=501). Clusters identified were: no anxiety problem (44.1%), persistent anxiety problem (33.9%) and transient anxiety symptoms (22.2%); no depression problem (74.1%), persistent depression problem (22.0%) and gradual depression symptom recovery (4.0%). Widespread pain, interference with valued activities, coping by increased behavioral activities, catastrophizing, perceived lack of instrumental support, age ≥70years, being female, and performing manual/routine work were associated with anxiety and/or depression clusters. CONCLUSIONS Older people with non-inflammatory musculoskeletal pain are at high risk of persistent anxiety and/or depression problems. Biopsychosocial factors, such as pain status, coping strategies, instrumental support, performing manual/routine work, being female and age ≥70years, may help identify patients with persistent anxiety and/or depression.
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French HP, Galvin R, Horgan NF, Kenny RA. Prevalence and burden of osteoarthritis amongst older people in Ireland: findings from The Irish LongituDinal Study on Ageing (TILDA). Eur J Public Health 2015; 26:192-8. [PMID: 26105959 DOI: 10.1093/eurpub/ckv109] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of osteoarthritis (OA) in a population aged ≥50 years in Ireland, and to determine its relationship with demographic and health-related variables. METHODS Cross-sectional data from Wave 1 of The Irish Longitudinal Study on Ageing (TILDA), a population-based study of 8175 people aged ≥50 years were analyzed. Logistic regression was used to determine associations between the presence of OA and a range of demographic and health-related variables. RESULTS A total of 8175 people ≥50 years in Ireland were identified from the TILDA database of whom 45.7% (n = 2941) were male and 54.3% (n = 4431) were female. The overall prevalence of OA was 12.9% (women-17.3%; men-9.4%). Prevalence increased with age, with prevalence in those aged ≥ 80 years twice that [17.7%; 95% confidence interval (CI) 13.97, 21.54] of those aged 50-60 years (8.23, 95% CI 7.32, 9.13). On multivariable analysis, OA was significantly associated (P < 0.02) with female gender, older age, pain severity, higher body mass index (BMI), fear of falling, greater number of physical limitations and medication use. In particular, there was a strong association between the use of NSAIDS and the presence of OA [adj odd ratio (OR) = 5.88, 95% CI 4.16, 8.31]. A significant association was also found between OA and increasing number of chronic diseases (adj OR = 2.75 9, 95% CI = 2.44, 3.09). CONCLUSIONS OA is a common and multifaceted condition, with comparable prevalence of self-reported OA in Ireland with similar populations. Assessment and management should focus on potentially modifiable factors such as BMI, pain, physical limitations, polypharmacy and fear of falling. More research is required to understand the complex inter-relationships between these and other risk-associated variables.
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Affiliation(s)
- H P French
- 1 School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephen's Green, Dublin 2, Republic of Ireland
| | - R Galvin
- 2 Department of Clinical Therapies, University of Limerick, Castletroy, Limerick, Republic of Ireland
| | - N F Horgan
- 1 School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephen's Green, Dublin 2, Republic of Ireland
| | - R A Kenny
- 3 The Irish Longitudinal Study on Ageing, Chemistry Extension, Trinity College Dublin (TCD), Dublin 2, Ireland
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Thombs BD, Jewett LR, Kwakkenbos L, Hudson M, Baron M. Major depression diagnoses among patients with systemic sclerosis: baseline and one-month followup. Arthritis Care Res (Hoboken) 2015; 67:411-6. [PMID: 25156077 DOI: 10.1002/acr.22447] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/12/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Depression is common in many rheumatic diseases and is associated with poor prognosis. No studies of patients with any rheumatic diseases, however, have assessed the stability of major depressive disorder (MDD) diagnoses over time. The objective of the present study was to assess the stability of MDD diagnoses among patients with systemic sclerosis (SSc; scleroderma), a rare autoimmune rheumatic disease, across 2 assessments approximately 1 month apart. METHODS SSc patients were recruited from 7 Canadian Scleroderma Research Group Registry sites (April 2009 to June 2012). Current (30-day) MDD was assessed with the Composite International Diagnostic Interview at baseline and approximately 1 month later. RESULTS Among 309 patients with baseline assessments who received followup assessments an average of 34 days later, prevalence of 30-day MDD was 4% (95% confidence interval [95% CI] 2%-7%; n = 12) at baseline and 5% (95% CI 3%-8%; n = 16) at followup. Only 3 of 12 patients (25% [95% CI 9%-53%]) with MDD at baseline had MDD 1 month later. CONCLUSION Most patients with SSc who meet criteria for MDD appear to experience mild, time-limited episodes of low mood that often resolve on their own without specific treatment. Consistent with international guidelines on depression management in nonpsychiatric settings, "watchful waiting" or "active monitoring" is a good strategy for SSc patients with mild depression to avoid unnecessary treatment among those whose symptoms may be transient and may resolve without medical intervention.
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Affiliation(s)
- Brett D Thombs
- McGill University and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
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Association between mental disorders and physical diseases in adolescents from a nationally representative cohort. Psychosom Med 2015; 77:319-32. [PMID: 25851547 DOI: 10.1097/psy.0000000000000151] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Pediatric health care and research focus mostly on single morbidities, although the single-disease framework has been challenged. The main objective was to estimate associations between childhood mental disorders and physical diseases. METHODS This study is based on weighted data (n = 6482) from the National Comorbidity Survey Replication Adolescent Supplement (age, 13-18 years). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition lifetime mental disorders were assessed using the fully structured World Health Organization Composite International Diagnostic Interview, complemented by parent report. Lifetime medical conditions and doctor-diagnosed diseases were assessed by adolescent self-report. RESULTS Of 6469 participants, 2137 (35.33%) reported at least one mental disorder and one physical disease. The most substantial associations included those between affective disorders and diseases of the digestive system (odds ratio [OR] = 3.46, 95% confidence interval [CI] = 2.28-5.24), anxiety disorders and arthritis (OR = 2.27, CI = 1.34-3.85), anxiety disorders and heart diseases (OR = 2.41, CI = 1.56-3.73), anxiety disorders and diseases of the digestive system (OR = 2.18, CI = 1.35-3.53), and eating disorders and epilepsy/seizures (OR = 5.45, CI = 1.57-18.87). Sociodemographic factors did not account for the association between mental disorders and physical diseases. CONCLUSIONS Findings suggest that mental disorders and physical diseases often co-occur in childhood. This association is a major public health challenge, and the child health system needs additional strategies in patient-centered care, research, medical education, health policy, and economics to develop well-coordinated interdisciplinary approaches linking mental and physical care in children.
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Stenquist DS, Elman SA, Davis AM, Bogart LM, Brownlee SA, Sanchez ES, Santiago A, Ghazinouri R, Katz JN. Physical activity and experience of total knee replacement in patients one to four years postsurgery in the dominican republic: a qualitative study. Arthritis Care Res (Hoboken) 2015; 67:65-73. [PMID: 24818572 DOI: 10.1002/acr.22367] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/29/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Musculoskeletal disorders are the second leading cause of years lived with disability globally. Total knee replacement (TKR) offers patients with advanced arthritis relief from pain and the opportunity to return to physical activity. We investigated the impact of TKR on physical activity for patients in a developing nation. METHODS As part of the Operation Walk Boston surgical mission program, we interviewed 18 Dominican patients (78% women) who received TKR about their level of physical activity after surgery. Qualitative interviews were conducted in Spanish, and English transcripts were analyzed using content analysis. RESULTS Most patients found that TKR increased their participation in physical activities in several life domains, such as occupational or social pursuits. Some patients limited their own physical activities due to uncertainty about medically appropriate levels of joint use and postoperative physical activity. Many patients noted positive effects of TKR on mood and mental health. For most patients in the study, religion offered a framework for understanding their receipt of and experience with TKR. CONCLUSION Our findings underscore the potential of TKR to permit patients in the developing world to return to physical activities. This research also demonstrates the influence of patients' education, culture, and religion on patients' return to physical activity. As the global burden of musculoskeletal disease increases, it is important to characterize the impact of activity limitation on patients' lives in diverse settings and the potential for surgical intervention to ease the burden of chronic arthritis.
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Chen CJ, McHugh G, Campbell M, Luker K. Subjective and Objective Sleep Quality in Individuals with Osteoarthritis in Taiwan. Musculoskeletal Care 2014; 13:148-159. [PMID: 25491038 DOI: 10.1002/msc.1094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The negative effects of osteoarthritis (OA), such as pain and depression, interfere with an individual's sleep quality. The main objective of the present study was to investigate the prevalence of poor quality of sleep in individuals with OA in Taiwan and identify potential predictors. A secondary objective was to examine agreement between objective and subjective measures of sleep quality. METHODS In a cross-sectional survey, OA outpatients in Taiwan completed a self-administered questionnaire, incorporating validated measurements for assessing quality of sleep (the Pittsburgh Sleep Quality Index (PSQI)), pain and physical functioning, anxiety and depression, and health-related quality of life. In a nested feasibility study, a sub-sample of participants wore an Actigraph wrist monitor to measure sleep objectively over a three-day period. RESULTS Of 192 individuals with OA who completed the survey, 30 completed the Actigraph study. The mean PSQI global score was 9.0 (standard deviation 4.5); most participants (135, 70.3%) had poor quality of sleep (global PSQI >5). Key predictors of poor quality of sleep included role limitation due to poor physical functioning, poor social functioning, higher anxiety levels and higher pain levels. There were moderate correlations between subjective and objective measures of sleep quality, although participants underestimated their true sleeping time by two hours. CONCLUSIONS Health professionals need to discuss sleep issues with individuals with OA and include strategies for coping with these difficulties. For reduced night-time pain which may interfere with sleep, additional and appropriate advice about medication is required. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ching-Ju Chen
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan, R.O.C
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Thapa SB, Martinez P, Clausen T. Depression and its correlates in South Africa and Ghana among people aged 50 and above: Findings from the WHO Study on global AGEing and adult health. JOURNAL OF PSYCHIATRY 2014; 17:1000167. [PMID: 25914902 PMCID: PMC4405524 DOI: 10.4172/1994-8220.1000167] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The growth of the older adult population in Africa demands more knowledge about their chronic health problems, such as depression. The aim of this paper is to estimate depression prevalence and identify correlates of depression among older adults in Ghana and South Africa. METHOD The WHO Study on global AGEing and adult health (SAGE study) was conducted in Ghana and South Africa from 2007 to 2009 by the World Health Organization, using a standardized questionnaire among an adult population. Our analyses included 4289 adults aged 50 and above in Ghana and 3668 in South Africa. Depression was measured using self-reported symptoms over the last 12 months according to ICD-10 criteria. RESULTS The prevalence of mild depression was 6.7% and 2.7% in Ghana and South Africa, respectively (p<.001), with a gender difference only in Ghana. Factors independently associated with depression among women in Ghana were migration and lack of current work.. Similarly, higher age, lack of current work and lower quality of life were independently associated with depression among women in South Africa, whereas higher age and lower quality of life were associated with depression among men in South Africa. CONCLUSIONS Ghana had a higher depression rate than South Africa and we identified different factors associated with depression among men and women in these two countries. Our finding underscores the need for culture- and gender-sensitive approaches for the prevention and management of depression among the older adult population in Ghana and South Africa.
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Affiliation(s)
- Suraj Bahadur Thapa
- Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway
- Mental Health and Addiction Clinic, Oslo University Hospital, Oslo, Norway
| | - Priscilla Martinez
- Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway
| | - Thomas Clausen
- Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway
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Individual and community socioeconomic status: impact on mental health in individuals with arthritis. ARTHRITIS 2014; 2014:256498. [PMID: 25152816 PMCID: PMC4137496 DOI: 10.1155/2014/256498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 06/18/2014] [Accepted: 06/19/2014] [Indexed: 11/17/2022]
Abstract
To examine the impact of individual and community socioeconomic status (SES) measures on mental health outcomes in individuals with arthritis, participants with self-reported arthritis completed a telephone survey assessing health status, health attitudes and beliefs, and sociodemographic variables. Regression analyses adjusting for race, gender, BMI, comorbidities, and age were performed to determine the impact of individual and community level SES on mental health outcomes (i.e., Medical Outcomes Study SF-12v2 mental health component, the Centers for Disease Control and Prevention Health-Related Quality of Life Healthy Days Measure, Center for Epidemiological Studies Depression [CES-D] scale). When entered singly, lower education and income, nonmanagerial occupation, non-homeownership, and medium and high community poverty were all significantly associated with poorer mental health outcomes. Income, however, was more strongly associated with the outcomes in comparison to the other SES variables. In a model including all SES measures simultaneously, income was significantly associated with each outcome variable. Lower levels of individual and community SES showed most consistent statistical significance in association with CES-D scores. Results suggest that both individual and community level SES are associated with mental health status in people with arthritis. It is imperative to consider how interventions focused on multilevel SES factors may influence existing disparities.
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