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Quintana R, Fernández S, Orzuza SM, Silvestre AMR, Bensi A, Goñi M, Iglesias P, Mathern N, García-Bianco V, Honeri A, Pons-Estel BA, Valdata M, Peláez-Ballestas I. «Living with rheumatoid arthritis» in an indigenous qom population in Argentina. A qualitative study. ACTA ACUST UNITED AC 2021; 17:543-548. [PMID: 34756317 DOI: 10.1016/j.reumae.2020.04.006] [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: 01/31/2020] [Accepted: 04/22/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic disease which impacts patients' quality of life. The prevalence of RA in the qom population was 2.4% and represented an aggressive and disabling disease. The study goal was to describe the experience of the indigenous qom community individual suffering from RA, along with their experience with the local health care system in the city of Rosario, Santa Fe, Argentina. METHODS Qualitative Study using techniques of participant observation and semi-structured interviews; following a guideline developed by a multidisciplinary research group comprising anthropologists, rheumatologists, nurses, and psychologists. A triangulation strategy was implemented for the analysis. RESULTS A total of 33 interviews were conducted in 29 individuals with RA. The results showed a "normalization" of their symptoms and of their limitations in performing daily tasks. The individuals' relationship with the local health care system was complex and limited in several aspects (e.g. access to health care, continuity of treatment, complexity of medical care pathway and lack of cultural competence). CONCLUSIONS RA is a disease that has a negative impact on the daily lives of the qom people living in Rosario. Improving the relationship between this population and the local health care system as well as the implementation of multidisciplinary work should be priorities.
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Affiliation(s)
- Rosana Quintana
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina.
| | - Sofía Fernández
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Stella M Orzuza
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Adriana M R Silvestre
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Ana Bensi
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Mario Goñi
- Centro de Especialidades Médicas Ambulatorias de Rosario, Secretaría de Salud Pública, Municipalidad de Rosario, Argentina
| | - Paola Iglesias
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Nora Mathern
- Instituto de Reumatología, Ortopedia y Fisiatría, Rosario, Argentina
| | - Vanina García-Bianco
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Andrés Honeri
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Bernardo A Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Marcela Valdata
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
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Shin S, Park EH, Kang EH, Lee YJ, Song YW, Ha YJ. Sex differences in clinical characteristics and their influence on clinical outcomes in an observational cohort of patients with rheumatoid arthritis. Joint Bone Spine 2020; 88:105124. [PMID: 33346105 DOI: 10.1016/j.jbspin.2020.105124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/22/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is more prevalent in women, but sex differences remain incompletely understood. This study aimed to elucidate sex differences in clinical characteristics and their potential impact on clinical outcomes in a large Korean cohort of patients with RA. METHODS In total, 5376 RA patients from the KORean Observational study Network for Arthritis (KORONA) database were examined at baseline and for 3 consecutive years using the disease activity score 28 (DAS28), health assessment questionnaire (HAQ), and patient-reported outcomes (PROs). Within a subgroup with active disease (DAS28≥3.2) at baseline, sex impacts on clinical outcome during follow-up were analyzed using generalized estimating equation (GEE) models. The factors related to achieving clinical remission were analyzed using Cox-proportional hazard regression. RESULTS At baseline, women (n=4574) were younger and had more erosive disease and longer disease duration than men (n=802) with higher scores in DAS28, HAQ, and PROs. The prevalence of interstitial lung disease, cardiovascular disease, and diabetes in men was higher than that of women. In a RA subgroup with active disease at baseline, GEE analyses demonstrated that women RA significantly influenced the rate of change of DAS28 over time. In that group, men are associated with achieving DAS28 sustained remission and point remission. CONCLUSIONS Women with RA in Korea report higher levels of disease activity and PROs compared to men, whereas most comorbidities were more prevalent in men. The longitudinal change in disease activity and the rate of achieving clinical remission were found to be worse in women with RA.
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Affiliation(s)
- Seunghwan Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Eun Hye Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - You-Jung Ha
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
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Quintana R, Fernández S, Orzuza SM, Silvestre AMR, Bensi A, Goñi M, Iglesias P, Mathern N, García-Bianco V, Honeri A, Pons-Estel BA, Valdata M, Peláez-Ballestas I. «Living with Rheumatoid Arthritis» in an Indigenous Qom Population in Argentina. A Qualitative Study. REUMATOLOGIA CLINICA 2020; 17:S1699-258X(20)30112-1. [PMID: 32600980 DOI: 10.1016/j.reuma.2020.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/13/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic disease which impacts patients' quality of life. The prevalence of RA in the qom population was 2.4% and represented an aggressive and disabling disease. The study goal was to describe the experience of the indigenous qom community individual suffering from RA, along with their experience with the local health care system in the city of Rosario, Santa Fe, Argentina. METHODS Qualitative Study using techniques of participant observation and semi-structured interviews; following a guideline developed by a multidisciplinary research group comprising anthropologists, rheumatologists, nurses, and psychologists. A triangulation strategy was implemented for the analysis. RESULTS A total of 33 interviews were conducted in 29 individuals with RA. The results showed a «normalization» of their symptoms and of their limitations in performing daily tasks. The individual relationships with the local health care system was complex and limited in several aspects (e.g. access to health care, continuity of treatment, complexity of medical care pathway and lack of cultural competence). CONCLUSIONS RA is a disease that has a negative impact on the daily lives of the qom people living in Rosario. Improving the relationship between this population and the local health care system as well as the implementation of multidisciplinary work should be priorities.
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Affiliation(s)
- Rosana Quintana
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina.
| | - Sofía Fernández
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Stella M Orzuza
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Adriana M R Silvestre
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Ana Bensi
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Mario Goñi
- Centro de Especialidades Médicas Ambulatorias de Rosario, Secretaría de Salud Pública, Municipalidad de Rosario, Argentina
| | - Paola Iglesias
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Nora Mathern
- Instituto de Reumatología, Ortopedia y Fisiatría, Rosario, Argentina
| | - Vanina García-Bianco
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Andrés Honeri
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Bernardo A Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Marcela Valdata
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
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Rodriguez-Amado J, Moreno-Montoya J, Alvarez-Nemegyei J, Goycochea-Robles MV, Sanin LH, Burgos-Vargas R, Cardiel MH, Garza-Elizondo MA, Maradiaga M, Pelaez-Ballestas I. The Social Gap Index and the prevalence of osteoarthritis in the community: a cross-sectional multilevel study in Mexico. Clin Rheumatol 2014; 35:175-82. [DOI: 10.1007/s10067-014-2776-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 08/14/2014] [Accepted: 09/07/2014] [Indexed: 11/29/2022]
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Mody GM, Brooks PM. Improving musculoskeletal health: global issues. Best Pract Res Clin Rheumatol 2013; 26:237-49. [PMID: 22794096 DOI: 10.1016/j.berh.2012.03.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 03/08/2012] [Indexed: 02/02/2023]
Abstract
Musculoskeletal (MSK) disorders are among the leading reasons why patients consult a family or primary health practitioner, take time off work and become disabled. Many of the MSK disorders are more common in the elderly. Thus, as the proportion of the elderly increases all over the world, MSK disorders will make a greater contribution to the global burden of disease. Epidemiological studies have shown that the spectrum of MSK disorders in developing countries is similar to that seen in industrialised countries, but the burden of disease tends to be higher due to a delay in diagnosis or lack of access to adequate health-care facilities for effective treatment. Musculoskeletal pain is very common in the community while fibromyalgia is being recognised as part of a continuum of chronic widespread pain rather than a narrowly defined entity. This will allow research to improve our understanding of pain in a variety of diffuse pain syndromes. The availability of newer more effective therapies has resulted in efforts to initiate therapy at an earlier stage of diseases. The new criteria for rheumatoid arthritis, and the diagnosis of axial and peripheral involvement in spondyloarthritis, permit an earlier diagnosis without having to wait for radiological changes. One of the major health challenges is the global shortage of health workers, and based on current training of health workers and traditional models of care for service delivery, the global situation is unlikely to change in the near future. Thus, new models of care and strategies to train community health-care workers and primary health-care practitioners to detect and initiate the management of patients with MSK disorders at an earlier stage are required. There is also a need for prevention strategies with campaigns to educate and raise awareness among the entire population. Lifestyle interventions such as maintaining an ideal body weight to prevent obesity, regular exercises, avoidance of smoking and alcohol abuse, intake of a balanced diet and nutrients to include adequate calcium and vitamin D, modification of the work environment and avoidance of certain repetitive activities will prevent or ameliorate disorders such as osteoarthritis, osteoporosis, rheumatoid arthritis, gout and MSK pain syndromes including low back pain and work-related pain syndromes. These prevention strategies also contribute to reducing the prevalence and outcome of diseases such as hypertension, cardiovascular diseases, diabetes and respiratory diseases. Thus, prevention strategies require urgent attention globally.
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Affiliation(s)
- Girish M Mody
- Department of Rheumatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Congella, Durban, South Africa.
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Hosseinpoor AR, Bergen N, Mendis S, Harper S, Verdes E, Kunst A, Chatterji S. Socioeconomic inequality in the prevalence of noncommunicable diseases in low- and middle-income countries: results from the World Health Survey. BMC Public Health 2012; 12:474. [PMID: 22726343 PMCID: PMC3490890 DOI: 10.1186/1471-2458-12-474] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 05/30/2012] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Noncommunicable diseases are an increasing health concern worldwide, but particularly in low- and middle-income countries. This study quantified and compared education- and wealth-based inequalities in the prevalence of five noncommunicable diseases (angina, arthritis, asthma, depression and diabetes) and comorbidity in low- and middle-income country groups. METHODS Using 2002-04 World Health Survey data from 41 low- and middle-income countries, the prevalence estimates of angina, arthritis, asthma, depression, diabetes and comorbidity in adults aged 18 years or above are presented for wealth quintiles and five education levels, by sex and country income group. Symptom-based classification was used to determine angina, arthritis, asthma and depression rates, and diabetes diagnoses were self-reported. Socioeconomic inequalities according to wealth and education were measured absolutely, using the slope index of inequality, and relatively, using the relative index of inequality. RESULTS Wealth and education inequalities were more pronounced in the low-income country group than the middle-income country group. Both wealth and education were inversely associated with angina, arthritis, asthma, depression and comorbidity prevalence, with strongest inequalities reported for angina, asthma and comorbidity. Diabetes prevalence was positively associated with wealth and, to a lesser extent, education. Adjustments for confounding variables tended to decrease the magnitude of the inequality. CONCLUSIONS Noncommunicable diseases are not necessarily diseases of the wealthy, and showed unequal distribution across socioeconomic groups in low- and middle-income country groups. Disaggregated research is warranted to assess the impact of individual noncommunicable diseases according to socioeconomic indicators.
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Affiliation(s)
- Ahmad Reza Hosseinpoor
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
| | - Nicole Bergen
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
| | - Shanthi Mendis
- Department of Chronic Diseases and Health Promotion, World Health Organization, Geneva, Switzerland
| | - Sam Harper
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada
| | - Emese Verdes
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
| | - Anton Kunst
- Department of Public Health, AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Somnath Chatterji
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
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Thomtén J, Soares JJ, Sundin Ö. Pain among women: Associations with socio-economic factors over time and the mediating role of depressive symptoms. Scand J Pain 2012; 3:62-67. [DOI: 10.1016/j.sjpain.2011.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 12/31/2011] [Indexed: 01/17/2023]
Abstract
Abstract
Background and aims
Lower socioeconomic status (SES), based on economic situation, education and occupation, has been associated with greater morbidity and mortality in a wide range of diseases, and socioeconomic inequalities have been found in several chronic pain populations. Since women are overrepresented in several clinical pain conditions, there is a need to understand the influence of SES among women with pain. In a previous cross-sectional study, socioeconomic-and work conditions were associated with pain among women from the general population of Sweden. In the present study, based on baseline and follow-up measures from 2300 of the same sample, we examined associations between pain variables, socioeconomic status and work conditions over time by means of multiple logistic/linear regression analyses. Additionally, a possible mediating role of depressive symptoms on the relationship between SES and pain was examined.
Methods
The study was a prospective panel survey with two measurements 12 months apart among 2300 women with and without pain from the general population in Stockholm (aged 18–64). Logistic and linear regression analyses were used to identify associations between SES and pain outcomes.
Results
Results revealed that pain is a rather stable condition with large impact on daily functioning among many women. Certain SES variables (educational level, financial strain, occupational level) were related to pain and pain related disability prospectively. Financial strain and to be a blue-collar worker were related to the incidence of pain among all women, while educational level was related to worse pain outcomes among women with pain in terms of pain intensity, pain frequency, number of pain locations and pain-related disability. Symptoms of depression were associated with pain incidence and with pain variables (intensity, number of pain locations and pain-related disability) and with lower SES.
Conclusions
Financial strain and occupational level were here identified as risk factors for the incidence of pain, and could be interpreted as increasing both physical and psychological stress and thereby work both as predisposing the individual to pain and to perpetuate the development of a pain condition. Educational level was associated with the course of pain in terms of pain duration and pain-related disability which may indicate that once affected by pain, lower educational level may be related to less functional coping strategies in the adaptation to the pain condition. Depressive symptoms could be understood as a mediator of the relationship between SES and pain among women in terms of limiting the individual’s strategies to handle pain in a functional manner by increasing passive behavior patterns such as avoidance.
Implications
The interplay between SES and symptoms of depression should be regarded in preventive interventions and in treatment of pain among women. An overall risk-profile in terms of psychosocial and biological factors needs to be assessed early on within pain treatment for women. Increased knowledge of socioeconomic risk factors for long term pain, e.g. low educational level, is needed on all levels among all professionals within the healthcare system in order to facilitate effective communication in the treatment of women with pain.
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Affiliation(s)
- Johanna Thomtén
- Department of Psychology , Division of Social Sciences , Mid Sweden University , Östersund , Sweden
| | | | - Örjan Sundin
- Department of Psychology , Division of Social Sciences , Mid Sweden University , Östersund , Sweden
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The relationship of demographic and psychosocial variables to pain-related outcomes in a rural chronic pain population. Pain 2011; 151:467-474. [PMID: 20817401 DOI: 10.1016/j.pain.2010.08.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 08/04/2010] [Accepted: 08/04/2010] [Indexed: 11/23/2022]
Abstract
Rural residency and low socioeconomic status (SES) are associated with increased likelihood of chronic pain. Other demographics are also differentially associated with the experience of pain. This study examines the relations between demographic and pain-related variables in a virtually unstudied population of rural Alabama chronic pain patients. One hundred and fifteen patients completed validated measures of pain catastrophizing, depression, pain intensity, pain interference, perceived disability, and life satisfaction. Average age of study participants was 52-years, 79% were female, 74% were African-American, 72% reported annual income between 00,000-12,999, and 61% were unemployed. Although average years of reported education was 12.26, reading level percentile (primary literacy indicant) was 17.33. Cross-sectional multivariate and univariate analyses were conducted to examine associations among demographic and psychosocial variables in relation to various pre-treatment pain-related variables. The mediating role of pain catastrophizing and depression was investigated. Results indicate that race was significantly associated with pain intensity and pain interference, such that African-Americans reported higher scores than White-Americans. Pain catastrophizing was uniquely associated with pain intensity, pain interference, and perceived disability; depression was uniquely associated with pain interference and life satisfaction. Pain catastrophizing mediated the relation between primary literacy and pain intensity; age effects were differentially mediated by either pain catastrophizing or depression. These analyses provide an insight into the specific demographic and psychosocial factors associated with chronic pain in a low-literacy, low-SES rural population.
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Weigl M, Cieza A, Cantista P, Stucki G. Physical disability due to musculoskeletal conditions. Best Pract Res Clin Rheumatol 2007; 21:167-90. [PMID: 17350551 DOI: 10.1016/j.berh.2006.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Musculoskeletal conditions (MSC) are common throughout the world and their impact on individuals is diverse and manifold. Knowledge of the determinants for disability and of strategies for prevention and rehabilitation management according to the scientific evidence is critical for reducing the burden of MSC. The first section of this chapter reviews the evidence for common determinants of functioning and disability in patients with MSC. We have focussed on environmental factors (EF) and personal factors (PF) and have structured them according to the International Classification of Functioning, Disability and Health (ICF) framework. The second section discusses prevention strategies. Generally, prevention needs to address those EF and PF that were presented in the first section. The final section describes modern principles of rehabilitation and reviews the evidence for specific rehabilitation interventions.
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Affiliation(s)
- Martin Weigl
- Department of Physical Medicine and Rehabilitation, Ludwig-Maximilian-University, Munich, Germany, and Hospital Geral de Santo António, Porto, Portugal
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Bergman S. Public health perspective--how to improve the musculoskeletal health of the population. Best Pract Res Clin Rheumatol 2007; 21:191-204. [PMID: 17350552 DOI: 10.1016/j.berh.2006.08.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Musculoskeletal disorders are the most common cause of long-term sick leave in several western countries and individuals with chronic musculoskeletal pain score very low on health status measurements. Musculoskeletal health is multidimensional and is best understood from a biopsychosocial perspective. Body structure and function interacts with personal and environmental factors, affecting the ability to perform activities and participate in society. Interventions aimed at the whole population must attend to the underlying causes of musculoskeletal disorders and promote a healthy lifestyle. Safe environments and activities could reduce the risk of traumatic events and also make participation possible for those with a disability. Public beliefs about musculoskeletal symptoms and consequences need to be changed in order to minimise fear and avoidance, which, together with other psychosocial factors, could lead to chronicity. Public awareness and identification of those at risk for the development of musculoskeletal problems could lead to early and properly timed management.
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Edwards RR, Goble L, Kwan A, Kudel I, McGuire L, Heinberg L, Wigley F, Haythornthwaite J. Catastrophizing, Pain, and Social Adjustment in Scleroderma: Relationships With Educational Level. Clin J Pain 2006; 22:639-46. [PMID: 16926580 DOI: 10.1097/01.ajp.0000210918.26159.94] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Low educational attainment is related to numerous adverse health outcomes, and some evidence suggests that psychosocial variables may mediate education's effects. Moreover, the relationship between psychosocial functioning and health-related outcomes may be moderated by educational level, with individuals lower in formal education being more susceptible to the deleterious effects of negative cognitive and affective states. The present study sought to characterize such interrelationships between educational level and pain-related catastrophizing. METHODS We investigated the association of self-reported educational level with pain and social disability, we evaluated catastrophizing's potential mediating role in those associations, and we also investigated education as a moderator of catastrophizing's effects on pain and social disability in a sample of patients with scleroderma, a frequently painful autoimmune disorder. RESULTS First, education-related differences in pain report were accounted for by catastrophizing and depression. Second, after controlling for demographic factors, disease severity, and depressive symptoms, education moderated the relationship between catastrophizing, pain affect, and social function. Specifically, catastrophizing was more highly associated with greater reporting of affective pain among those with less formal education. In addition, catastrophizing inversely correlated with social disruption among individuals with less formal education. DISCUSSION Collectively, study findings support multiple models of interaction between education and pain-related cognitive/affective functioning, though in both mediational and moderational analyses, lower levels of formal education act as a risk factor for adverse pain-related outcomes.
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Affiliation(s)
- Robert R Edwards
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
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