Primary health care use from the perspective of gender and morbidity burden

Effect of Combined Physical Exercise Training in Reducing Cardiovascular Risk Among Adults with Obesity: A Randomized Clinical Trial

It is necessary to understand the relationship between different models of exercise periodization and the reduction of cardiovascular risk in adults with obesity. The aim of this study was to verify the effect of two periodization models of combined training on the cardiovascular risk of adults with obesity of both sexes. A randomized clinical trial was conducted with adults of both sexes with obesity. They were divided into three groups: control group (CG), non-periodized combined training group (NG), and combined training group with linear periodization (PG). The NG and PG groups underwent physical exercise training regimen for 16 weeks, in three weekly sessions of 60 min each, with the volume and intensity equalized. Cardiovascular risk was measured by the overall Framingham risk score (FRS). Generalized estimation equations and individual responsiveness analyses were used, stratified by sex. A statistically significant reduction in FRS was observed only in men of the NG (pre: 2.50 ± 0.56; post: 0.50 ± 1.02; p-value = 0.001). There was no statistically significant intervention effect on the women's cardiovascular risk. It was found that, regardless of sex, subjects in the control group mostly presented results of increased cardiovascular risk. In contrast, those belonging to the exercise groups, if not reduced, at least stabilized the chances of suffering a cardiovascular event in the next ten years after 16 weeks of combined training. Sixteen weeks of non-periodized combined training were sufficient to reduce cardiovascular risk in men with obesity. Both periodization models were important to stabilize the risk of developing a cardiovascular disease in the next 10 years.

Relationship of frailty status with health resource use and healthcare costs in the population aged 65 and over in Catalonia

BACKGROUND

Frailty is a geriatric syndrome with repercussions on health, disability, and dependency.

OBJECTIVES

To assess health resource use and costs attributable to frailty in the aged population.

METHODS

A population-based observational longitudinal study was performed, with follow-up from January 2018 to December 2019. Data were obtained retrospectively from computerized primary care and hospital medical records. The study population included all inhabitants aged ≥ 65 years ascribed to 3 primary care centres in Barcelona (Spain). Frailty status was established according to the Electronic Screening Index of Frailty. Health costs considered were hospitalizations, emergency visits, outpatient visits, day hospital sessions, and primary care visits. Cost analysis was performed from a public health financing perspective.

RESULTS

For 9315 included subjects (age 75.4 years, 56% women), frailty prevalence was 12.3%. Mean (SD) healthcare cost in the study period was €1420.19 for robust subjects, €2845.51 for pre-frail subjects, €4200.05 for frail subjects, and €5610.73 for very frail subjects. Independently of age and sex, frailty implies an additional healthcare cost of €1171 per person and year, i.e., 2.25-fold greater for frail compared to non-frail.

CONCLUSIONS

Our findings underline the economic relevance of frailty in the aged population, with healthcare spending increasing as frailty increases.

Gender Awareness in Healthcare: Contextualization of an Arabic Version of the Nijmegen Gender Awareness in Medicine Scale (N-GAMS)

Gender is one of the important social determinants of health known to be highly associated with health status. Despite the importance of gender awareness, it has not been addressed and researched in the Arab region, including Palestine. This study aimed to contextualize an Arabic version of the Nijmegen Gender Awareness in Medicine Scale (N-GAMS) and to assess the level of gender awareness and its associated factors among primary health care providers. The N-GAMS tool was translated and adapted through a gender expert consultation and a focus group discussion. Then, it was administered online to a sample of primary health care general physicians and nurses of all health care providing actors in Ramallah and al-Bireh Governorate. The reliability of the N-GAMS subscales using Cronbach's alpha (α) was 0.681 for the gender sensitivity (GS) scale (9 items), 0.658 for the gender role ideology towards co-workers (GRIC) scale (6 items), and α = 0.848 for the gender role ideology towards patients (GRIP) scale (11 items). The results showed that participants had scored near the midpoint of the gender sensitivity subscale (M = 2.84, SD = 0.486). They also expressed moderate gender stereotypes towards patients (M = 3.11, SD = 0.624), where females held lower stereotypical thinking. Participants also expressed low to moderate stereotypes towards co-workers (M = 2.72, SD = 0.660) and females expressed less stereotypical thinking compared to males. Furthermore, the participant's age had some effect on the outcome, specifically on the GRIP subscale, while gender was associated with both GRIP and GRID subscales. The rest of the social and other variables showed no association with the gender awareness subscales. This study adds to our understanding of gender awareness. Further tests are required to confirm the psychometric qualities of the instrument.

Fall-related health service use in Stepping On programme participants and matched controls: a non-randomised observational trial within the 45 and Up Study

BACKGROUND

Falls and fall-related health service use among older adults continue to increase. The New South Wales Health Department, Australia, is delivering the Stepping On fall prevention programme at scale. We compared fall-related health service use in Stepping On participants and matched controls.

METHODS

A non-randomised observational trial was undertaken using 45 and Up Study data. 45 and Up Study participants who did and did not participate in Stepping On were extracted in a 1:4 ratio. Rates of fall-related health service use from linked routinely collected data were compared between participants and controls over time using multilevel Poisson regression models with adjustment for the minimally sufficient set of confounders identified from a directed acyclic graph.

RESULTS

Data from 1,452 Stepping On participants and 5,799 controls were analysed. Health service use increased over time and was greater in Stepping On participants (rate ratios (RRs) 1.47-1.82) with a spike in use in the 6 months prior to programme participation. Significant interactions indicated differential patterns of health service use in participants and controls: stratified analyses revealed less fall-related health service use in participants post-programme compared to pre-programme (RRs 0.32-0.48), but no change in controls' health service use (RRs 1.00-1.25). Gender was identified to be a significant effect modifier for health service use (P < 0.05 for interaction).

DISCUSSION

Stepping On appeared to mitigate participants' rising fall-related health service use. Best practice methods were used to maximise this study's validity, but cautious interpretation of results is required given its non-randomised nature.

Diagnostic accuracy of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) within a civilian primary care sample

OBJECTIVE

This study aims to evaluate the diagnostic accuracy of the Primary Care Posttraumatic Stress Disorder (PTSD) Screen for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) (PC-PTSD-5) as a screening tool for the identification of PTSD among a civilian sample receiving behavioral health treatment within a primary care setting. Validation within a civilian sample will increase the generalizability of the PC-PTSD-5 as a brief screening measure to identify PTSD within primary care practices.

METHOD

The present study is a retrospective review of data (N = 198) collected as part of a patient registry for an integrated behavioral health consultation service within a primary care clinic. The PC-PTSD-5 was administered as part of a standardized set of brief screening measures and a standard clinical interview. Diagnostic validation was accomplished via a consensus model between a board-certified family medicine physician and a licensed psychologist along with medical/psychology trainees.

RESULTS

Fifty-two participants (26.26%) out of 198 who completed the PC-PTSD-5 were diagnosed with PTSD. The PC-PTSD-5 demonstrated excellent diagnostic accuracy (area under the curve = 0.933, 95% confidence interval [CI]: 0.901-0.965). A cutoff score of 4 maximized sensitivity (sensitivity% = 100) while maintaining acceptable specificity (specificity% = 85.2). This score also maximized efficiency (κ[0.5] = 0.77, SE = 0.05, 95% CI: 0.67-0.86) and maintained a good (≥0.60) quality index for specificity (κ[0] = 0.61).

CONCLUSION

The PC-PTSD-5 maintained strong diagnostic accuracy within a civilian primary care sample.

Health complaints in individual visiting primary health care: population-based national electronic health records of Iran

Background

The mission of medical schools is a sustainable commitment to orient education, research, and services based on the priorities and expectations of society. The most common complaints of patients from comprehensive health service centers (CHSCs) based on the data from electronic health records were assessed in order to determine primary health care (PHC) priorities for the educational planning of medical students in Iran.

Methods

A population-based national study was designed to assess clinical complaints of patients in all age groups who were referred to CHSCs at least once to be visited by physicians. All the data in the census were extracted from electronic health records in PHC system during 2015–2020, classified by the International Classification of Primary Care 2^nd edition (ICPC-2e-English), and statistically analyzed. The total number of complaints that were recorded in the system was 17,430,139.

Results

59% of the referring patients were women. The highest number of referrals was related to the age group of 18–59 years (56.9%), while the lowest belonged to the elderly people (13.3%). In all age and sex groups, the first ten complaints of patients with three top priorities in each category included process (follow-up, consultation, and results exam), digestive (toothache and gum complaint, abdominal pain, and diarrhea), respiratory (cough, sore throat, and runny nose), general (fever, pain, and weakness and fatigue), musculoskeletal (back pain, leg complaint, and knee injuries), endocrine and nutritional (weight gain, Feeding problem, and weight loss), cardiovascular (hypertension, palpitations, and Postural hypotension), neurological (headache, dizziness, and paralysis), sexual dysfunction (vaginal complaint, discharge, and irregular menstruation), and dermatological (pruritus, rash, and inflammation) problems.

Conclusion

High priorities in referring to PHC had a key role in assessing the country's health needs. Since this study was in line with the national pattern of complaints and patients' profile, the present findings can be helpful to amend policy-making, educational planning and curricula development in medical schools.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07880-z.

Cross-sectional analysis of coding, patient characteristics, consultation frequency and pharmacological treatment of adults with severe mental disorders in Irish general practice

Background

General practitioners are the gatekeepers of Irish healthcare and they offer continuity of care to patients. Irish general practice is therefore considered appropriate for preventing, diagnosing and managing most mental health problems.

Aims

This study sought to establish the coding frequency, consultation frequency, patient characteristics and pharmacological treatment of patients with severe mental disorders (SMDs) in Irish general practice.

Methods

A cross-sectional design was used. A finder tool embedded in the practice software assisted general practitioners (GPs) coding adult patients with SMDs. Eleven practices uploaded anonymous data on 2,203 patients. Variables analysed included disease code, consultations, prescriptions, sex, patient status and age.

Results

Overall, 2.9% (n = 2,337) of patients had ever been coded with a SMD, 2.4% (n = 1,964) coded with depressive disorder ever and 0.26% (n = 209) and 0.3% (n = 233) with bipolar disorder and schizophrenia, respectively. Overall, 68.0% (n = 1,336) of patients with depressive disorder were female, and 74.0% (n = 171) of patients with schizophrenia were public patients. The median consultation rate in the previous 3 years was highest for schizophrenia patients at 24.5 visits.

Conclusions

Coding of SMDs in Irish general practice appears incomplete. Patients with SMDs have high consultation rates. Patients with depressive disorder are more likely to be female and public patients. This research suggests that the improvement of coding in Irish general practice is the first practical step required to detecting prevalence rates.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11845-021-02747-4.

Early environmental factors and somatic comorbidity in schizophrenia and nonschizophrenic psychoses: A 50-year follow-up of the Northern Finland Birth Cohort 1966

Background.

We studied the cumulative incidence of physical illnesses, and the effect of early environmental factors (EEFs) on somatic comorbidity in schizophrenia, in nonschizophrenic psychosis and among nonpsychotic controls from birth up to the age of 50 years.

Methods.

The sample included 10,933 members of the Northern Finland Birth Cohort 1966, of whom, 227 had schizophrenia and 205 had nonschizophrenic psychosis. Diagnoses concerning physical illnesses were based on nationwide registers followed up to the end of 2016 and classified into 13 illness categories. Maternal education and age, family type at birth and paternal socioeconomic status were studied as EEFs of somatic illnesses.

Results.

When adjusted by gender and education, individuals and especially women with nonschizophrenic psychosis had higher risk of morbidity in almost all somatic illness categories compared to controls, and in some categories, compared to individuals with schizophrenia. The statistically significant adjusted hazard ratios varied from 1.27 to 2.42 in nonschizophrenic psychosis. Regarding EEFs, single-parent family as the family type at birth was a risk factor for a higher somatic score among men with schizophrenia and women with nonschizophrenic psychosis. Maternal age over 35 years was associated with lower somatic score among women with nonschizophrenic psychosis.

Conclusions.

Persons with nonschizophrenic psychoses have higher incidence of somatic diseases compared to people with schizophrenia and nonpsychotic controls, and this should be noted in clinical work. EEFs have mostly weak association with somatic comorbidity in our study.

Prevalence and Patterns of Health Care Use Among Poor Older People Under the Livelihood Empowerment Against Poverty Program in the Atwima Nwabiagya District of Ghana

In spite of the growing literature on prevalence and patterns of health care use in later life globally, studies have generally overlooked subjective standpoints of vulnerable Ghanaian older people obstructing the achievement of the United Nations' health-related Sustainable Development Goals. We examined the prevalence and patterns of health care use among poor older people in the Atwima Nwabiagya District of Ghana. Cross-sectional data were obtained from an Aging, Health, Lifestyle and Health Services Survey conducted between June 1 and 20, 2018 (N = 200). Chi-square and Fisher's exact tests were carried out to estimate the differences between gender and health care utilization with significant level of less than or equal to 0.05. Whereas, 85% of the respondents utilized health care, females were higher utilizers (88% vs. 75%) but males significantly incurred higher health care expenditure. The majority utilized health services on monthly basis (38%) and consulted public health care providers (77%). While 68% utilized services from hospitals, most sourced health information from family members (54%) and financed their health care through personal income (45%). The study found that the Livelihood Empowerment Against Poverty grant played a little role in reducing health poverty. Stakeholders should review social programs that target poor older people in order to improve their well-being and utilization of health care.

Examining determinants of health service utilisation among Filipino older people: A cross-sectional study

OBJECTIVE

This study was done to study, using Andersen's Behavioral Model, factors affecting health service utilisation among older Filipinos.

METHODS

A total of 237 older people from Marikina City, Philippines, were randomly selected and surveyed face-to-face on factors affecting health service utilisation, specifically age, civil status, educational level, employment status, sex, health insurance coverage, household income, chronic disease status and perceived health status.

RESULTS

Seventy-nine per cent had used health services in the past year (mean: 5.7 visits per year). Female sex and having a chronic disease were significantly associated with health service utilisation. The odds of using health services was 3.1 times higher for those who had a chronic disease and 2.2 times higher for female sex, assuming all other variables are held constant.

CONCLUSION

Findings of this study support targeting men in health promotion campaigns and implementing population-based, chronic disease screening programs to improve the reach of health services among Filipino older people.

Treatment adequacy for social anxiety disorder in primary care patients

OBJECTIVES

There is a gap between clinical practice guidelines for social anxiety disorder and clinical practice that needs to be addressed to ensure the delivery of evidence-based treatments. The objectives of this study were: 1) to describe mental health service utilization in a cohort of primary care patients with social anxiety disorder; 2) to examine treatment adequacy for pharmacotherapy and psychotherapy according to indicators based on clinical practice guidelines; and 3) to explore correlates of treatment adequacy.

METHOD

The "Dialogue" project (Quebec, Canada) is a large study conducted in 67 primary care clinics. After a mental health screening in primary care (n = 14 833), participants with anxiety or depressive symptoms took part in a telephone/web structured interview on mental health symptoms and service utilization (n = 1956). This study included 289 participants meeting DSM-IV criteria for social anxiety disorder.

RESULTS

Overall, 86.2% of participants reported consulting for mental health reasons over the past 12 months. Only 23.6% of our sample reported the detection of social anxiety disorder by a healthcare professional in the past 12 months. Approximately 2 in 5 respondents with social anxiety disorder reported receiving pharmacotherapy or psychotherapy meeting our treatment adequacy indicators. Antidepressant medication was the most common treatment. Logistic regression models showed that the detection of major depression (OR = 4.651; 95% CI: 2.559-8.453) or other anxiety disorder(s) (OR = 2.957; 95% CI: 1.555-5.625) were associated with receiving any adequate treatment, but the detection of social anxiety disorder itself was not (OR = 1.420; 95% CI: 0.696-2.899).

CONCLUSION

Low rates of detection and treatment adequacy based on our indicators demonstrate that efforts must be made to ensure the quality of care for individuals with social anxiety disorder in primary care.

Developing a new predictor of health expenditure: preliminary results from a primary healthcare setting

OBJECTIVES

Risk adjustment is a widely used tool for health expenditure prediction and control. Early approaches for estimating health expenditure were based on patient demographic variables alone, whereas more recent models incorporate patient information, such as chronic medical conditions, clinical diagnoses, and self-reported health status. Many studies have investigated the health expenditure predictive capacity of single demographic, morbidity, or health-related quality of life measures, but the best models prove to be those that include them all. The aim of this study was to develop an index that combines measures of perceived health and disease severity and to compare its efficacy in predicting health expenditure with that of the measures taken individually.

STUDY DESIGN

This is a linked cross-sectional study.

METHODS

In 2009 and 2010, the health-related quality of life questionnaire SF-36 (8 scales, two indices: Physical Component Summary [PCS] and Mental Component Summary [MCS]) was distributed to 886 patients of general practitioners in the Province of Siena, Italy. Severity of diseases was calculated for each patient using the Charlson Index (CH-I) and Cumulative Illness Rating Scale Severity Index (CIRS-SI). Siena Local Health Unit 2012 data on health expenditure were obtained for each patient. Multivariate linear regression was applied to test the performance of severity (CH-I, CIRS-SI) and perceived health (PCS and MCS) measures in predicting health expenditure. The indexes that predicted health expenditure best were then combined in a new tool, and its expenditure predictive capacity was tested.

RESULTS

The best health expenditure predictors proved to be PCS and SI (R² = 0.15 and R² = 0.17, respectively). When combined in a new index (PCS-SI), better predictive capacity of health expenditure was obtained than with the two single measures separately (R² = 0.19).

CONCLUSIONS

A multidimensional indicator proved to be a better predictor of healthcare expenditure than single health measures.

Equity in health care: An urban and rural, and gender perspective; the Suriname Health Study

BACKGROUND

The literature reports that the use of healthcare services in urban areas compared to rural areas and by females compared to males is often higher. The aim of this study is to evaluate equity on geographical living area and gender for the use of primary and secondary healthcare in Suriname.

METHODS

We used 5,671 records (99%) from the Suriname Health study which was designed according to World Health Organization (WHO) Steps guidelines. We evaluated the Prevalence Ratio (PR) for living area and gender in using primary (PHC) and secondary healthcare (SHC) adjusted for the perceived need for healthcare, socio-economic factors and disease factors and the effect of all factors was measured.

RESULTS

Overall a percentage of 46.7 (95% Confidence Interval (CI) 45.1-48.4) had used primary healthcare and 12.7 (95% CI 11.6-13.8) secondary healthcare in the past 12 months. The PR for males compared to females was 0.75 (95% CI 0.70-0.81) for primary healthcare and 0.82 (95% CI 0.69-0.98) for secondary healthcare. The PR for urban and rural coastal areas compared to the rural interior was 1.52 (95 % CI 1.36-1.70) and 1.53 (95% CI 1.36-1.71), respectively. For the use of SHC, the PR for urban and rural coastal areas compared to the rural interior was 9.3 (95 % CI 5.44-15.89) and 8.58 (95% CI 4.98-14.81). The attributable effect of perceived healthcare-need to the PR of the urban and rural coastal areas was 39.64% and 37.81% compared to the rural interior for secondary healthcare. Further, 31.74% and 13.56% were due to socioeconomic factors.

CONCLUSION

Although we observed equity between living areas for PHC use, for SHC use we observed a disadvantaged position for the rural interior, mainly influenced by socioeconomic factors. We measured gender equity for both PHC and SHC use.

Short-term effectiveness of a culturally tailored educational intervention on foot self-care among type 2 diabetes patients in Morocco

BACKGROUND

Self-management education (SME) is an important yet unacknowledged aspect of diabetes care. Despite the raise of diabetes and its complications with significant burden in developing countries, research on SME interventions in Morocco is lacking.

AIMS

To assess the effectiveness of a culturally tailored SME intervention on foot-care self-management practices among type 2 diabetes patients and to identify factors associated with practices variation.

METHODS

We designed a pre-post prospective quasi-experimental study and recruited patients with type 2 diabetes aged 30 years old or above. The intervention consisted of an interactive group discussion using different materials: a narrative video, a PowerPoint presentation and a printed guide. Foot-care practices were assessed prior to the session and one month later using 2 items from the Summary of Diabetes Self-Care Activities (SDSCA). Binary logistic regression was performed to identify factors associated with a favorable variation, defined as an increase in the mean frequency score of foot-care by a minimum of 1 day/week.

RESULTS

A total of 199 participants were recruited and 133 completed the second assessment. Mean age was 55.2 ± 11.2 years old. Women represented 67% and 72% of participants was illiterate. The foot-care score mean increased from 3.5 ± 2.9 days to 5.9 ± 1.8 days one month after the intervention (mean variation was 2.4 ± 3.1 days; p < 0.001). A favorable variation was found among 75 (37.7%) participants. In multivariate analysis, literacy was associated with higher likelihood of a favorable variation of foot-care practices (OR = 2.82; 95%CI: 1.09-7.31) while previous education about diabetic foot was associated with lower likelihood of a favorable variation (OR = 0.26; 95%CI: 0.08-0.78).

CONCLUSIONS

There was a general improvement in foot-care practices after the intervention. Our findings suggest the role of literacy and previous patient education in shaping the observed variation. Culturally tailored interventions targeting other disease management domains are needed in our context.

Socioeconomic Inequalities in Visits to the Dentist to Receive Professionally Applied Topical Fluoride in a Developing Country

Objective: To determine the frequency and associated factors of visits to the dentist in the last year by Nicaraguan schoolchildren to receive professionally applied topical fluoride (PATF). Material and Methods: A cross-sectional study was designed in children from public schools in the city of León, Nicaragua, were included. A series of socioeconomic, sociodemographic, and behavioural variables were collected through a questionnaire. The dependent variable was the visit to the dentist to receive professionally applied topical fluoride in the last year, which was dichotomised as (0) Did not receive PATF and (1) Yes received PATF. In the statistical analysis, binary logistic regression was used. Results: The mean age of the students included was 9 years, and 49.9% were girls. The prevalence of visits to the dentist in the last year to receive PATF was 3.1%. In the multivariate model, the associated characteristics (p < 0.05) were: female (OR = 2.73, 95% CI = 1.34–4.50); the positive attitude of the mother to the oral health of her child (OR = 2.15, 95% CI = 1.03–4.50); and the best socioeconomic position (OR = 2.68, 95% CI = 1.36—5.31). Conclusions: The prevalence of visits to the dentist in the last year to receive professionally applied topical fluoride was very low (3.1%). The results of the socioeconomic position suggest the existence of certain inequalities in oral health. It is necessary to implement policies and programs aimed at improving this scenario.

The effect of multimorbidity on sickness absence by specific diagnoses

BACKGROUND

As the world's population ages, the prevalence of multiple chronic and non-chronic health-related conditions is increasing. Research on multimorbidity, the co-occurrence of two or more health-related conditions, has mainly involved patient and older populations. Its effect in working populations, presumably younger and healthier, is not well known but could conceivably affect sickness absence (SA) and ability to return to work.

AIMS

To examine the effect of multimorbidity on the incidence and duration of SA episodes by frequent diagnostic groups.

METHODS

A prospective study (in 2006-2008) of workers in Spain. Information on health-related conditions was gathered with a standardized questionnaire and used to construct a sex-specific multidimensional multimorbidity score (MDMS). In order to estimate the effect of MDMS on incidence and duration of SA episodes due to cardiovascular diseases (CVD), musculoskeletal disorders (MSD) and mental health disorders (MHD), we fitted Cox models adjusted by age, occupational social class and number of prior SA episodes for both sexes.

RESULTS

The study population was 372370. Men with high MDMS showed a trend towards higher incidence risk for SA due to CVD and MSD [adjusted hazard ratio (aHR) = 2.03; 95% confidence interval (CI) 1.48-2.78 and aHR = 1.20; 95% CI 1.01-1.43, respectively]. Women showed a similar trend for MSD, but MHD had the strongest association (aHR = 4.78; 95% CI 1.97-11.62) for high MDMS. In both sexes, the effect of MDMS was strongest among those without a prior SA. No consistent associations with SA duration were observed.

CONCLUSIONS

Multimorbidity increased the risk of incident musculoskeletal, mental and cardiovascular SA episodes but not their duration.

No Evidence of Reciprocal Associations between Daily Sleep and Physical Activity

PURPOSE

This study aimed to determine whether physical activity patterns are associated with sleep later at night and if nighttime sleep is associated with physical activity patterns the next day among adult women.

METHODS

Women (N = 353) living throughout the United States wore a wrist and a hip accelerometer for 7 d. Total sleep time (TST, hours per night) and sleep efficiency (SE, %) were estimated from the wrist accelerometer, and moderate to vigorous physical activity (MVPA, >1040 counts per minute, h·d) and sedentary behavior (SB, <100 counts per minute, h·d) were estimated from the hip accelerometer. Mixed-effects models adjusted for age, race, body mass index, education, employment, marital status, health status, and hip accelerometer wear time were used to analyze the data. Follow-up analyses using quantile regression were used to investigate associations among women with below average TST and MVPA and above average SB.

RESULTS

The average age of our sample was 55.5 yr (SD = 10.2 yr). The majority of participants were White (79%) and married (72%), and half were employed full time (49%). The participants spent on average 8.9 and 1.1 h·d in SB and MVPA, respectively, and 6.8 h per night asleep. No associations were observed between MVPA and SB with nighttime TST or SE. There were no associations between nighttime TST and SE with MVPA or SB the next day. The findings were the same in the quantile regression analyses.

CONCLUSION

In free-living adult women, accelerometry-estimated nighttime sleep and physical activity patterns were not associated with one another. On the basis of our observational study involving a sample of adult women, higher physical activity will not necessarily improve sleep at night on a day-to-day basis (and vice versa).

Chronic non-cancer pain and the epidemic prescription of opioids in the Danish population: trends from 2000 to 2013

BACKGROUND

Chronic pain has serious consequences for individuals and society. In addition, opioid prescription for chronic non-cancer pain (CNCP) has become more frequent. This study aims to examine the trends regarding the prevalence of CNCP, dispensed opioids, and concurrent use of benzodiazepine (BZD)/BZD-related drugs in the Danish population.

METHODS

Data from the cross-sectional national representative Danish Health and Morbidity Surveys (2000, 2005, 2010, and 2013) were combined with The Danish National Prescription Registry at an individual level. The study populations varied between 5000 and 13,000 individuals ≥16 years (response rates: 51-63%). Respondents completed a self-administered questionnaire, which included the analyzed items on identification of chronic pain (≥6 months).

RESULTS

From 2000 to 2013, the prevalence of CNCP increased and subsequently the annual prevalence of opioid use from 4.1% to 5.7% among CNCP individuals. Higher CNCP prevalence was related to female gender, no cohabitation partner, short education, non-Western origin, and overweight/obesity. In addition, women with CNCP, especially >65 years, became more frequent users of opioids and used higher doses than men. Concurrent use of BZD/BZD-related drugs decreased (13%) from 2010 to 2013, still one-third of long-term opioid user were co-medicated with these drugs.

CONCLUSIONS

The use of opioids has increased in Denmark, especially among elderly women. The concurrent use of BZD/BZD-related drugs has decreased from 2010 to 2013, but still one-third of long-term opioid users were co-medicated.

Measuring multimorbidity in a working population: the effect on incident sickness absence

PURPOSE

Multimorbidity research typically focuses on chronic and common diseases in patient and/or older populations. We propose a multidimensional multimorbidity score (MDMS) which incorporates chronic conditions, symptoms, and health behaviors for use in younger, presumably healthier, working populations.

METHODS

Cross-sectional study of 372,370 Spanish workers who underwent a standardized medical evaluation in 2006. We computed a MDMS (range 0-100) based on the sex-specific results of a multicorrespondence analysis (MCA). We then used Cox regression models to assess the predictive validity of this MDMS on incident sickness absence (SA) episodes.

RESULTS

Two dimensions in the MCA explained about 80% of the variability in both sexes: (1) chronic cardiovascular conditions and health behaviors, and (2) pain symptoms, in addition to sleep disturbances in women. More men than women had at least one condition (40 vs 15%) and two or more (i.e., multimorbidity) (12 vs 2%). The MDMS among those with multimorbidity ranged from 16.8 (SD 2.4) to 51.7 (SD 9.9) in men and 18.5 (SD 5.8) to 43.8 (SD 7.8) in women. We found that the greater the number of health conditions, the higher the risk of SA. A higher MDMS was also a risk factor for incident SA, even after adjusting for prior SA and other covariates. In women, this trend was less evident.

CONCLUSIONS

A score incorporating chronic health conditions, behaviors, and symptoms provides a more holistic approach to multimorbidity and may be useful for defining health status in working populations and for predicting key occupational outcomes.

Prevalence and correlates of probable common mental disorders in a population with high prevalence of HIV in Zimbabwe

BACKGROUND

In 2014 close to 10 million people living with HIV (PLWH) in sub-Saharan Africa were on highly active anti-retroviral therapy (HAART). The incidence of non-communicable diseases has increased markedly in PLWH as mortality is reduced due to use of HAART. Common mental disorders (CMD) are highly prevalent in PLWH. We aimed to determine factors associated with probable CMD and depression, assessed by 2 locally validated screening tools in a population with high prevalence of HIV in Harare, Zimbabwe.

METHODS

We carried out a cross-sectional survey of a systematic random sample of patients utilizing the largest primary health care facility in Harare. Adults aged ≥18 years attending over a 2-week period were eligible, excluding those who were critically ill or unable to give written informed consent. Two locally validated screening tools the Shona symptom questionnaire (SSQ-14) and the Patient Health Questionnaire (PHQ-9) were administered by trained research assistants to identify probable CMD and depression.

RESULTS

Of the 264 participants, 165 (62.5 %) were PLWH, and 92 % of these were on HAART. The prevalence of probable CMD (SSQ14 > = 9) and depression (PHQ9 > = 11) were higher among people living with HIV than among those without HIV (67.9 and 68.5 % vs 51.4 and 47.2 % respectively). Multivariable analysis showed female gender and recent negative life events to be associated with probable CMD and depression among PLWH (gender: OR = 2.32 95 % CI:1.07-5.05; negative life events: OR = 4.14; 95 % CI 1.17-14.49) and with depression (gender: OR = 1.84 95 % CI:0.85-4.02; negative life events: OR = 4.93.; 95 % CI 1.31-18.50) CONCLUSION: Elevated scores on self-report measures for CMD and depression are highly prevalent in this high HIV prevalence population. There is need to integrate packages of care for CMD and depression in existing primary health care programs for HIV/AIDS.