Physical Functioning, Physical Activity, Exercise Self-Efficacy, and Quality of Life Among Individuals With Chronic Heart Failure in Korea: A Cross-Sectional Descriptive Study.

PubMed

Lee, Haejung; Boo, Sunjoo; Yu, Jihyoung; Suh, Soon-Rim; Chun, Kook Jin; Kim, Jong Hyun

2017-04-01

Both the beneficial relationship between exercise and quality of life and the important role played by exercise self-efficacy in maintaining an exercise regimen among individuals with chronic heart failure are well known. However, most nursing interventions for Korean patients with chronic heart failure focus only on providing education related to risk factors and symptoms. Little information is available regarding the influence of physical functions, physical activity, and exercise self-efficacy on quality of life. This study was conducted to examine the impact of physical functioning, physical activity, and exercise self-efficacy on quality of life among individuals with chronic heart failure. This study used a cross-sectional descriptive design. Data were collected from 116 outpatients with chronic heart failure in Korea. Left ventricular ejection fraction and New York Heart Association classifications were chart reviewed. Information pertaining to levels of physical activity, exercise self-efficacy, and quality of life were collected using self-administered questionnaires. Data were analyzed using descriptive statistics, t tests, analyses of variance, correlations, and hierarchical multiple regressions. About 60% of participants were physically inactive, and most showed relatively low exercise self-efficacy. The mean quality-of-life score was 80.09. The significant correlates for quality of life were poverty, functional status, physical inactivity, and exercise self-efficacy. Collectively, these four variables accounted for 50% of the observed total variance in quality of life. Approaches that focus on enhancing exercise self-efficacy may improve patient-centered outcomes in those with chronic heart failure. In light of the low level of exercise self-efficacy reported and the demonstrated ability of this factor to predict quality of life, the development of effective strategies to enhance exercise self-efficacy offers a novel and effective approach to improving the quality of life of patients with chronic heart failure. Nurses should be proactive in advising patients with chronic heart failure to be more physically active and to enhance their self-confidence in diverse ways.

The influence of job stress, social support and health status on intermittent and chronic sleep disturbance: an 8-year longitudinal analysis.

PubMed

Gosling, John A; Batterham, Philip J; Glozier, Nick; Christensen, Helen

2014-08-01

To determine the role of health status and social support in the relationship between job stress and sleep disturbance, for both intermittent and chronic sleep disturbance. A total of 1946 mid-life adults completed three questionnaires spanning an 8-year time frame. Sleep disturbance was assessed at each time point, and participants were classified as experiencing intermittent, chronic or no sleep disturbance across this 8-year period. Independent variables included a range of job stress measures, social support, physical and mental health, and demographic characteristics. After controlling for physical and mental health, perceived lack of job marketability increased risk of intermittent sleep disturbance (odds ratio (OR)=1.33, p=0.012). No other job stress measures were associated with either intermittent or chronic sleep disturbance after adjusting for years of education, social support, and employment status. Poorer mental and physical health status, although significantly increasing odds for intermittent sleep disturbance, represented a significantly greater increase in the odds for chronic sleep disturbance over and above intermittent disturbance (OR=0.96, p<0.001 for both SF-12 mental and physical health). This population-based cohort study found little evidence that job stress had an independent effect on chronic or intermittent sleep disturbance independent of health, social support, and education. Risk profiles for intermittent and chronic sleep disturbance did not differ with regard to job stress; however, various demographic and social support factors were distinguishing factors. Health status, both physical and mental, also showed a significantly greater impact on chronic sleep disturbance than intermittent sleep disturbance. Karasek's model of job strain had little value in predicting sleep disturbance outcomes. Copyright © 2014 Elsevier B.V. All rights reserved.

Social participation and psychosocial outcomes of young adults with chronic physical conditions: Comparing recipients and non-recipients of disability benefits.

PubMed

Bal, Marjolijn I; Sattoe, Jane N T; Miedema, Harald S; van Staa, AnneLoes

2018-03-01

Little is known about any differences between young people with chronic physical conditions who do and do not apply for disability benefits in young adulthood for providing insights for future policy and rehabilitation care. We aimed to identify predictors during adolescence of receiving disability benefits in young adulthood and to compare recipients and non-recipients of benefits in social participation and psychosocial outcomes in young adulthood. Follow-up study of 18 to 25 year olds with various chronic conditions who at adolescent age completed a web-based survey (n=518; T0). The outcome was receiving disability benefits (yes or no). Associations with background characteristics, social participation, and impact of the chronic condition were explored with stepwise multivariate modelling, using T0 variables. Differences between recipients and non-recipients were explored using chi-square tests and t-tests. Receiving disability benefits in young adulthood was associated with greater extent of physical disability, receiving less special education, absenteeism at school/work, and low health-related quality of life during adolescence. In young adulthood, recipients of benefits reported higher perceived impact of the chronic condition on their school/work career and lower quality of life than non-recipients. Social participation varied across domains. This study provides important insights into the characteristics of a vulnerable subgroup of young people with chronic physical conditions. Disability benefit recipients experienced more impact of their chronic condition and reported a lower health-related quality of life over time than non-recipients. Rehabilitation professionals are encouraged to use patient-reported outcomes to address the lived experiences and screen the need for psychosocial support of this vulnerable subgroup of young people with chronic physical conditions. Copyright © 2018. Published by Elsevier Masson SAS.

Prolonged grief symptoms related to loss of physical functioning: examining unique associations with medical service utilization.

PubMed

Holland, Jason M; Graves, Stacy; Klingspon, Kara L; Rozalski, Vincent

2016-01-01

Prolonged grief, a severe and chronic form of grieving most commonly studied in the context of bereavement, may have relevance to losses associated with chronic illness (e.g. grief related to loss of functioning or loss of a planned future). The purpose of the present study is to examine the unique associations between prolonged grief symptoms and service utilization patterns. An online self-report assessment battery was administered among a sample of 275 older adults with at least one chronic illness that caused significant physical impairment. Even after statistically controlling for relevant physical health (e.g. severity of physical limitations, somatic symptoms, number of chronic illnesses) and psychosocial variables (e.g. social support, depression/anxiety), more severe prolonged grief symptoms were associated with a greater number of emergency room visits, overnight stays in the hospital and total nights in the hospital. These findings highlight the importance of screening for prolonged grief symptomatology with older individuals with a debilitating chronic illness. Recent evidence suggests that prolonged grief may have relevance for losses associated with physical illness. The present study shows that prolonged grief reactions related to physical illness (e.g. grieving the loss of functioning) are uniquely associated with increased hospital-based service utilization. Given the relevance of prolonged grief reactions in this population, practitioners may wish to assess for these symptoms. Future clinical research should focus on developing interventions to target prolonged grief symptoms associated with these losses.

Joint association of multimorbidity and work ability with risk of long-term sickness absence: a prospective cohort study with register follow-up.

PubMed

Sundstrup, Emil; Jakobsen, Markus Due; Mortensen, Ole Steen; Andersen, Lars Louis

2017-03-01

Objectives The aim of this study was to determine the joint association of multimorbidity and work ability with the risk of long-term sickness absence (LTSA) in the general working population. Methods Cox regression analysis censoring for competing events (statutory retirement, early retirement, disability pension, immigration, or death) was performed to estimate the joint association of chronic diseases and work ability in relation to physical and mental demands of the job with the prospective risk for LTSA (defined as ≥6 consecutive weeks during 2-year follow-up) among 10 427 wage earners from the general working population (2010 Danish Work Environment Cohort Study). Control variables were age, gender, psychosocial work environment, smoking, leisure physical activity, body mass index, job group, and previous LTSA. Results Of the 10 427 respondents, 56.8% had experienced ≥1 chronic disease at baseline. The fully adjusted model showed an association between number of chronic diseases and risk of LTSA. This association was stronger among employees with poor work ability (either physical or mental). Compared to employees with no diseases and good physical work ability, the risk estimate for LTSA was 1.95 [95% confidence interval (95% CI) 1.50-2.52] for employees with ≥3 chronic diseases and good physical work ability, whereas it was 3.60 (95% CI 2.50-5.19) for those with ≥3 chronic diseases and poor physical work ability. Overall, the joint association of chronic disease and work ability with LTSA appears to be additive. Conclusions Poor work ability combined with ≥1 chronic diseases is associated with high risk of long-term sickness absence in the general working population. Initiatives to improve or maintain work ability should be highly prioritized to secure sustainable employability among workers with ≥1 chronic diseases.

Marijuana use trajectories during college predict health outcomes nine years post-matriculation

PubMed Central

Arria, Amelia M.; Caldeira, Kimberly M.; Bugbee, Brittany A.; Vincent, Kathryn B.; O’Grady, Kevin E.

2015-01-01

Background Several studies have linked marijuana use with a variety of health outcomes among young adults. Information about marijuana’s long-term health effects is critically needed. Methods Data are from a ten-year study of 1,253 young adults originally recruited as first-year college students and assessed annually thereafter. Six trajectories of marijuana use during college (Non-Use, Low-Stable, Early-Decline, College-Peak, Late-Increase, Chronic) were previously derived using latent variable growth mixture modeling. Nine health outcomes assessed in Year 10 (modal age 27) were regressed on a group membership variable for the six group trajectories, holding constant demographics, baseline health status, and alcohol and tobacco trajectory group membership. Results Marijuana trajectory groups differed significantly on seven of the nine outcomes (functional impairment due to injury, illness, or emotional problems; psychological distress; subjective well-being; and mental and physical health service utilization; all ps<.001), but not on general health rating or body mass index. Non-Users fared better than the Late-Increase and Chronic groups on most physical and mental health outcomes. The declining groups (Early-Decline, College-Peak) fared better than the Chronic group on mental health outcomes. The Late-Increase group fared significantly worse than the stable groups (Non-Use, Low-Stable, Chronic) on both physical and mental health outcomes. Conclusions Even occasional or time-limited marijuana use might have adverse effects on physical and mental health, perhaps enduring after several years of moderation or abstinence. Reducing marijuana use frequency might mitigate such effects. Individuals who escalate their marijuana use in their early twenties might be at especially high risk for adverse outcomes. PMID:26778758

Mental health service use for adult patients with co-occurring depression and physical chronic health care needs, 2007-2010.

PubMed

Jolles, Mónica Pérez; Haynes-Maslow, Lindsey; Roberts, Megan C; Dusetzina, Stacie B

2015-08-01

Individuals with mental illness experience poor health and may die prematurely from chronic illness. Understanding whether the presence of co-occurring chronic physical health conditions complicates mental health treatment is important, particularly among patients seeking treatment in primary care settings. Examine (1) whether the presence of chronic physical conditions is associated with mental health service use for individuals with depression who visit a primary care physician, and (2) whether race modifies this relationship. Secondary analysis of the National Ambulatory Medical Care Survey, a survey of patient-visits collected annually from a random sample of 3000 physicians in office-based settings. Office visits from 2007 to 2010 were pooled for adults aged 35-85 with a depression diagnosis at the time of visit (N=3659 visits). Mental health services were measured using a dichotomous variable indicating whether mental health services were provided during the office visit or a referral made for: (1) counseling, including psychotherapy and other mental health counseling and/or (2) prescribing of psychotropic medications. Most patient office visits (70%) where a depression diagnosis was recorded also had co-occurring chronic physical conditions recorded. The presence of at least 1 physical chronic condition was associated with a 6% decrease in the probability of receiving any mental health services (P<0.05). There were no differences in service use by race/ethnicity after controlling for other factors. Additional research is needed on medical care delivery among patients with co-occurring health conditions, particularly as the health care system moves toward an integrated care model.

Monitoring physical functioning as the sixth vital sign: evaluating patient and practice engagement in chronic illness care in a primary care setting--a quasi-experimental design

PubMed Central

2012-01-01

Background In Canada, one in three adults or almost 9 million people report having a chronic condition. Over two thirds of total deaths result from cardiovascular disease, diabetes, cancer and respiratory illness and 77% of persons ≥65 years have at least one chronic condition. Persons with chronic disease are at risk for functional decline; as a result, there is an increased awareness of the significance of functional status as an important health outcome. The purpose of this study was to determine whether patients who receive a multi-component rehabilitation intervention, including online monitoring of function with feedback and self-management workshops, showed less functional decline than case matched controls who did not receive this intervention. In addition, we wanted to determine whether capacity building initiatives within the Family Health Team promote a collaborative approach to Chronic Disease Management. Methods A population-based multi-component rehabilitation intervention delivered to persons with chronic illnesses (≥ 44 yrs) (n = 60) was compared to a group of age and sex matched controls (n = 60) with chronic illnesses receiving usual care within a primary healthcare setting. The population-based intervention consisted of four main components: (1) function-based individual assessment and action planning, (2) rehabilitation self-management workshops, (3) on-line self-assessment of function and (4) organizational capacity building. T-tests and chi-square tests were used for continuous and categorical variables respectively in baseline comparison between groups. Results Two MANOVA showed significant between group differences in patient reported physical functioning (Λ = 0.88, F = (2.86) = 5.97. p = 0.004) and for the physical performance measures collectively as the dependent variable (Λ = 0.80, F = (6.93) = 3.68. p = 0.0025). There were no within group differences for the capacity measures. Conclusion It is feasible to monitor physical functioning as a health outcome for persons with chronic illness in primary care. The timeline for this study was not sufficient to show an increase in the capacity within the team; however there were some differences in patient outcomes. The short timeline was likely not sufficient to build the capacity required to support this approach. Trial registration NCT00859638 PMID:22471378

Effects of subchronic exposures to concentrated ambient particles (CAPs) in mice. III. Acute and chronic effects of CAPs on heart rate, heart-rate fluctuation, and body temperature.

PubMed

Hwang, Jing-Shiang; Nadziejko, Christine; Chen, Lung Chi

2005-04-01

Normal mice (C57) and mice prone to develop atherosclerosis (ApoE-/-) were implanted with electrocardiograph (EKG), core body temperature, and motion transmitters were exposed daily for 6 h to Tuxedo, NY, concentrated ambient particles (CAPs) for 5 day/wk during the spring and summer of 2003. The series of 5-min EKG monitoring and body-temperature measurements were obtained for each animal in the CAPs and filtered air sham exposure groups. Our hypothesis was that chronic exposure could cause cumulative health effects. We used our recently developed nonparametric method to estimate the daily time periods that mean heart rates (HR), body temperature, and physical activity differed significantly between the CAPs and sham exposed group. CAPs exposure most affected heart rate between 1:30 a.m. and 4:30 a.m. With the response variables being the average heart rate, body temperature, and physical activity, we adopted a two-stage modeling approach to obtain the estimates of chronic and acute effects on the changes of these three response variables. In the first stage, a time-varying model estimated daily crude effects. In the second stage, the true means of the estimated crude effects were modeled with a polynominal function of time for chronic effects, a linear term of daily CAPs exposure concentrations for acute effects, and a random component for unknown noise. A Bayesian framework combined these two stages. There were significant decreasing patterns of HR, body temperature, and physical activity for the ApoE-/- mice over the 5 mo of CAPs exposure, with smaller and nonsignificant changes for the C57 mice. The chronic effect changes of the three response variables for ApoE-/- mice were maximal in the last few weeks. There was also a significant relationship between CAPs exposure concentration and short-term changes of heart rate in ApoE-/- mice during exposure. Response variables were also defined for examining fluctuations of 5-min heart rates within long (i.e., 3-6 h) and short time periods (i.e., approximately 15 min). The results for the ApoE-/- mice showed that heart-rate fluctuation within the longer periods increased to 1.35-fold by the end of exposure experiment, while the heart-rate fluctuation within 15 min decreased to 0.7-fold.

Physical activity as a mediator of the impact of chronic conditions on quality of life in older adults.

PubMed

Sawatzky, Richard; Liu-Ambrose, Teresa; Miller, William C; Marra, Carlo A

2007-12-19

Chronic conditions could negatively affect the quality of life of older adults. This may be partially due to a relative lack of physical activity. We examined whether physical activity mediates the relationship between different chronic conditions and several health outcomes that are important to the quality of life of older adults. The data were taken from the Canadian Community Health Survey (cycle 1.1), a cross-section survey completed in 2001. Only respondents who were 65 years or older were included in our study (N = 22,432). The Health Utilities Index Mark 3 (HUI3) was used to measure overall quality of life, and to measure selected health outcomes (dexterity, mobility, pain, cognition, and emotional wellbeing) that are considered to be of importance to the quality of life of older adults. Leisure-time physical activity was assessed by determining weekly energy expenditure (Kcal per week) based on the metabolic equivalents of self-reported leisure activities. Linear and logistic regression models were used to determine the mediating effect of leisure-time physical activity while controlling for demographic variables (age and sex), substance use (tobacco use and alcohol consumption), and obesity. Having a chronic condition was associated with a relative decrease in health utility scores and a relative increase in mobility limitations, dexterity problems, pain, emotional problems (i.e., decreased happiness), and cognitive limitations. These negative consequences could be partially attributed to a relative lack of physical activity in older adults with a chronic condition (14% mediation for the HUI3 score). The corresponding degree of mediation was 18% for mobility limitations, 5% for pain, and 13% for emotional wellbeing (statistically significant mediation was not observed for the other health attributes). These values varied with respect to the different chronic conditions examined in our study. Older adults with chronic conditions are less likely to engage in leisure-time physical activities of at least 1,000 Kcal per week, and this association partially accounts for some negative consequences of chronic conditions, including mobility limitations, pain, and emotional problems. These findings provide support for health promotion programs that facilitate or encourage increased leisure-time physical activity in older people with chronic conditions.

Excess risk of chronic physical conditions associated with depression and anxiety

PubMed Central

2014-01-01

Background Depression and anxiety have been reported to be associated with chronic physical conditions. We examined the excess risk of chronic physical conditions associated with depression and/or anxiety within a multivariate framework controlling for demographic and modifiable lifestyle risk factors. Methods We used a retrospective cross-sectional study design. Study participants were adults aged 22–64 years from 2007 and 2009 Medical Expenditure Panel Survey. We defined presence of depression-anxiety based on self-reported depression and anxiety and classified adults into 4 groups: 1) depression only; 2) anxiety only; 3) comorbid depression and anxiety 4) no depression and no anxiety. We included presence/absence of arthritis, asthma, chronic obstructive pulmonary disorder, diabetes, heart disease, hypertension, and osteoporosis as dependent variables. Complementary log-log regressions were used to examine the excess risk associated with depression and/or anxiety for chronic physical conditions using a multivariate framework that controlled for demographic (gender, age, race/ethnicity) and modifiable lifestyle (obesity, lack of physical activity, smoking) risk factors. Bonferroni correction for multiple comparisons was applied and p ≤0.007 was considered statistically significant. Results Overall, 7% had only depression, 5.2% had only anxiety and 2.5% had comorbid depression and anxiety. Results from multivariable regressions indicated that compared to individuals with no depression and no anxiety, individuals with comorbid depression and anxiety, with depression only and with anxiety only, all had higher risk of all the chronic physical conditions. ARRs for comorbid depression and anxiety ranged from 2.47 (95% CI: 1.47, 4.15; P = 0.0007) for osteoporosis to 1.64 (95% CI: 1.33, 2.04; P < 0.0001) for diabetes. Presence of depression only was also found to be significantly associated with all chronic conditions except for osteoporosis. Individuals with anxiety only were found to have a higher risk for arthritis, COPD, heart disease and hypertension. Conclusion Presence of depression and/or anxiety conferred an independent risk for having chronic physical conditions after adjusting for demographic and modifiable lifestyle risk factors. PMID:24433257

Quality of life in Chinese family caregivers for elderly people with chronic diseases.

PubMed

Xie, Hui; Cheng, Cheng; Tao, Yisheng; Zhang, Jie; Robert, Delprino; Jia, Jihui; Su, Yonggang

2016-07-06

Inadequate studies have been conducted in China to examine quality of life in family caregivers. Quality of life in family caregivers for elderly people with chronic diseases was evaluated, and the demographic and characteristic factors of both elderly people and their caregivers were explored. The 36-Item Short Form Health Survey (SF-36) was used to assess health-related quality of life in 407 family caregivers caring for elderly people with chronic diseases in six communities on the Mainland China. The explanatory variables included family caregivers' demographic and other caregiving variables related to eldercare. Descriptive statistics and multiple linear regression analysis were used in the data analysis, performed via SPSS 17.0. Mean SF-36 and physical and mental component scores were 66.14 ± 17.50, 70.06 ± 16.49, and 62.22 ± 18.51, respectively. The scores of caregivers' physical function and bodily pain were significantly higher, while the scores of caregivers' role limitations due to physical problems, general health, vitality, social function, mental health and role limitations due to emotional problems were significantly lower. Caregivers' ages, comorbidity, the perceived effects of caregiving on caregivers' social lives and elderly individuals' ages, marital status and Activities of Daily Living scores were significantly associated with the physical component score. In addition, caregivers' age, the affordability of the elderly person's healthcare expenses, the perceived effects of caregiving on caregivers' social lives, and elderly people's marital status and ADL scores were significantly associated with the mental component score. Family caregivers for elderly people with chronic diseases showed poorer mental and better physical well-being. Factors of both elderly people and their caregivers impact the caregivers' quality of life. These findings highlight the importance of addressing mental health of family caregivers, and of providing economical support and psychological care for them.

Exploring the facilitators and barriers to engagement in physical activity for people with multiple sclerosis.

PubMed

Kayes, Nicola M; McPherson, Kathryn M; Schluter, Philip; Taylor, Denise; Leete, Marta; Kolt, Gregory S

2011-01-01

To explore the relationship that cognitive behavioural and other previously identified variables have with physical activity engagement in people with multiple sclerosis (MS). This study adopted a cross-sectional questionnaire design. Participants were 282 individuals with MS. Outcome measures included the Physical Activity Disability Survey--Revised, Cognitive and Behavioural Responses to Symptoms Questionnaire, Barriers to Health Promoting Activities for Disabled Persons Scale, Multiple Sclerosis Self-efficacy Scale, Self-Efficacy for Chronic Diseases Scales and Chalder Fatigue Questionnaire. Multivariable stepwise regression analyses found that greater self-efficacy, greater reported mental fatigue and lower number of perceived barriers to physical activity accounted for a significant proportion of variance in physical activity behaviour, over that accounted for by illness-related variables. Although fear-avoidance beliefs accounted for a significant proportion of variance in the initial analyses, its effect was explained by other factors in the final multivariable analyses. Self-efficacy, mental fatigue and perceived barriers to physical activity are potentially modifiable variables which could be incorporated into interventions designed to improve physical activity engagement. Future research should explore whether a measurement tool tailored to capture beliefs about physical activity identified by people with MS would better predict participation in physical activity.

Associations between lifetime potentially traumatic events and chronic physical conditions in the South African Stress and Health Survey: a cross-sectional study.

PubMed

Atwoli, Lukoye; Platt, Jonathan M; Basu, Archana; Williams, David R; Stein, Dan J; Koenen, Karestan C

2016-07-07

This study examined the association between the type, and cumulative number of lifetime potentially traumatic events (PTEs), and chronic physical conditions, in a South African sample. PTE exposures have been associated with an increased risk for a wide range of chronic physical conditions, but it is unclear whether psychiatric disorders mediate this association. Given the established differences in trauma occurrence, and the epidemiology of posttraumatic stress disorder (PTSD) in South Africa relative to other countries, examining associations between PTEs and chronic physical conditions, particularly while accounting for psychiatric comorbidity is important. Data were drawn from the South African Stress and Health Study, a cross-sectional population-representative study of psychological and physical health of South African adults. Twenty-seven PTEs, based on the World Health Organization Composite International Diagnostic Interview Version 3.0, DSM-IV PTSD module were grouped into seven PTE types (war events, physical violence, sexual violence, accidents, unexpected death of a loved one, network events, and witnessing PTEs). Five clusters of physical conditions (cardiovascular, arthritis, respiratory, chronic pain, and other health conditions) were examined. Logistic regressions assessed the odds of reporting a physical condition in relation to type and cumulative number of PTEs. Cochran-Armitage test for trend was used to examine dose-response effect of cumulative PTEs on physical conditions. After adjusting for sociodemographic variables and psychiatric disorders, respondents with any PTE had increased odds of all assessed physical conditions, ranging between 1.48 (95 % CI: 1.06-2.07) for arthritis and 2.07 (95 % CI: 1.57-2.73) for respiratory conditions, compared to those without PTE exposure. Sexual violence, physical violence, unexpected death of a loved one, and network PTEs significantly increased the odds of all or nearly all the physical conditions assessed. There was a dose-response relationship between number of PTEs and increased odds of all physical conditions. Results from this study, the first in an African general population, are consistent with other population-based studies; PTEs confer a broad-spectrum risk for chronic physical conditions, independent of psychiatric disorders. These risks increase with each cumulative PTE exposure. Clinically, comprehensive evaluations for risk of mental and physical health morbidities should be considered among PTE survivors.

Gender, depression and physical impairment: an epidemiologic perspective from Aleppo, Syria

PubMed Central

Rastam, Samer; Ward, Kenneth D.; Maziak, Wasim

2010-01-01

Objective Examine the association of physical impairment with gender, depression, and socio-demographics in the community in Aleppo, Syria. Method We conducted a cross-sectional, population-based study in Aleppo on adults aged 18–65 (N = 2,038). We used a computerized interviewer-administered structured questionnaire. Physical impairment was measured via an adapted 12-item World Health Organization, Health State Description Individual Questionnaire which includes both physical and emotional items. We used physical impairment items score to classify individuals into low, middle, and high physical impairment category. Self-report of physician-diagnosed depression and chronic diseases active in the past year and their current treatment status were obtained. Results Sample mean age (SD) was 35.3 (12.1) years, 55% were female, and 4.5% had depression. Female gender, low socioeconomic status (SES), and depression were associated with high physical impairment. Women had more impairment (OR = 3.35, 95% CI: 2.15–5.21) with little change after controlling for depression and chronic diseases, but significantly decreased after controlling for socio-demographics (OR = 1.51, 95% CI: 0.84–2.73). The association with low (vs. high) SES was prominent (OR = 2.48, 95% CI: 1.32–4.67) after controlling for all variables. Depression’s association (OR = 4.85, 95% CI: 1.93–12.15) lost significance after controlling for chronic diseases (OR = 2.81, 95% CI: 0.96–8.25), but further adjustment for socio-demographics had little effect. Conclusion Women and individuals of low SES appear more vulnerable to physical impairment in the community in Aleppo. Depression’s association with physical impairment may be mediated through co-existing chronic diseases. Public health planning regarding physical impairment in Syria should encompass these as putative risk factors. PMID:20195569

[Comorbidity in people with depression seeking help at primary health care centers in Santiago, Chile].

PubMed

Martínez, Pablo; Rojas, Graciela; Fritsch, Rosemarie; Martínez, Vania; Vöhringer, Paul A; Castro, Ariel

2017-01-01

International evidence has shown the complex interaction between depression and chronic physical diseases. Depression in scenarios involving multiple comorbidities has not received enough attention in Chile. To characterize the depressed people who consult at Primary Health Care Centers (PHCCs), taking into account the presence of chronic physical or psychiatric comorbidity. A secondary analysis of databases used in a clinical trial. Two hundred fifty six adults seeking professional help were recruited in four PHCCs located in the Metropolitan Region. These people had a major depressive episode, identified with a structured psychiatric interview (MINI), and gave their informed consent to participate. Socio-demographic information was collected, depressive symptomatology was measured with the patient health questionnaire 9 (PHQ-9), psychiatric morbidity was assessed using the Mini International Neuropsychiatric Interview (MINI), and chronic physical diseases were self-reported by the patients. Descriptive analyses of all the variables were conducted. Seventy percent of patients had a history of depression, with a median of two prior depressive episodes. Depressive symptoms were mostly considered as moderate to severe and severe and 31% of the patients had high suicide risk. Seventy eight percent displayed a physical or psychiatric comorbidity. Of these patients, 29% only had a chronic physical comorbidity, while 46% suffered from an additional psychiatric disorder. Depressed individuals who seek help at PHCCs constitute an especially complex population that must be treated taking into account multiple comorbidities.

Mental Health Service Use for Patients with Co-occurring Mental and Physical Chronic Health Care Needs in Primary Care Settings

PubMed Central

Haynes-Maslow, Lindsey; Roberts, Megan C.; Dusetzina, Stacie B.

2016-01-01

Background Individuals with mental illness experience poor health and may die prematurely from chronic illness. Understanding whether the presence of co-occurring chronic physical health conditions complicates mental health treatment is important, particularly among patients seeking treatment in primary care settings. Objectives Examine (1) whether the presence of chronic physical conditions is associated with mental health service use for individuals with depression who visit a primary care physician, and (2) whether race modifies this relationship. Research Design Secondary analysis of the National Ambulatory Medical Care Survey, a survey of patient-visits collected annually from a random sample of 3,000 physicians in office-based settings. Subjects Office visits from 2007–2010 were pooled for adults ages 35–85 with a depression diagnosis at the time of visit (N=3,659 visits). Measures Mental health services were measured using a dichotomous variable indicating whether mental health services were provided during the office visit or a referral made for: (1) counseling, including psychotherapy and other mental health counseling and/or (2) prescribing of psychotropic medications. Results Most patient office visits (70%) where a depression diagnosis was recorded also had co-occurring chronic physical conditions recorded. The presence of at least one physical chronic condition was associated with a 6% decrease in the probability of receiving any mental health services (p<0.05). There were no differences in service use by race/ethnicity after controlling for other factors. Conclusions Additional research is needed on medical care delivery among patients with co-occurring health conditions, particularly as the health care system moves towards an integrated care model. PMID:26147863

Health, lifestyle, belief and knowledge differences between two ethnic groups with specific reference to tobacco, diet and physical activity.

PubMed

Anthony, Denis; Baggott, Rob; Tanner, Judith; Jones, Kathryn; Evans, Hala; Perkins, Gill; Palmer, Hilary

2012-11-01

  To compare physical activity levels, body mass index, habitual diet, tobacco use and prevalence of non-communicable disease between the two ethnic groups and to identify predictors for differences between groups.   Tobacco use, poor diet and physical inactivity are major lifestyle risk factors for chronic cardiovascular diseases, certain cancers, diabetes and chronic lung diseases. There are higher risk and incidence of these diseases in some ethnic groups, for example Asians have higher incidence of diabetes.   Cross sectional survey.   Cross sectional survey of Asians of Indian descent and white British adults conducted between October-December 2009. Main outcome variables were lifestyle behaviours and BMI. Self-reported disease diagnosis was also collected. In a regression analysis, predictors of outcome variables were demographic variables and beliefs/attitudes/knowledge towards lifestyle behaviours.   Body mass index, tobacco use and non-communicable disease (except diabetes) were lower in Indians. Indians reported lower physical activity levels and greater salt use than Whites. Tobacco use was higher in Whites, but knowledge, attitudes and beliefs were similar between Whites and Indians.   Health risk behaviour and morbidity are different between the two ethnic groups. Gender, age, educational level, beliefs, attitudes and knowledge do not explain these differences. Health promotion that aims to improve knowledge will probably not work and innovative methods are needed to improve health in high risk groups. © 2012 Blackwell Publishing Ltd.

[Effects of exercise and physical activity on vital age].

PubMed

Tanaka, Kiyoji; Matsuo, Tomoaki

2009-07-01

Advances in medical care have enabled many middle-aged and older adults to live for long periods of time. However, considerable variability is present among those people with regards to both longevity and physical health status. Physical inactivity is a significant risk factor for many chronic diseases, while exercise habituation is beneficial for the maintenance of good health and high vitality. The authors have developed the concept of so-called vital age for the assessment of health and functional status in middle-aged and older adults. The vital age is estimated using a variety of bio-medical, primarily cardiovascular risk factor parameters. Previous research has compared vital age between sedentary persons and those with obesity and chronic diseases and between sedentary persons and those with exercise habituation, and found that exercise habituation can certainly contribute to better physical vitality in previously sedentary persons as well as diseased persons.

Predictive factors for progression through the difficulty levels of Pilates exercises in patients with low back pain: a secondary analysis of a randomized controlled trial.

PubMed

Franco, Katherinne Ferro Moura; Franco, Yuri Rafael Dos Santos; Oliveira, Naiane Teixeira Bastos de; Padula, Rosimeire Simprini; Cabral, Cristina Maria Nunes

2018-04-17

The progression through the difficulty levels of Pilates exercises is a subjective criterion, that depends on the therapist's experience and ability to identify the best moment to progress to the next level. To identify the factors that interfere in the progression through the difficulty levels of the Pilates exercises in patients with chronic nonspecific low back pain. Data from 139 patients with chronic nonspecific low back pain from a randomized controlled trial were used for statistical analysis using binary logistic regression. The dependent variable was the progression through the difficulty levels, and the independent variables were age, gender, educational level, low back pain duration, pain intensity, general disability, kinesiophobia, previous physical activity, and number of absences. The factors that interfered in the progression through the difficulty levels were previous physical inactivity (odds ratio [OR]=5.14, 95% confidence interval [CI]: 1.53-17.31), low educational level (OR=2.62, 95% CI: 1.12-6.10), more advanced age (OR=0.95, 95% CI: 0.92-0.98) and more absences (OR=0.63, 95% CI: 0.50-0.79). These variables explain 41% of the non-progression through the difficulty level of the exercises. Physical inactivity, low educational level, more advanced age and greater number of absences can be interfering factors in the progression through the difficulty levels of the Pilates exercises in patients with chronic nonspecific low back pain. Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Associations between psychosocial factors and pain intensity, physical functioning, and psychological functioning in patients with chronic pain: a cross-cultural comparison.

PubMed

Ferreira-Valente, Maria A; Pais-Ribeiro, José L; Jensen, Mark P

2014-08-01

Current models of chronic pain recognize that psychosocial factors influence pain and the effects of pain on daily life. The role of such factors has been widely studied on English-speaking individuals with chronic pain. It is possible that the associations between such factors and adjustment may be influenced by culture. This study sought to evaluate the importance of coping responses, self-efficacy beliefs, and social support to adjust to chronic pain in a sample of Portuguese patients, and discuss the findings with respect to their similarities and differences from findings of studies on English-speaking individuals. Measures of pain intensity and interference, physical and psychological functioning, coping responses, self-efficacy, and satisfaction with social support were administered to a sample of 324 Portuguese patients with chronic musculoskeletal pain. Univariate and multivariate analyses were computed. Findings were interpreted with respect to those from similar studies using English-speaking individuals. Coping responses and perceived social support were significantly associated with pain interference and both physical and psychological functioning; self-efficacy beliefs were significantly associated with all criterion variables. All coping responses, except for task persistence, were positively associated with pain interference and negatively associated with physical and psychological functioning, with the strongest associations found for catastrophizing, praying/hoping, guarding, resting, asking for assistance, and relaxation. The findings provide support for the importance of the psychosocial factors studied in terms of adjustment to chronic pain in Portuguese patients, and also suggest the possibility of some differences in the role of these factors due to culture.

[Depression, social support and compliance in patients with chronic heart failure].

PubMed

Reutlinger, Julia; Müller-Tasch, Thomas; Schellberg, Dieter; Frankenstein, Lutz; Zugck, Christian; Herzog, Wolfgang; Lossnitzer, Nicole

2010-01-01

Depressive patients with chronic heart failure (CHF) show less social integration and greater physical impairment as well as poorer compliance than non depressive CHF patients. Using multiple regression analyses, this study (n=84) investigated a potential mediating effect of depression on the relationship between compliance and both social support and physical functioning. Results did not support the hypothesized mediating effect of depression. However, the variables age, depression, left ventricular ejection fraction (LVEF) and social support were associated with self-reported compliance. Therefore, a lack of social support and depression should be considered as possible reasons, if patients are noncompliant during the treatment process. © Georg Thieme Verlag KG Stuttgart · New York.

Perceived barriers, benefits, and motives for physical activity: two primary-care physical activity prescription programs.

PubMed

Patel, Asmita; Schofield, Grant M; Kolt, Gregory S; Keogh J, W L

2013-01-01

This study examined whether perceived barriers, benefits, and motives for physical activity differed based on allocation to 2 different types of primary-care activity-prescription programs (pedometer-based vs. time-based Green Prescription). Eighty participants from the Healthy Steps study completed a questionnaire that assessed their perceived barriers, benefits, and motives for physical activity. Factor analysis was carried out to identify common themes of barriers, benefits, and motives for physical activity. Factor scores were then used to explore between-groups differences for perceived barriers, benefits, and motives based on group allocation and demographic variables. No significant differences were found in factor scores based on allocation. Demographic variables relating to the existence of chronic health conditions, weight status, and older age were found to significantly influence perceived barriers, benefits, and motives for physical activity. Findings suggest that the addition of a pedometer to the standard Green Prescription does not appear to increase perceived motives or benefits or decrease perceived barriers for physical activity in low-active older adults.

Personality and physical functioning among older adults: the moderating role of education.

PubMed

Jaconelli, Alban; Stephan, Yannick; Canada, Brice; Chapman, Benjamin P

2013-07-01

Drawing upon a vulnerability model, this study tested whether low educational level would amplify the negative contribution of risky personality traits, such as high neuroticism and low conscientiousness, on older adults physical functioning. Five hundred and thirteen French-speaking community-dwelling older adults aged 60-91 years (mean age = 66.37, SD = 5.32) completed measures of physical functioning, education, personality traits, chronic conditions, and demographic variables. Results revealed that extraversion and conscientiousness were positively associated with physical functioning, whereas neuroticism was a negative predictor, beyond demographics, chronic conditions, and education. The negative relationship between neuroticism and physical functioning was stronger among individuals with low educational level and was nonsignificant among older people with higher level of education. This study is the first to support a vulnerability model, which entails an amplification of neuroticism risk at low education, but a diminishment of neuroticism risk for activity limitations at high education. As a whole, it appears that a focus on either personality or education without taking into account each other provides only a partial account of the predictors of basic daily physical activities in old age.

Individual and social determinants of multiple chronic disease behavioral risk factors among youth.

PubMed

Alamian, Arsham; Paradis, Gilles

2012-03-22

Behavioral risk factors are known to co-occur among youth, and to increase risks of chronic diseases morbidity and mortality later in life. However, little is known about determinants of multiple chronic disease behavioral risk factors, particularly among youth. Previous studies have been cross-sectional and carried out without a sound theoretical framework. Using longitudinal data (n = 1135) from Cycle 4 (2000-2001), Cycle 5 (2002-2003) and Cycle 6 (2004-2005) of the National Longitudinal Survey of Children and Youth, a nationally representative sample of Canadian children who are followed biennially, the present study examines the influence of a set of conceptually-related individual/social distal variables (variables situated at an intermediate distance from behaviors), and individual/social ultimate variables (variables situated at an utmost distance from behaviors) on the rate of occurrence of multiple behavioral risk factors (physical inactivity, sedentary behavior, tobacco smoking, alcohol drinking, and high body mass index) in a sample of children aged 10-11 years at baseline. Multiple behavioral risk factors were assessed using a multiple risk factor score. All statistical analyses were performed using SAS, version 9.1, and SUDAAN, version 9.01. Multivariate longitudinal Poisson models showed that social distal variables including parental/peer smoking and peer drinking (Log-likelihood ratio (LLR) = 187.86, degrees of freedom (DF) = 8, p < .001), as well as individual distal variables including low self-esteem (LLR = 76.94, DF = 4, p < .001) increased the rate of occurrence of multiple behavioral risk factors. Individual ultimate variables including age, sex, and anxiety (LLR = 9.34, DF = 3, p < .05), as well as social ultimate variables including family socioeconomic status, and family structure (LLR = 10.93, DF = 5, p = .05) contributed minimally to the rate of co-occurrence of behavioral risk factors. The results suggest targeting individual/social distal variables in prevention programs of multiple chronic disease behavioral risk factors among youth.

Leisure-time physical activities for community older people with chronic diseases.

PubMed

Lin, Yen-Chun; Huang, Lian-Hua; Yeh, Mei Chang; Tai, John Jen

2011-04-01

(1) To explore the types and three components (frequency, duration and caloric expenditure) of leisure-time physical activity in community older people with chronic diseases. (2) To identify leisure-time physical activity-related factors in these community older people. Previous research has focused primarily on measuring the actual physiological or psychological benefits of exercise or leisure-time physical activity, little is known about the factors that determine the frequency, intensity and duration of exercise or leisure-time physical activity. The identification of reliable predictors of the various components of leisure-time physical activity will enable healthcare providers to intervene and change the patterns of leisure-time physical activity in the sedentary older people more effectively. A cross-sectional design was used for this study. Participants were recruited from the Xinyi District in Taipei, Taiwan. A total of 206 older people were recruited and were asked to complete three questionnaires during a face-to-face interview with a researcher at the activity setting. The results showed that walking leisurely was the most frequent leisure-time physical activity for participants. The age, gender, living arrangement, affective feeling and environmental control were significant variables of leisure-time physical activity. The study constructs accounted for moderate amounts of variance (22% for leisure-time physical activity frequency, 27% for leisure-time physical activity duration and 24% for leisure-time physical activity caloric expenditure). This study also showed that different variables play different influential roles in the different components of LTPA. An effective intervention strategy for improving leisure-time physical activity of older people may involve tailoring the type, format, intensity, frequency and duration of a physical activity according to an individual's needs. This study described some environmental barriers to LTPA and recommended an increase in the accessibility to LTPA areas. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Income-related inequalities and inequities in health and health care utilization in Mexico, 2000-2006.

PubMed

Barraza-Lloréns, Mariana; Panopoulou, Giota; Díaz, Beatriz Yadira

2013-02-01

To measure income-related inequalities and inequities in the distribution of health and health care utilization in Mexico. The National Health Survey (NHS) 2000 and the National Health and Nutrition Survey (NHNS) 2006 were used to estimate concentration indices for health outcomes and health care utilization variables before and after standardization. The study analyzed 110 460 individuals 18 years or older for NHS 2000 and 124 149 individuals for NHNS 2006. Health status variables were self-assessed health, physical limitations, and chronic illness. Health care utilization included curative visits and dental, hospital, and preventive care. Individuals were ranked by three standard-of-living measures: household income, wealth, and expenditure. Other independent variables were area of residence, geographic region, education, employment, ethnicity, and health insurance. Decomposition analysis allowed for assessing the contributions of independent variables to the distribution of health care among individuals. The worse-off population reports less good self-assessed health and more physical limitations, whereas better-off individuals report more chronic illnesses. Utilization of curative visits and hospitalization is more concentrated among the better-off population. No significant changes in these results can be established between 2000 and 2006. According to available evidence, standard of living, health insurance, and education largely contribute to the inequitable distribution of health care. Despite improvements in health care utilization patterns, income-related health and health care inequities prevail. Equity remains a challenge for Mexico.

The Effect of Leisure-Time Physical Activity on Obesity, Diabetes, High BP and Heart Disease Among Canadians: Evidence from 2000/2001 to 2005/2006.

PubMed

Sarma, Sisira; Devlin, Rose Anne; Gilliland, Jason; Campbell, M Karen; Zaric, Gregory S

2015-12-01

Although studies have looked at the effect of physical activity on obesity and other health outcomes, the causal nature of this relationship remains unclear. We fill this gap by investigating the impact of leisure-time physical activity (LTPA) and work-related physical activity (WRPA) on obesity and chronic conditions in Canadians aged 18-75 using instrumental variable and recursive bivariate probit approaches. Average local temperatures surrounding the respondents' interview month are used as a novel instrument to help identify the causal relationship between LTPA and health outcomes. We find that an active level of LTPA (i.e., walking ≥1 h/day) reduces the probability of obesity by five percentage points, which increases to 11 percentage points if also combined with some WRPA. WRPA exhibits a negative effect on the probability of obesity and chronic conditions. Copyright © 2014 John Wiley & Sons, Ltd.

Electromagnetic fields in medicine - The state of art.

PubMed

Pasek, Jarosław; Pasek, Tomasz; Sieroń-Stołtny, Karolina; Cieślar, Grzegorz; Sieroń, Aleksander

2016-01-01

Intense development of methods belonging to physical medicine has been noted recently. There are treatment methods, which in many cases lead to reduction treatment time and positively influence on quality of life treatment patients. The present physical medicine systematically extends their therapeutic possibilities. This above applies to illnesses and injuries of locomotor system, diseases affecting of soft tissues, as well as chronic wounds. The evidence on this are the results of basic and clinical examinations relating the practical use of electromagnetic fields in medicine. In this work the authors introduced the procedure using the current knowledge relating to physical characteristic and biological effects of the magnetic fields. In the work the following methods were used: static magnetic fields, spatial magnetic fields, the variable magnetic fields both with laser therapy (magnetolaserotherapy) and variable magnetic fields both with light optical non-laser (magnetoledtherapy) talked.

A comparison of patients with Q fever fatigue syndrome and patients with chronic fatigue syndrome with a focus on inflammatory markers and possible fatigue perpetuating cognitions and behaviour.

PubMed

Keijmel, Stephan P; Saxe, Johanna; van der Meer, Jos W M; Nikolaus, Stephanie; Netea, Mihai G; Bleijenberg, Gijs; Bleeker-Rovers, Chantal P; Knoop, Hans

2015-10-01

Comparison of Q fever fatigue syndrome (QFS) and chronic fatigue syndrome (CFS) patients, with a focus on markers of inflammation and fatigue-related cognitive-behavioural variables. Data from two independent prospective studies on QFS (n=117) and CFS (n=173), respectively, were pooled and analyzed. QFS patients were less often female, had a higher BMI, and had less often received treatment for depression before the onset of symptoms. After controlling for symptom duration and correcting for differences in diagnostic criteria for QFS and CFS with respect to the level of impairment and the presence of additional symptoms, differences in the proportion of females and BMI remained significant. After correction, QFS patients were also significantly older. In all analyses QFS patients were as fatigued and distressed as CFS patients, but reported less additional symptoms. QFS patients had stronger somatic attributions, and higher levels of physical activity. No differences were found with regard to inflammatory markers and in other fatigue-related cognitive-behavioural variables. The relationship between cognitive-behavioural variables and fatigue, previously established in CFS, could not be confirmed in QFS patients with the exception of the negative relationship between physical activity and fatigue. Differences and similarities between QFS and CFS patients were found. Although the relationship between perpetuating factors and fatigue previously established in CFS could not be confirmed in QFS patients, the considerable overlap in fatigue-related cognitive-behavioural variables and the relationship found between physical activity and fatigue may suggest that behavioural interventions could reduce fatigue severity in QFS patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Biobehavioral Triggers of Cardiac Arrhythmia during Daily Life: The Role of Emotion, Physical Activity, and Heart Rate Variability

DTIC Science & Technology

2004-01-01

chronically reduced HRV (e.g., Kawachi, et al, 1995). Heart rate variability among individuals without psychopathology, but with high levels of trait anxiety ...Figure 1.) After controlling for ejection fraction, anxiety scores remained predictive of all of the aforementioned measures of HRV (VLF r = -.49, p...associated with any measure of HRV (r = .07 to -.30, p = .80 to .26). Results regarding anxiety and HRV were unchanged after analyzing participants with

The Putative Role of Viruses, Bacteria, and Chronic Fungal Biotoxin Exposure in the Genesis of Intractable Fatigue Accompanied by Cognitive and Physical Disability.

PubMed

Morris, Gerwyn; Berk, Michael; Walder, Ken; Maes, Michael

2016-05-01

Patients who present with severe intractable apparently idiopathic fatigue accompanied by profound physical and or cognitive disability present a significant therapeutic challenge. The effect of psychological counseling is limited, with significant but very slight improvements in psychometric measures of fatigue and disability but no improvement on scientific measures of physical impairment compared to controls. Similarly, exercise regimes either produce significant, but practically unimportant, benefit or provoke symptom exacerbation. Many such patients are afforded the exclusionary, non-specific diagnosis of chronic fatigue syndrome if rudimentary testing fails to discover the cause of their symptoms. More sophisticated investigations often reveal the presence of a range of pathogens capable of establishing life-long infections with sophisticated immune evasion strategies, including Parvoviruses, HHV6, variants of Epstein-Barr, Cytomegalovirus, Mycoplasma, and Borrelia burgdorferi. Other patients have a history of chronic fungal or other biotoxin exposure. Herein, we explain the epigenetic factors that may render such individuals susceptible to the chronic pathology induced by such agents, how such agents induce pathology, and, indeed, how such pathology can persist and even amplify even when infections have cleared or when biotoxin exposure has ceased. The presence of active, reactivated, or even latent Herpes virus could be a potential source of intractable fatigue accompanied by profound physical and or cognitive disability in some patients, and the same may be true of persistent Parvovirus B12 and mycoplasma infection. A history of chronic mold exposure is a feasible explanation for such symptoms, as is the presence of B. burgdorferi. The complex tropism, life cycles, genetic variability, and low titer of many of these pathogens makes their detection in blood a challenge. Examination of lymphoid tissue or CSF in such circumstances may be warranted.

Heritability and lifestyle factors in chronic low back pain: results of the Australian twin low back pain study (The AUTBACK study).

PubMed

Junqueira, D R G; Ferreira, M L; Refshauge, K; Maher, C G; Hopper, J L; Hancock, M; Carvalho, M G; Ferreira, P H

2014-11-01

Heritability and population-specific lifestyle factors are considered to significantly contribute to chronic low back pain (LBP), but traditional population studies fail to (1) adjust for genetics; and (2) use standard and validated definitions for LBP and for lifestyle factors. Using a classical and a co-twin control study design and validated definitions for chronic LBP and lifestyle variables, we explored the relative contribution of genetics and environment on the prevalence of chronic LBP in a sample of adult Australian twins. Data from 105 twin pairs showed that the prevalence of chronic LBP is significantly determined by genetic factors (heritability = 32%). Additionally, monozygotic twins were five times more likely to have chronic LBP than dizygotic twins when one of the siblings of the pair was affected. In a case-control analysis (n = 38 twin pairs), an exploratory analysis showed higher prevalence of chronic LBP associated with light walking exercises and vigorous gardening or heavy work around the house. Daily time spent in sitting was also positively associated with chronic LBP, but not moderate physical activities such as jogging, cycling and gentle swimming. In the final multivariate model, only time spent in vigorous gardening or heavy work around the house remained associated with chronic LBP (odds ratio 6.5; 95% confidence interval 1.47-28.8). The type, frequency and duration of physical activity may be important to understand risk factors for chronic LBP. The causation path between chronic LBP and people's engagement in activities involving frequent bending and twisting such as gardening and housework should be further investigated. © 2014 European Pain Federation - EFIC®

Accumulated workloads and the acute:chronic workload ratio relate to injury risk in elite youth football players

PubMed Central

Bowen, Laura; Gross, Aleksander Stefan; Gimpel, Mo; Li, François-Xavier

2017-01-01

Aim The purpose of this study was to investigate the relationship between physical workload and injury risk in elite youth football players. Methods The workload data and injury incidence of 32 players were monitored throughout 2 seasons. Multiple regression was used to compare cumulative (1, 2, 3 and 4-weekly) loads and acute:chronic (A:C) workload ratios (acute workload divided by chronic workload) between injured and non-injured players for specific GPS and accelerometer-derived variables:total distance (TD), high-speed distance (HSD), accelerations (ACC) and total load. Workloads were classified into discrete ranges by z-scores and the relative risk was determined. Results A very high number of ACC (≥9254) over 3 weeks was associated with the highest significant overall (relative risk (RR)=3.84) and non-contact injury risk (RR=5.11). Non-contact injury risk was significantly increased when a high acute HSD was combined with low chronic HSD (RR=2.55), but not with high chronic HSD (RR=0.47). Contact injury risk was greatest when A:C TD and ACC ratios were very high (1.76 and 1.77, respectively) (RR=4.98). Conclusions In general, higher accumulated and acute workloads were associated with a greater injury risk. However, progressive increases in chronic workload may develop the players' physical tolerance to higher acute loads and resilience to injury risk. PMID:27450360

Physical activity in patients with stable coronary heart disease: an international perspective.

PubMed

Stewart, Ralph; Held, Claes; Brown, Rebekkah; Vedin, Ola; Hagstrom, Emil; Lonn, Eva; Armstrong, Paul; Granger, Christopher B; Hochman, Judith; Davies, Richard; Soffer, Joseph; Wallentin, Lars; White, Harvey

2013-11-01

Despite the known benefits of regular exercise, the reasons why many coronary heart disease (CHD) patients engage in little physical activity are not well understood. This study identifies factors associated with low activity levels in individuals with chronic CHD participating in the STABILITY study, a global clinical outcomes trial evaluating the lipoprotein phospholipaseA2 inhibitor darapladib. Prior to randomization, 15 486 (97.8%) participants from 39 countries completed a lifestyle questionnaire. Total physical activity was estimated from individual subject self-reports of hours spend each week on mild, moderate, and vigorous exercise, corresponding approximately to 2, 4, and 8 METS, respectively. Multivariate logistic regression evaluated clinical and demographic variables for the lowest compared with higher overall exercise levels, and for individuals who decreased rather than maintained or increased activity since diagnosis of CHD. The least active 5280 subjects (34%) reported exercise of ≤ 24 MET.h/week. A total of 7191 subjects (46%) reported less exercise compared with before diagnosis of CHD. The majority of participants were either 'not limited' or 'limited a little' walking 100 m (84%), climbing one flight of stairs (82%), or walking 1 km/1/2; mile (68%), and <10% were limited 'a lot' by dyspnoea or angina. Variables independently associated with both low physical activity and decreasing exercise after diagnosis of CHD included more co-morbid conditions, poorer general health, fewer years of education, race, and country (P < 0.001 for all). In this international study, low physical activity was only partly explained by cardiovascular symptoms. Potentially modifiable societal and health system factors are important determinants of physical inactivity in patients with chronic CHD.

Physical activity, health status and risk of hospitalization in patients with severe chronic obstructive pulmonary disease.

PubMed

Benzo, Roberto P; Chang, Chung-Chou H; Farrell, Max H; Kaplan, Robert; Ries, Andrew; Martinez, Fernando J; Wise, Robert; Make, Barry; Sciurba, Frank

2010-01-01

Chronic obstructive pulmonary disease (COPD) is a leading cause of death and 70% of the cost of COPD is due to hospitalizations. Self-reported daily physical activity and health status have been reported as predictors of a hospitalization in COPD but are not routinely assessed. We tested the hypothesis that self-reported daily physical activity and health status assessed by a simple question were predictors of a hospitalization in a well-characterized cohort of patients with severe emphysema. Investigators gathered daily physical activity and health status data assessed by a simple question in 597 patients with severe emphysema and tested the association of those patient-reported outcomes to the occurrence of a hospitalization in the following year. Multiple logistic regression analyses were used to determine predictors of hospitalization during the first 12 months after randomization. The two variables tested in the hypothesis were significant predictors of a hospitalization after adjusting for all univariable significant predictors: >2 h of physical activity per week had a protective effect [odds ratio (OR) 0.60; 95% confidence interval (95% CI) 0.41-0.88] and self-reported health status as fair or poor had a deleterious effect (OR 1.57; 95% CI 1.10-2.23). In addition, two other variables became significant in the multivariate model: total lung capacity (every 10% increase) had a protective effect (OR 0.88; 95% CI 0.78-0.99) and self-reported anxiety had a deleterious effect (OR 1.75; 95% CI 1.13-2.70). Self-reported daily physical activity and health status are independently associated with COPD hospitalizations. Our findings, assessed by simple questions, suggest the value of patient-reported outcomes in developing risk assessment tools that are easy to use.

Correlations between gait speed, 6-minute walk distance, physical activity, and self-efficacy in patients with severe chronic lung disease.

PubMed

DePew, Zachary S; Karpman, Craig; Novotny, Paul J; Benzo, Roberto P

2013-12-01

Four-meter gait speed (4MGS) has been associated with functional capacity and overall mortality in elderly patients, and may easily be translated to daily practice. We evaluated the association of 4MGS with meaningful outcomes. In 70 subjects we conducted the 4MGS, 6-min walk test (6MWT), objectively measured physical activity, and assessed dyspnea, quality of life, and self-efficacy for walking and routine physical activity. 4MGS was measured in 3 separate time epochs during the 6MWT, to explore 4MGS variability. Diagnoses included COPD (51.4%), interstitial lung disease (38.6%), and other pulmonary conditions (10%). The mean ± SD values were: 4MGS 0.85 ± 0.21 m/s, 6-min walk distance (6MWD) 305 ± 115 m, and physical activity level 1.28 ± 0.17, which is consistent with severe physical inactivity. The gait speeds within the time epochs 1-2, 3-4, and 5-6 min during the 6MWT were not significantly different: 1.01 ± 0.29 m/s, 0.98 ± 0.31 m/s, and 1.00 ± 0.31 m/s, respectively. 4MGS had a significant correlation with 6MWD (r = 0.70, P < .001). 6MWD was the dominant variable for predicting 4MGS. Other significant predictors of 4MGS included dyspnea, self-efficacy, quality of life, and objectively measured physical activity. 4MGS is significantly and independently associated with 6MWD, and may serve as a reasonable simple surrogate for 6MWD in subjects with chronic lung disease. Gait speed was remarkably stable throughout the 6MWT, which supports the validity of an abbreviated walk test such as 4MGS.

Organization of care and diagnosed depression among women veterans.

PubMed

Sambamoorthi, Usha; Bean-Mayberry, Bevanne; Findley, Patricia A; Yano, Elizabeth M; Banerjea, Ranjana

2010-09-01

To analyze the association between the organizational features of integration of physical and mental healthcare in womens health clinics and the diagnosis of depression among women veterans with or at risk for cardiovascular conditions (ie, diabetes mellitus, heart disease, or hypertension). Retrospective and observational secondary data analyses. We studied 27,972 women veterans from 118 facilities with diagnosed cardiovascular conditions in fiscal year 2001 (FY2001) using merged Medicare claims and Veterans Health Administration (VHA) data merged with the 1999 VHA Survey of Primary Care Practices and the 2001 VHA Survey of Women Veterans Health Programs and Practices. The dependent variable was a binary indicator for diagnosed depression during FY2001 at the individual level. We used a multilevel logistic regression model to control for clustering of women veterans within facilities. Individual-level independent variables included demographics, socioeconomic characteristics, and chronic physical conditions. Overall, 27% of women veterans using the VHA were diagnosed as having depression in FY2001. Across facilities, rates of diagnosed depression varied from 13% to 41%. After controlling for individual-level and facility-level independent variables, women veterans who were served in separate women's health clinics with integrated physical and mental healthcare were more likely to have diagnosed depression. The adjusted odds ratio was 1.12 (95% confidence interval, 1.01-1.25). Existing women-specific VHA organizational features with integration of primary care and mental health seem effective in diagnosing depression. Emerging patient-centered medical home models may facilitate diagnosis and treatment of mental health issues among women with complex chronic conditions.

Functional disability as an explanation of the associations between chronic physical conditions and 12-month major depressive episode

PubMed Central

Stegmann, Mariken E.; Ormel, Johan; de Graaf, Ron; Haro, Josep-Maria; de Girolamo, Giovanni; Demyttenaere, Koen; Kovess, Vivianne; Matschinger, Herbert; Vilagut, Gemma; Alonso, Jordi; Burger, Huibert

2013-01-01

Background The link between physical conditions and mental health is poorly understood. Functional disability could explain the association of physical conditions with major depressive episode (MDE) as an intermediary factor. Methods Data was analyzed from a subsample (N=8,796) of the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional general population survey. MDE during the last 12 months was assessed using a revision of the Composite International Diagnostic Interview (CIDI 3.0). Lifetime chronic physical conditions were assessed by self-report. Functional disability was measured using a version of the World Health Organization Disability Assessment Schedule (WHODAS). The associations of physical conditions with MDE and explanation by functional disability were quantified using logistic regression. Results All physical conditions were significantly associated with MDE. The increases in risk of MDE ranged from 30% for allergy to amply 100% for arthritis and heart disease. When adjusted for physical comorbidity, associations decreased and were no longer statistically significant for allergy and diabetes. Functional disability explained between 17 and 64% of these associations, most substantially for stomach or duodenum ulcer, arthritis and heart disease. Limitations Due to the cross-sectional nature of the study the temporal relationship of the variables could not be assessed and the amount of explanation can not simply be interpreted as the amount of mediation. Conclusions Our findings suggest that the association of chronic physical conditions with MDE is partly explained by functional disability. Such explanation is more pronounced for pain causing conditions and heart disease. Health professionals should be particularly aware of the increased risk of depressive disorder when patients experience disability from these conditions. PMID:19939461

Functional disability as an explanation of the associations between chronic physical conditions and 12-month major depressive episode.

PubMed

Stegmann, Mariken E; Ormel, Johan; de Graaf, Ron; Haro, Josep-Maria; de Girolamo, Giovanni; Demyttenaere, Koen; Kovess, Vivianne; Matschinger, Herbert; Vilagut, Gemma; Alonso, Jordi; Burger, Huibert

2010-07-01

The link between physical conditions and mental health is poorly understood. Functional disability could explain the association of physical conditions with major depressive episode (MDE) as an intermediary factor. Data was analyzed from a subsample (N=8796) of the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional general population survey. MDE during the last 12 months was assessed using a revision of the Composite International Diagnostic Interview (CIDI 3.0). Lifetime chronic physical conditions were assessed by self-report. Functional disability was measured using a version of the World Health Organization Disability Assessment Schedule (WHODAS). The associations of physical conditions with MDE and explanation by functional disability were quantified using logistic regression. All physical conditions were significantly associated with MDE. The increases in risk of MDE ranged from 30% for allergy to amply 100% for arthritis and heart disease. When adjusted for physical comorbidity, associations decreased and were no longer statistically significant for allergy and diabetes. Functional disability explained between 17 and 64% of these associations, most substantially for stomach or duodenum ulcer, arthritis and heart disease. Due to the cross-sectional nature of the study the temporal relationship of the variables could not be assessed and the amount of explanation cannot simply be interpreted as the amount of mediation. Our findings suggest that the association of chronic physical conditions with MDE is partly explained by functional disability. Such explanation is more pronounced for pain causing conditions and heart disease. Health professionals should be particularly aware of the increased risk of depressive disorder when patients experience disability from these conditions.

[Treatment of functional somatic syndrome with abdominal pain].

PubMed

Abe, Tetsuya; Kanbara, Kenji; Mizuno, Yasuyuki; Fukunaga, Mikihiko

2009-09-01

Functional somatic syndrome (FSS) with abdominal pain include functional gastrointestinal disorder, chronic pancreatitis, chronic pelvic pain syndrome, which generally contain autonomic dysfunction. Regarding the treatment of FSS, it is important to know about FSS for a therapist at first. Secondly, the therapist should find out physical dysfunction of patients positively, and confirm objectively the hypotheses about both peripheral and central pathophysiological mechanisms as much as possible. Heart rate variability is an easy method, and useful to assess autonomic function. After grasping the patient's explanatory model about the illness, the therapist showes the most acceptable treatment for the patient at last.

Awareness of chronic disease related health benefits of physical activity among residents of a rural South Indian region: a cross-sectional study.

PubMed

Veluswamy, Sundar Kumar; Maiya, Arun G; Nair, Suma; Guddattu, Vasudeva; Nair, Narayanapillai Sreekumaran; Vidyasagar, Sudha

2014-02-27

Physical activity trends for a lower-middle income country like India suggest a gradual decline in work related physical activity and no concomitant increase in leisure time physical activity. Perceived health benefits of physical activity and intention to increase physical activity have been established as independent correlates of physical activity status. In India, not much is known about peoples' perceptions of health benefits of physical activity and their intention to increase physical activity levels. This study was performed to understand peoples' perceptions and awareness about health benefits of physical activity in a rural South Indian region. This cross-sectional study was conducted using a multistage cluster sampling design. A content validated, field tested questionnaire was administered in person by a trained interviewer in the participants' native language. The questionnaire assessed the participants' perceptions about their lifestyle (active or sedentary), health benefits of physical activity and need for increasing their physical activity. In addition, the participant's physical activity was assessed using version 2 of global physical activity questionnaire. Frequencies and percentages were used to summarise perceived health benefits of physical activity and other categorical variables. Age and body mass index were summarised using mean ± SD, whereas physical activity (MET.min.wk -1) was summarised using median and interquartile range. Four hundred fifty members from 125 randomly selected households were included in the study, of which 409 members participated. 89% (364) of participants felt they lead an active lifestyle and 83.1% (340) of participants did not feel a need to increase their physical activity level. 86.1%, (352) of the participants were physically active. Though 92.4% (378) of participants felt there were health benefits of physical activity, majority of them (75.1%) did not report any benefit related to chronic diseases. None mentioned health benefits related to heart disease or stroke. There is low awareness of chronic disease related benefits of physical activity and participants do not see a need to increase their physical activity level. Public health awareness programs on importance and health benefits of physical activity would be useful to counter the anticipated decline in physical activity.

Predictors of emotional and physical dating violence in a sample of serious juvenile offenders.

PubMed

Sweeten, Gary; Larson, Matthew; Piquero, Alex R

2016-10-01

We estimate group-based dating violence trajectories and identify the adolescent risk factors that explain membership in each trajectory group. Using longitudinal data from the Pathways to Desistance Study, which follows a sample of 1354 serious juvenile offenders from Philadelphia, Pennsylvania and Phoenix, Arizona between mid-adolescence and early adulthood, we estimate group-based trajectory models of both emotional dating violence and physical dating violence over a span of five years in young adulthood. We then estimate multinomial logistic regression models to identify theoretically motivated risk factors that predict membership in these groups. We identified three developmental patterns of emotional dating violence: none (33%), low-level (59%) and high-level decreasing (8%). The best-fitting model for physical dating violence also had three groups: none (73%), low-level (24%) and high-level (3%). Race/ethnicity, family and psychosocial variables were among the strongest predictors of both emotional and physical dating violence. In addition, delinquency history variables predicted emotional dating violence and relationship variables predicted physical dating violence. Dating violence is quite prevalent in young adulthood among serious juvenile offenders. Numerous predictors distinguish between chronic dating violence perpetrators and other groups. These may suggest points of intervention for reducing future violence. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Towards ageing well: Use it or lose it: Exercise, epigenetics and cognition.

PubMed

Rea, Irene Maeve

2017-08-01

More and more people are living into the 90s or becoming centenarians. But, the gift of increased 'age span' seldom equates with an improved 'health-span'. Governments across the world are expressing concern about the epidemic of chronic disease, and have responded by initiating policies that make prevention, reduction and treatment of chronic disease, a public health priority. But understanding, how to age long and well, with the avoidance of chronic disease and later life complex disease morbidity is challenging. While inherited genes have an undoubted role to play in the chance of maintaining good health or conversely a predilection to developing disease and chronic ill health, there is increasing evidence that behavioural and environmental life-style choices may contribute up to 50% of the variability of human lifespan. Physical exercise is readily available to everyone, and is a simple cheap and effective form of life-style intervention. Exercise appears to help maintain good health and to reduce the risk of developing chronic disease and ill health. Evidence suggests that physical activity improves well-being across many health domains through out life, continues to offer important health benefits in older age groups and tracks with a 'healthy ageing' profile. Although many of the molecular pathways remain to be fully identified, here we discuss how physical activity and exercise is understood to produce changes in the human epigenome, which have the potential to enhance cognitive and psychological health, improve muscular fitness, and lead to better ageing with improved quality of life in older age.

[Greater level of physical activity associated with better cognitive function in hemodialysis in end stage renal disease].

PubMed

Stringuetta-Belik, Fernanda; Shiraishi, Flávio Gobbis; Oliveira e Silva, Viviana Rugolo; Barretti, Pasqual; Caramori, Jacqueline Costa Teixeira; Bôas, Paulo José Fortes Villas; Martin, Luis Cuadrado; Franco, Roberto Jorge da Silva

2012-01-01

Patients with chronic kidney disease (CKD) have a lower exercise tolerance and poor functional capacity, carry on a sedentary lifestyle. Another important change found in patients with CKD is cognitive dysfunction. Physical inactivity has been associated with cognitive dysfunction in the general population, but few studies have evaluated this association in CKD. To assess the association between physical activity and cognitive function in patients with CKD on hemodialysis (HD). We evaluated 102 patients undergoing HD. The participants completed the International Physical Activity Questionnaire, which assesses the level of physical activity and the Mini Mental State Examination, used for cognitive screening. Patients were divided into three groups according to their level of physical activity (GI: active/GII: irregularly active/GIII: sedentary). It was applied logistic regression analysis and adopted as outcome variable the presence of cognitive impairment and preserving as independent variables those with a probability of statistical difference between groups of less than 0.1. It was considered statistically significant when p less than 0.05. The groups were similar in age, duration of HD, and smoking. Statistically significant difference regarding race, body mass index, diabetes mellitus, underlying disease and degree of cognitive impairment. Regarding laboratory data, the groups differed in terms of creatinine, glucose, hemoglobin and hematocrit. There was significant association with better physical activity and cognitive function, even adjusting for confounding variables. the highest level of physical activity was associated with better cognitive function in CKD patients undergoing HD.

Geography, Race/Ethnicity, and Physical Activity Among Men in the United States.

PubMed

Sohn, Elizabeth Kelley; Porch, Tichelle; Hill, Sarah; Thorpe, Roland J

2017-07-01

Engaging in regular physical activity reduces one's risk of chronic disease, stroke, cardiovascular disease, and some forms of cancer. These preventive benefits associated with physical activity are of particular importance for men, who have shorter life expectancy and experience higher rates of chronic diseases as compared to women. Studies at the community and national levels have found that social and environmental factors are important determinants of men's physical activity, but little is known about how regional influences affect physical activity behaviors among men. The objective of this study is to examine the association between geographic region and physical activity among men in the United States, and to determine if there are racial/ethnic differences in physical activity within these geographic regions. Cross-sectional data from men who participated the 2000 to 2010 National Health Interview Survey ( N = 327,556) was used. The primary outcome in this study was whether or not men had engaged in sufficient physical activity to receive health benefits, defined as meeting the 2008 Physical Activity Guidelines for Americans. Race/ethnicity and geographic region were the primary independent variables. Within every region, Hispanic and Asian men had lower odds of engaging in sufficient physical activity compared to white men. Within the Northeast, South, and West, black men had lower odds of engaging in sufficient physical activity compared to white men. The key findings indicate that the odds of engaging in sufficient physical activity among men differ significantly between geographic regions and within regions by race/ethnicity.

Barriers to physical activity among working mothers.

PubMed

Dombrowski, Jill J

2011-04-01

Working mothers experience several barriers to physical activity. If these barriers can be identified by occupational health nurses and they can partner with working mothers to reduce these perceived barriers, the health of these workers can be improved and chronic disease risk prevented. The purpose of this study was to measure the effect of self-regulatory efficacy on physical activity among working mothers and to describe specific barriers to physical activity. The Barriers Specific Self-Efficacy Scale (BARSE) and the Kaiser Physical Activity Survey (KPAS) were used to measure the variables. Self-regulatory efficacy was found to be a strong predictor of physical activity in a diverse sample of working mothers who did not meet current recommendations for physical activity. Occupational health nurses can use these findings to design programs for groups and for counseling individuals. Copyright 2011, SLACK Incorporated.

An educational approach based on a non-injury model compared with individual symptom-based physical training in chronic LBP. A pragmatic, randomised trial with a one-year follow-up

PubMed Central

2010-01-01

Background In the treatment of chronic back pain, cognitive methods are attracting increased attention due to evidence of effectiveness similar to that of traditional therapies. The purpose of this study was to compare the effectiveness of performing a cognitive intervention based on a non-injury model with that of a symptom-based physical training method on the outcomes of low back pain (LBP), activity limitation, LBP attitudes (fear-avoidance beliefs and back beliefs), physical activity levels, sick leave, and quality of life, in chronic LBP patients. Methods The study was a pragmatic, single-blind, randomised, parallel-group trial. Patients with chronic/recurrent LBP were randomised to one of the following treatments: 1. Educational programme : the emphasis was on creating confidence that the back is strong, that loads normally do not cause any damage despite occasional temporary pain, that reducing the focus on the pain might facilitate more natural and less painful movements, and that it is beneficial to stay physically active. 2. Individual symptom-based physical training programme : directional-preference exercises for those centralising their pain with repetitive movements; 'stabilising exercises' for those deemed 'unstable' based on specific tests; or intensive dynamic exercises for the remaining patients. Follow-up questionnaires (examiner-blinded) were completed at 2, 6 and 12 months. The main statistical test was an ANCOVA adjusted for baseline values. Results A total of 207 patients participated with the median age of 39 years (IQR 33-47); 52% were female, 105 were randomised to the educational programme and 102 to the physical training programme. The two groups were comparable at baseline. For the primary outcome measures, there was a non-significant trend towards activity limitation being reduced mostly in the educational programme group, although of doubtful clinical relevance. Regarding secondary outcomes, improvement in fear-avoidance beliefs was also better in the educational programme group. All other variables were about equally influenced by the two treatments. The median number of treatment sessions was 3 for the educational programme group and 6 for the physical training programme group. Conclusions An educational approach to treatment for chronic LBP resulted in at least as good outcomes as a symptom-based physical training method, despite fewer treatment sessions. Trial registration Clinicaltrials.gov: # NCT00410319 PMID:20849601

The influence of physical and mental health on life satisfaction is mediated by self-rated health: A study with Brazilian elderly.

PubMed

Pinto, Juliana Martins; Fontaine, Anne Marie; Neri, Anita Liberalesso

2016-01-01

Chronic diseases, signals and symptoms of health problems and objective losses in functionality are seen as strongly related to low levels of life satisfaction in old age. Among seniors, self-rated health is associated with both quality of health and life satisfaction, but its relationships with objective health measures are controversial. This study aimed at identifying the influence of self-rated health as a mediator of the relationships between objectives indicators of physical and mental health and the elderly's life satisfaction. Self-reporting and physical performance measures were derived from the data basis of the FIBRA Study, which investigated frailty and associated variables in a cross-sectional sample of 2164 subjects aged 65 and above, randomly selected in seven Brazilian cities. A model considering satisfaction as a dependent variable, the number of diseases, frailty, cognitive status and depressive symptoms as predictors and self-rated health as a mediating variable was tested through path analysis. The model fit the data well and explained 19% of life satisfaction's variance. According to the bootstrapping method, indirect effects were significant for all trajectories, suggesting that self-rated health is a mediator variable between physical and mental health and elderlýs life satisfaction. In conclusion, adverse conditions of physical and mental health can influence the elderlýs life satisfaction, mostly when they determine a decrease in their levels of self-rated health. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Perceived weight discrimination and chronic medical conditions in adults with overweight and obesity.

PubMed

Udo, Tomoko; Purcell, Katherine; Grilo, Carlos M

2016-12-01

This study investigated whether perceived weight discrimination is associated with increased risk for major chronic medical conditions and whether the associations persist after adjusting for other stressful life events in addition to BMI, physical activity and sociodemographic variables. The study included 21 357 overweight/obese adults (52.9% women) from the 2001 to 2002 and 2004 to 2005 National Survey of Alcohol and Related Conditions. Perceived weight discrimination was significantly associated with risk for arteriosclerosis, diabetes, high cholesterol, myocardial infarction, minor heart conditions and stomach ulcers. Perceived weight discrimination was associated with reporting more stressful life events. After adjusting additionally for stressful life events in the final multiple logistic regression, associations with arteriosclerosis, diabetes and minor cardiac conditions remained significant. Gender-stratified analyses revealed that perceived weight discrimination was associated with different medical conditions in women than men, and many associations became non-significant when adjusting for stressful life events, particularly for women. Among overweight/obese adults, perceived weight discrimination is associated with significantly increased risk for obesity-related chronic medical conditions even after adjusting for BMI, physical activity and sociodemographic variables. Accounting for other acute stressful life events may also be important in understanding the health effects of perceived weight discrimination. Such added health risk of overweight/obesity posed by perceived weight discrimination warrants public health and policy interventions against weight discrimination to reduce the socioeconomic burden of obesity. © 2016 John Wiley & Sons Ltd.

Trauma and posttraumatic stress disorder in women with chronic pelvic pain.

PubMed

Meltzer-Brody, Samantha; Leserman, Jane; Zolnoun, Denniz; Steege, John; Green, Emily; Teich, Alice

2007-04-01

To examine the effect of abuse history, other major trauma, and posttraumatic stress disorder (PTSD) on medical symptoms and health-related daily functioning in women with chronic pelvic pain. We administered a questionnaire to 713 consecutive women seen in a referral-based pelvic pain clinic. We found that 46.8% reported having either a sexual or physical abuse history. A total of 31.3% had a positive screen for PTSD. Using regression and path analysis, controlling for demographic variables, we found that a trauma history was associated with worse daily physical functioning due to poor health (P<.001), more medical symptoms (P<.001), more lifetime surgeries (P<.001), more days spent in bed (P<.001), and more dysfunction due to pain (P<.001). Furthermore, a positive screen for PTSD was highly related to most measures of poor health status (P<.001) and somewhat explained the trauma-related poor health status. The association of trauma with poor health may be due in part to the development of PTSD resulting from trauma. These findings demonstrate the importance of screening for trauma and PTSD in women with chronic pelvic pain. II.

Stress, social relationships and health outcomes in low-income Francistown, Botswana.

PubMed

Modie-Moroka, Tirelo

2014-08-01

Studies assessing the impact of stress on health outcomes are lacking in developing countries such as Botswana, in Southern Africa. This study examines the relationships between individual life stressors (stressful life events and chronic life stressors), social relationships and quality of life (QoL), for low-income urban residents in Francistown, Botswana. Although there are many studies of social support and quality of life, no studies have so far explored the relationship among the three variables. Selected concepts from stress theory are used as a conceptual framework. Using a cross-sectional quantitative design (both descriptive and explanatory), this study examined the associations among life stress (stressful life events and chronic life stressors), social relationships, and four indicators of health and QoL among a sample of 388 low-income urban dwellers in Francistown, Botswana. Using multiple regression models, the results of this study show that the availability of social relationships was associated with better physical and psychological health and level of independence. Controlling for the physical domain of QoL, social relationships buffered the effects of chronic life stressors on QoL and level of independence. Social relationships buffer the effects of stressful life events on quality, not on psychological well-being. Social relationships had no moderating effect on physical health, level of independence and on quality of life.

Are people with chronic low back pain meeting the physical activity guidelines? A co-twin control study.

PubMed

Zadro, Joshua Robert; Shirley, Debra; Amorim, Anita; Pérez-Riquelme, Francisco; Ordoñana, Juan R; Ferreira, Paulo H

2017-06-01

Despite a large amount of research investigating physical activity (PA) levels in people with chronic low back pain (LBP), no study has investigated whether people with chronic LBP are meeting the World Health Organization (WHO) PA guidelines. Furthermore, with genetics and the early shared environment substantially influencing the presence of LBP and PA engagement, these factors could confound the association between LBP and PA and need to be controlled for. This study aimed to investigate the association between chronic LBP and meeting the PA guidelines, while controlling for the effects of genetics and early shared environment. This is a cross-sectional co-twin control study. A cross-sectional analysis was performed on 1,588 twins from the Murcia Twin Registry in Spain with available data on LBP and PA from the 2013 data collection wave. The exposure and outcome variables in our study were self-reported. Twins reporting a history of chronic LBP were asked follow-up questions to inform on the presence of recent LBP (within the past 4 weeks), previous LBP (no pain within the past 4 weeks), and persistent LBP (no pain-free month in the last 6 months). These were our exposure variables. Our outcome variable was meeting the WHO PA guidelines, which involved at least 75 minutes of vigorous-intensity PA, or at least 150 minutes of moderate-intensity PA per week. To investigate the association between chronic LBP and meeting the PA guidelines, we first performed a multivariate logistic regression on the total sample of twins. Co-variables entered the model if the univariate association between the co-variable, and both the exposure and the outcome reached a significance of p<.2. Second, to adjust for the influence of genetics and early shared environment, we performed a conditional multivariate logistic regression on complete twin pairs discordant for LBP. The Murcia Twin Registry is supported by Fundación Séneca, Regional Agency for Science and Technology, Murcia, Spain (08633/PHCS/08 and 15302/PHCS/10) and the Ministry of Science and Innovation, Spain (PSI11560-2009). Funding for this project has also been received from Fundación MAPFRE (2012). The authors declare that there are no conflicts of interest. There was a significant inverse association between recent LBP and meeting the PA guidelines (odds ratio [OR]=0.71, p=.034). When controlling for genetics and early shared environment, this association disappeared. There was no association between previous (OR=0.95, p=.779) or persistent LBP (OR=0.78, p=.192) and meeting the PA guidelines. Twins with recent LBP are less likely to meet the PA guidelines than those with no history of chronic LBP, highlighting the importance of incorporating PA promotion in the treatment of these individuals. Genetics and early shared environment appear to be confounding the association between LBP and PA, although this needs to be further tested in larger twin samples. Copyright © 2017 Elsevier Inc. All rights reserved.

Predictors of suicidal ideation in chronic pain patients: an exploratory study.

PubMed

Racine, Mélanie; Choinière, Manon; Nielson, Warren R

2014-05-01

To explore whether chronic pain (CP) patients who report suicidal ideation (SI) present a distinctive profile with regard to their sociodemographic characteristics, physical health, psychological well-being, cognitions, and use of antidepressants, illicit drugs, and alcohol for pain relief. Eighty-eight CP patients completed self-administered questionnaires during their intake assessment at 3 pain clinics located in the province of Québec (Canada). Patients reporting active or passive SI on the Beck Depression Inventory were compared with patients reporting no SI. Between-group univariate analyses were performed using profile variables to compare patients with and without SI. Significant variables were then entered into multiple logistic regression analyses to identify significant independent predictors of SI. Twenty-four percent of patients reported having had SI. Unemployed/disabled patients were 6 times more likely to report SI. Poor sleep quality was the only predictor of SI among the physical variables. For psychological well-being, depressive symptoms did not significantly predict SI. However, the poorer the patients perceived their mental health to be the more likely they were to report SI. Pain-related helplessness was the only predictor for SI among the cognitive variables. Patients who had used illicit drugs as a form of pain relief at any time since pain onset were 5 times more likely to report SI. Similar results were obtained for those who were on antidepressants. Some factors associated with SI seem pain specific, whereas others are more generally associated with SI. Better identification and understanding of these factors is essential for the development of targeted suicide prevention programs for at-risk CP patients.

The differential impact of job isostrain and home-work interference on indicators of physical and mental health in women and men.

PubMed

Casini, Annalisa; Clays, Els; Godin, Isabelle; De Backer, Guy; Kornitzer, Marcel; Kittel, France

2010-12-01

To evaluate (1) whether the physical and mental health of male workers differs from that of female workers, and, if so, whether (2) this is affected by the interplay between work and nonwork burden. We pooled two large Belgian databases (BELSTRESS III, SOMSTRESS) comprising data on 4810 (2847 women). Gender-specific logistic regressions were performed using a four-level variable as predictor. This combined two predictors: isolated job strain (isostrain) and home-work interference (HWI). Male workers are at greater risk of chronic fatigue when they experience high isostrain but not high HWI. Although accumulated high isostrain and high HWI affect women mainly via chronic fatigue, the same pattern has a greater impact on men's perceived health. There was no difference for the other patterns. To improve workers' well-being, organizations should develop work and nonwork balance policies specific for men and women.

Optimism on quality of life in Portuguese chronic patients: moderator/mediator?

PubMed

Vilhena, Estela; Pais-Ribeiro, José; Silva, Isabel; Pedro, Luísa; Meneses, Rute F; Cardoso, Helena; Silva, António Martins da; Mendonça, Denisa

2014-07-01

optimism is an important variable that has consistently been shown to affect adjustment to quality of life in chronic diseases. This study aims to clarify if dispositional optimism exerts a moderating or a mediating influence on the personality traits-quality of life association, in Portuguese chronic patients. multiple regression models were used to test the moderation and mediation effects of dispositional optimism in quality of life. A sample of 729 patients was recruited in Portugal's main hospitals and completed self-reported questionnaires assessing socio-demographic and clinical variables, personality, dispositional optimism, quality of life (QoL) and subjective well-being (SWB). the results of the regression models showed that dispositional optimism did not moderate the relationships between personality traits and quality of life. After controlling for gender, age, education level and severity of disease perception, the effects of personality traits on QoL and in SWB were mediated by dispositional optimism (partially and completely), except for the links between neuroticism/openness to experience and physical health. dispositional optimism is more likely to play a mediating, rather than a moderating role in personality traits-quality of life pathway in Portuguese chronic patients, suggesting that "the expectation that good things will happen" contributes to a better quality of life and subjective well-being.

[Efficiency of multidisciplinary treatment of chronic pain with locomotor disability].

PubMed

Collado Cruz, A; Torres i Mata, X; Arias i Gassol, A; Cerdà Gabaroi, D; Vilarrasa, R; Valdés Miyar, M; Muñoz-Gómez, J

2001-10-13

Disabling chronic pain is especially devastating among working population and, in many cases, it does not respond to conventional therapies. In chronic pain, the importance of psychosocial and occupational factors, in addition to biological ones, has prompted the development of successful multidisciplinary treatment programmes in various countries. We assessed the outcome of a multidisciplinary therapeutic program for work-disabled selected patients with chronic pain refractory to conventional treatment. The study included 70 patients (58 women, mean age [SD]: 42 [9]years) with chronic pain and sick leave (mean [SD]: 7 [4] months of work disability) diagnosed with fibromyalgia (51%), chronic low back pain (16%), regional myofascial pain (15%), cervicocraneal syndrome (3%), anquilosing spondylitis (3%), and other conditions(12%). All patients had received previous pharmacological treatment,physical therapy and/or other measures (surgery in 12% cases)without improvement. All patients underwent an intensive multidisciplinary treatment of 4 weeks' duration including medical techniques for pain control, cognitive-behavioural therapy, physical therapy,and occupational therapy. Average follow-up was 10 (4) months(1-24 months) post-discharge. Significant improvements were observed with regard to all relevant variables, as reflected in pre and post-discharge measures: pain(Visual-Analogue Scale 1-10 cm): 7.4 (1.5) versus 3.2 (2) (p <0.01); anxiety (HARS), 19 (7) versus 14 (8) (p < 0.01); depression(BDI), 16 (8) versus 10 (8) (p < 0.01); functional ability(HAQ), 1.6 (0.4) versus 0.6 (0.5) (p < 0.001). At discharge,73% of patients returned to work. In addition, 69% of treated patients maintained the acquired improvement and their employment status at the end of follow-up. Multidisciplinary treatment of chronic pain with special attention to work return is useful for selected patients with a disabling chronic pain syndrome refractory to conventional treatment.

The PROactive instruments to measure physical activity in patients with chronic obstructive pulmonary disease

PubMed Central

Gimeno-Santos, Elena; Raste, Yogini; Demeyer, Heleen; Louvaris, Zafeiris; de Jong, Corina; Rabinovich, Roberto A.; Hopkinson, Nicholas S.; Polkey, Michael I.; Vogiatzis, Ioannis; Tabberer, Maggie; Dobbels, Fabienne; Ivanoff, Nathalie; de Boer, Willem I.; van der Molen, Thys; Kulich, Karoly; Serra, Ignasi; Basagaña, Xavier; Troosters, Thierry; Puhan, Milo A.; Karlsson, Niklas

2015-01-01

No current patient-centred instrument captures all dimensions of physical activity in chronic obstructive pulmonary disease (COPD). Our objective was item reduction and initial validation of two instruments to measure physical activity in COPD. Physical activity was assessed in a 6-week, randomised, two-way cross-over, multicentre study using PROactive draft questionnaires (daily and clinical visit versions) and two activity monitors. Item reduction followed an iterative process including classical and Rasch model analyses, and input from patients and clinical experts. 236 COPD patients from five European centres were included. Results indicated the concept of physical activity in COPD had two domains, labelled “amount” and “difficulty”. After item reduction, the daily PROactive instrument comprised nine items and the clinical visit contained 14. Both demonstrated good model fit (person separation index >0.7). Confirmatory factor analysis supported the bidimensional structure. Both instruments had good internal consistency (Cronbach's α>0.8), test–retest reliability (intraclass correlation coefficient ≥0.9) and exhibited moderate-to-high correlations (r>0.6) with related constructs and very low correlations (r<0.3) with unrelated constructs, providing evidence for construct validity. Daily and clinical visit “PROactive physical activity in COPD” instruments are hybrid tools combining a short patient-reported outcome questionnaire and two activity monitor variables which provide simple, valid and reliable measures of physical activity in COPD patients. PMID:26022965

The PROactive instruments to measure physical activity in patients with chronic obstructive pulmonary disease.

PubMed

Gimeno-Santos, Elena; Raste, Yogini; Demeyer, Heleen; Louvaris, Zafeiris; de Jong, Corina; Rabinovich, Roberto A; Hopkinson, Nicholas S; Polkey, Michael I; Vogiatzis, Ioannis; Tabberer, Maggie; Dobbels, Fabienne; Ivanoff, Nathalie; de Boer, Willem I; van der Molen, Thys; Kulich, Karoly; Serra, Ignasi; Basagaña, Xavier; Troosters, Thierry; Puhan, Milo A; Karlsson, Niklas; Garcia-Aymerich, Judith

2015-10-01

No current patient-centred instrument captures all dimensions of physical activity in chronic obstructive pulmonary disease (COPD). Our objective was item reduction and initial validation of two instruments to measure physical activity in COPD.Physical activity was assessed in a 6-week, randomised, two-way cross-over, multicentre study using PROactive draft questionnaires (daily and clinical visit versions) and two activity monitors. Item reduction followed an iterative process including classical and Rasch model analyses, and input from patients and clinical experts.236 COPD patients from five European centres were included. Results indicated the concept of physical activity in COPD had two domains, labelled "amount" and "difficulty". After item reduction, the daily PROactive instrument comprised nine items and the clinical visit contained 14. Both demonstrated good model fit (person separation index >0.7). Confirmatory factor analysis supported the bidimensional structure. Both instruments had good internal consistency (Cronbach's α>0.8), test-retest reliability (intraclass correlation coefficient ≥0.9) and exhibited moderate-to-high correlations (r>0.6) with related constructs and very low correlations (r<0.3) with unrelated constructs, providing evidence for construct validity.Daily and clinical visit "PROactive physical activity in COPD" instruments are hybrid tools combining a short patient-reported outcome questionnaire and two activity monitor variables which provide simple, valid and reliable measures of physical activity in COPD patients. Copyright ©ERS 2015.

Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews

PubMed Central

Geneen, Louise J; Moore, R Andrew; Clarke, Clare; Martin, Denis; Colvin, Lesley A; Smith, Blair H

2017-01-01

Background Chronic pain is defined as pain lasting beyond normal tissue healing time, generally taken to be 12 weeks. It contributes to disability, anxiety, depression, sleep disturbances, poor quality of life, and healthcare costs. Chronic pain has a weighted mean prevalence in adults of 20%. For many years, the treatment choice for chronic pain included recommendations for rest and inactivity. However, exercise may have specific benefits in reducing the severity of chronic pain, as well as more general benefits associated with improved overall physical and mental health, and physical functioning. Physical activity and exercise programmes are increasingly being promoted and offered in various healthcare systems, and for a variety of chronic pain conditions. It is therefore important at this stage to establish the efficacy and safety of these programmes, and furthermore to address the critical factors that determine their success or failure. Objectives To provide an overview of Cochrane Reviews of adults with chronic pain to determine (1) the effectiveness of different physical activity and exercise interventions in reducing pain severity and its impact on function, quality of life, and healthcare use; and (2) the evidence for any adverse effects or harm associated with physical activity and exercise interventions. Methods We searched theCochrane Database of Systematic Reviews (CDSR) on the Cochrane Library (CDSR 2016, Issue 1) for systematic reviews of randomised controlled trials (RCTs), after which we tracked any included reviews for updates, and tracked protocols in case of full review publication until an arbitrary cut-off date of 21 March 2016 (CDSR 2016, Issue 3). We assessed the methodological quality of the reviews using the AMSTAR tool, and also planned to analyse data for each painful condition based on quality of the evidence. We extracted data for (1) self-reported pain severity, (2) physical function (objectively or subjectively measured), (3) psychological function, (4) quality of life, (5) adherence to the prescribed intervention, (6) healthcare use/attendance, (7) adverse events, and (8) death. Due to the limited data available, we were unable to directly compare and analyse interventions, and have instead reported the evidence qualitatively. Main results We included 21 reviews with 381 included studies and 37,143 participants. Of these, 264 studies (19,642 participants) examined exercise versus no exercise/minimal intervention in adults with chronic pain and were used in the qualitative analysis. Pain conditions included rheumatoid arthritis, osteoarthritis, fibromyalgia, low back pain, intermittent claudication, dysmenorrhoea, mechanical neck disorder, spinal cord injury, postpolio syndrome, and patellofemoral pain. None of the reviews assessed 'chronic pain' or 'chronic widespread pain' as a general term or specific condition. Interventions included aerobic, strength, flexibility, range of motion, and core or balance training programmes, as well as yoga, Pilates, and tai chi. Reviews were well performed and reported (based on AMSTAR), and included studies had acceptable risk of bias (with inadequate reporting of attrition and reporting biases). However the quality of evidence was low due to participant numbers (most included studies had fewer than 50 participants in total), length of intervention and follow-up (rarely assessed beyond three to six months). We pooled the results from relevant reviews where appropriate, though results should be interpreted with caution due to the low quality evidence. Pain severity: several reviews noted favourable results from exercise: only three reviews that reported pain severity found no statistically significant changes in usual or mean pain from any intervention. However, results were inconsistent across interventions and follow-up, as exercise did not consistently bring about a change (positive or negative) in self-reported pain scores at any single point. Physical function: was the most commonly reported outcome measure. Physical function was significantly improved as a result of the intervention in 14 reviews, though even these statistically significant results had only small-to-moderate effect sizes (only one review reported large effect sizes). Psychological function and quality of life: had variable results: results were either favourable to exercise (generally small and moderate effect size, with two reviews reporting significant, large effect sizes for quality of life), or showed no difference between groups. There were no negative effects. Adherence to the prescribed intervention: could not be assessed in any review. However, risk of withdrawal/dropout was slightly higher in the exercising group (82.8/1000 participants versus 81/1000 participants), though the group difference was non-significant. Healthcare use/attendance: was not reported in any review. Adverse events, potential harm, and death: only 25% of included studies (across 18 reviews) actively reported adverse events. Based on the available evidence, most adverse events were increased soreness or muscle pain, which reportedly subsided after a few weeks of the intervention. Only one review reported death separately to other adverse events: the intervention was protective against death (based on the available evidence), though did not reach statistical significance. Authors' conclusions The quality of the evidence examining physical activity and exercise for chronic pain is low. This is largely due to small sample sizes and potentially underpowered studies. A number of studies had adequately long interventions, but planned follow-up was limited to less than one year in all but six reviews. There were some favourable effects in reduction in pain severity and improved physical function, though these were mostly of small-to-moderate effect, and were not consistent across the reviews. There were variable effects for psychological function and quality of life. The available evidence suggests physical activity and exercise is an intervention with few adverse events that may improve pain severity and physical function, and consequent quality of life. However, further research is required and should focus on increasing participant numbers, including participants with a broader spectrum of pain severity, and lengthening both the intervention itself, and the follow-up period. Physical activity and exercise for chronic pain in adults - an overview of Cochrane Reviews Background Chronic (long-term) pain is pain that has lasted beyond the body's usual healing time. It is often described as pain that has lasted for at least three months. Chronic pain causes many problems, beyond the pain itself, including fatigue, anxiety, depression, and a poor quality of life. In the past, people with chronic pain were told to rest. However, general advice now is to keep active - whether to affect the pain directly or to combat the other problems associated with it. Therefore, research studies have attempted to examine the effect of physical activity in people with chronic pain. This overview aimed to bring together and analyse any reviews published by Cochrane that looked at physical activity and exercise studies in any chronic pain condition, including arthritis, back and neck pain, and menstrual (period) pain. Key results and quality of the evidence In January 2016, we identified 21 Cochrane Reviews which covered 10 different diagnoses (osteoarthritis (a joint disease), rheumatoid arthritis (joint pain and swelling), fibromyalgia (widespread pain condition), low back pain, intermittent claudication (cramping pain in the legs), dysmenorrhoea (period pain), mechanical neck disorders (neck pain), spinal cord injury, postpolio syndrome (a condition occurring in people who have had polio), patellofemoral pain (pain at the front of the knee)). The physical activity or exercise programme used in the trials ranged in frequency, intensity, and type, including land- and water-based activities, those focusing on building strength, endurance, flexibility and range of motion, and muscle activation exercises. The quality of the evidence was low. This was mostly due to the small numbers of people with chronic pain who participated in each reviewed study. Ideally, a study should have hundreds of people assigned to each group, whereas most of the studies included in the review process here had fewer than 50 people in total. There was evidence that physical activity reduced the severity of pain, improved physical function, and had a variable effect on both psychological function and quality of life. However, these results were not found in all studies. The inconsistency could be due to the quality of the studies or because of the mix of different types of physical activity tested in the studies. Additionally, participants had predominantly mild-to-moderate pain, not moderate-to-severe pain. Conclusions According to the available evidence (only 25% of included studies reported on possible harm or injury from the intervention), physical activity did not cause harm. Muscle soreness that sometimes occurs with starting a new exercise subsided as the participants adapted to the new activities. This is important as it shows physical activity in general is acceptable and unlikely to cause harm in people with chronic pain, many of whom may have previously feared it would increase their pain further. Future studies should focus on increasing participant numbers, including a wider range of severity of pain (more people with more severe pain), and lengthening both the intervention (exercise programme) itself, and the follow-up period. This pain is chronic in nature, and so a long-term intervention, with longer periods of recovery or follow-up, may be more effective. PMID:28436583

Risk correlates for physical-mental multimorbidities in South Africa: a cross-sectional study.

PubMed

Petersen, I; Rathod, S; Kathree, T; Selohilwe, O; Bhana, A

2017-12-04

The aim of this study was to identify the risk correlates for coexisting common mental disorders (CMDs) in the chronic care population in South Africa, with the view to identifying particularly vulnerable patient populations. The sample comprised 2549 chronic care patients enrolled in the baseline and endline rounds of a facility detection survey conducted by the Programme for Improving Mental Health Care in three large facilities in the Dr Kenneth Kaunda district in the North West province of South Africa. Participants were screened for depression using the Patient Health Questionnaire (PHQ9) and for alcohol misuse using the Alcohol Use Disorders Identification Test (AUDIT). Data were analysed according to the number of morbidities, disorder type (physical or mental) and demographic variables. Multimorbidity was defined as the presence of two or more disorders (physical and/or mental). Just over one-third of the sample reported two or more physical conditions. Women were more at risk of being depressed than were men, with men more at risk of alcohol misuse. Those who were employed were at lower risk of having coexisting CMDs, while being younger, HIV positive, and food deprived were all found to be associated with higher risk for having coexisting CMDs. In the face of the large treatment gap for CMDs in South Africa, and the role that coexisting CMDs can play in exacerbating the burden of chronic physical diseases, mental health screening and treatment interventions should target HIV-positive, younger patients living in circumstances where there is household food insecurity.

Psychological Factors in Chronic Pelvic Pain in Women: Relevance and Application of the Fear-Avoidance Model of Pain

PubMed Central

Bishop, Mark D.

2011-01-01

Chronic pelvic pain in women is a debilitating, costly condition often treated by physical therapists. The etiology of this condition is multifactorial and poorly understood, given the complex interplay of muscles, bones, and soft tissue that comprise the pelvis. There are few guidelines directing treatment interventions for this condition. In the last decade, several investigators have highlighted the role of psychological variables in conditions such as vulvodynia and painful bladder syndrome. Pain-related fear is the focus of the fear-avoidance model (FAM) of pain, which theorizes that some people are more likely to develop and maintain pain after an injury because of their emotional and behavioral responses to pain. The FAM groups people into 2 classes on the basis of how they respond to pain: people who have low fear, confront pain, and recover from injury and people who catastrophize pain—a response that leads to avoidance/escape behaviors, disuse, and disability. Given the presence of pain-related cognitions in women with chronic pelvic pain, including hypervigilance, catastrophizing, and anxiety, research directed toward the application of the FAM to guide therapeutic interventions is warranted. Isolated segments of the FAM have been studied to theorize why traditional approaches (ie, medications and surgery) may not lead to successful outcomes. However, the explicit application of the FAM to guide physical therapy interventions for women with chronic pelvic pain is not routine. Integrating the FAM might direct physical therapists' clinical decision making on the basis of the pain-related cognitions and behaviors of patients. The aims of this article are to provide information about the FAM of musculoskeletal pain and to provide evidence for the relevance of the FAM to chronic pelvic pain in women. PMID:21835893

Comparison of efficacy of neural therapy and physical therapy in chronic low back pain.

PubMed

Atalay, Nilgun Simsir; Sahin, Fusun; Atalay, Ali; Akkaya, Nuray

2013-01-01

The aim of this prospective study was to evaluate the effects of neural therapy, and physical therapy on level of pain, disability, quality of life, and psychological status in patients with chronic low back pain. Patients admitted to the physical therapy and rehabilitation outpatient clinic with the complaint of low back pain of at least 3 months duration. Group 1 (n=27), physical therapy (PT, hotpack, ultrasound, TENS 15 sessions), group 2 (n=33), neural therapy (NT, 1:1 mixture of 20 mg/mL Lidocaine HCl (Jetokain simplex®) and saline for 5 sessions. For pain, Visual Analogue Scale (VAS), for disability Roland Morris Disability Questionnaire (RMDQ), for quality-of-life Nottingham-Health-Profile (NHP), for depression, and anxiety, Hospital Anxiety-Depression Scale (HADS) were used before and after the treatment. Mean age was 47.3±11.32 years, symptom time was 13.78±11.98 months. There were no differences for demographic variables between groups. Significant improvements were detected for VAS, RMDQ, NHP-Pain, NHP-Physical activity, HADS for both of two groups after treatment. In addition to these findings, significant improvements were found for NHP-Energy, NHP-Social isolation in NT group. The differences of pre- and post-treatment values of parameters were evaluated for each group. Although there were no differences for VAS, NHP-sleep, NHP-Emotional reaction, HADS between groups, RMDQ, NHP-Pain, NHP-Physical activity, NHP-Social isolation were higher in NT than PT before treatment, the improvements for these parameters were better in NT than PT. In conclusion both of NT and PT are effective on pain, function, quality of life, anxiety, and depression in patients with chronic low back pain.

Examining the Disability Model From the International Classification of Functioning, Disability, and Health Using a Large Data Set of Community-Dwelling Malaysian Older Adults

PubMed Central

Loke, Seng Cheong; Lim, Wee Shiong; Someya, Yoshiko; Hamid, Tengku A.; Nudin, Siti S. H.

2015-01-01

Objective: This study examines the International Classification of Functioning, Disability, and Health model (ICF) using a data set of 2,563 community-dwelling elderly with disease-independent measures of mobility, physical activity, and social networking, to represent ICF constructs. Method: The relationship between chronic disease and disability (independent and dependent variables) was examined using logistic regression. To demonstrate variability in activity performance with functional impairment, graphing was used. The relationship between functional impairment, activity performance, and social participation was examined graphically and using ANOVA. The impact of cognitive deficits was quantified through stratifying by dementia. Results: Disability is strongly related to chronic disease (Wald 25.5, p < .001), functional impairment with activity performance (F = 34.2, p < .001), and social participation (F= 43.6, p < .001). With good function, there is considerable variability in activity performance (inter-quartile range [IQR] = 2.00), but diminishes with high impairment (IQR = 0.00) especially with cognitive deficits. Discussion: Environment modification benefits those with moderate functional impairment, but not with higher grades of functional loss. PMID:26472747

Discrepancy between functional exercise capacity and daily physical activity: a cross-sectional study in patients with mild to moderate COPD.

PubMed

Fastenau, Annemieke; van Schayck, Onno C P; Gosselink, Rik; Aretz, Karin C P M; Muris, Jean W M

2013-12-01

In patients with moderate to severe chronic obstructive pulmonary disease (COPD) the six-minute walk distance reflects the functional exercise level for daily physical activity. It is unknown if this also applies to patients with mild to moderate COPD in primary care. To assess the relationship between functional exercise capacity and physical activity in patients with mild to moderate COPD. A cross-sectional study was performed in 51 patients with mild to moderate COPD in primary care. Functional exercise capacity was assessed by the six-minute walk test and physical activity was measured with an accelerometer-based activity monitor. Functional exercise capacity was close to normal values. However, the daily physical activity of the patients could be classified as 'sedentary' and 'low active'. No significant correlations were observed between six-minute walk distance (% predicted) and any of the physical activity variables (steps per day, movement intensity during walking, total active time, total walking time, physical activity level, and time spent in moderate physical activity). A discrepancy was found between functional exercise capacity and daily physical activity in patients with mild to moderate COPD recruited and assessed in primary care. We conclude that these variables represent two different concepts. Our results reinforce the importance of measuring daily physical activity in order to fine-tune treatment (i.e. focusing on enhancement of exercise capacity or behavioural change, or both).

Gender differences in the quality of life of patients with liver cirrhosis related to hepatitis C after liver transplantation.

PubMed

Bianco, Tonino; Cillo, Umberto; Amodio, Piero; Zanus, Giacomo; Salari, Annalisa; Neri, Daniele; Bombonato, Giancarlo; Schiff, Sami; Baggio, Giovannella; Ronco, Claudio; Brocca, Alessandra; Soni, Sachin; Minazzato, Lina

2013-01-01

Hepatitis C virus (HCV) infection frequently leads to chronic liver disease, which adversely affects the quality of life (QoL) of the patient. The gender of the patient may be an important variable in the way severity of the disease is perceived. The aim of our study is to evaluate the effect of the gender variable on QoL in HCV-positive patients. This study included a total of 52 patients (26 men and 26 women) who completed a 1-year follow-up after liver transplantation. QoL was assessed using the SF-36 questionnaire. Male subjects have significantly higher scores on physical role functioning, bodily pain and physical activity compared with females. Females have a better QoL compared to males with regard to the emotional state and mental health. These results show a significant effect of the gender variable on QoL in HCV patients. © 2013 S. Karger AG, Basel.

Awareness of chronic disease related health benefits of physical activity among residents of a rural South Indian region: a cross-sectional study

PubMed Central

2014-01-01

Background Physical activity trends for a lower-middle income country like India suggest a gradual decline in work related physical activity and no concomitant increase in leisure time physical activity. Perceived health benefits of physical activity and intention to increase physical activity have been established as independent correlates of physical activity status. In India, not much is known about peoples’ perceptions of health benefits of physical activity and their intention to increase physical activity levels. This study was performed to understand peoples’ perceptions and awareness about health benefits of physical activity in a rural South Indian region. Methods This cross-sectional study was conducted using a multistage cluster sampling design. A content validated, field tested questionnaire was administered in person by a trained interviewer in the participants’ native language. The questionnaire assessed the participants’ perceptions about their lifestyle (active or sedentary), health benefits of physical activity and need for increasing their physical activity. In addition, the participant’s physical activity was assessed using version 2 of global physical activity questionnaire. Frequencies and percentages were used to summarise perceived health benefits of physical activity and other categorical variables. Age and body mass index were summarised using mean ± SD, whereas physical activity (MET.min.wk −1) was summarised using median and interquartile range. Results Four hundred fifty members from 125 randomly selected households were included in the study, of which 409 members participated. 89% (364) of participants felt they lead an active lifestyle and 83.1% (340) of participants did not feel a need to increase their physical activity level. 86.1%, (352) of the participants were physically active. Though 92.4% (378) of participants felt there were health benefits of physical activity, majority of them (75.1%) did not report any benefit related to chronic diseases. None mentioned health benefits related to heart disease or stroke. Conclusion There is low awareness of chronic disease related benefits of physical activity and participants do not see a need to increase their physical activity level. Public health awareness programs on importance and health benefits of physical activity would be useful to counter the anticipated decline in physical activity. PMID:24575767

Explaining differences in perceived health-related quality of life: a study within the Spanish population.

PubMed

Martín-Fernández, Jesús; Ariza-Cardiel, Gloria; Polentinos-Castro, Elena; Sanz-Cuesta, Teresa; Sarria-Santamera, Antonio; Del Cura-González, Isabel

2017-09-25

To assess the burden of several determinants on health-related quality of life (HRQOL) and to study its heterogeneity among the different Spanish regions. Cross-sectional study. Data were obtained from the Spanish National Health Survey (2012), and HRQOL was measured using the EQ-5D-5L questionnaire (utility and visual analogue scale -VAS- scores). Demographic variables, physical health condition, social variables, mental health status, and lifestyle were also analysed. Tobit regression models were employed to study the relationships between expressed HRQOL and personal characteristics. A total of 20,979 surveys were obtained. Of them, 62.4% expressed a utility score of 1, corresponding to perfect health (95%CI: 61.8%-63.2%), and 54.2% showed VAS scores ≥80 (95%CI: 53.5%-54.9%). HRQOL was mainly described as a function of age, chronic limitation in daily activities, and mental health status. Belonging to a higher-class strata and physical activity were related to better self-perceived HRQOL. Ageing worsened perceived HRQOL, but did not influence its determinants, and differences in HRQOL by regions were also not significant after model adjustment. HRQOL perception in the Spanish population varied slightly depending on the measure used (utilities index or VAS). Age, chronic limitations in daily life, and mental health status best explained the variability in perception, and no meaningful differences in HRQOL perception among regions were found after adjustment. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Impact of chronic cough on quality of life.

PubMed

French, C L; Irwin, R S; Curley, F J; Krikorian, C J

Cough is the most common complaint for which adult patients seek medical care in the United States; however, the reason(s) for this is unknown. To determine whether chronic cough was associated with adverse psychosocial or physical effects on the quality of life and whether the elimination of chronic cough with specific therapy improved these adverse effects. The study design was a prospective before-and-after intervention trial with patients serving as their own controls. Study subjects were a convenience sample of 39 consecutive and unselected adult patients referred for evaluation and management of a chronic, persistently troublesome cough. Baseline data were available for 39 patients and follow-up for 28 patients (22 women and 6 men). At baseline, demographic, Adverse Cough Outcome Survey (ACOS), and Sickness Impact Profile (SIP) data were collected and patients were managed according to a validated, systematic protocol. Following specific therapy for cough, ACOS and SIP instruments were readministered. The ages, sex, duration, and spectra and frequencies of the causes of cough were similar to multiple other studies. At baseline, patients reported a mean +/- SD of 8.6 +/- 4.8 types of adverse occurrences related to cough. There were significant correlations between multiple ACOS items and total, physical, and psychosocial SIP scores. Psychosocial score correlated with total number of symptoms (P<.02). After cough disappeared with treatment, ACOS complaints decreased to a mean +/- SD of 1.9 +/- 3.2 (P<.0001) as did total (mean +/- SD, 4.8 +/- 4.5 to 1.8 +/- 2.2) (P= .004), psychosocial (mean +/- SD, 4.2 +/- 6.8 to 0.8 +/- 2.3) (P = .004), and physical (mean +/- SD, 2.2 +/- 2.9 to 0.9 +/- 1.8) (P = .05) SIP scores. Multiple linear regression analysis showed that 54% of variability of the psychosocial SIP score was explained by 4 ACOS items while none of the physical score was explained. Chronic cough was associated with deterioration in patients' quality of life. The health-related dysfunction was most likely psychosocial. The ACOS and SIP appear to be valid tools in assessing the impact of chronic cough.

A review of the evidence linking adult attachment theory and chronic pain: presenting a conceptual model.

PubMed

Meredith, Pamela; Ownsworth, Tamara; Strong, Jenny

2008-03-01

It is now well established that pain is a multidimensional phenomenon, affected by a gamut of psychosocial and biological variables. According to diathesis-stress models of chronic pain, some individuals are more vulnerable to developing disability following acute pain because they possess particular psychosocial vulnerabilities which interact with physical pathology to impact negatively upon outcome. Attachment theory, a theory of social and personality development, has been proposed as a comprehensive developmental model of pain, implicating individual adult attachment pattern in the ontogenesis and maintenance of chronic pain. The present paper reviews and critically appraises studies which link adult attachment theory with chronic pain. Together, these papers offer support for the role of insecure attachment as a diathesis (or vulnerability) for problematic adjustment to pain. The Attachment-Diathesis Model of Chronic Pain developed from this body of literature, combines adult attachment theory with the diathesis-stress approach to chronic pain. The evidence presented in this review, and the associated model, advances our understanding of the developmental origins of chronic pain conditions, with potential application in guiding early pain intervention and prevention efforts, as well as tailoring interventions to suit specific patient needs.

Integrative medicine for chronic pain

PubMed Central

Saha, Felix J.; Brüning, Alexander; Barcelona, Cyrus; Büssing, Arndt; Langhorst, Jost; Dobos, Gustav; Lauche, Romy; Cramer, Holger

2016-01-01

Abstract Introduction: Integrative medicine inpatient treatment has been shown to improve physical and mental health in patients with internal medicine conditions. The aim of this study was to investigate the effectiveness of a 2-week integrative medicine inpatient treatment in patients with chronic pain syndromes and the association of treatment success with patient-related process variables. Methods: Inpatients with chronic pain syndromes participating in a 2-week integrative medicine inpatient program were included. Patients’ pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were measured on admission, discharge, and 6 months after discharge. Likewise process variables including ability and will to change, emotional/rational disease acceptance, mindfulness, life and health satisfaction, and easiness of life were assessed. Results: A total of 310 inpatients (91% female, mean age 50.7 ± 12.4 year, 26.5% low back pain, and 22.9% fibromyalgia) were included. Using mixed linear models, significant improvements in pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were found (all P < 0.05). Ability to change and implementation, disease acceptance, mindfulness, life and health satisfaction, and light heartedness/easiness likewise improved (all P < 0.05). Improved outcomes were associated with increases in process variables, mainly ability to change and implementation, disease acceptance, life and health satisfaction, and light heartedness/easiness (R2 = 0.03–0.40). Conclusions: Results of this study suggest that a 2-week integrative medicine inpatient treatment can benefit patients with chronic pain conditions. Functional improvements are associated with improved ability to change and implementation, disease acceptance, and satisfaction. PMID:27399133

Difference in resource utilization between patients with acute and chronic heart failure from Japanese administrative database.

PubMed

Kuwabara, Kazuaki; Matsuda, Shinya; Anan, Makoto; Fushimi, Kiyohide; Ishikawa, Koichi B; Horiguchi, Hiromasa; Hayashida, Kenshi; Fujimori, Kenji

2010-06-11

Many studies have reported economic evaluation of evolving agents or therapies for patients with heart failure (HF). However, little is known whether the disease progression category (acute or chronic HF) would be considered as a risk adjustment in health service research. This study profiles the difference in resource use or medical care for acute versus chronic HF. This study analyzed 17,912 HF patients treated in 62 academic hospitals and 351 community hospitals. Study variables included demographic variables, comorbid status, physical activity or disease progression at admission, procedures and laboratory tests, type and dose of heart-related medications, length of stay (LOS), and total charges (TC; 1 US$= 100 yen) for acute and chronic HF. The independent contributions of disease progression categories on LOS and TC were identified using multivariate analysis. We identified 9813 chronic and 8099 acute HF patients. Median LOS was 18 days for both chronic and acute HF, whereas TC was US$5731 and US$6447, respectively. Regression analysis revealed that acute HF was associated with a slightly greater TC, whereas performance of procedures was the most prominent factor. As NYHA class was the next most influential factor, class 3 or 4 resulted in longer LOS or greater TC, than did class 1. This study suggests that acute HF increased resource use slightly, whereas use of some practices indicated in critical care was affected more by the procedures performed. Disease progression category should remain an indicator for appropriateness of medical care. Copyright (c) 2008 Elsevier Ireland Ltd. All rights reserved.

Are religious beliefs and practices of Buddhism associated with disability and salivary cortisol in office workers with chronic low back pain?

PubMed

Sooksawat, Annop; Janwantanakul, Prawit; Tencomnao, Tewin; Pensri, Praneet

2013-01-17

Low back pain (LBP) is common among office workers. A number of studies have established a relationship between Christianity and physical and mental health outcomes among chronic pain patients. The purpose of this study was to examine the relationship between the religious beliefs and practices of Buddhism and disability and psychological stress in office workers with chronic LBP. A cross-sectional survey was conducted with a self-administered questionnaire delivered by hand to 463 office workers with chronic LBP. Saliva samples were collected from a randomly selected sub-sample of respondents (n=96). Disability due to LBP was assessed using the Roland-Morris Disability Questionnaire and psychological stress was assessed based on salivary cortisol. Two hierarchical regression models were built to determine how much variance in disability and psychological stress could be explained by religious beliefs and practices of Buddhism variables after controlling for potential confounder variables. Only 6% of variance in psychological stress was accounted for by the religious beliefs and practices of Buddhism. Those with high religiousness experienced lower psychological stress. No association between the religious beliefs and practices of Buddhism and disability level was found. Depressive symptoms were attributed to both psychological stress and disability status in our study population. The findings suggest that, although being religious may improve the psychological condition in workers with chronic LBP, its effect is insufficient to reduce disability due to illness. Further research should examine the role of depression as a mediator of the effect of psychological stress on disability in patients with chronic LBP.

Do Program Implementation Factors or Fidelity Affect Chronic Disease Self-Management Education Programs' Outcomes?

PubMed

Brady, Teresa J; Murphy, Louise B; O'Colmain, Benita J; Hobson, Reeti Desai

2017-09-01

To evaluate whether implementation factors or fidelity moderate chronic disease self-management education program outcomes. Meta-analysis of 34 Arthritis Self-Management Program and Chronic Disease Self-Management Program studies. Community. N = 10 792. Twelve implementation factors: program delivery fidelity and setting and leader and participant characteristics. Eighteen program outcomes: self-reported health behaviors, physical health status, psychological health status, and health-care utilization. Meta-analysis using pooled effect sizes. Modest to moderate statistically significant differences for 4 of 6 implementation factors; these findings were counterintuitive with better outcomes when leaders and participants were unpaid, leaders had less than minimum training, and implementation did not meet fidelity requirements. Exploratory study findings suggest that these interventions tolerate some variability in implementation factors. Further work is needed to identify key elements where fidelity is essential for intervention effectiveness.

Sexuality as an Independent Variable: The Contribution to (or Protection against) Chronic Disease,

DTIC Science & Technology

1978-01-05

science has come to indict a long list of risk factors in disabling and fatal diseases: dietary intake, physical exercise activities, food chain pollutants...impulses, sensations, behaviors, and physiological happenings coincident with the instrumental acts of sexual stimulation , excitation, and expression...agent. The Freudian theory of psycho- pathology (e.g., Freud, 1935) invokes repressed sexuality as a fore- runner of psychoneurosis. Sexual stimulation

Leisure time physical activity and sedentary behavior and substance use among in-school adolescents in eight African countries.

PubMed

Peltzer, Karl

2010-12-01

Physical inactivity leads to higher morbidity and mortality from chronic non-communicable diseases. In high income countries, studies have measured school population level physical activity and substance use, but comparable data are lacking from most African countries. To study the relationship between self-reported leisure time physical activity frequency and sedentary behavior and alcohol, tobacco, and other drug use behaviors among school children. A cross-sectional survey was conducted with the total sample of 24,593 school children aged 13 to 15 years from nationally representative samples from eight African countries. Univariate and multivariate analyses were conducted to assess the relationship between physical activity frequency, six measures of alcohol, tobacco, and other drug use, socioeconomic status, and mental health variables. In all, only 14.2% of the school children were frequently physically active (5 days and more in a week, at least 60 min/day) during leisure time; this was significantly higher among boys than girls. Ugandan and Kenyan school children were most physically active (17.7% and 16.0%, respectively), and Zambian and Senegalese the least (9.0% and 10.9%, respectively). Frequency of alcohol consumption and higher socioeconomic status were significantly associated with leisure time physical activity, while tobacco, illicit drug use, and mental health variables were not. Leisure time sedentary behavior of five and more hours spent sitting on a usual day were highly associated with all substance use variables. These findings suggest that leisure time physical activity frequency is associated with frequency of alcohol use and not with tobacco and illicit drug use, and leisure time sedentary behavior is highly associated with alcohol, tobacco, and drug use among adolescents.

[Effects of a resistance training program in patients with chronic kidney disease on hemodialysis].

PubMed

Cigarroa, Igor; Barriga, Rodrigo; Michéas, Camila; Zapata-Lamana, Rafael; Soto, Claudio; Manukian, Tomas

2016-07-01

Exercise may be a therapeutic tool for improving the functional capacity in patients with chronic kidney disease (CKD) who are on hemodialysis (HD). To determine the effects on muscle strength (MS), functional capacity (FC) and quality of life related to health (QOLRH) of a resistance training program in patients with CKD on HD. Thirteen CKD patients aged 38.8 ± 3 years, (7 men) on HD for more than one year participated in an exercise program twice a week during 8 weeks. At the beginning and at the end of the program, MS using a knee extension isometric strength test, FC using the six minutes walking test (6MWT) and QOLRH using the KDQOL CV-36 questionnaire were evaluated. Heart and respiratory rates, blood pressure, oxygen saturation and modified Borg scale were measured as control variables. After training, there were significant improvements in MS in both legs; in the distance travelled during 6MWT and in the physical component summary score of the KDQOL-36. Furthermore, a significant decline in diastolic blood pressure was observed. All other control variables did not change significantly. Exercise training during eight weeks in CKD patients in HD resulted in significant improvements in muscle strength, walking capacity and in the physical component of a quality of life score for patients with CKD.

Complete physical mapping of IL6 reveals a new marker associated with chronic periodontitis.

PubMed

Farhat, S B; de Souza, C M; Braosi, A P R; Kim, S H; Tramontina, V A; Papalexiou, V; Olandoski, M; Mira, M T; Luczyszyn, S M; Trevilatto, P C

2017-04-01

Interleukin-6 (IL-6) is a powerful stimulator of osteoclast differentiation and bone resorption. Production of IL-6 is modulated by polymorphisms, and higher levels of this cytokine are found locally in patients with chronic periodontitis. In this study we performed a modern approach - Complete physical mapping of the IL6 gene - to identify the polymorphisms associated with chronic periodontitis in a southern Brazilian population sample. One-hundred and nine individuals of both genders (mean age: 41.5 ± 8.5 years) were divided into a study group (56 participants with periodontitis) and a control group (53 individuals without periodontitis). After collection and purification of DNA, nine tag single nucleotide polymorphisms (SNPs; rs1524107, rs2069835, rs2069837, rs2069838, rs2069840, rs2069842, rs2069843, rs2069845 and rs2069849) covering the entire gene were selected according to the information available on the International HapMap Project website and evaluated using real-time PCR. Differences in the distribution of the following parameters were statistically significant between study and control groups: number of teeth (p = 0.030); probing depth (p < 0.001); clinical attachment level (p < 0.001); gingival index (p < 0.001); plaque index (p = 0.003); calculus index (p < 0.001); and dental mobility (p < 0.001). It was found that marker rs2069837 (located in intron 2 of IL6) under G dominant was associated with protection against chronic periodontitis in a Brazilian population in the presence of clinical variables, such as visible plaque, dentist visit frequency and dental floss use, and was suggested for the first time as a marker of susceptibility to chronic periodontitis. Complete physical mapping of IL6 (using tag SNPs) was carried out for the first time, unveiling allele G of polymorphism rs2069837 (located in the second intron of IL6) as a suggestive marker of protection against chronic periodontitis in a Brazilian population. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Absenteeism and Employer Costs Associated With Chronic Diseases and Health Risk Factors in the US Workforce.

PubMed

Asay, Garrett R Beeler; Roy, Kakoli; Lang, Jason E; Payne, Rebecca L; Howard, David H

2016-10-06

Employers may incur costs related to absenteeism among employees who have chronic diseases or unhealthy behaviors. We examined the association between employee absenteeism and 5 conditions: 3 risk factors (smoking, physical inactivity, and obesity) and 2 chronic diseases (hypertension and diabetes). We identified 5 chronic diseases or risk factors from 2 data sources: MarketScan Health Risk Assessment and the Medical Expenditure Panel Survey (MEPS). Absenteeism was measured as the number of workdays missed because of sickness or injury. We used zero-inflated Poisson regression to estimate excess absenteeism as the difference in the number of days missed from work by those who reported having a risk factor or chronic disease and those who did not. Covariates included demographics (eg, age, education, sex) and employment variables (eg, industry, union membership). We quantified absenteeism costs in 2011 and adjusted them to reflect growth in employment costs to 2015 dollars. Finally, we estimated absenteeism costs for a hypothetical small employer (100 employees) and a hypothetical large employer (1,000 employees). Absenteeism estimates ranged from 1 to 2 days per individual per year depending on the risk factor or chronic disease. Except for the physical inactivity and obesity estimates, disease- and risk-factor-specific estimates were similar in MEPS and MarketScan. Absenteeism increased with the number of risk factors or diseases reported. Nationally, each risk factor or disease was associated with annual absenteeism costs greater than $2 billion. Absenteeism costs ranged from $16 to $81 (small employer) and $17 to $286 (large employer) per employee per year. Absenteeism costs associated with chronic diseases and health risk factors can be substantial. Employers may incur these costs through lower productivity, and employees could incur costs through lower wages.

The effect of physical and psychosocial occupational factors on the chronicity of low back pain in the workers of Iranian metal industry: a cohort study.

PubMed

Aghilinejad, Mashallah; Tavakolifard, Negah; Mortazavi, Sayed Aliakbar; Kabir Mokamelkhah, Elahe; Sotudehmanesh, Akbar; Mortazavi, Seyed Alireza

2015-01-01

Low back pain (LBP) is one of the most common problems among the workers of different industries. The role of occupational factors in causing the LBP has been indicated previously. LBP has great socio-economic costs and most of its costs are related to the chronic LBP. The aim of this study was to identify the occupational risk factors that are related to the progression of the LBP from acute to chronic phase. This cohort study has been conducted on 185 workers with acute LBP. Information related to their occupational exposure at baseline has been measured with a valid questionnaire using the self-report approach. Patients follow up was done monthly for three months after the start of the pain. Those workers whose occupational exposure had not changed during the follow up were divided into two groups of chronic LBP (n = 49) and cured (n = 136) according to the duration of the pain period (more or less than 3 months), and their job exposures were compared. Among the physical and psychosocial risk factors, social support (OR= 0.466, CI= 0.231- 0.940) and job satisfaction (OR= 0.455, CI= 0.232-0.891), and lifting weights more than 15kg (OR=2.482, CI= 1.274-4.834) indicated a significant relationship with the chronicity of the LBP. After putting the variables into the regression model, only lifting>15kg remained statistically significant. According to the observed relationship between these occupational risk factors (social support, job satisfaction, lifting>15kg) and the chronicity of the LBP, there is hope that eliminating these factors in the workers with acute LBP will prevent its progression to the chronic phase.

Absenteeism and Employer Costs Associated With Chronic Diseases and Health Risk Factors in the US Workforce

PubMed Central

Roy, Kakoli; Lang, Jason E.; Payne, Rebecca L.; Howard, David H.

2016-01-01

Introduction Employers may incur costs related to absenteeism among employees who have chronic diseases or unhealthy behaviors. We examined the association between employee absenteeism and 5 conditions: 3 risk factors (smoking, physical inactivity, and obesity) and 2 chronic diseases (hypertension and diabetes). Methods We identified 5 chronic diseases or risk factors from 2 data sources: MarketScan Health Risk Assessment and the Medical Expenditure Panel Survey (MEPS). Absenteeism was measured as the number of workdays missed because of sickness or injury. We used zero-inflated Poisson regression to estimate excess absenteeism as the difference in the number of days missed from work by those who reported having a risk factor or chronic disease and those who did not. Covariates included demographics (eg, age, education, sex) and employment variables (eg, industry, union membership). We quantified absenteeism costs in 2011 and adjusted them to reflect growth in employment costs to 2015 dollars. Finally, we estimated absenteeism costs for a hypothetical small employer (100 employees) and a hypothetical large employer (1,000 employees). Results Absenteeism estimates ranged from 1 to 2 days per individual per year depending on the risk factor or chronic disease. Except for the physical inactivity and obesity estimates, disease- and risk-factor–specific estimates were similar in MEPS and MarketScan. Absenteeism increased with the number of risk factors or diseases reported. Nationally, each risk factor or disease was associated with annual absenteeism costs greater than $2 billion. Absenteeism costs ranged from $16 to $81 (small employer) and $17 to $286 (large employer) per employee per year. Conclusion Absenteeism costs associated with chronic diseases and health risk factors can be substantial. Employers may incur these costs through lower productivity, and employees could incur costs through lower wages. PMID:27710764

Biopsychosocial factors associated with dyspareunia in a community sample of adolescent girls.

PubMed

Landry, Tina; Bergeron, Sophie

2011-10-01

Although various biopsychosocial factors have been associated with dyspareunia, research to date has focused on retrospective reports of adult women, and lack of consensus regarding etiology remains. By targeting girls at the beginning of their reproductive life, this study aimed to examine the biomedical, behavioral, and psychosocial correlates of chronic painful intercourse in sexually active adolescents compared to pain-free girls. With written informed consent, data were obtained from 1425 girls (12-19 year olds) from seven metropolitan high schools using self-report questionnaires pertaining to gynaecologic/biomedical history, physical/psychological/sexual abuse, anxiety, depression, attitudes towards sexuality, and social support. While the chronic painful intercourse (n = 51) and pain-free comparison group (n = 167) did not differ significantly on biomedical variables, painful intercourse was associated with significantly more pain during tampon insertion, and avoidance of tampons was linked to a fourfold risk of experiencing pain during sex. Cases also reported engaging in significantly more detrimental vulvar hygiene habits than pain-free girls, whereas no significant group differences were observed for self-treatment using over-the-counter antifungal preparations. Sexual abuse, fear of physical abuse, and trait anxiety were identified as significant psychosocial correlates of chronic painful intercourse. A logistic regression further identified pain during first tampon insertion and trait anxiety as statistical predictors of adolescent pain during intercourse. In addition to a possible intrinsic dysfunction in central pain processing, findings suggest that psychological variables, such as anxiety, play a significant role in painful intercourse's very first manifestations in adolescent girls.

Prevalence, presentation and occupational risk factors of chronic venous disease in nurses.

PubMed

Diken, A I; Yalçınkaya, A; Aksoy, E; Yılmaz, S; Özşen, K; Sarak, T; Çağlı, K

2016-03-01

In this study involving a group of nurses employed in a number of different medical services with relatively well-defined working conditions, the presence and symptoms of chronic venous insufficiency were screened and their association with work burden and physical working conditions was explored. Of the 294 actively employed nurses during the study period, 232 (79%) were recruited on the basis of their willingness for participation and fulfilment of the inclusion criteria. Among the study subjects, 62.9% had at least one symptom of chronic venous insufficiency, and 50.4% were found to have chronic venous insufficiency according to Clinical-Etiology-Anatomy-Pathophysiology classification criteria. A significant association was found between the diurnal ankle circumference difference in the left-right ankles and the mean duration of hospital stay. Our results have shown that the average duration of hospital stay, which is among the variables used to estimate the work burden of nurses, is associated with an increased frequency of the signs and symptoms of chronic venous insufficiency. © The Author(s) 2015.

Children’s Body composition and Stress – the ChiBS study: aims, design, methods, population and participation characteristics

PubMed Central

2012-01-01

Background The last decades, the prevalence of childhood obesity has increased. Apart from other lifestyle factors, the effect of chronic psychosocial stress on the development of obesity has been recognized. However, more research is needed into the influence of chronic stress on appetite regulation, energy balance and body composition, as well as on the interaction with physical activity/sedentary behavior, diet and sleep in children. In this regard, the ChiBS study (Children’s Body composition and Stress) was designed at the Ghent University. Within this paper, we describe the aims, design, methods, participation and population characteristics of the ChiBS study. Methods The influence of chronic stress on changes in body composition is investigated over a two-year follow-up period (February-June 2010, 2011 and 2012) in primary-school children between 6 and 12 years old in the city Aalter (Flanders, Belgium). Stress is measured by child- and parent-reported stress-questionnaires, as well as by objective stress biomarkers (serum, salivary and hair cortisol) and heart rate variability. Body composition is evaluated using basic anthropometric measurements and air displacement plethysmography. Additional information on socio-economic status, medical history, physical activity, dietary intake and sleep are obtained by questionnaires, and physical activity by accelerometers. Results The participation percentage was 68.7% (N = 523/761), with 71.3% of the children willing to participate in the first follow-up survey. Drop-out proportions were highest for serum sampling (12.1%), salivary sampling (8.3%) and heart rate variability measurements (7.4%). Discussion The ChiBS project is unique in its setting: its standardized and longitudinal approach provides valuable data and new insights into the relationship between stress and changes in body composition in a large cohort of young children. In addition, this study allows an in-depth investigation of the validity of the different methods that were used to assess stress levels in children. PMID:22958377

Assessment of physical activity in chronic kidney disease.

PubMed

Robinson-Cohen, Cassianne; Littman, Alyson J; Duncan, Glen E; Roshanravan, Baback; Ikizler, T Alp; Himmelfarb, Jonathan; Kestenbaum, Bryan R

2013-03-01

Physical inactivity plays an important role in the development of kidney disease and its complications; however, the validity of standard tools for measuring physical activity (PA) is not well understood. We investigated the performance of several readily available and widely used PA and physical function questionnaires, individually and in combination, against accelerometry among a cohort of chronic kidney disease (CKD) participants. Forty-six participants from the Seattle Kidney Study, an observational cohort study of persons with CKD, completed the Physical Activity Scale for the Elderly, Human Activity Profile (HAP), Medical Outcomes Study SF-36 questionnaire, and the Four-week Physical Activity History questionnaires. We simultaneously measured PA using an Actigraph GT3X accelerometer during a 14-day period. We estimated the validity of each instrument by testing its associations with log-transformed accelerometry counts. We used the Akaike information criterion to investigate the performance of combinations of questionnaires. All questionnaire scores were significantly associated with log-transformed accelerometry counts. The HAP correlated best with accelerometry counts (r(2) = 0.32) followed by SF-36 (r(2) = 0.23). Forty-three percent of the variability in accelerometry counts data was explained by a model that combined the HAP, SF-36, and Four-week Physical Activity History questionnaires. A combination of measurement tools can account for a modest component of PA in patients with CKD; however, a substantial proportion of PA is not captured by standard assessments. Copyright © 2013 National Kidney Foundation, Inc. All rights reserved.

Age group differences in positive and negative affect among oldest-old adults: findings from the Georgia Centenarian Study.

PubMed

Cho, Jinmyoung; Martin, Peter; Poon, Leonard W; MacDonald, M; Jazwinski, S M; Green, R C; Gearing, M; Johnson, M A; Markesbery, W R; Woodard, J L; Tenover, J S; Siegler, L C; Rott, C; Rodgers, W L; Hausman, D; Arnold, J; Davey, A

2013-01-01

The developmental adaptation model (Martin & Martin, 2002) provides insights into how current experiences and resources (proximal variables) and past experiences (distal variables) are correlated with outcomes (e.g., well-being) in later life. Applying this model, the current study examined proximal and distal variables associated with positive and negative affect in oldest-old adults, investigating age differences. Data from 306 octogenarians and centenarians who participated in Phase III of the Georgia Centenarian Study were used. Proximal variables included physical functioning, cognitive functioning, self-rated health, number of chronic conditions, social resources, and perceived economic status; distal variables included education, social productive activities, management of personal assets, and other learning experiences. Analysis of variance and block-wise regression analyses were conducted. Octogenarians showed significantly higher levels of positive emotion than centenarians. Cognitive functioning was significantly associated with positive affect, and number of health problems was significantly associated with negative affect after controlling for gender, ethnicity, residence, and marital status. Furthermore, four significant interaction effects suggested that positive affect significantly depended on the levels of cognitive and physical functioning among centenarians, whereas positive affect was dependent on the levels of physical health problems and learning experiences among octogenarians. Findings of this study addressed the importance of current and past experiences and resources in subjective well-being among oldest-old adults as a life-long process. Mechanisms connecting aging processes at the end of a long life to subjective well-being should be explored in future studies.

A RCT comparing lumbosacral orthosis to routine physical therapy on postural stability in patients with chronic low back pain.

PubMed

Azadinia, Fatemeh; Ebrahimi-Takamjani, Ismail; Kamyab, Mojtaba; Parnianpour, Mohamad; Asgari, Morteza

2017-01-01

Background: Poor balance performance and impaired postural control have been frequently reported in patients with low back pain. However, postural control is rarely monitored during the course of treatment even though poor postural control may contribute to chronicity and recurrence of symptoms. Therefore, the present study aimed at investigating the effect of a nonextensible lumbosacral orthosis (LSO) versus routine physical therapy on postural stability of patients with nonspecific chronic low back pain. Methods: This was a randomized controlled trial conducted between November 2015 and May 2016 at the outpatient physical therapy clinic of the School of Rehabilitation Sciences. Patients with nonspecific chronic low back pain aged 20 to 55 years were randomly allocated to the intervention and control groups. Both groups received 8 sessions of physical therapy twice weekly for 4 weeks. The intervention group received nonextensible LSO in addition to routine physical therapy. Pain intensity, functional disability, fear of movement/ (re)injury, and postural stability in 3 levels of postural difficulty were measured before and after 4 weeks of intervention. A 2×2×3 mixed model of analysis of variance (ANOVA) was used to determine the main and interactive effects of the 3 factors including group, time, and postural difficulty conditions for each variable of postural stability. Results: The LSO and control groups displayed significant improvement in postural stability at the most difficult postural task conditions (P-value for 95% area ellipse was 0.003; and for phase plane, the mean total velocity and standard deviation of velocity was <0.001). Both groups exhibited a decrease in pain intensity, Oswestry Disability Index, and Tampa Scale of Kinesiophobia after 4 weeks of intervention. A significant difference between groups was found only for functional disability, with greater improvement in the orthosis group (t = 3.60, P<0.001). Conclusion: Both routine physical therapy and LSO significantly improved clinical and postural stability outcomes immediately after 4 weeks of intervention. The orthosis group did not display superior outcomes, except for functional disability.

A RCT comparing lumbosacral orthosis to routine physical therapy on postural stability in patients with chronic low back pain

PubMed Central

Azadinia, Fatemeh; Ebrahimi-Takamjani, Ismail; Kamyab, Mojtaba; Parnianpour, Mohamad; Asgari, Morteza

2017-01-01

Background: Poor balance performance and impaired postural control have been frequently reported in patients with low back pain. However, postural control is rarely monitored during the course of treatment even though poor postural control may contribute to chronicity and recurrence of symptoms. Therefore, the present study aimed at investigating the effect of a nonextensible lumbosacral orthosis (LSO) versus routine physical therapy on postural stability of patients with nonspecific chronic low back pain. Methods: This was a randomized controlled trial conducted between November 2015 and May 2016 at the outpatient physical therapy clinic of the School of Rehabilitation Sciences. Patients with nonspecific chronic low back pain aged 20 to 55 years were randomly allocated to the intervention and control groups. Both groups received 8 sessions of physical therapy twice weekly for 4 weeks. The intervention group received nonextensible LSO in addition to routine physical therapy. Pain intensity, functional disability, fear of movement/ (re)injury, and postural stability in 3 levels of postural difficulty were measured before and after 4 weeks of intervention. A 2×2×3 mixed model of analysis of variance (ANOVA) was used to determine the main and interactive effects of the 3 factors including group, time, and postural difficulty conditions for each variable of postural stability. Results: The LSO and control groups displayed significant improvement in postural stability at the most difficult postural task conditions (P-value for 95% area ellipse was 0.003; and for phase plane, the mean total velocity and standard deviation of velocity was <0.001). Both groups exhibited a decrease in pain intensity, Oswestry Disability Index, and Tampa Scale of Kinesiophobia after 4 weeks of intervention. A significant difference between groups was found only for functional disability, with greater improvement in the orthosis group (t = 3.60, P<0.001). Conclusion: Both routine physical therapy and LSO significantly improved clinical and postural stability outcomes immediately after 4 weeks of intervention. The orthosis group did not display superior outcomes, except for functional disability. PMID:29445655

Daily physical activity and its contribution to the health-related quality of life of ambulatory individuals with chronic stroke

PubMed Central

2010-01-01

Background Participation in daily physical activity (PA) post-stroke has not previously been investigated as a possible explanatory variable of health-related quality of life (HRQL). The aims were 1) to determine the contribution of daily PA to the HRQL of individuals with chronic stroke and 2) to assess the relationship between the functional ability of these individuals to the amount of daily PA. Methods The amount of daily PA of forty adults with chronic stroke (mean age 66.5 ± 9.6 years) was monitored using two measures. Accelerometers (Actical) were worn on the hip for three consecutive days in conjunction with a self-report questionnaire [the PA Scale for Individuals with Physical Disabilities (PASIPD)]. The daily physical activity was measured as the mean total accelerometer activity counts/day and the PASIPD scores as the metabolic equivalent (MET) hr/day. HRQL was assessed by the Physical and Mental composite scores of the Medical Outcomes Study Short-Form 36 (SF-36) in addition to the functional ability of the participants. Correlation and regression analyses were performed. Results After controlling for the severity of the motor impairment, the amount of daily PA, as assessed by the PASIPD and accelerometers, was found to independently contribute to 10-12% of the variance of the Physical Composite Score of the SF-36. No significant relationship was found between PA and the Mental Composite Score of the SF-36.The functional ability of the participants was found to be correlated to the amount of daily PA (r = 0.33 - 0.67, p < 0.01). Conclusion The results suggest that daily PA is associated with better HRQL (as assessed by the Physical composite score of the SF-36) for people living with stroke. Daily PA should be encouraged to potentially increase HRQL. Accelerometers in conjunction with a self-report questionnaire may provide important measures of PA which can be monitored and modified, and potentially influence HRQL. PMID:20682071

Daily physical activity and its contribution to the health-related quality of life of ambulatory individuals with chronic stroke.

PubMed

Rand, Debbie; Eng, Janice J; Tang, Pei-Fang; Hung, Chihya; Jeng, Jiann-Shing

2010-08-03

Participation in daily physical activity (PA) post-stroke has not previously been investigated as a possible explanatory variable of health-related quality of life (HRQL). The aims were 1) to determine the contribution of daily PA to the HRQL of individuals with chronic stroke and 2) to assess the relationship between the functional ability of these individuals to the amount of daily PA. The amount of daily PA of forty adults with chronic stroke (mean age 66.5 +/- 9.6 years) was monitored using two measures. Accelerometers (Actical) were worn on the hip for three consecutive days in conjunction with a self-report questionnaire [the PA Scale for Individuals with Physical Disabilities (PASIPD)]. The daily physical activity was measured as the mean total accelerometer activity counts/day and the PASIPD scores as the metabolic equivalent (MET) hr/day. HRQL was assessed by the Physical and Mental composite scores of the Medical Outcomes Study Short-Form 36 (SF-36) in addition to the functional ability of the participants. Correlation and regression analyses were performed. After controlling for the severity of the motor impairment, the amount of daily PA, as assessed by the PASIPD and accelerometers, was found to independently contribute to 10-12% of the variance of the Physical Composite Score of the SF-36. No significant relationship was found between PA and the Mental Composite Score of the SF-36.The functional ability of the participants was found to be correlated to the amount of daily PA (r = 0.33 - 0.67, p < 0.01). The results suggest that daily PA is associated with better HRQL (as assessed by the Physical composite score of the SF-36) for people living with stroke. Daily PA should be encouraged to potentially increase HRQL. Accelerometers in conjunction with a self-report questionnaire may provide important measures of PA which can be monitored and modified, and potentially influence HRQL.

Return to play after infectious mononucleosis.

PubMed

Becker, Jonathan A; Smith, Julie Anne

2014-05-01

Infectious mononucleosis is a disease primarily of adolescence and early adulthood. The risk of splenic injury and chronic fatigue make return-to-play decisions a challenge for the clinician caring for athletes with infectious mononucleosis. Data were obtained from the PubMed and MEDLINE databases through December 2012 by searching for epidemiology, diagnosis, clinical manifestations, management, and the role of the spleen in infectious mononucleosis. Clinical review. Level 4. Infectious mononucleosis is commonly encountered in young athletes. Its disease pattern is variable and can affect multiple organ systems. Supportive care is the cornerstone, with little role for medications such as corticosteroids. Physical examination is unreliable for the spleen, and ultrasound imaging has limitations in its ability to guide return-to-play decisions. Exercise does not appear to place the young athlete at risk for chronic fatigue, but determining who is at risk for persistent symptoms is a challenge. Return-to-play decisions for the athlete with infectious mononucleosis need to be individualized because of the variable disease course and lack of evidence-based guidelines.

The Role of Maternal Distress in the Report of Behavioral and Emotional Problems among Children with Chronic Disabilities.

PubMed

Silberg, Tamar; Brezner, Amichai; Gal, Gilad; Ahonniska-Assa, Jaana; Levav, Miriam

2016-01-01

Assessments of psychological symptoms in children often rely on caregivers' (usually mothers') reports. However, the reliability may be affected by the caregivers' own emotional distress (ED). The main objectives of this study were to assess the variability in ED of mothers of children with chronic physical disabilities, and its association with the ratings of their children's emotional and behavioral problems. Medical data of children diagnosed with chronic disabilities were analyzed (N = 72). Mothers completed the 12-item General Health Questionnaire (12-GHQ) to measure ED and the Child Behavior Checklist (CBCL) to assess children's emotional and behavioral problems Mothers' ED scores were compared with communitybased counterparts with similar socio-demographic characteristics (N = 657) from the Israel National Health Survey (INHS). Mothers of children with chronic physical disabilities had higher levels of ED compared to mothers in the general population. About 20% of the sample mothers had 12-GHQ scores compatible with DSM- IV depression or anxiety disorders. No differences in ED were found according to the type of child's disability or IQ score. Marked differences in CBCL scores were reported by mothers with high versus low ED, controlling for baseline maternal and child characteristics. High levels of maternal ED were associated with mothers' reports on child's behavioral and emotional problems.This may contaminate the reliability of parental reports on their child's psychological state.

Environmental barriers and subjective health among people with chronic spinal cord injury: A cohort study

PubMed Central

Cao, Yue; Walker, Elizabeth A.; Krause, James S.

2015-01-01

Objective Although previous studies have found environmental barriers to be associated with social participation and life satisfaction after spinal cord injury (SCI), few studies exist reporting their effects on subjective health after SCI. Our purpose was to identify the prevalence of perceived environmental barriers and their effects on subjective health in persons with chronic SCI who completed two repeated measurements during a 5-year longitudinal study. Design This is a prospective cohort study. Environmental barriers were measured at baseline by the Craig Hospital Inventory of Environmental Factors-Short Form. Subjective health was measured at baseline and 5-year follow-up by days of physical and mental health not good. Other control variables included sex, race, age at injury, years since injury, and injury severity at baseline. Setting Data were collected at a specialty hospital and analyzed at a medical university in the Southeastern USA. Participants A total of 1635 participants completed both baseline and follow-up surveys. Results Twenty per cent of participants reported at least one policy barrier, 46% at least one physical and structural barrier, 22% at least one attitudinal and support barrier, 26% at least one barrier to services and assistance, and 13% at least one barrier at work or school. After controlling for sex, race, age at injury, years since injury, and injury severity, the physical and structural barriers, and services and assistance barriers measured at baseline significantly predicted subjective physical and mental health measured at follow-up. Conclusion Environmental barriers are prevalent among people with chronic SCI. They are important predictors for future subjective health. PMID:25329423

[Physical urticaria].

PubMed

Fleischer, M; Grabbe, J

2004-04-01

The different types of physical urticaria are triggered by mechanical and thermal stimuli, as well as electromagnetic waves. Localized forms restricted to the skin and mucous membranes are most common, but generalized urticaria with variable extracutaneous manifestations can also occur. Physical urticaria is usually sporadic but may rarely have a familial form; it is often associated with chronic urticaria. In most instances, the short time interval between the physical stimulus and reaction points to a causal relationship, but in delayed types the exact diagnosis may be missed without provocation tests. The clinical implication of physical urticaria is demonstrated by investigations showing a greater degree of disability in affected patients as compared to other types of urticaria. There is still an incomplete understanding of the crucial pathophysiological aspects; most likely inflammatory reactions involving leukocytes, endothelial cells and nerves stimulated by various mediators play an important role in this form of urticaria.

Determinants of quality of life in patients with fibromyalgia: A structural equation modeling approach.

PubMed

Lee, Jeong-Won; Lee, Kyung-Eun; Park, Dong-Jin; Kim, Seong-Ho; Nah, Seong-Su; Lee, Ji Hyun; Kim, Seong-Kyu; Lee, Yeon-Ah; Hong, Seung-Jae; Kim, Hyun-Sook; Lee, Hye-Soon; Kim, Hyoun Ah; Joung, Chung-Il; Kim, Sang-Hyon; Lee, Shin-Seok

2017-01-01

Health-related quality of life (HRQOL) in patients with fibromyalgia (FM) is lower than in patients with other chronic diseases and the general population. Although various factors affect HRQOL, no study has examined a structural equation model of HRQOL as an outcome variable in FM patients. The present study assessed relationships among physical function, social factors, psychological factors, and HRQOL, and the effects of these variables on HRQOL in a hypothesized model using structural equation modeling (SEM). HRQOL was measured using SF-36, and the Fibromyalgia Impact Questionnaire (FIQ) was used to assess physical dysfunction. Social and psychological statuses were assessed using the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), the Arthritis Self-Efficacy Scale (ASES), and the Social Support Scale. SEM analysis was used to test the structural relationships of the model using the AMOS software. Of the 336 patients, 301 (89.6%) were women with an average age of 47.9±10.9 years. The SEM results supported the hypothesized structural model (χ2 = 2.336, df = 3, p = 0.506). The final model showed that Physical Component Summary (PCS) was directly related to self-efficacy and inversely related to FIQ, and that Mental Component Summary (MCS) was inversely related to FIQ, BDI, and STAI. In our model of FM patients, HRQOL was affected by physical, social, and psychological variables. In these patients, higher levels of physical function and self-efficacy can improve the PCS of HRQOL, while physical function, depression, and anxiety negatively affect the MCS of HRQOL.

Determinants of quality of life in patients with fibromyalgia: A structural equation modeling approach

PubMed Central

Lee, Jeong-Won; Lee, Kyung-Eun; Park, Dong-Jin; Kim, Seong-Ho; Nah, Seong-Su; Lee, Ji Hyun; Kim, Seong-Kyu; Lee, Yeon-Ah; Hong, Seung-Jae; Kim, Hyun-Sook; Lee, Hye-Soon; Kim, Hyoun Ah; Joung, Chung-Il; Kim, Sang-Hyon

2017-01-01

Objective Health-related quality of life (HRQOL) in patients with fibromyalgia (FM) is lower than in patients with other chronic diseases and the general population. Although various factors affect HRQOL, no study has examined a structural equation model of HRQOL as an outcome variable in FM patients. The present study assessed relationships among physical function, social factors, psychological factors, and HRQOL, and the effects of these variables on HRQOL in a hypothesized model using structural equation modeling (SEM). Methods HRQOL was measured using SF-36, and the Fibromyalgia Impact Questionnaire (FIQ) was used to assess physical dysfunction. Social and psychological statuses were assessed using the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), the Arthritis Self-Efficacy Scale (ASES), and the Social Support Scale. SEM analysis was used to test the structural relationships of the model using the AMOS software. Results Of the 336 patients, 301 (89.6%) were women with an average age of 47.9±10.9 years. The SEM results supported the hypothesized structural model (χ2 = 2.336, df = 3, p = 0.506). The final model showed that Physical Component Summary (PCS) was directly related to self-efficacy and inversely related to FIQ, and that Mental Component Summary (MCS) was inversely related to FIQ, BDI, and STAI. Conclusions In our model of FM patients, HRQOL was affected by physical, social, and psychological variables. In these patients, higher levels of physical function and self-efficacy can improve the PCS of HRQOL, while physical function, depression, and anxiety negatively affect the MCS of HRQOL. PMID:28158289

Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables

PubMed Central

Juenger, J; Schellberg, D; Kraemer, S; Haunstetter, A; Zugck, C; Herzog, W; Haass, M

2002-01-01

Objective: To assess health related quality of life of patients with congestive heart failure; to compare their quality of life with the previously characterised general population and in those with other chronic diseases; and to correlate the different aspects of quality of life with relevant somatic variables. Setting: University hospital. Patients and design: A German version of the generic quality of life measure (SF-36) containing eight dimensions was administered to 205 patients with congestive heart failure and systolic dysfunction. Cardiopulmonary evaluation included assessment of New York Heart Association (NYHA) functional class, left ventricular ejection fraction, peak oxygen uptake, and the distance covered during a standardised six minute walk test. Results: Quality of life significantly decreased with NYHA functional class (linear trend: p < 0.0001). In NYHA class III, the scores of five of the eight quality of life domains were reduced to around one third of those in the general population. The pattern of reduction was different in patients with chronic hepatitis C and major depression, and similar in patients on chronic haemodialysis. Multiple regression analysis showed that only the NYHA functional class was consistently and closely associated with all quality of life scales. The six minute walk test and peak oxygen uptake added to the explanation of the variance in only one of the eight quality of life domains (physical functioning). Left ventricular ejection fraction, duration of disease, and age showed no clear association with quality of life. Conclusions: In congestive heart failure, quality of life decreases as NYHA functional class worsens. Though NYHA functional class was the most dominant predictor among the somatic variables studied, the major determinants of reduced quality of life remain unknown. PMID:11847161

Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables.

PubMed

Juenger, J; Schellberg, D; Kraemer, S; Haunstetter, A; Zugck, C; Herzog, W; Haass, M

2002-03-01

To assess health related quality of life of patients with congestive heart failure; to compare their quality of life with the previously characterised general population and in those with other chronic diseases; and to correlate the different aspects of quality of life with relevant somatic variables. University hospital. A German version of the generic quality of life measure (SF-36) containing eight dimensions was administered to 205 patients with congestive heart failure and systolic dysfunction. Cardiopulmonary evaluation included assessment of New York Heart Association (NYHA) functional class, left ventricular ejection fraction, peak oxygen uptake, and the distance covered during a standardised six minute walk test. Quality of life significantly decreased with NYHA functional class (linear trend: p < 0.0001). In NYHA class III, the scores of five of the eight quality of life domains were reduced to around one third of those in the general population. The pattern of reduction was different in patients with chronic hepatitis C and major depression, and similar in patients on chronic haemodialysis. Multiple regression analysis showed that only the NYHA functional class was consistently and closely associated with all quality of life scales. The six minute walk test and peak oxygen uptake added to the explanation of the variance in only one of the eight quality of life domains (physical functioning). Left ventricular ejection fraction, duration of disease, and age showed no clear association with quality of life. In congestive heart failure, quality of life decreases as NYHA functional class worsens. Though NYHA functional class was the most dominant predictor among the somatic variables studied, the major determinants of reduced quality of life remain unknown.

Integrative medicine for chronic pain: A cohort study using a process-outcome design in the context of a department for internal and integrative medicine.

PubMed

Saha, Felix J; Brüning, Alexander; Barcelona, Cyrus; Büssing, Arndt; Langhorst, Jost; Dobos, Gustav; Lauche, Romy; Cramer, Holger

2016-07-01

Integrative medicine inpatient treatment has been shown to improve physical and mental health in patients with internal medicine conditions. The aim of this study was to investigate the effectiveness of a 2-week integrative medicine inpatient treatment in patients with chronic pain syndromes and the association of treatment success with patient-related process variables. Inpatients with chronic pain syndromes participating in a 2-week integrative medicine inpatient program were included. Patients' pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were measured on admission, discharge, and 6 months after discharge. Likewise process variables including ability and will to change, emotional/rational disease acceptance, mindfulness, life and health satisfaction, and easiness of life were assessed. A total of 310 inpatients (91% female, mean age 50.7 ± 12.4 year, 26.5% low back pain, and 22.9% fibromyalgia) were included. Using mixed linear models, significant improvements in pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were found (all P < 0.05). Ability to change and implementation, disease acceptance, mindfulness, life and health satisfaction, and light heartedness/easiness likewise improved (all P < 0.05). Improved outcomes were associated with increases in process variables, mainly ability to change and implementation, disease acceptance, life and health satisfaction, and light heartedness/easiness (R = 0.03-0.40). Results of this study suggest that a 2-week integrative medicine inpatient treatment can benefit patients with chronic pain conditions. Functional improvements are associated with improved ability to change and implementation, disease acceptance, and satisfaction.

Correlates of Sexual Functioning and Relationship Satisfaction Among Men and Women Experiencing Chronic Pain.

PubMed

Finn, Erica; Morrison, Todd G; McGuire, Brian E

2018-05-01

The aims of the study were to 1) examine the prevalence of sexual functioning difficulties in a chronic pain sample; 2) identify correlates of sexual functioning and relationship satisfaction utilizing pain variables (pain severity and pain interference) and psychological variables (mood, pain-related cognitions, self-efficacy, self-esteem, body-image); and 3) investigate possible sex differences in the correlates of sexual functioning and relationship satisfaction. Two hundred sixty-nine participants were recruited online from chronic pain organizations, websites, social media sites, and discussion forums. Those who met criteria for inclusion were presented with a variety of measures related to pain, sexual functioning, and relationship satisfaction (for those in a relationship), as well as cognitive and affective variables. Participant mean age was 37 years, and the majority were female, heterosexual, and currently in a relationship. High levels of pain severity and interference from pain, fatigue, depression, anxiety, stress, and body image concerns were reported, along with low levels of self-esteem and pain self-efficacy. In addition, substantial proportions of male (43%) and female (48%) respondents had scores indicative of sexual problems. Exploratory hierarchical regression analyses revealed that, for women, age and relationship satisfaction (which were both treated as covariates) as well as depression emerged as statistically significant correlates of sexual functioning (i.e., women who were older and reported greater levels of depression and less satisfaction with their current relationship indicated poorer sexual functioning). When relationship satisfaction was the criterion measure, age and sexual functioning (again, treated as covariates) and perceived stress emerged as significant (i.e., women who were older, reported poorer sexual functioning, and reported greater perceived stress also indicated being less satisfied with their current relationship). For male participants, age emerged as the only statistically significant correlate of sexual functioning (i.e., older men reported poorer functioning). In terms of relationship satisfaction, self-esteem was the lone significant correlate variable (men who reported lower self-esteem also were less satisfied with their current relationship). Some sex differences were evident in the variables that predict sexual difficulties and relationship satisfaction among those suffering from chronic pain. Of note is that when psychological variables were considered, pain-specific physical variables (e.g., pain severity and activity limitations) accounted for very little additional variance.

Are religious beliefs and practices of Buddhism associated with disability and salivary cortisol in office workers with chronic low back pain?

PubMed Central

2013-01-01

Background Low back pain (LBP) is common among office workers. A number of studies have established a relationship between Christianity and physical and mental health outcomes among chronic pain patients. The purpose of this study was to examine the relationship between the religious beliefs and practices of Buddhism and disability and psychological stress in office workers with chronic LBP. Methods A cross-sectional survey was conducted with a self-administered questionnaire delivered by hand to 463 office workers with chronic LBP. Saliva samples were collected from a randomly selected sub-sample of respondents (n=96). Disability due to LBP was assessed using the Roland-Morris Disability Questionnaire and psychological stress was assessed based on salivary cortisol. Two hierarchical regression models were built to determine how much variance in disability and psychological stress could be explained by religious beliefs and practices of Buddhism variables after controlling for potential confounder variables. Results Only 6% of variance in psychological stress was accounted for by the religious beliefs and practices of Buddhism. Those with high religiousness experienced lower psychological stress. No association between the religious beliefs and practices of Buddhism and disability level was found. Depressive symptoms were attributed to both psychological stress and disability status in our study population. Conclusions The findings suggest that, although being religious may improve the psychological condition in workers with chronic LBP, its effect is insufficient to reduce disability due to illness. Further research should examine the role of depression as a mediator of the effect of psychological stress on disability in patients with chronic LBP. PMID:23324474

Perception of built environmental factors and physical activity among adolescents in Nigeria

PubMed Central

2014-01-01

Background Understanding environmental factors related to adolescents’ physical activity can inform intervention for obesity control and prevention, but virtually no study has been conducted in the African region, where adolescents’ physical inactivity and chronic diseases rates are rising. This study assessed associations between perceived built environmental variables and adolescents’ physical activity (active transportation to school and leisure-time moderate-to- vigorous physical activity), and the moderating effects of neighborhood-level income on association between environmental variables and physical activity among Nigerian boys and girls. Methods Participants were 1006 adolescents (12–19 years, 50.4% girls) randomly selected from 11 secondary schools in Maiduguri city, Nigeria. Physical activity and perceptions of environmental characteristics were assessed by validated self-report questionnaires. Separate gender-based, hierarchical multiple moderated linear regression analyses were used to examine the direct associations between the environmental perceptions and physical activity variables (active transportation and leisure-time MVPA; dependent variables), as well as the moderating effects of neighborhood-level income. Results Only in boys were direct associations and interaction effect of neighborhood-level income found. Access to destinations was positively associated with active transportation to school (β = 0.18; CI = 0.67, 2.24); while residential density (β = 0.10; CI = 0.01, 1.74) and availability/quality of infrastructures (β = 0.14; CI = 0.49, 2.68) were positively associated with leisure-time MVPA. Also, neighborhood-level income moderated the association between perceived safety and leisure-time MVPA, with more perceived safety related to less MVPA (β = -0.16; CI = -0.01, -0.70) in boys living in high SES neighborhood but marginally related to more MVPA (β = 0.11; CI = -0.04, 2.88, p = 0.06) in boys living in low SES neighborhood. Conclusions Few environmental attributes were associated with adolescents’ physical activity in Nigeria. Future studies are needed to determine the multidimensional correlates of physical activity that may be relevant for both adolescents’ boys and girls in Nigeria. PMID:24766710

The Canadian Partnership for Tomorrow Project: a pan-Canadian platform for research on chronic disease prevention

PubMed Central

Awadalla, Philip; Boileau, Catherine; Craig, Camille; Fortier, Isabel; Goel, Vivek; Hicks, Jason M.T.; Jacquemont, Sébastien; Knoppers, Bartha Maria; Le, Nhu; McDonald, Treena; McLaughlin, John; Mes-Masson, Anne-Marie; Nuyt, Anne-Monique; Palmer, Lyle J.; Parker, Louise; Purdue, Mark; Robson, Paula J.; Spinelli, John J.; Thompson, David; Vena, Jennifer; Zawati, Ma’n

2018-01-01

BACKGROUND: Understanding the complex interaction of risk factors that increase the likelihood of developing common diseases is challenging. The Canadian Partnership for Tomorrow Project (CPTP) is a prospective cohort study created as a population-health research platform for assessing the effect of genetics, behaviour, family health history and environment (among other factors) on chronic diseases. METHODS: Volunteer participants were recruited from the general Canadian population for a confederation of 5 regional cohorts. Participants were enrolled in the study and core information obtained using 2 approaches: attendance at a study assessment centre for all study measures (questionnaire, venous blood sample and physical measurements) or completion of the core questionnaire (online or paper), with later collection of other study measures where possible. Physical measurements included height, weight, percentage body fat and blood pressure. Participants consented to passive follow-up through linkage with administrative health databases and active follow-up through recontact. All participant data across the 5 regional cohorts were harmonized. RESULTS: A total of 307 017 participants aged 30–74 from 8 provinces were recruited. More than half provided a venous blood sample and/or other biological sample, and 33% completed physical measurements. A total of 709 harmonized variables were created; almost 25% are available for all participants and 60% for at least 220 000 participants. INTERPRETATION: Primary recruitment for the CPTP is complete, and data and biosamples are available to Canadian and international researchers through a data-access process. The CPTP will support research into how modifiable risk factors, genetics and the environment interact to affect the development of cancer and other chronic diseases, ultimately contributing evidence to reduce the global burden of chronic disease. PMID:29891475

The Canadian Partnership for Tomorrow Project: a pan-Canadian platform for research on chronic disease prevention.

PubMed

Dummer, Trevor J B; Awadalla, Philip; Boileau, Catherine; Craig, Camille; Fortier, Isabel; Goel, Vivek; Hicks, Jason M T; Jacquemont, Sébastien; Knoppers, Bartha Maria; Le, Nhu; McDonald, Treena; McLaughlin, John; Mes-Masson, Anne-Marie; Nuyt, Anne-Monique; Palmer, Lyle J; Parker, Louise; Purdue, Mark; Robson, Paula J; Spinelli, John J; Thompson, David; Vena, Jennifer; Zawati, Ma'n

2018-06-11

Understanding the complex interaction of risk factors that increase the likelihood of developing common diseases is challenging. The Canadian Partnership for Tomorrow Project (CPTP) is a prospective cohort study created as a population-health research platform for assessing the effect of genetics, behaviour, family health history and environment (among other factors) on chronic diseases. Volunteer participants were recruited from the general Canadian population for a confederation of 5 regional cohorts. Participants were enrolled in the study and core information obtained using 2 approaches: attendance at a study assessment centre for all study measures (questionnaire, venous blood sample and physical measurements) or completion of the core questionnaire (online or paper), with later collection of other study measures where possible. Physical measurements included height, weight, percentage body fat and blood pressure. Participants consented to passive follow-up through linkage with administrative health databases and active follow-up through recontact. All participant data across the 5 regional cohorts were harmonized. A total of 307 017 participants aged 30-74 from 8 provinces were recruited. More than half provided a venous blood sample and/or other biological sample, and 33% completed physical measurements. A total of 709 harmonized variables were created; almost 25% are available for all participants and 60% for at least 220 000 participants. Primary recruitment for the CPTP is complete, and data and biosamples are available to Canadian and international researchers through a data-access process. The CPTP will support research into how modifiable risk factors, genetics and the environment interact to affect the development of cancer and other chronic diseases, ultimately contributing evidence to reduce the global burden of chronic disease. © 2018 Joule Inc. or its licensors.

Influence of Temple Headache Frequency on Physical Functioning and Emotional Functioning in Subjects with Temporomandibular Disorder Pain

PubMed Central

List, Thomas; John, Mike T.; Ohrbach, Richard; Schiffman, Eric L.; Truelove, Edmond L.; Anderson, Gary C.

2015-01-01

Aims To investigate the relationship of headache frequency with patient-reported physical functioning and emotional functioning in temporomandibular disorder (TMD) subjects with concurrent temple headache. Methods The Research Diagnostic Criteria for TMD (RDC/TMD) Validation Project identified, as a subset of 614 TMD cases and 91 controls (n = 705), 309 subjects with concurrent TMD pain diagnoses (RDC/TMD) and temple headache. The temple headaches were subdivided into infrequent, frequent, and chronic headache according to the International Classification of Headache Disorders, second edition (ICHD–II). Study variables included self-report measures of physical functioning (Jaw Function Limitation Scale [JFLS], Graded Chronic Pain Scale [GCPS], Short Form–12 [SF–12]) and emotional functioning (depression and anxiety as measured by the Symptom Checklist–90R/SCL–90R). Differences among the three headache subgroups were characterized by increasing headache frequency. The relationship between ordered headache frequency and physical as well as emotional functioning was analyzed using linear regression and trend tests for proportions. Results Physical functioning, as assessed with the JFLS (P < .001), SF-12 (P < .001), and GCPS (P < .001), was significantly associated with increased headache frequency. Emotional functioning, reflected in depression and anxiety, was also associated with increased frequency of headache (both P < .001). Conclusion Headache frequency was substantially correlated with reduced physical functioning and emotional functioning in subjects with TMD and concurrent temple headaches. A secondary finding was that headache was precipitated by jaw activities more often in subjects with more frequent temple headaches. PMID:22558607

Cigarette smoking, physical activity, and alcohol consumption: relationship to blood lipids and lipoproteins in premenopausal females.

PubMed

Stamford, B A; Matter, S; Fell, R D; Sady, S; Cresanta, M K; Papanek, P

1984-07-01

A total of 164 premenopausal female subjects were randomly selected for evaluation from a much larger pool of volunteers. The relationships between blood lipid and lipoprotein levels as dependent variables and cigarette smoking, physical activity, and alcohol consumption were determined from partial regression coefficients. A lower HDL-C level (10.1 mg/dL) was seen in smokers v nonsmokers. For each ounce of alcohol consumed, HDL-C level was higher by 2.8 mg/dL, and greater physical activity was associated with a higher HDL-C level of 8.6 mg/dL. An analysis of covariance with covariance adjustments for age and body fat revealed that smokers who regularly exercise or consume alcohol had significantly lower HDL-C levels than nonsmokers with similar habits. Subjects who both exercise and consume alcohol demonstrated higher HDL-C levels than those who indulge in one or the other separately. Results suggest that cigarette smoking may attenuate the effects of chronic exercise or alcohol consumption, or of both, to raise HDL-C levels. Also, chronic exercise and alcohol consumption may exert an additive effect, raising HDL-C level.

Narcissistic rage: The Achilles’ heel of the patient with chronic physical illness

PubMed Central

Hyphantis, Thomas; Almyroudi, Augustina; Paika, Vassiliki; Goulia, Panagiota; Arvanitakis, Konstantinos

2009-01-01

Based on the psychoanalytic reading of Homer’s Iliad whose principal theme is “Achilles’ rage” (the semi-mortal hero invulnerable in all of his body except for his heel, hence “Achilles’ heel” has come to mean a person’s principal weakness), we aimed to assess whether “narcissistic rage” has an impact on several psychosocial variables in patients with severe physical illness across time. In 878 patients with cancer, rheumatological diseases, multiple sclerosis, inflammatory bowel disease, and glaucoma, we assessed psychological distress (SCL-90 and GHQ-28), quality of life (WHOQOL-BREF), interpersonal difficulties (IIP-40), hostility (HDHQ), and defense styles (DSQ). Narcissistic rage comprised DSQ “omnipotence” and HDHQ “extraverted hostility”. Hierarchical multiple regressions analyses were performed. We showed that, in patients with disease duration less than one year, narcissistic rage had a minor impact on psychosocial variables studied, indicating that the rage was rather part of a “normal” mourning process. On the contrary, in patients with longer disease duration, increased rates of narcissistic rage had a great impact on all outcome variables, and the opposite was true for patients with low rates of narcissistic rage, indicating that narcissistic rage constitutes actually an “Achilles’ Heel” for patients with long-term physical illness. These findings may have important clinical implications. PMID:19936167

Disparity between Physical Capacity and Participation in Seniors with Chronic Disease

PubMed Central

Ashe, Maureen C.; Eng, Janice J.; Miller, William C.; Soon, Judith A.

2011-01-01

Consistently low rates of physical activity are reported for older adults and there is even lower participation if a chronic disease is present. Purpose To explore the predictors of physical capacity and participation in older community-dwelling individuals living with multiple chronic diseases. Methods This was a descriptive cross-sectional investigation of physical capacity (physiological potential) and physical activity participation (recorded engagement in physical activity). Multiple regression and odds ratios were used to investigate determinants of physical capacity (6 Minute Walk Test) and physical activity participation (Physical Activity Scale for Individuals with Physical Disabilities Questionnaire; pedometer steps/day). Results 200 community dwelling ambulatory participants living with 2 or more chronic disease were assessed. Sixty-five percent (65%) were women and the mean age was 74 ± 6 years (range 65–90 years). Mobility (Timed Up and Go) was a consistent determinant across all 3 primary outcomes. For the Six Minute Walk Test, determinants included mobility, BMI, grip strength, number of medications, leg strength, balance and Chronic Disease Management Self Efficacy Scale (r2=0.58; P=.000). The determinants for the self-reported participation measure (Physical Activity Scale for Individuals with Physical Disabilities Questionnaire) was mobility (r2=0.04; P=.007). For the mean daily pedometer steps, the determinants included mobility, body mass index (BMI), age and Chronic Disease Management Self-Efficacy Scale (r2=0.27; P=.000). There were higher risks for inactivity associated with impairments compared with the presence of a chronic disease. In addition, over 1/3 of participants had sufficient physical capacity, but did not meet minimal recommendations of physical activity. Conclusion This study suggests that it is easier to predict an individual’s physical capacity than their actual physical participation. PMID:17596782

Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews.

PubMed

Geneen, Louise J; Moore, R Andrew; Clarke, Clare; Martin, Denis; Colvin, Lesley A; Smith, Blair H

2017-01-14

Chronic pain is defined as pain lasting beyond normal tissue healing time, generally taken to be 12 weeks. It contributes to disability, anxiety, depression, sleep disturbances, poor quality of life, and healthcare costs. Chronic pain has a weighted mean prevalence in adults of 20%.For many years, the treatment choice for chronic pain included recommendations for rest and inactivity. However, exercise may have specific benefits in reducing the severity of chronic pain, as well as more general benefits associated with improved overall physical and mental health, and physical functioning.Physical activity and exercise programmes are increasingly being promoted and offered in various healthcare systems, and for a variety of chronic pain conditions. It is therefore important at this stage to establish the efficacy and safety of these programmes, and furthermore to address the critical factors that determine their success or failure. To provide an overview of Cochrane Reviews of adults with chronic pain to determine (1) the effectiveness of different physical activity and exercise interventions in reducing pain severity and its impact on function, quality of life, and healthcare use; and (2) the evidence for any adverse effects or harm associated with physical activity and exercise interventions. We searched theCochrane Database of Systematic Reviews (CDSR) on the Cochrane Library (CDSR 2016, Issue 1) for systematic reviews of randomised controlled trials (RCTs), after which we tracked any included reviews for updates, and tracked protocols in case of full review publication until an arbitrary cut-off date of 21 March 2016 (CDSR 2016, Issue 3). We assessed the methodological quality of the reviews using the AMSTAR tool, and also planned to analyse data for each painful condition based on quality of the evidence.We extracted data for (1) self-reported pain severity, (2) physical function (objectively or subjectively measured), (3) psychological function, (4) quality of life, (5) adherence to the prescribed intervention, (6) healthcare use/attendance, (7) adverse events, and (8) death.Due to the limited data available, we were unable to directly compare and analyse interventions, and have instead reported the evidence qualitatively. We included 21 reviews with 381 included studies and 37,143 participants. Of these, 264 studies (19,642 participants) examined exercise versus no exercise/minimal intervention in adults with chronic pain and were used in the qualitative analysis.Pain conditions included rheumatoid arthritis, osteoarthritis, fibromyalgia, low back pain, intermittent claudication, dysmenorrhoea, mechanical neck disorder, spinal cord injury, postpolio syndrome, and patellofemoral pain. None of the reviews assessed 'chronic pain' or 'chronic widespread pain' as a general term or specific condition. Interventions included aerobic, strength, flexibility, range of motion, and core or balance training programmes, as well as yoga, Pilates, and tai chi.Reviews were well performed and reported (based on AMSTAR), and included studies had acceptable risk of bias (with inadequate reporting of attrition and reporting biases). However the quality of evidence was low due to participant numbers (most included studies had fewer than 50 participants in total), length of intervention and follow-up (rarely assessed beyond three to six months). We pooled the results from relevant reviews where appropriate, though results should be interpreted with caution due to the low quality evidence. Pain severity: several reviews noted favourable results from exercise: only three reviews that reported pain severity found no statistically significant changes in usual or mean pain from any intervention. However, results were inconsistent across interventions and follow-up, as exercise did not consistently bring about a change (positive or negative) in self-reported pain scores at any single point. Physical function: was the most commonly reported outcome measure. Physical function was significantly improved as a result of the intervention in 14 reviews, though even these statistically significant results had only small-to-moderate effect sizes (only one review reported large effect sizes). Psychological function and quality of life: had variable results: results were either favourable to exercise (generally small and moderate effect size, with two reviews reporting significant, large effect sizes for quality of life), or showed no difference between groups. There were no negative effects. Adherence to the prescribed intervention: could not be assessed in any review. However, risk of withdrawal/dropout was slightly higher in the exercising group (82.8/1000 participants versus 81/1000 participants), though the group difference was non-significant. Healthcare use/attendance: was not reported in any review. Adverse events, potential harm, and death: only 25% of included studies (across 18 reviews) actively reported adverse events. Based on the available evidence, most adverse events were increased soreness or muscle pain, which reportedly subsided after a few weeks of the intervention. Only one review reported death separately to other adverse events: the intervention was protective against death (based on the available evidence), though did not reach statistical significance. The quality of the evidence examining physical activity and exercise for chronic pain is low. This is largely due to small sample sizes and potentially underpowered studies. A number of studies had adequately long interventions, but planned follow-up was limited to less than one year in all but six reviews.There were some favourable effects in reduction in pain severity and improved physical function, though these were mostly of small-to-moderate effect, and were not consistent across the reviews. There were variable effects for psychological function and quality of life.The available evidence suggests physical activity and exercise is an intervention with few adverse events that may improve pain severity and physical function, and consequent quality of life. However, further research is required and should focus on increasing participant numbers, including participants with a broader spectrum of pain severity, and lengthening both the intervention itself, and the follow-up period.

Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews.

PubMed

Geneen, Louise J; Moore, R Andrew; Clarke, Clare; Martin, Denis; Colvin, Lesley A; Smith, Blair H

2017-04-24

Chronic pain is defined as pain lasting beyond normal tissue healing time, generally taken to be 12 weeks. It contributes to disability, anxiety, depression, sleep disturbances, poor quality of life, and healthcare costs. Chronic pain has a weighted mean prevalence in adults of 20%.For many years, the treatment choice for chronic pain included recommendations for rest and inactivity. However, exercise may have specific benefits in reducing the severity of chronic pain, as well as more general benefits associated with improved overall physical and mental health, and physical functioning.Physical activity and exercise programmes are increasingly being promoted and offered in various healthcare systems, and for a variety of chronic pain conditions. It is therefore important at this stage to establish the efficacy and safety of these programmes, and furthermore to address the critical factors that determine their success or failure. To provide an overview of Cochrane Reviews of adults with chronic pain to determine (1) the effectiveness of different physical activity and exercise interventions in reducing pain severity and its impact on function, quality of life, and healthcare use; and (2) the evidence for any adverse effects or harm associated with physical activity and exercise interventions. We searched theCochrane Database of Systematic Reviews (CDSR) on the Cochrane Library (CDSR 2016, Issue 1) for systematic reviews of randomised controlled trials (RCTs), after which we tracked any included reviews for updates, and tracked protocols in case of full review publication until an arbitrary cut-off date of 21 March 2016 (CDSR 2016, Issue 3). We assessed the methodological quality of the reviews using the AMSTAR tool, and also planned to analyse data for each painful condition based on quality of the evidence.We extracted data for (1) self-reported pain severity, (2) physical function (objectively or subjectively measured), (3) psychological function, (4) quality of life, (5) adherence to the prescribed intervention, (6) healthcare use/attendance, (7) adverse events, and (8) death.Due to the limited data available, we were unable to directly compare and analyse interventions, and have instead reported the evidence qualitatively. We included 21 reviews with 381 included studies and 37,143 participants. Of these, 264 studies (19,642 participants) examined exercise versus no exercise/minimal intervention in adults with chronic pain and were used in the qualitative analysis.Pain conditions included rheumatoid arthritis, osteoarthritis, fibromyalgia, low back pain, intermittent claudication, dysmenorrhoea, mechanical neck disorder, spinal cord injury, postpolio syndrome, and patellofemoral pain. None of the reviews assessed 'chronic pain' or 'chronic widespread pain' as a general term or specific condition. Interventions included aerobic, strength, flexibility, range of motion, and core or balance training programmes, as well as yoga, Pilates, and tai chi.Reviews were well performed and reported (based on AMSTAR), and included studies had acceptable risk of bias (with inadequate reporting of attrition and reporting biases). However the quality of evidence was low due to participant numbers (most included studies had fewer than 50 participants in total), length of intervention and follow-up (rarely assessed beyond three to six months). We pooled the results from relevant reviews where appropriate, though results should be interpreted with caution due to the low quality evidence. Pain severity: several reviews noted favourable results from exercise: only three reviews that reported pain severity found no statistically significant changes in usual or mean pain from any intervention. However, results were inconsistent across interventions and follow-up, as exercise did not consistently bring about a change (positive or negative) in self-reported pain scores at any single point. Physical function: was the most commonly reported outcome measure. Physical function was significantly improved as a result of the intervention in 14 reviews, though even these statistically significant results had only small-to-moderate effect sizes (only one review reported large effect sizes). Psychological function and quality of life: had variable results: results were either favourable to exercise (generally small and moderate effect size, with two reviews reporting significant, large effect sizes for quality of life), or showed no difference between groups. There were no negative effects. Adherence to the prescribed intervention: could not be assessed in any review. However, risk of withdrawal/dropout was slightly higher in the exercising group (82.8/1000 participants versus 81/1000 participants), though the group difference was non-significant. Healthcare use/attendance: was not reported in any review. Adverse events, potential harm, and death: only 25% of included studies (across 18 reviews) actively reported adverse events. Based on the available evidence, most adverse events were increased soreness or muscle pain, which reportedly subsided after a few weeks of the intervention. Only one review reported death separately to other adverse events: the intervention was protective against death (based on the available evidence), though did not reach statistical significance. The quality of the evidence examining physical activity and exercise for chronic pain is low. This is largely due to small sample sizes and potentially underpowered studies. A number of studies had adequately long interventions, but planned follow-up was limited to less than one year in all but six reviews.There were some favourable effects in reduction in pain severity and improved physical function, though these were mostly of small-to-moderate effect, and were not consistent across the reviews. There were variable effects for psychological function and quality of life.The available evidence suggests physical activity and exercise is an intervention with few adverse events that may improve pain severity and physical function, and consequent quality of life. However, further research is required and should focus on increasing participant numbers, including participants with a broader spectrum of pain severity, and lengthening both the intervention itself, and the follow-up period.

Clinical and Polysomnographic Predictors of the Natural History of Poor Sleep in the General Population

PubMed Central

Fernandez-Mendoza, Julio; Vgontzas, Alexandros N.; Bixler, Edward O.; Singareddy, Ravi; Shaffer, Michele L.; Calhoun, Susan L.; Karataraki, Maria; Vela-Bueno, Antonio; Liao, Duanping

2012-01-01

Study Objectives: Approximately 8-10% of the general population suffers from chronic insomnia, whereas another 20-30% of the population has insomnia symptoms at any given time (i.e., poor sleep). However, few longitudinal studies have examined risk factors of the natural history of poor sleep, and none have examined the role of polysomnographic (PSG) variables. Design: Representative longitudinal study. Setting: Sleep laboratory. Participants: From a random, general population sample of 1,741 individuals of the adult Penn State Cohort, 1,395 were followed up after 7.5 yr. Measurements: Full medical evaluation and 1-night PSG at baseline and telephone interview at follow-up. Results: The rate of incident poor sleep was 18.4%. Physical (e.g., obesity, sleep apnea, and ulcer) and mental (e.g., depression) health conditions and behavioral factors (e.g., smoking and alcohol consumption) increased the odds of incident poor sleep as compared to normal sleep. The rates of persistent, remitted, and poor sleepers who developed chronic insomnia were 39%, 44%, and 17%, respectively. Risk factors for persistent poor sleep were physical health conditions combined with psychologic distress. Shorter objective sleep duration and a family history of sleep problems were risk factors for poor sleep evolving into chronic insomnia. Conclusions: Poor sleep appears to be primarily a symptom of physical and mental health conditions, whereas the persistence of poor sleep is associated with psychologic distress. Importantly, sleep apnea appears to be associated with incident poor sleep but not with chronic insomnia. Finally, this study suggests that objective short sleep duration in poor sleepers is a biologic marker of genetic predisposition to chronic insomnia. Citation: Fernandez-Mendoza J; Vgontzas AN; Bixler EO; Singareddy R; Shaffer ML; Calhoun SL; Karataraki M; Vela-Bueno A; Liao D. Clinical and polysomnographic predictors of the natural history of poor sleep in the general population. SLEEP 2012;35(5):689-697. PMID:22547895

Early development of physical aggression and early risk factors for chronic physical aggression in humans.

PubMed

Tremblay, Richard E

2014-01-01

This chapter describes the state of knowledge on the development of physical aggression from early childhood to adulthood, the long term outcomes of chronic physical aggression during childhood and the risk factors for chronic physical aggression. Unraveling the development of physical aggression is important to understand when and why humans start using physical aggression, to understand why some humans suffer from chronic physical aggression and to understand how to prevent the development of this disorder which causes much distress to the aggressors and their victims. The study of the developmental origins of aggression also sheds light on the reasons why situational prevention of aggression is important at all ages and in all cultures.

Lumbar kinematic variability during gait in chronic low back pain and associations with pain, disability and isolated lumbar extension strength.

PubMed

Steele, James; Bruce-Low, Stewart; Smith, Dave; Jessop, David; Osborne, Neil

2014-12-01

Chronic low back pain is a multifactorial condition with many dysfunctions including gait variability. The lumbar spine and its musculature are involved during gait and in chronic low back pain the lumbar extensors are often deconditioned. It was therefore of interest to examine relationships between lumbar kinematic variability during gait, with pain, disability and isolated lumbar extension strength in participants with chronic low back pain. Twenty four participants with chronic low back pain were assessed for lumbar kinematics during gait, isolated lumbar extension strength, pain, and disability. Angular displacement and kinematic waveform pattern and offset variability were examined. Angular displacement and kinematic waveform pattern and offset variability differed across movement planes; displacement was highest and similar in frontal and transverse planes, and pattern variability and offset variability higher in the sagittal plane compared to frontal and transverse planes which were similar. Spearman's correlations showed significant correlations between transverse plane pattern variability and isolated lumbar extension strength (r=-.411) and disability (r=.401). However, pain was not correlated with pattern variability in any plane. The r(2) values suggested 80.5% to 86.3% of variance was accounted for by other variables. Considering the lumbar extensors role in gait, the relationship between both isolated lumbar extension strength and disability with transverse plane pattern variability suggests that gait variability may result in consequence of lumbar extensor deconditioning or disability accompanying chronic low back pain. However, further study should examine the temporality of these relationships and other variables might account for the unexplained variance. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effects of 8 weeks of mat-based Pilates exercise on gait in chronic stroke patients.

PubMed

Roh, SuYeon; Gil, Ho Jong; Yoon, Sukhoon

2016-09-01

[Purpose] The purpose of this study was to investigate the effects of an 8-week program of Pilates exercise on gait in chronic hemiplegia patients and to determine whether or not it can be used for rehabilitation in postsrtoke patients. [Subjects and Methods] Twenty individuals with unilateral chronic hemiparetic stroke (age, 66.1 ± 4.4 yrs; height, 162.3 ± 8.3 cm; weight, 67.4 ± 12.3 kg) participated in this study and were randomly allocated equally to either a Pilates exercise group or a control group. To identify the effects of Pilates exercise, a 3-D motion analysis with 8 infrared cameras was performed. [Results] For the gait parameters, improvements were found in the Pilates exercise group for all variables, and statistical significance was observed for stride length, gait velocity, knee range of motion and hip range of motion. For the asymmetry indexes, insignificant improvements were found for all variables in the Pilates exercise group. [Conclusion] In conclusion, an 8-week program of Pilates exercise had a positive influence on improving the gait ability of poststroke patients, and the intervention could be applied to poststroke patients with various levels of physical disability by adjusting the intensity of training.

Effects of 8 weeks of mat-based Pilates exercise on gait in chronic stroke patients

PubMed Central

Roh, SuYeon; Gil, Ho Jong; Yoon, Sukhoon

2016-01-01

[Purpose] The purpose of this study was to investigate the effects of an 8-week program of Pilates exercise on gait in chronic hemiplegia patients and to determine whether or not it can be used for rehabilitation in postsrtoke patients. [Subjects and Methods] Twenty individuals with unilateral chronic hemiparetic stroke (age, 66.1 ± 4.4 yrs; height, 162.3 ± 8.3 cm; weight, 67.4 ± 12.3 kg) participated in this study and were randomly allocated equally to either a Pilates exercise group or a control group. To identify the effects of Pilates exercise, a 3-D motion analysis with 8 infrared cameras was performed. [Results] For the gait parameters, improvements were found in the Pilates exercise group for all variables, and statistical significance was observed for stride length, gait velocity, knee range of motion and hip range of motion. For the asymmetry indexes, insignificant improvements were found for all variables in the Pilates exercise group. [Conclusion] In conclusion, an 8-week program of Pilates exercise had a positive influence on improving the gait ability of poststroke patients, and the intervention could be applied to poststroke patients with various levels of physical disability by adjusting the intensity of training. PMID:27799706

Stability of physical assessment of older drivers over 1 year.

PubMed

Smith, Andrew; Marshall, Shawn; Porter, Michelle; Ha, Linda; Bédard, Michel; Gélinas, Isabelle; Man-Son-Hing, Malcolm; Mazer, Barbara; Rapoport, Mark; Tuokko, Holly; Vrkljan, Brenda

2013-12-01

Older adults represent the fastest-growing population of drivers with a valid driver's licence. Also common in this age group are multiple chronic medical conditions that may have an effect on physical function and driving ability. Determining the reliability of physical measures used to assess older drivers' functional ability is important to identifying those who are safe to continue driving. Most previous reliability studies of clinical physical measures of health used test-retest intervals shorter than those between patient visits with a clinician. In the present study we examined a more clinically representative interval of 1 year to determine the stability of commonly used physical measures collected during the Candrive II prospective cohort study of older drivers. Reliability statistics indicate that the sequential finger-thumb opposition, rapid pace walk and the Pelli-Robson contrast sensitivity tests have adequate stability over 1 year. Poor stability was observed for the one-legged stance and Snellen visual acuity test. Several assessments with nominal data (Marottoli method [functional neck range of motion], whispered voice test, range of motion and strength testing) lacked sufficient variability to conduct reliability analyses; however, a lack of variability between test days suggests consistency over a 1-year time frame. Our results provide evidence that specific physical measures are stable in monitoring functional ability over the course of a year. Copyright © 2013 Elsevier Ltd. All rights reserved.

Profile of patients with chronic obstructive pulmonary disease classified as physically active and inactive according to different thresholds of physical activity in daily life

PubMed Central

Furlanetto, Karina C.; Pinto, Isabela F. S.; Sant’Anna, Thais; Hernandes, Nidia A.; Pitta, Fabio

2016-01-01

ABSTRACT Objective To compare the profiles of patients with chronic obstructive pulmonary disease (COPD) considered physically active or inactive according to different classifications of the level of physical activity in daily life (PADL). Method Pulmonary function, dyspnea, functional status, body composition, exercise capacity, respiratory and peripheral muscle strength, and presence of comorbidities were assessed in 104 patients with COPD. The level of PADL was quantified with a SenseWear Armband activity monitor. Three classifications were used to classify the patients as physically active or inactive: 30 minutes of activity/day with intensity >3.2 METs, if age ≥65 years, and >4 METs, if age <65 years; 30 minutes of activity/day with intensity >3.0 METs, regardless of patient age; and 80 minutes of activity/day with intensity >3.0 METs, regardless of patient age. Results In all classifications, when compared with the inactive group, the physically active group had better values of anthropometric variables (higher fat-free mass, lower body weight, body mass index and fat percentage), exercise capacity (6-minute walking distance), lung function (forced vital capacity) and functional status (personal care domain of the London Chest Activity of Daily Living). Furthermore, patients classified as physically active in two classifications also had better peripheral and expiratory muscle strength, airflow obstruction, functional status, and quality of life, as well as lower prevalence of heart disease and mortality risk. Conclusion In all classification methods, physically active patients with COPD have better exercise capacity, lung function, body composition, and functional status compared to physically inactive patients. PMID:27683835

Nutritional Status of Patients with Chronic Obstructive Pulmonary Disease in Relation to their Physical Performance.

PubMed

Matkovic, Zinka; Cvetko, Danijel; Rahelic, Dario; Esquinas, Cristina; Zarak, Marko; Miravitlles, Marc; Tudoric, Neven

2017-12-01

Nutritional abnormalities and physical inactivity are highly prevalent in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to determine the association between nutritional status/body composition and physical performance in patients with COPD. A cross-sectional observational study was conducted in outpatients with clinically stable, moderate to very severe COPD. In the assessment of nutritional status, we used dual energy X-ray absorptiometry, anthropometry, serum biomarkers, and the Mini-Nutritional Assessment (MNA) questionnaire. Physical performance was measured by the 6-minute walk distance (6MWD), 4-metre gait speed (4MGS), and physical activity. Univariate and multivariate analyses were performed. In 111 patients (mean age 68 years, 69% men), the mean 6MWD was 376 ± 119 m, 4MGS 0.9 ± 0.2 m/s, and the average daily step count 8,059 ± 4,757. Patients with low exercise capacity (6MWD ≤ 350 m) had a significantly lower lean mass index (LMI) (p < 0.01), fat-free mass index (FFMI) (p < 0.01), bone mineral content (p < 0.01), bone mineral density (p < 0.01), T-score (p < 0.05), MNA score (p < 0.01), and serum albumin and prealbumin levels (p < 0.05). Patients with low physical activity (daily step count ≤ median) had lower LMI, FFMI, MNA score, serum prealbumin (for all comparisons p < 0.05) and vitamin D levels (p < 0.01). However, none of the nutritional variables showed an independent association with low physical performance in the multivariate models. In conclusion, patients with low physical performance have deficient nutritional status, but we could not demonstrate an independent relationship between nutritional parameters and physical performance.

Social Relatedness and Physical Health Are More Strongly Related in Older Than Younger Adults: Findings from the Korean Adult Longitudinal Study

PubMed Central

Choi, Eunsoo; Kwon, Yuri; Lee, Minha; Choi, Jongan; Choi, Incheol

2018-01-01

Previous research indicates that social relatedness is beneficial to physical health; however, findings on the relative strength of the relationship between these variables have been inconsistent. The present study employed cross-sectional survey (Study 1) and a daily diary survey (Study 2) to examine the link between social relatedness and physical health by age. Using a representative sample of Korean adults (N = 371) aged from 20 to 69, Study 1 examines the link between social relatedness (loneliness, perceived social support) and physical health (physical symptoms, chronic health conditions) using age as a moderator. The results show that participants' age moderates the association between social relatedness and physical health. Study 2 (N = 384) further corroborated the findings from Study 1 by showing that when controlling for the physical symptoms experienced prior to the daily diary reports, the level of loneliness experienced over a 13-day period exacerbates the age differences in the physical symptoms. The present study thus provides converging evidence that social relatedness plays a significant role in physical health, particularly in the older population. PMID:29403415

Physical activity interventions and children's mental function: An introduction and overview

PubMed Central

Tomporowski, Phillip D.; Lambourne, Kate; Okumura, Michelle S.

2011-01-01

Background This review provides a historical overview of physical activity interventions designed by American educators and an evaluation of research that has assessed the effects of exercise on children's mental function. Method Historical descriptions of the emergence of American physical education doctrine throughout the 20th century were evaluated. Prior reviews of studies that assessed the effects of single acute bouts of exercise and the effects of chronic exercise training on children's mental function were examined and the results of recent studies were summarized. Results Physical activity interventions designed for American children have reflected two competing views: activities should promote physical fitness and activities should promote social, emotional, and intellectual development. Research results indicate that exercise fosters the emergence of children's mental function; particularly executive functioning. The route by which physical activity impacts mental functioning is complex and is likely moderated by several variables, including physical fitness level, health status, and numerous psycho-social factors. Conclusion Physical activity interventions for children should be designed to meet multiple objectives; e.g., optimize physical fitness, promote health-related behaviors that offset obesity, and facilitate mental development. PMID:21420981

The role of disease management programs in the health behavior of chronically ill patients.

PubMed

Cramm, Jane Murray; Adams, Samantha A; Walters, Bethany Hipple; Tsiachristas, Apostolos; Bal, Roland; Huijsman, Robbert; Rutten-Van Mölken, Maureen P M H; Nieboer, Anna Petra

2014-04-01

Investigate the effects of disease management program (DMP) implementation on physical activity, smoking, and physical quality of life among chronically ill patients. This study used a mixed-methods approach involving qualitative (35 interviews with project managers) and quantitative (survey of patients from 18 DMPs) data collection. Questionnaire response rates were 51% (2010; 2619/5108) at T0 and 47% (2011; 2191/4693) at T1. Physical activity and the percentage of smokers improved significantly over time, whereas physical quality of life declined. After adjusting for patients' physical quality of life at T0, age, educational level, marital status, and gender, physical activity at T0 (p<0.01), changes in physical activity (p<0.001), and percentage of smokers at T0 (p<0.05) predicted physical quality of life at T1. Project managers reported that DMPs improved patient-professional interaction. The ability to set more concrete targets improved patients' health behaviors. DMPs appear to improve physical activity among chronically ill patients over time. Furthermore, (changes in) health behavior are important for the physical quality of life of chronically ill patients. Redesigning care systems and implementing DMPs based on the chronic care model may improve health behavior among chronically ill patients. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Predictors of health-related quality of life in chronically ill children and adolescents over time.

PubMed

Barthel, D; Ravens-Sieberer, U; Nolte, S; Thyen, U; Klein, M; Walter, O; Meyrose, A-K; Rose, M; Otto, C

2018-06-01

This study aims at identifying predictors of generic health-related quality of life (HRQoL) in chronically ill children and adolescents over time. The newly developed computer-adaptive test Kids-CAT was used to assess five dimensions of HRQoL. Longitudinal data from the Kids-CAT study on children and adolescents with asthma, diabetes and juvenile arthritis (n = 248; aged 7-17 years) were assessed at three measurement points over six months. Individual growth modeling served to investigate effects of sociodemographic, disease- and health-related as well as psychosocial factors on HRQoL dimensions Physical Well-Being (WB), Psychological WB, Parent Relations, Social Support & Peers, and School WB over time. Besides effects of sociodemographic variables on HRQoL dimensions Social Support & Peers as well as School WB, we found that a longer duration of the disease was associated with better Physical WB. Lower scores were found for patients with juvenile arthritis compared to those with diabetes in HRQoL dimensions Physical WB and Social Support & Peers. Disease control was positively related to Physical and Psychological WB over time. Mental health problems were negatively associated with four, and subjective health complaints with all five HRQoL dimensions over time. Parental mental health was positively related to the patients' HRQoL score in Parent Relations over time. HRQoL as a multidimensional construct is associated with a wide range of different factors. Pediatricians should consider potential mental health problems and subjective health complaints in their patients. Finally, parental HRQoL can affect HRQoL in chronically ill children and adolescents. Copyright © 2018 Elsevier Inc. All rights reserved.

Acute and chronic menisco-capsular separation in the young athlete: diagnosis, treatment and results in thirty seven consecutive patients.

PubMed

Hirtler, Lena; Unger, Julia; Weninger, Patrick

2015-05-01

Menisco-capsular separation (MCS) is an avulsion type of injury of the medial and/or lateral meniscus and is defined as detachment of the meniscus from its capsular attachment. The aims of this study were to show the results of arthroscopic all-inside menisco-capsular repair in a large number of consecutive patients with acute or chronic MCS, emphasise the advantages of this safe treatment option and stress the superiority of the treatment on the basis of thorough physical examination of the knee joint over magnetic resonance imaging (MRI) diagnosis in MCS. We evaluated data of patients treated between October 2011 and July 2012. Inclusion and exclusion criteria were defined and demographic variables evaluated. All patients were examined physically and with MRI. Knee arthroscopy was performed and the MCS repaired through all-inside menisco-capsular repair. Postoperative treatment was standardised. Patients were followed up for at least 24 weeks. Thirty-seven athletes (12 women, 25 men) were evaluated. Only in six patients was MCS detected on MRI. In all patients, MCS was diagnosed via physical examination. Arthroscopic treatment led to significant (p < 0.01) improvement. There were no complications reported postoperatively. Isolated MCS is not as rare a meniscus pathology after trauma in young athletes as could be expected after reviewing current literature. It is occult on MRI scans in most of the cases and should therefor be taken into consideration in patients with acute or chronic tenderness at the level of the joint line and negative MRI scans. Thorough physical examination has higher diagnostic value than MRI alone, as shown in this study. Treatment of MCS using all-inside nonabsorbable sutures, as described in this study using Ultra FasT Fix®, is effective if performed by an experienced surgeon.

Positive Psychological Wellbeing Is Required for Online Self-Help Acceptance and Commitment Therapy for Chronic Pain to be Effective.

PubMed

Trompetter, Hester R; Bohlmeijer, Ernst T; Lamers, Sanne M A; Schreurs, Karlein M G

2016-01-01

The web-based delivery of psychosocial interventions is a promising treatment modality for people suffering from chronic pain, and other forms of physical and mental illness. Despite the promising findings of first studies, patients may vary in the benefits they draw from self-managing a full-blown web-based psychosocial treatment. We lack knowledge on moderators and predictors of change during web-based interventions that explain for whom web-based interventions are especially (in)effective. In this study, we primarily explored for which chronic pain patients web-based Acceptance and Commitment Therapy (ACT) was (in)effective during a large three-armed randomized controlled trial. Besides standard demographic, physical and psychosocial factors we focused on positive mental health. Data from 238 heterogeneously diagnosed chronic pain sufferers from the general Dutch population following either web-based ACT (n = 82), or one of two control conditions [web-based Expressive Writing (EW; n = 79) and Waiting List (WL; n = 77)] were analysed. ACT and EW both consisted of nine modules and lasted nine to 12 weeks. Exploratory linear regression analyses were performed using the PROCESS macro in SPSS. Pain interference at 3-month follow-up was predicted from baseline moderator (characteristics that influence the outcome of specific treatments in comparison to other treatments) and predictor (characteristics that influence outcome regardless of treatment) variables. The results showed that none of the demographic or physical characteristics moderated ACT treatment changes compared to both control conditions. The only significant moderator of change compared to both EW and WL was baseline psychological wellbeing, and pain intensity was a moderator of change compared to EW. Furthermore, higher pain interference, depression and anxiety, and also lower levels of emotional well-being predicted higher pain interference in daily life 6 months later. These results suggest that web-based self-help ACT may not be allocated to chronic pain sufferers experiencing low levels of mental resilience resources such as self-acceptance, goals in life, and environmental mastery. Other subgroups are identified that potentially need specific tailoring of (web-based) ACT. Emotional and psychological wellbeing should receive much more attention in subsequent studies on chronic pain and illness.

DETERMINANTS OF VARIABILITY IN ACUTE TO CHRONIC TOXICITY RATIOS IN AQUATIC INVERTEBRATES AND FISH

EPA Science Inventory

Variability in acute to chronic ratios (ACRs; LC50/chronic value) has been a continuing interest in aquatic toxicology because of the reliance on ACRs to estimate chronic toxicity for chemicals and species with known acute toxicity but limited or no information on sublethal toxic...

The Effects of Race, Ethnicity, and Mood/Anxiety Disorders on the Chronic Physical Health Conditions of Men From a National Sample

PubMed Central

Johnson-Lawrence, Vicki; Griffith, Derek M.; Watkins, Daphne C.

2013-01-01

Racial/ethnic differences in health are evident among men. Previous work suggests associations between mental and physical health but few studies have examined how mood/anxiety disorders and chronic physical health conditions covary by age, race, and ethnicity among men. Using data from 1,277 African American, 629 Caribbean Black, and 371 non-Hispanic White men from the National Survey of American Life, we examined associations between race/ethnicity and experiencing one or more chronic physical health conditions in logistic regression models stratified by age and 12-month mood/anxiety disorder status. Among men <45 years without mood/anxiety disorders, Caribbean Blacks had lower odds of chronic physical health conditions than Whites. Among men aged 45+ years with mood/anxiety disorders, African Americans had greater odds of chronic physical health conditions than Whites. Future studies should explore the underlying causes of such variation and how studying mental and chronic physical health problems together may help identify mechanisms that underlie racial disparities in life expectancy among men. PMID:23609347

[Anaemia as a cause of haemodynamic angina in a patient with chronic ischaemic heart disease].

PubMed

Miguéns Blanco, I; Bravo Amaro, M

2014-01-01

Ischaemic heart disease is the leading cause of mortality and morbidity and one of the primary causes of morbidity in Spain. The variability in the clinical presentation of this condition at both primary care and emergency services level requires a careful history and a thorough physical examination. In the case presented, the main symptoms of angina and dyspnea reported in the anamnesis, and the obvious pallor in the physical examination, were the key data to identify anaemia as a cause of angina. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Risk Factors for Incident Chronic Insomnia: A General Population Prospective Study

PubMed Central

Singareddy, Ravi; Vgontzas, Alexandros N.; Fernandez-Mendoza, Julio; Liao, Duanping; Calhoun, Susan; Shaffer, Michele L.; Bixler, Edward O.

2012-01-01

Objective The few population-based, prospective studies that have examined risk factors of incident insomnia were limited by small sample size, short follow-up, and lack of data on medical disorders or polysomnography. We prospectively examined the associations between demographics, behavioral factors, psychiatric and medical disorders, and polysomnography with incident chronic insomnia. Methods From a random, general population sample of 1741 individuals of the adult Penn State Sleep Cohort, 1395 were followed-up after 7.5 years. Only subjects without chronic insomnia at baseline (n=1246) were included in this study. Structured medical and psychiatric history, personality testing, and 8-hour polysomnography were obtained at baseline. Structured sleep history was obtained at baseline and follow-up. Results Incidence of chronic insomnia was 9.3%, with a higher incidence in women (12.9%) than in men (6.2%). Younger age (20–35 years), non-white ethnicity, and obesity increased the risk of chronic insomnia. Poor sleep and mental health were stronger predictors of incident chronic insomnia compared to physical health. Higher scores in MMPI-2, indicating maladaptive personality traits, and excessive use of coffee at baseline predicted incident chronic insomnia. Polysomnographic variables, such as short sleep duration or sleep apnea, did not predict incident chronic insomnia. Conclusion Mental health, poor sleep, and obesity, but not sleep apnea, are significant risk factors for incident chronic insomnia. Focusing on these more vulnerable groups and addressing the modifiable risk factors may help reduce the incident of chronic insomnia, a common and chronic sleep disorder associated with significant medical and psychiatric morbidity and mortality. PMID:22425576

Physical Therapy for Chronic Low Back Pain in North Carolina: Overuse, Underuse, or Misuse?

PubMed Central

Carey, Timothy S.; Holmes, George M.

2011-01-01

Background There are limited population-based studies of determinants of physical therapy use for chronic low back pain (LBP) and of the types of treatments received by individuals who see a physical therapist. Objective The purposes of this study were: (1) to identify determinants of physical therapy use for chronic LBP, (2) to describe physical therapy treatments for chronic LBP, and (3) to compare use of treatments with current best evidence on care for this condition. Design This study was a cross-sectional, population-based telephone survey of North Carolinians. Methods Five hundred eighty-eight individuals with chronic LBP who had sought care in the previous year were surveyed on their health and health care use. Bivariate and multivariable analyses were conducted to identify predisposing, enabling, and need characteristics associated with physical therapy use. Descriptive analyses were conducted to determine the use of physical treatments for individuals who saw a physical therapist. Use of treatments was compared with evidence from systematic reviews. Results Of our sample, 29.7% had seen a physical therapist in the previous year, with a mean of 15.6 visits. In multivariable analyses, receiving workers' compensation, seeing physician specialists, and higher Medical Outcomes Study 12-Item Short-Form Health Survey questionnaire (SF-12) physical component scores were positively associated with physical therapy use. Having no health insurance was negatively associated with physical therapy use. Exercise was the most frequent treatment received (75% of sample), and traction was the least frequent treatment received (7%). Some effective treatments were underutilized, whereas some ineffective treatments were overutilized. Limitations Only one state was examined, and findings were based on patient report. Conclusions Fewer than one third of individuals with chronic LBP saw a physical therapist. Health-related and non–health-related factors were associated with physical therapy use. Individuals who saw a physical therapist did not always receive evidence-based treatments. There are potential opportunities for improving access to and quality of physical therapy for chronic LBP. PMID:21330449

Prevalence and correlates of heart disease among adults in Singapore.

PubMed

Picco, Louisa; Subramaniam, Mythily; Abdin, Edimansyah; Vaingankar, Janhavi Ajit; Chong, Siow Ann

2016-02-01

Heart disease is one of the leading causes of morbidity and mortality worldwide and it has been well established that it is associated with both mental and physical conditions. This paper describes the prevalence of heart disease with mental disorders and other chronic physical conditions among the Singapore resident population. Data were from the Singapore Mental Health Study which was a representative, cross-sectional epidemiological survey undertaken with 6616 Singapore residents, between December 2009 and December 2010. The Composite International Diagnostic Interview Version 3.0 was used to establish the diagnosis of mental disorders, while a chronic medical conditions checklist was used to gather information on 15 physical conditions, including various forms of heart disease. Health-related quality of life was measured using the Euro-Quality of Life Scale (EQ-5D). The lifetime prevalence of heart disease was 2.8%. Socio-demographic correlates of heart disease included older age, Indian ethnicity, secondary education (vs. tertiary) and being economically inactive. After adjusting for socio-demographic variables and other comorbid physical and mental disorders, the prevalence of major depressive disorder and bipolar disorder were significantly higher among those with heart disease, as were diabetes, arthritis, kidney failure and lung disease. These findings highlight important associations between heart disease and various socio-demographic correlates, mental disorders and physical conditions. Given the high prevalence of mood disorders among heart disease patients, timely and appropriate screening and treatment of mental disorders among this group is essential. Copyright © 2015 Elsevier B.V. All rights reserved.

Increased prevalence of chronic physical health disorders in Australians with diagnosed mental illness.

PubMed

Scott, David; Burke, Karena; Williams, Susan; Happell, Brenda; Canoy, Doreen; Ronan, Kevin

2012-10-01

To compare chronic physical health disorder prevalence amongst Australian adults with and without mental illness. Total n=1,716 participants (58% female) with a mean age of 52 ± 13 years (range: 18 to 89 years) completed an online survey of Australian adults in 2010. Outcome measures including prevalence of chronic physical conditions and self-reported body mass index (BMI) in n=387 (23%) with a self-reported mental illness diagnosis were compared to respondents without mental illness. A significantly higher proportion of participants with mental illness were obese (BMI ≥ 30; 31 vs 24%, p=0.005). Adjusted odds ratios (OR) for coronary heart disease, diabetes, chronic bronchitis or emphysema, asthma, irritable bowel syndrome, and food allergies or intolerances (OR range: 1.54-3.19) demonstrated that chronic physical disorders were significantly more common in participants with a mental illness. Australian adults with a diagnosis for mental illness have a significantly increased likelihood of demonstrating chronic physical health disorders compared to persons without mental illness. Health professionals must be alert to the increased likelihood of comorbid chronic physical disorders in persons with a mental illness and should consider the adoption of holistic approaches when treating those with either a mental or physical illness. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

Association between physical activity and inflammatory markers among U.S. adults with chronic obstructive pulmonary disease.

PubMed

Loprinzi, Paul D; Walker, Jerome F; Lee, Hyo

2014-01-01

Chronic obstructive pulmonary disease (COPD) may cause not only inflammation in the lungs but also systemic effects. One potential strategy to reduce systemic inflammation and attenuate disease progression is physical activity (PA). However, no nationally representative studies, to our knowledge, have examined the association between objectively measured physical activity and inflammation among those with COPD. Cross-sectional. National Health and Nutrition Examination Survey 2003-2006. Two hundred thirty-eight former or current smokers with self-reported COPD who had complete data on study variables. Participants wore an accelerometer for ≥4 days to assess light-intensity PA (LPA), moderate-to-vigorous PA (MVPA), and total physical activity (TPA); completed questionnaires to assess self-reported COPD and smoking status; and had their blood taken to assess white blood cell (WBC) and neutrophil levels. Multivariable linear regression analysis was used. LPA (β = -.0004), MVPA (β = -.04), and TPA (β = -.0004) were significantly inversely associated with WBC level. Similarly, LPA (β = -.001) and TPA (β = -.001) were significantly inversely associated with neutrophils; however, MVPA was marginally associated with neutrophils (β = -.05; p =.06). These analyses demonstrate an inverse association between objectively measured PA and inflammation among current or former smokers with COPD. If these findings are confirmed elsewhere, then PA among those with COPD may serve as an anti-inflammatory strategy to possibly decrease cardiovascular and metabolic disease occurrence.

High-quality chronic care delivery improves experiences of chronically ill patients receiving care

PubMed Central

Cramm, Jane Murray; Nieboer, Anna Petra

2013-01-01

Objective Investigate whether high-quality chronic care delivery improved the experiences of patients. Design This study had a longitudinal design. Setting and Participants We surveyed professionals and patients in 17 disease management programs targeting patients with cardiovascular diseases, chronic obstructive pulmonary disease, heart failure, stroke, comorbidity and eating disorders. Main Outcome Measures Patients completed questionnaires including the Patient Assessment of Chronic Illness Care (PACIC) [T1 (2010), 2637/4576 (58%); T2 (2011), 2314/4330 (53%)]. Professionals' Assessment of Chronic Illness Care (ACIC) scores [T1, 150/274 (55%); T2, 225/325 (68%)] were used as a context variable for care delivery. We used two-tailed, paired t-tests to investigate improvements in chronic illness care quality and patients' experiences with chronic care delivery. We employed multilevel analyses to investigate the predictive role of chronic care delivery quality in improving patients' experiences with care delivery. Results Overall, care quality and patients' experiences with chronic illness care delivery significantly improved. PACIC scores improved significantly from 2.89 at T1 to 2.96 at T2 and ACIC-S scores improved significantly from 6.83 at T1 to 7.18 at T2. After adjusting for patients' experiences with care delivery at T1, age, educational level, marital status, gender and mental and physical quality of life, analyses showed that the quality of chronic care delivery at T1 (P < 0.001) and changes in care delivery quality (P < 0.001) predicted patients' experiences with chronic care delivery at T2. Conclusion This research showed that care quality and changes therein predict more positive experiences of patients with various chronic conditions over time. PMID:24123243

Quality of life and depression in a cohort of female patients with chronic disease.

PubMed

Cardin, Fabrizio; Ambrosio, Francesco; Amodio, Piero; Minazzato, Lina; Bombonato, Giancarlo; Schiff, Sami; Finotti, Katiuscia; Giuliani, Daria; Bianco, Tonino; Terranova, Claudio; Militello, Carmelo; Ori, Carlo

2012-01-01

Differences in health-related quality of life perception in patients with chronic disease may depend on pre-existing differences in personality profile. The purpose of the study was to investigate in a cohort of female patients with chronic diseases the relationship between the Quality of Life perception and the potential presence of depressive symptoms. Female patients with chronic diseases were enrolled in the study. Exclusion criteria were diagnosis of psychopathological condition, treatment with psychoactive substances.Methodological approach was based on administration of the following test. Short Form health survey SF-36, Symptom Check List SCL-90-R, Satisfaction Profile test (SAT-P) and Beck Depression Inventory-II (BDI-II). The Pearson correlation coefficient was used to evaluate the relationship between depressive symptoms and Quality of life as assessed by psychometric test. 57 patients, aged 52(± 3,4), responded to inclusion criteria. 57% of patients had a diagnosis of functional dyspepsia or gastro-oesophageal reflux not complicated, and the remaining 43% musculoskeletal diseases. The statistical analysis showed an inverse correlation between the variable Bodily Pain of the SF-36 and the variable Depression scales of the SCL-90-R.In a second phase another sample of female patients was enrolled in the study. 64 patients, aged 49(± 3,2), responded to inclusion criteria.Another significant negative correlation was found between the Somatic-Affective factor of the BDI-II and the scale Physical Functioning of the SAT-P. In female patients with chronic disease depressive symptoms resulted influenced by pain and vice versa. The treatment of depressive symptoms could improve the quality of life of patients.

Impact of CPAP on physical exercise tolerance and sympathetic-vagal balance in patients with chronic heart failure.

PubMed

Reis, Hugo V; Borghi-Silva, Audrey; Catai, Aparecida M; Reis, Michel S

2014-01-01

Chronic heart failure (CHF) leads to exercise intolerance. However, non-invasive ventilation is able to improve functional capacity of patients with CHF. The aim of this study was to evaluate the effectiveness of continuous positive airway pressure (CPAP) on physical exercise tolerance and heart rate variability (HRV) in patients with CHF. Method : Seven men with CHF (62 ± 8 years) and left ventricle ejection fraction of 41 ± 8% were submitted to an incremental symptom-limited exercise test (IT) on the cicloergometer. On separate days, patients were randomized to perform four constant work rate exercise tests to maximal tolerance with and without CPAP (5 cmH2O) in the following conditions: i) at 50% of peak work rate of IT; and ii) at 75% of peak work rate of IT. At rest and during these conditions, instantaneous heart rate (HR) was recorded using a cardiofrequencimeter and HRV was analyzed in time domain (SDNN and RMSSD indexes). For statistical procedures, Wilcoxon test or Kruskall-Wallis test with Dunn's post-hoc were used accordingly. In addition, categorical variables were analysed through Fischer's test (p<0.05). There were significant improvements in exercise tolerance at 75% of peak work rate of IT with CPAP (405 ± 52 vs. 438 ± 58 s). RMSSD indexes were lower during exercise tests compared to CPAP at rest and with 50% of peak work rate of IT. These data suggest that CPAP appears to be a useful strategy to improve functional capacity in patients with CHF. However, the positive impact of CPAP did not generate significant changes in the HRV during physical exercises.

Self-Report of Aerobic Activity among Older African Americans with Multiple Chronic Conditions.

PubMed

McCaskill, Gina M; Bolland, Kathleen A; Brown, Cynthia J; Mark Beasley, T

2018-02-23

Physical inactivity among older adults around the world is a growing concern. In the United States, older African Americans report high levels of physical inactivity, especially older African Americans with chronic conditions. This study examined the influence of chronic conditions on aerobic activity among a sample of community-dwelling, older African Americans with a self-reported diagnosis of type 2 diabetes and other chronic conditions, such as hypertension and arthritis. Findings indicate that regardless of age, the number of chronic conditions was a significant influence in self-report of aerobic activity. Successful self-management of type 2 diabetes and other chronic conditions may promote physical activity among sedentary older African Americans with multiple chronic conditions. Furthermore, research that considers a life course epidemiological approach are needed to enhance our understanding about the cumulative effects of MCC on physical activity among sedentary, older African Americans with MCC.

Treatment Expectation for Pain Coping Skills Training: Relationship to Osteoarthritis Patients' Baseline Psychosocial Characteristics

PubMed Central

Broderick, Joan E.; Junghaenel, Doerte U.; Schneider, Stefan; Bruckenthal, Patricia; Keefe, Francis J.

2010-01-01

Objectives This study examined predictors of treatment expectation among osteoarthritis (OA) patients in a multi-site clinical trial of pain coping strategies training (CST). Methods Patients (N=171) completed a pre-treatment assessment battery that asked questions about treatment expectations, pain coping variables, pain, physical function, psychological distress, quality of life, and depression as well as background demographic and medical variables. Results Regression analyses indicated that several variables accounted for 21% of the variance in treatment expectations (p < .0001). Patients who were classified as adaptive copers, reported higher self efficacy and social interaction, had higher quality of life, and who had lower levels of affective distress and depression had more positive expectations about engaging in pain coping skills training. Variables that were not associated with treatment expectation were level of pain and physical dysfunction, duration of disease, and disability status as well as demographic variables. Discussion Thus, while many OA patients will approach pain coping skills training with positive expectations, others have lower expectations. This study suggests that a multidimensional assessment of OA patients with chronic pain can identify those who have higher expectations versus lower expectations. The results suggest that patients who are psychologically distressed are less optimistic about engaging in treatment and that these patients, in particular, may benefit from and need pre-treatment motivational interviewing to enhance their uptake of pain coping skills PMID:21178591

Return to Play After Infectious Mononucleosis

PubMed Central

Becker, Jonathan A.; Smith, Julie Anne

2014-01-01

Context: Infectious mononucleosis is a disease primarily of adolescence and early adulthood. The risk of splenic injury and chronic fatigue make return-to-play decisions a challenge for the clinician caring for athletes with infectious mononucleosis. Evidence Acquisition: Data were obtained from the PubMed and MEDLINE databases through December 2012 by searching for epidemiology, diagnosis, clinical manifestations, management, and the role of the spleen in infectious mononucleosis. Study Design: Clinical review. Level of Evidence: Level 4. Results: Infectious mononucleosis is commonly encountered in young athletes. Its disease pattern is variable and can affect multiple organ systems. Supportive care is the cornerstone, with little role for medications such as corticosteroids. Physical examination is unreliable for the spleen, and ultrasound imaging has limitations in its ability to guide return-to-play decisions. Exercise does not appear to place the young athlete at risk for chronic fatigue, but determining who is at risk for persistent symptoms is a challenge. Conclusion: Return-to-play decisions for the athlete with infectious mononucleosis need to be individualized because of the variable disease course and lack of evidence-based guidelines. PMID:24790693

Heart rate variability indexes as a marker of chronic adaptation in athletes: a systematic review.

PubMed

da Silva, Vanessa Pereira; de Oliveira, Natacha Alves; Silveira, Heitor; Mello, Roger Gomes Tavares; Deslandes, Andrea Camaz

2015-03-01

Regular exercise promotes functional and structural changes in the central and peripheral mechanisms of the cardiovascular system. Heart rate variability (HRV) measurement provides a sensitive indicator of the autonomic balance. However, because of the diversity of methods and variables used, the results are difficult to compare in the sports sciences. Since the protocol (supine, sitting, or standing position) and measure (time or frequency domain) are not well defined, the aim of this study is to investigate the HRV measures that better indicates the chronic adaptations of physical exercise in athletes. PubMed (MEDLINE), Web of Science, SciELO (Scientific Electronic Library), and Scopus databases were consulted. Original complete articles in English with short-term signals evaluating young and adult athletes, between 17 and 40 years old, with a control group, published up to 2013 were included. Selected 19 of 1369 studies, for a total sample pool of 333 male and female athletes who practice different sports. The main protocols observed were the supine or standing positions in free or controlled breathing conditions. The main statistical results found in this study were the higher mean RR, standard deviation of RR intervals, and high frequency in athletes group. In addition, the analyses of Cohen's effect size showed that factors as modality of sport, protocol used and unit of measure selected could influence this expected results. Our findings indicate that time domain measures are more consistent than frequency domain to describe the chronic cardiovascular autonomic adaptations in athletes. © 2014 Wiley Periodicals, Inc.

Impact of pain characteristics and fear-avoidance beliefs on physical activity levels among older adults with chronic pain: a population-based, longitudinal study.

PubMed

Larsson, Caroline; Ekvall Hansson, Eva; Sundquist, Kristina; Jakobsson, Ulf

2016-02-24

To explore the level of physical activity in a population based sample of older adults; to analyze the influence of pain characteristics and fear-avoidance beliefs as predictors of physical activity among older adults reporting chronic pain. Demographics, pain characteristics (duration, intensity), physical activity, kinesiophobia (excessive fear of movement/(re) injury), self-efficacy and self-rated health were measured with questionnaires at baseline and 12-months later. Logistic regression analyses were done to identify associations at baseline and predictors of physical activity 12-months later during follow-up. Of the 1141 older adults (mean age 74.4 range 65-103 years, 53.5% women) included in the study, 31.1% of those with chronic pain were sufficiently active (scoring ≥ 4 on Grimby's physical activity scale) compared to 56.9% of those without chronic pain. Lower age (OR = 0.93, 95% CI = 0.88-0.99), low kinesiophobia OR = 0.95, 95% CI = 0.91-0.99), and higher activity level at baseline (OR = 10.0, 95% CI = 4.98-20.67) significantly predicted higher levels of physical activity in individuals with chronic pain. The level of physical activity was significantly lower among those with chronic pain and was significantly associated with kinesiophobia. Our findings suggest that fear- avoidance believes plays a more important role in predicting future physical activity levels than pain characteristics. Thus our findings are important to consider when aiming to increase physical activity in older adults that have chronic pain.

Rate and Predictors of Persistent Major Depressive Disorder in a Nationally Representative Sample.

PubMed

Walker, Elizabeth Reisinger; Druss, Benjamin G

2015-08-01

This study examined predictors of persistent major depressive disorder over 10 years, focusing on the effects of clinical variables, physical health, and social support. Data from the National Survey of Midlife Development in the United States in 1995-1996 and 2004-2006 were analyzed. Logistic regression was used to predict non-recovery from major depression among individuals who met clinical-based criteria for major depressive disorder at baseline. Fifteen percent of the total sample was classified as having major depression in 1995-1996; of these individuals, 37 % had major depression in 2004-2006. Baseline variables that were significantly associated with persistent major depression at follow-up were being female, having never married, having two or more chronic medical conditions, experiencing activity limitation, and less contact with family. Therefore, treatment strategies focused on physical health, social support, and mental health needs are necessary to comprehensively address the factors that contribute to persistent major depressive disorder.

Association Between Chronic Conditions and Physical Function Among Veteran and Non-Veteran Women With Diabetes

PubMed Central

Gray, Kristen E.; Katon, Jodie G.; Rillamas-Sun, Eileen; Bastian, Lori A.; Nelson, Karin M.; LaCroix, Andrea Z.; Reiber, Gayle E.

2016-01-01

Abstract Purpose of the Study: To compare the number of chronic conditions among a list of 12 and their association with physical function among postmenopausal non-Veteran and Veteran women with diabetes. Design and Methods: Among women with diabetes from the Women’s Health Initiative, we compared the average number of chronic conditions between non-Veterans and Veterans and the association between total number of chronic conditions on subsequent RAND-36 physical function. To examine associations between each condition and subsequent physical function, we compared women with diabetes plus one chronic condition to women with diabetes alone using linear regression in separate models for each condition and for non-Veterans and Veterans. Results: Both non-Veterans ( N = 23,542) and Veterans ( N = 618) with diabetes had a median of 3 chronic conditions. Decreases in physical function for each additional condition were larger among Veterans than non-Veterans (−6.3 vs. −4.1 points). Decreases in physical function among women with diabetes plus one chronic condition were greater than that reported for diabetes alone for all combinations and were more pronounced among Veterans (non-Veterans: −11.1 to −24.2, Veterans: −16.6 to −40.4 points). Hip fracture, peripheral artery disease, cerebrovascular disease, and coronary disease in combination with diabetes were associated with the greatest decreases in physical function. Implications: Chronic conditions were common among postmenopausal women with diabetes and were associated with large declines in physical function, particularly among Veterans. Interventions to prevent and reduce the impact of these conditions and facilitate coordination of care among women with diabetes may help them maintain physical function. PMID:26768385

Religiosity of depressed elderly inpatients.

PubMed

Payman, Vahid; George, Kuruvilla; Ryburn, Bridget

2008-01-01

To determine the prevalence of religious practices and beliefs of depressed elderly Australian inpatients and their relationship to physical, social, and cognitive variables known to influence the prognosis of depression in the elderly. To compare the results obtained with those from similar North American studies. Inpatients with a DSM-IV diagnosis of major depression were interviewed on admission to the psychogeriatric unit of a Melbourne geriatric centre. Information collected included patient demographics, intrinsic and extrinsic religiosity, cognitive function, severity of depression, number of chronic illnesses, physical function, and numbers and quality of social support. Pearson correlation and multivariate analysis using a standard regression model were used to examine relationships between the religious and other variables. Of the 86 patients who completed the assessment, 25% attended church regularly and 37% prayed, meditated, or read the Bible, at least once a day. Just over half rarely or never engaged in such behaviours. Three out of every eight patients were 'intrinsically' religious. Religious patients expressed higher levels of social support and physically disabled patients were more likely to be religious. Depressed elderly Australian inpatients are less religious than their North American counterparts. Nevertheless, religion remains important for a large minority of such individuals. Clinicians need to be aware that such individuals may turn to religion when depressed, especially to cope with the presence of physical disability.

The context of aggressive behavior in marriage: a longitudinal study of newlyweds.

PubMed

Frye, Nancy E; Karney, Benjamin R

2006-03-01

Under what circumstances are spouses more or less likely to engage in aggressive behaviors? To address this question, the current study drew on multiple longitudinal assessments of 1st-married newlyweds to examine correlates of within-subject variability in aggressive behavior. Controlling for marital satisfaction, the authors found that spouses were more likely to engage in physical aggression at times when they engaged in higher levels of psychological aggression. Additionally, husbands reporting higher levels of chronic stress were more likely to engage in physical aggression overall and were more likely to engage in physical aggression when they were experiencing higher than average levels of acute stress. These results highlight how demands and supports in the context external to a marriage may affect processes within the marriage. Copyright 2006 APA, all rights reserved.

Improving Exercise Adherence and Physical Measures in English-Speaking Latina Women.

PubMed

Martin, Lorena; Signorile, Joseph F; Kahn, Barbara E; Perkins, Andrew W; Ahn, Soyeon; Perry, Arlette C

2015-12-01

Epidemiological data have established that lack of physical activity increases risk factors for chronic diseases. Data also suggests that physical activity participation is lowest in minority women, particularly Latinas, and that the nature of the exercise and attitudes toward exercise may influence exercise adherence. The purpose of this study was to determine the effect of hypertrophy training (HT) or power training (PT) used concomitantly with evaluative conditioning (EC) or neutral conditioning (NC) on exercise adherence as well as in physical and psychosocial variables in Latina women. EC is a behavioral method using paired stimuli to develop and strengthen new associations in memory. Two hundred thirty-one English-speaking Latina women (mean ± SD, age 36.8 ± 15.9 years) were randomly assigned to standard HT or high-speed circuit PT and then further stratified to receive EC or NC. One hundred forty-two Latina women completed pre- and posttesting. For HT, EC produced significantly greater exercise time across the training period than NC. HT and PT both significantly improved all physical, functional, and psychosocial variables, with exception of leg extension and usual gait speed (p < 0.05). EC can positively impact exercise adherence during HT in Latina women; while body composition, neuromuscular, and functional performances can be increased using HT and PT independent of psychological conditioning.

[Results of a physical therapy program in nursing home residents: A randomized clinical trial].

PubMed

Casilda-López, Jesús; Torres-Sánchez, Irene; Garzón-Moreno, Victor Manuel; Cabrera-Martos, Irene; Valenza, Marie Carmen

2015-01-01

The maintenance of the physical functionality is a key factor in the care of the elderly. Inactive people have a higher risk of death due to diseases associated with inactivity. In addition, the maintenance of optimal levels of physical and mental activity has been suggested as a protective factor against the development and progression of chronic illnesses and disability. The objective of this study is to assess the effectiveness of an 8-week exercise program with elastic bands, on exercise capacity, walking and balance in nursing home residents. A nursing home sample was divided into two groups, intervention group (n=26) and control group (n=25). The intervention group was included in an 8-week physical activity program using elastic bands, twice a week, while the control group was took part in a walking programme. Outcome measurements were descriptive variables (anthropometric characteristics, quality of life, fatigue, fear of movement) and fundamental variables (exercise capacity, walking and balance). A significant improvement in balance and walking speed was observed after the programme. Additionally, exercise capacity improved significantly (P≤.001), and the patients showed an improvement in perceived dyspnea after the physical activity programme in the intervention group. The exercise program was safe and effective in improving dyspnea, exercise capacity, walking, and balance in elderly. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

The relationship between health literacy and quality of life among frequent users of health care services: a cross-sectional study.

PubMed

Couture, Éva Marjorie; Chouinard, Maud-Christine; Fortin, Martin; Hudon, Catherine

2017-07-06

Although health literacy and quality of life are important concepts in health care, the link between them is unclear, especially for a population of frequent users of health care services with chronic diseases. Low health literacy is a common problem that has been linked to several negative health outcomes. Quality of life is an important health outcome in patient-centered care. Frequent users of health care services are a vulnerable population that deserves attention due to high costs and negative outcomes such as lower quality of life and higher mortality. The objective of this study was to examine the relationship between health literacy and the physical and mental components of quality of life among frequent users of health care services with chronic diseases. This study presents the cross-sectional analysis of data collected through the V1SAGES project, a randomized controlled trial on the effectiveness of a case management intervention in primary care in Quebec, Canada. Participants (n = 247) were frequent users of health care services presenting at least one chronic condition. Health literacy was measured by the Newest Vital Sign (NVS), and the physical and mental components of quality of life were evaluated by the Short Form Health Survey Version 2 (SF-12v2). The association between health literacy (independent variable) and the physical and mental components of quality of life was examined using biserial correlation. No association was found between health literacy and quality of life (physical component: r = 0.108, ρ = 0.11; mental component: r = 0.147, ρ = 0.15). This study suggests that there is no relationship between health literacy and the physical and mental components of quality of life among frequent users of health care services. NCT01719991 . Registered October 25, 2012.

Applying the Chronic Care Model to Support Ostomy Self-Management: Implications for Oncology Nursing Practice.

PubMed

Ercolano, Elizabeth; Grant, Marcia; McCorkle, Ruth; Tallman, Nancy J; Cobb, Martha D; Wendel, Christopher; Krouse, Robert

2016-06-01

Living with an ostomy requires daily site and equipment care, lifestyle changes, emotional management, and social role adjustments. The Chronic Care Ostomy Self-Management Training Program (CCOSMTP) offers an ostomy self-management curriculum, emphasizing problem solving, self-efficacy, cognitive reframing, and goal setting. The qualitative method of content analysis was employed to categorize self-reported goals of ostomates identified during a nurse-led feasibility trial testing the CCOSMTP. Thirty-eight ostomates identified goals at three CCOSMTP sessions. The goals were classified according to the City of Hope Health-Related Qualify of Life Model, a validated multidimensional framework, describing physical, psychological, social, and spiritual ostomy-related effects. Nurse experts coded the goals independently and then collaborated to reach 100% consensus on the goals' classification. A total of 118 goals were identified by 38 participants. Eighty-seven goals were physical, related to the care of the skin, placement of the pouch or bag, and management of leaks; 26 were social goals, which addressed engagement in social or recreational roles and daily activities; and 5 were psychological goals, which were related to confidence and controlling negative thinking. Although the goals of survivors of cancer with an ostomy are variable, physical goals are most common in self-management training.

[Functional restoration--it depends on an adequate mixture of treatment].

PubMed

Pfingsten, M

2001-12-01

In the last 50 years conventional treatments have not been able to slow down the expanding chronic low back pain problem. However, nowadays health care has changed according to a broad biopsychosocial model of health, the positive effect of activity on health and healing, emphasis on function rather than pain or impairment, and reliance upon clinical evidence. In search for new solutions "functional restoration" (FR) programs have been developed. They include multidisciplinary treatment of patients in groups, consisting of 6-8 h of treatment a day, lasting 3 to 6 weeks and usually integrating intense physical and ergonomic training, psychological (behavioral) therapy, patient education, and instruction in social- and work-related issues. FR programs have yet to demonstrate their effectiveness in several countries. Controlled studies in the USA were very positive regarding the return-to-work rate, whereas studies in Scandinavian countries did not demonstrate similar results. Possible reasons for the different results concerning back-to-work ratios might be that study design, patient population, content of the program, and other external factors are different and studies as well as effects are therefore not directly comparable. According to several well-controlled studies, the most probable reason for this different effect may be that social and security (health care) systems and cultures differ among countries and that patients with chronic low back pain respond differently to this combination. Sick absenteeism and inability to work may be influenced by many factors besides pain that cannot be addressed by intervention or prevention programs, e.g., job satisfaction, education level, and the compensation systems. It may be that the lower economic benefit during sick leave in the United States leads to favorable results from functional restoration programs. Concerning the prediction of success, several studies have shown that medical background, diagnosis and physical impairment as well as physical variables (mobility, strength) have limited predictive value. Return to work and pain reduction are much better predicted by length of absence from work, application for pension, and the patients' disability in daily-life activities. In the last five years another important variable of success has been identified: avoidance behavior has been suspected to be a major contributor to the initiation and maintenance of chronic low back pain. The perpetuation of avoidance behavior beyond normal healing time subsequently leads to negative consequences such as "disuse syndrome", which is associated with physical deconditioning, sick role behavior, psychosocial withdrawal and negative affect. Accordingly, fear-avoidance beliefs were strongly related to absenteeism from work due to back pain and were the best predictors of therapy outcome in 300 acute low back pain patients. In a prospective study on 87 patients with chronic low back pain (CLBP) we demonstrated that fear-avoidance beliefs were the strongest predictors of return to work after a functional restoration treatment program. Although nonspecific mechanisms such as emotional disturbance, helplessness, pain anticipation, disability, and job circumstances could be identified as influencing the chronic pain process, we have to remember that long-lasting experience of pain is usually a very individual process in which several conditions may work together in a unique combination. Treatment procedures must consider this variability by focusing on general mechanisms, as well as on individual conditions and deficits. FR treatment strongly depends on behavioral principles that rule the whole therapeutic process: Adequate information is necessary to overcome unhelpful beliefs; information has to be related to the patients' daily experiences and their mental capability to understand them. Pacing, goal-setting, graded exposure with exercise quotas and permanent feedback as well as contingent motivation characterize the training procedures. Training procedures must incorporate the patients' daily activities early on. The patients' efficacy expectations are the most potent determinants of change in the training process. Exacerbation of pain is not taken as a failure of the therapeutic concept, but as a challenge to self-management. However, the important principle in managing chronic low back pain is "treating patients rather than spines."

Can chronic multimorbidity explain the age-related differences in strength, speed and balance in older adults?

PubMed

Welmer, Anna-Karin; Kåreholt, Ingemar; Angleman, Sara; Rydwik, Elisabeth; Fratiglioni, Laura

2012-10-01

It is known that physical performance declines with age in general, however there remains much to be understood in terms of age-related differences amongst older adults across a variety of physical components (such as speed, strength and balance), and particularly in terms of the role played by multimorbidity of chronic diseases. We aimed to detect the age-related differences across four components of physical performance and to explore to what extent chronic diseases and multimorbidity may explain such differences. We analyzed cross-sectional data from a population-based sample of 3323 people, aged 60 years and older from the SNAC-K study, Stockholm, Sweden. Physical performance was assessed by trained nurses using several tests (grip strength, walking speed, balance and chair stands). Clinical diagnoses were made by the examining physician based on clinical history and examination. Censored normal regression analyses showed that the 72-90+ year-old persons had 17-40% worse grip strength, 44-86% worse balance, 30-86% worse chair stand score, and 21-59% worse walking speed, compared with the 60-66 year-old persons. Chronic diseases were strongly associated with physical impairment, and this association was particularly strong among the younger men. However, chronic diseases explained only some of the age-related differences in physical performance. When controlling for chronic diseases in the analyses, the age-related differences in physical performance changed 1-11%. In spite of the strong association between multimorbidity and physical impairment, chronic morbidities explained only a small part of the age-related differences in physical performance.

Comparison of the CBA-H and SF-36 for the screening of the psychological and behavioural variables in chronic dialysis patients.

PubMed

De Pasquale, Concetta; Conti, Daniela; Pistorio, Maria Luisa; Fatuzzo, Pasquale; Veroux, Massimiliano; Di Nuovo, Santo

2017-01-01

The aim of the study was to perform an analysis of the emotional reactions, perception of stressful life and behavioural changes related to Haemodialysis (HD) in order to identify those variables that can improve lifestyle and the adherence to treatment. Some psychometric assessment, such as the Cognitive Behavioural Assessment, Hospital Form, (CBA-H) and the Health Survey (SF-36), which provides two indexes: the Physical Component Score (PCS) and the Mental Component Score (MCS), are suitable to assess a patient's psychological and behavioural style and their health-related quality of life. The study involved 37 Italian out-patients with end-stage renal disease under HD therapy. We calculated the Spearman correlation between variables of CBA-H, SF-36, age and time on HD. We also performed a multivariate linear regression using the CBA-H variables as predictors and PCS and MCS as dependent variables. From the CBA-H, 95% of participants self-reported psychological characteristics comparable to Type A personality, which identifies an anxious, hyperactive and hostile subject. Physical limitations were found to be directly proportional to the time on dialysis (rs = -0.42). The condition of perceived stress worsens the state of mental health (rs = -0.68) and general health perception (rs = -0.44). The condition of vital exhaustion correlates both the PCS and the MCS (p<0.01) with possible outcomes of physical and mental illness. The psychological wellbeing of a dialyzed patient could be due to the combination of several factors, including life parameters, the positive perception of psychosocial outcomes, and the perceived quality of life. A multidisciplinary team (neurologists, psychiatrists, psychologists, and nurses) is essential to plan effective psychological and psychotherapeutic interventions to improve a mind-body integration.

Suicide and self-injury among children and youth with chronic health conditions.

PubMed

Barnes, Andrew J; Eisenberg, Marla E; Resnick, Michael D

2010-05-01

Chronic conditions may be associated with suicide risk. This study aimed to specify the extent to which youth chronic conditions are at risk for suicidality and self-harm. Logistic regression was used to estimate odds of self-harm, suicidal ideation, and suicide attempts in 10- to 19-year-olds with and without chronic physical and/or mental health conditions. Independent of race, socioeconomic status, absent parent, special education status, substance use, and emotional distress, youth with co-occurring chronic physical and mental conditions (n = 4099) had significantly higher odds of self-harm (odds ratio [OR]: 2.5 [99% confidence interval (CI): 2.3-2.8), suicidal ideation (OR: 2.5 [99% CI: 2.3-2.8), and suicide attempts (OR: 3.5 [99% CI: 3.1-3.9]) than healthy peers (n = 106,967), as did those with chronic mental conditions alone (n = 8752). Youth with chronic physical conditions alone (n = 12,554) were at slightly elevated risk for all 3 outcomes. Findings were similar among male and female youth, with a risk gradient by grade. Chronic physical conditions are associated with a slightly elevated risk for self-harm, suicidal thinking, and attempted suicide; chronic mental conditions are associated with an increased risk for all 3 outcomes. Co-occurring chronic physical and mental conditions are associated with an increased risk for self-harm and suicidal ideation that is similar to the risk in chronic mental conditions and with an attempted suicide risk in excess of that predicted by the chronic mental health conditions alone. Preventive interventions for these youth should be developed and evaluated.

Chronic health conditions and work ability in the ageing workforce: the impact of work conditions, psychosocial factors and perceived health.

PubMed

Koolhaas, Wendy; van der Klink, Jac J L; de Boer, Michiel R; Groothoff, Johan W; Brouwer, Sandra

2014-05-01

The aim of this study was to determine the influence of work conditions, psychosocial factors and perceived health on the association between the presence of a chronic health condition and (single-item) work ability among workers aged 45 years and older. In addition, we aimed to examine variables associated with work ability for workers with and without a chronic health condition separately. The data of this cross-sectional study were obtained from 5,247 workers aged 45 years and older in five different work sectors. Work ability was assessed with the first item of the Work Ability Index. The presence of a chronic health condition was assessed by self-report. Independent variables in the multivariable linear regression analysis were work conditions, psychosocial factors and perceived health status. The presence of a chronic health condition was negatively associated with work ability (B = -0.848). The strength of this association slightly attenuated after subsequently adding individual characteristics (B = -0.824), work conditions (B = -0.805) and more so after adding psychosocial factors (B = -0.704) and especially perceived health variables (B = -0.049) to the model. Variables associated with work ability for workers with and without a chronic health condition were similar. Perceived health and psychosocial factors, rather than work conditions, explained the association between the presence of a chronic health condition and work ability. Substantial differences in variables associated with work ability for workers with and without a chronic health condition were not found. Based on the lower mean scores for workers with a chronic health condition and work ability as well for predictors, these workers might have the most benefit by a policy focussing on enhancing these associated variables.

Social Disruption Mediates the Relationship Between Perceived Injustice and Anger in Chronic Pain: a Collaborative Health Outcomes Information Registry Study.

PubMed

Sturgeon, John A; Carriere, Junie S; Kao, Ming-Chih J; Rico, Thomas; Darnall, Beth D; Mackey, Sean C

2016-12-01

Perceptions of pain as unfair are a significant risk factor for poorer physical and psychological outcomes in acute injury and chronic pain. Chief among the negative emotions associated with perceived injustice is anger, arising through frustration of personal goals and unmet expectations regarding others' behavior. However, despite a theoretical connection with anger, the social mediators of perceived injustice have not been demonstrated in chronic pain. The current study examined two socially based variables and a broader measure of pain interference as mediators of the relationships between perceived injustice and both anger and pain intensity in a sample of 302 patients in a tertiary care pain clinic setting. Data from the Collaborative Health Outcomes Information Registry (CHOIR) were analyzed using cross-sectional path modeling analyses to examine social isolation, satisfaction with social roles and activities, and pain-related interference as potential mediators of the relationships between perceived injustice and both anger and pain intensity. When modeled simultaneously, ratings of social isolation mediated the relationship between perceived injustice and anger, while pain-related interference and social satisfaction did not. Neither social variable was found to mediate the relationship between perceived injustice and pain intensity, however. The current findings highlight the strongly interpersonal nature of perceived injustice and anger in chronic pain, though these effects do not appear to extend to the intensity of pain itself. Nevertheless, the results highlight the need for interventions that ameliorate both maladaptive cognitive appraisal of pain and pain-related disruptions in social relationships.

Understanding the direction of the relationship between white matter hyperintensities of vascular origin, sleep quality, and chronic kidney disease-Results from the Atahualpa Project.

PubMed

Del Brutto, Oscar H; Mera, Robertino M

2018-02-01

The burden of cerebral small vessel disease, sleep disorders, and chronic kidney disease is on the rise in remote rural settings. However, information on potential links between these conditions is limited. We aimed to assess the relationships between these conditions in community-dwelling older adults living in rural Ecuador. Atahualpa residents aged ≥60 years were offered a brain MRI. A venous blood sample was obtained for serum creatinine determination. Baseline interviews and procedures were directed to assess demographics, cardiovascular risk factors, and sleep quality. Using generalized structural equation modeling (GSEM), we assessed the associations between white matter hyperintensities (WMH) of vascular origin, sleep quality and kidney function, as well as the directions of the relationships between these variables. Of 423 candidates, 314 (74%) were enrolled. Moderate-to-severe WMH were noticed in 74 (24%) individuals, poor sleep quality in 101 (31%), and moderate-to-severe chronic kidney disease in 28 (9%). GSEM showed that the direction of the effect was from kidney function to WMH and from the latter to sleep quality. Of independent variables investigated, worse kidney function was associated with age, high glucose levels and male sex. WMH was associated with cholesterol blood levels, blood pressure, level of education and severe edentulism. Poor sleep quality was associated with poor physical activity. This population based study shows that chronic kidney disease is associated with increased severity of WMH, which, in turn, is associated with a poor sleep quality. Copyright © 2017 Elsevier B.V. All rights reserved.

Anaesthetic injection versus ischemic compression for the pain relief of abdominal wall trigger points in women with chronic pelvic pain.

PubMed

Montenegro, Mary L L S; Braz, Carolina A; Rosa-e-Silva, Julio C; Candido-dos-Reis, Francisco J; Nogueira, Antonio A; Poli-Neto, Omero B

2015-12-01

Chronic pelvic pain is a common condition among women, and 10 to 30 % of causes originate from the abdominal wall, and are associated with trigger points. Although little is known about their pathophysiology, variable methods have been practiced clinically. The purpose of this study was to evaluate the efficacy of local anaesthetic injections versus ischemic compression via physical therapy for pain relief of abdominal wall trigger points in women with chronic pelvic pain. We conducted a parallel group randomized trial including 30 women with chronic pelvic pain with abdominal wall trigger points. Subjects were randomly assigned to one of two intervention groups. One group received an injection of 2 mL 0.5 % lidocaine without a vasoconstrictor into a trigger point. In the other group, ischemic compression via physical therapy was administered at the trigger points three times, with each session lasting for 60 s, and a rest period of 30 s between applications. Both treatments were administered during one weekly session for four weeks. Our primary outcomes were satisfactory clinical response rates and percentages of pain relief. Our secondary outcomes are pain threshold and tolerance at the trigger points. All subjects were evaluated at baseline and 1, 4, and 12 weeks after the interventions. The study was conducted at a tertiary hospital that was associated with a university providing assistance predominantly to working class women who were treated by the public health system. Clinical response rates and pain relief were significantly better at 1, 4, and 12 weeks for those receiving local anaesthetic injections than ischemic compression via physical therapy. The pain relief of women treated with local anaesthetic injections progressively improved at 1, 4, and 12 weeks after intervention. In contrast, women treated with ischemic compression did not show considerable changes in pain relief after intervention. In the local anaesthetic injection group, pain threshold and tolerance improved with time in the absence of significant differences between groups. Lidocaine injection seems to be better for reducing the severity of chronic pelvic pain secondary to abdominal wall trigger points compared to ischemic compression via physical therapy. ClinicalTrials.gov NCT00628355. Date of registration: February 25, 2008.

Dual burden of chronic physical diseases and anxiety/mood disorders among São Paulo Megacity Mental Health Survey Sample, Brazil.

PubMed

Askari, Melanie S; Andrade, Laura Helena; Filho, Alexandre Chiavegatto; Silveira, Camila Magalhães; Siu, Erica; Wang, Yuan-Pang; Viana, Maria Carmen; Martins, Silvia S

2017-10-01

We assessed comorbid associations of 12-month DSM-IV mood/any anxiety disorders with chronic physical conditions within the São Paulo (SP) Megacity Mental Health cross-sectional survey of 5037 participants and explored whether strength of comorbid associations were modified when controlling for demographics. Chi-square tests and logistic regressions were used to examine comorbid associations of DSM-IV mood/anxiety disorders as measured by the WHO Composite International Diagnostic Interview (CIDI 3.0), and self-reported chronic physical conditions among adults from the SP Megacity Mental Health Survey. Among those with any mood or anxiety disorder, chronic pain disorder was the most common physical condition (48.9% and 44.9%, respectively). Significant unadjusted odds ratios (OR) of comorbidity were found between diagnosis of two or more physical conditions and any mood disorders (3.08, 95% CI: 2.27-4.17), and any anxiety disorders (2.49, 95% CI: 1.95-3.17). Comorbidities remained significant when stratified by gender and controlling for marital status, household income, and education (latter two only included within anxiety models). These results cannot be generalized to other cities or rural populations. Homeless and institutionalized populations were not surveyed. Due to cross-sectional study design, the direction of association between chronic disease/chronic disease risk factors and mood disorders is unclear. Dual burden of chronic physical conditions and mood/anxiety disorders is a notable problem among the São Paulo Megacity Survey population, with enhanced comorbidity experienced by community members with multiple physical conditions. Clinicians should consider these findings in understanding healthcare delivery for individuals suffering from both psychiatric disorders and chronic physical conditions. Copyright © 2017 Elsevier B.V. All rights reserved.

Physical and psychosocial factors in the prevention of chronic pain in older age.

PubMed

Fancourt, D; Steptoe, A

2018-06-24

Chronic pain is recognised as a major challenge as people age. Yet, despite growing research on chronic pain management, there is little research into chronic pain prevention. So there is a clear need to identify multimodal activities that could be encouraged amongst older adults as part of a healthy lifestyle to reduce the incidence risk of chronic pain. Using data from the English Longitudinal Study of Ageing we tracked 2,631 adults aged 50+ who were free from chronic pain at baseline across a decade and explore whether physical or psychosocial factors reduced the risk of developing chronic pain. In relation to physical factors, engaging in vigorous weekly activity was protective against the development of chronic pain (OR=0.74, SE=0.07, CI=0.62 to 0.89) when controlling for all identified socio-economic, health and social confounders. But no effects were found for moderate weekly activity. In relation to psychosocial factors, cultural engagement was also protective against the development of chronic pain (OR=0.75, SE=0.07, CI=0.63 to 0.91), but community group participation was not. These findings extend previous work showing that physical activity and psychosocial factors such as positive affect are key factors in the long-term success of chronic pain self-management. Future interventional studies for chronic pain are encouraged. Perspective This article explores whether physical and psychosocial activities could reduce the risk of developing chronic pain in older age. These results could potentially help clinicians to recommend multimodal activities as part of a broader healthy lifestyle for those aged 50+ to reduce the incidence rate of chronic pain. Copyright © 2018. Published by Elsevier Inc.

Trajectory of Declines in Physical Activity in Community-Dwelling Older Women: Social Cognitive Influences

PubMed Central

Hall, Katherine S.; Motl, Robert W.; White, Siobhan M.; Wójcicki, Thomas R.; Hu, Liang; Doerksen, Shawna E.

2009-01-01

Studies examining physical activity behavior suggest that activity levels decline with age. Such declines are particularly problematic among older adults in light of the research suggesting a protective effect of physical activity on numerous physical health outcomes associated with independent living. Despite a growing recognition of the importance of a physically active lifestyle, little is known about the role of demographic and psychosocial variables on this trajectory of change. In this study, the roles played by outcome expectations, self-efficacy, and functional limitations on changes in physical activity levels over a 2-year period in older women were assessed using latent growth curve modeling. Data were obtained from 249 community-dwelling older women (M age = 68.12, n = 81 Black, and n = 168 White). Demographic, health status, and psychosocial data were collected via self-report upon entry into the study. Self-reported physical activity was assessed at baseline and again at 12 and 24 months. As expected, physical activity declined over the 2-year period. Self-efficacy demonstrated an indirect association with the trajectory of decline in physical activity through functional limitations. Importantly, the pattern of relationships appears independent of demographic factors and chronic health conditions. PMID:19528360

Kinesiophobia in relation to physical activity in chronic neck pain.

PubMed

Demirbüken, İlkşan; Özgül, Bahar; Kuru Çolak, Tuğba; Aydoğdu, Onur; Sarı, Zübeyir; Yurdalan, Saadet Ufuk

2016-01-01

Little research is available concerning physical activity and its determinants in people with chronic neck pain. To explore the relation between kinesiophobia and physical activity and gender effect on these relations in people with chronic neck pain. Ninety-nine subjects (34 men and 65 women) with chronic neck pain were participated in the study. Pain intensity was assessed with Visual Analog Scale and kinesiophobia degree was determined by using Tampa Scale of Kinesiophobia. Level of physical activity was assessed with short form of the International Physical Activity Questionnaire. There was no statistically correlation between neck pain intensity and kinesiophobia degree (p= 0.246, r= 0.123) and physical activity level (p= 0.432, r= -0.083). It was also found that kinesiophobia degree was not correlated to physical activity level (p= 0.148, r= -0.153). There was a negative correlation between kinesiophobia degree and physical activity level only for women, not for men (p= 0.011, r= -0.318). Our results showed that although people with chronic neck pain reported higher pain intensity and fear of movement, pain intensity and kinesiophobia degree did not associate to their physical activity levels. It can be speculated that high kinesiophobia degrees cause low physical activity levels for women, but not for men.

The lasting legacy of childhood adversity for disease risk in later life.

PubMed

McCrory, Cathal; Dooley, Cara; Layte, Richard; Kenny, Rose Anne

2015-07-01

There has been an increased interest in the role of the childhood social environment in the etiology of adult diseases in recent years. The present study examines whether the experience of adversity during childhood increases risk for disease in later life independent of later life socioeconomic, behavioral, and psychosocial factors. The study involved a nationally representative sample of 6,912 persons aged 50 years and older who were participating in the first wave of the Irish Longitudinal Study on Ageing. Childhood adversity was indexed using a 4-item measure that captured challenging and potentially noxious childhood environmental exposures including, socioeconomic disadvantage, substance abuse among parents, physical abuse, and sexual abuse. A doctor diagnosis of disease across 9 chronic disease types represented the primary outcome variables. The experience of adversity during childhood was associated with increased risk of disease in midlife and older ages across a large number of chronic disease types including cardiovascular disease, lung disease, and emotional, nervous, or psychiatric disorders. Analysis of the dose-response pattern revealed positively graded associations between the number of adverse events experienced during childhood and the occurrence of chronic disease in later life. Cox proportional hazard models revealed that the experience of adversity during childhood was associated with earlier age of onset for any physical disease type or emotional, nervous, or psychiatric disorders. These findings indicate that childhood may represent a sensitive or critical period in the development of disease and reinforces the necessity of adopting a life-course approach to the study of chronic diseases. (c) 2015 APA, all rights reserved.

Changes in disability, physical/mental health states and quality of life during an 8-week multimodal physiotherapy programme in patients with chronic non-specific neck pain: a prospective cohort study.

PubMed

Cuesta-Vargas, Antonio Ignacio; González-Sánchez, Manuel

2015-01-01

The aim of this study was to analyse the effect of an 8-week multimodal physiotherapy programme (MPP), integrating physical land-based therapeutic exercise (TE), adapted swimming and health education, as a treatment for patients with chronic non-specific neck pain (CNSNP), on disability, general health/mental states and quality of life. 175 CNSNP patients from a community-based centre were recruited to participate in this prospective study. 60-minute session (30 minutes of land-based exercise dedicated to improving mobility, motor control, resistance and strengthening of the neck muscles, and 30 minutes of adapted swimming with aerobic exercise keeping a neutral neck position using a snorkel). Health education was provided using a decalogue on CNSNP and constant repetition of brief advice by the physiotherapist during the supervision of the exercises in each session. primary: disability (Neck Disability Index); secondary: physical and mental health states and quality of life of patients (SF-12 and EuroQoL-5D respectively). Differences between baseline data and that at the 8-week follow-up were calculated for all outcome variables. Disability showed a significant improvement of 24.6% from a mean (SD) of 28.2 (13.08) at baseline to 16.88 (11.62) at the end of the 8-week intervention. All secondary outcome variables were observed to show significant, clinically relevant improvements with increase ranges between 13.0% and 16.3% from a mean of 0.70 (0.2) at baseline to 0.83 (0.2), for EuroQoL-5D, and from a mean of 40.6 (12.7) at baseline to 56.9 (9.5), for mental health state, at the end of the 8-week intervention. After 8 weeks of a MPP that integrated land-based physical TE, health education and adapted swimming, clinically-relevant and statistically-significant improvements were observed for disability, physical and mental health states and quality of life in patients who suffer CNSNP. The clinical efficacy requires verification using a randomised controlled study design. ClinicalTrials.gov NCT02046876.

Physical and Social Environment Are Associated to Leisure Time Physical Activity in Adults of a Brazilian City: A Cross-Sectional Study

PubMed Central

Gomes, Crizian Saar; Matozinhos, Fernanda Penido; Mendes, Larissa Loures; Pessoa, Milene Cristine; Velasquez-Melendez, Gustavo

2016-01-01

The physical activity practice is highlighted as a strategy to health promotion and to avoid chronic diseases. In addition to individual factors, environmental characteristics in which people live, may offer opportunities or barriers in adopting healthy habits and this is related to the physical activity (PA) practice among individuals. The aim of this study is to investigate the associations between neighborhood environment and leisure-time physical activity in adults. This is a cross-sectional study, developed using the database of Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL 2008/2010) of Belo Horizonte, Brazil. Individuals with the habit of practicing PA for at least 150 minutes of moderate-intensity PA or at least 75 minutes of vigorous-intensity PA throughout the week in leisure time were classified as active in leisure time. To characterize the built and social environment we used georeferenced data of public and private places for physical activity, population density, residential density, homicide rate and total income of the coverage area of the basic health units. The covered area of the basic health units was used as context unit. For data analysis, we used multilevel logistic regression. The study included 5779 adults, 58.77% female. There was variability of physical activity in leisure time between area covered by the basic health units (Median Odds ratio = 1.30). After adjusting for individual characteristics, the increase of density of private places for physical activity (Odds ratios—OR = 1.31; 95% confidence interval—95% CI: 1.15 to 1.48) and the smaller homicide rate (OR = 0.82; IC95%: 0.70 to 0.96) in the neighborhood increased physical activity in leisure time. The evidence of this study shows that neighborhood environment may influence the physical activity practice in leisure time and should be considered in future interventions and health promotion strategies. PMID:26915091

Physical and Social Environment Are Associated to Leisure Time Physical Activity in Adults of a Brazilian City: A Cross-Sectional Study.

PubMed

Gomes, Crizian Saar; Matozinhos, Fernanda Penido; Mendes, Larissa Loures; Pessoa, Milene Cristine; Velasquez-Melendez, Gustavo

2016-01-01

The physical activity practice is highlighted as a strategy to health promotion and to avoid chronic diseases. In addition to individual factors, environmental characteristics in which people live, may offer opportunities or barriers in adopting healthy habits and this is related to the physical activity (PA) practice among individuals. The aim of this study is to investigate the associations between neighborhood environment and leisure-time physical activity in adults. This is a cross-sectional study, developed using the database of Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL 2008/2010) of Belo Horizonte, Brazil. Individuals with the habit of practicing PA for at least 150 minutes of moderate-intensity PA or at least 75 minutes of vigorous-intensity PA throughout the week in leisure time were classified as active in leisure time. To characterize the built and social environment we used georeferenced data of public and private places for physical activity, population density, residential density, homicide rate and total income of the coverage area of the basic health units. The covered area of the basic health units was used as context unit. For data analysis, we used multilevel logistic regression. The study included 5779 adults, 58.77% female. There was variability of physical activity in leisure time between area covered by the basic health units (Median Odds ratio = 1.30). After adjusting for individual characteristics, the increase of density of private places for physical activity (Odds ratios-OR = 1.31; 95% confidence interval-95% CI: 1.15 to 1.48) and the smaller homicide rate (OR = 0.82; IC95%: 0.70 to 0.96) in the neighborhood increased physical activity in leisure time. The evidence of this study shows that neighborhood environment may influence the physical activity practice in leisure time and should be considered in future interventions and health promotion strategies.

[Overweight and obesity in Colombian college students and its association with physical activity].

PubMed

Rangel Caballero, Luis Gabriel; Rojas Sánchez, Lyda Zoraya; Gamboa Delgado, Edna Magaly

2014-11-01

Overweight, obesity and physical activity are considered modifiable factors related to development of chronic diseases. Taking into account physical activity patterns in college students, it is necessary to establish its association with the excessive weight in order to prevent and to decrease the prevalence of future chronic diseases. The aim of this study was to determine the association between excessive weight and physical inactivity among college students. An analytical cross sectional study was carried out in 2013 among college students from a private university of Bucaramanga, Colombia. Students (n=306) 18 to 25 years old were included using simple random sampling. An interview was realized using a survey that included the International Physical Activity Questionnaire (IPAQ), together with socio demographic variables. An assessment of body composition was realized in order to measure height, weight, body mass index (BMI), total fat percentage, and waist and hip circumferences. A trained professional in physical activity was in charge of data collection and anthropometric measurements. This study was approved by the university research and ethics committee. Participation was both voluntary and anonymous. All data were analyzed in compliance with the Helsinki Declaration. Written consent was signed by every participant of the study. A descriptive analysis of the studied population's general characteristics was realized. The association between excessive weight and physical inactivity was estimated using regression logistic models that allows estimate row and adjusted Odds Ratios (OR). An excessive weight was observed in 26.47% of the students, among which 20.26% were overweight and 6.21% obese, according to BMI cutoff. Taking into account the total fat percentage, 12.09% of the students were in risk of becoming obese and 10.13% were already obese. 50.56% of the students practiced very little weekly physical activity. The median of daily sedentary lifestyle was 12 hours, with an interquartile range of 4 hours. A statistically significant association was found between excessive weight and sedentary behavior, according to the total fat method (adjusted OR: 1.11, CI 95%: 1.01-1.23). College students' health behavior is often inadequate in terms of physical activity and dietary habits. Our study observed an association between physical inactivity and excessive weight. Physical inactivity is an important lifestyle factor related to chronic diseases. Further research should focus on determinants to increase their physical activity and to improve their daily lifestyle in order to lower the risk of future diseases. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Experiences and attitudes about physical activity and exercise in patients with chronic pain: a qualitative interview study.

PubMed

Karlsson, Linn; Gerdle, Björn; Takala, Esa-Pekka; Andersson, Gerhard; Larsson, Britt

2018-01-01

The purpose of this study was to describe how patients with chronic pain experience physical activity and exercise (PA&E). This qualitative interview study included 16 women and two men suffering from chronic pain and referred to a multimodal pain rehabilitation program. Semi-structured interviews were conducted and qualitative content analysis was used to analyze the interviews. One main theme emerged: "To overcome obstacles and to seize opportunities to be physically active despite chronic pain." This main theme was abstracted from five themes: "Valuing a life with physical activity," "Physical activity and exercise - before and after pain," "A struggle - difficulties and challenges," "The enabling of physical activity," and "In need of continuous and active support." Although these participants valued PA&E, they seldom achieved desirable levels, and performance of PA&E was undermined by difficulties and failure. The discrepancy between the intention to perform physical activity and the physical activity accomplished could be related to motivation, self-efficacy, and action control. The participants desired high-quality interaction with healthcare providers. The findings can be applied to chronic pain rehabilitation that uses PA&E as treatment.

Physical inactivity and obesity: relation to asthma and chronic obstructive pulmonary disease?

PubMed

ten Hacken, Nick H T

2009-12-01

Physical inactivity and obesity are modifiable risk factors for many chronic diseases, including cardiovascular disease, diabetes mellitus, osteoporosis, osteoarthritis, and depression. Both physical inactivity and obesity are associated with low-grade systemic inflammation that may contribute to the inflammatory processes present in many chronic diseases. In asthma, almost no studies are available in which physical inactivity has been studied using performance-based instruments. In contrast, the association between obesity and a higher prevalence of asthma has often been suggested in a large number of studies. In chronic obstructive pulmonary disease (COPD) physical inactivity has been demonstrated in a few studies that used performance-based instruments; this was associated with the higher COPD Global Initiative on Obstructive Lung Disease (GOLD) stages and a higher degree of systemic inflammation, independent of body mass index. In contrast to physical inactivity, obesity in COPD is associated with the lower GOLD stages. Additionally, obesity is associated with the chronic obstructive phenotype and features of the metabolic syndrome. To elucidate the independent relation of physical inactivity and obesity with systemic inflammation, performance-based studies of physical inactivity in asthma and COPD are highly needed.

Depression treatment and short-term healthcare expenditures among elderly Medicare beneficiaries with chronic physical conditions.

PubMed

Shen, Chan; Shah, Neel; Findley, Patricia A; Sambamoorthi, Usha

2013-10-22

Research on the impact of depression treatment on expenditures is nascent and shows results that vary from negative associations with healthcare expenditures to increased expenditures. However many of these studies did not include psychotherapy as part of the depression treatment. None of these studies included "no treatment" as a comparison group. In addition, no study has included a broad group of chronic physical conditions in studying depression treatment expenditures. We determined the association between depression treatment and short-term healthcare expenditures using a nationally representative sample of Medicare beneficiaries with chronic physical conditions and depression. In this retrospective cohort study, we examined the association between depression treatment in the baseline year and healthcare expenditures in the following year using data from 2000 through 2005 of the Medicare Current Beneficiary Survey (MCBS), a nationally representative survey of Medicare beneficiaries. Using the rotating panel design of MCBS, we derived five two-year cohorts: 2000-2001, 2001-2002, 2002-2003, 2003-2004, and 2004-2005. The study sample included 1,055 elderly Medicare beneficiaries aged 65 or over. We compared healthcare expenditures of no depression treatment group with depression treatment groups using t-tests. Linear regressions of log-transformed dollars were used to assess the relationship between depression treatment and healthcare expenditures after controlling for demographic, socio-economic, health status, lifestyle risk factors, year of observation and baseline expenditures. Compared to no depression treatment ($16,795), the average total expenditures were higher for those who used antidepressants only ($17,425) and those who used psychotherapy with or without antidepressants ($19,733). After controlling for the independent variables, antidepressant use and psychotherapy with or without antidepressants were associated with 20.2% (95% CI: 14.1-26.7%) and 29.4% (95% CI: 18.8-41.0%) increase in total expenditures, respectively. We observed that depression treatment was positively associated with inpatient, medical provider and prescription drug expenditures. Among the elderly Medicare beneficiaries with chronic physical conditions, depression treatment was associated with greater short-term healthcare expenditures. Future research needs to replicate these findings and also examine whether depression treatment reduces expenditures over a longer period of time.

Health in Adapted Youth Sports Study (HAYS): health effects of sports participation in children and adolescents with a chronic disease or physical disability.

PubMed

Lankhorst, Kristel; van der Ende-Kastelijn, Karin; de Groot, Janke; Zwinkels, Maremka; Verschuren, Olaf; Backx, Frank; Visser-Meily, Anne; Takken, Tim

2015-01-01

In typically developing children, participation in sports has been proven to be positively correlated to both physical and psychosocial health outcomes. In children and adolescents with a physical disability or chronic disease participation in both recreational and competitive sports is often reduced, while for this population an active lifestyle may be even more important in reaching optimal levels of physical and psychosocial health. Therefore, the aim of the Health in Adapted Youth Sports (HAYS) Study is to determine both negative and positive effects of sports on children and adolescents with a chronic disease or physical disability. In this cross-sectional study differences will be compared in regards to physical and psychosocial health, cognitive functioning, school performance, daily physical activity and injuries between children and adolescents with a chronic disease or physical disability who participate in sports and those who do not. Children and adolescents, both ambulatory and wheelchair dependent, in the age of 10-19 years with a physical disability or chronic disease will be included. "Sports" is defined as participation in an organized sport at least two times a week for a duration of 3 months or more prior to the assessment. Parametric and non-parametric statistics will be used to determine the differences between the two groups. This study provides insight in the effects of sports participation in relation to health, psychosocial functioning, physical activity and school performance in children and adolescents (10-19 years) with a chronic disease or physical disability. Results will guide healthcare professionals working with these children to better guide this population in reaching optimal levels of health and physical activity levels.

A Survey on the Willingness to Use Physical Activity Smartphone Applications (Apps) in Patients with Chronic Diseases.

PubMed

Sun, Liu; Jiao, Chen; Wang, Yanling; Xiao, Qian; Zhang, Yiling; Wu, Ying

2016-01-01

This study aimed to explore the willingness of using physical activity smartphone apps among patients with chronic diseases. 218 outpatients from a tertiary hospital in Beijing were involved using a questionnaire. Over half of the patients (53.7%) were willing to use smartphone apps to promote physical activities. The individuals more likely to use physical activity apps tended to be younger (≤44 years), be more educated, perceiving their disease need exercise instruction or professional support, current smartphone user, having previous experience of using physical activity apps, and accepting paid apps (P<0.05). The results could help health educator suggest chronic disease patients to use apps to do more exercises. Further research could be focus on evaluate the effects of using physical activity apps in chronic disease patients.

Lack of exercise is a major cause of chronic diseases

PubMed Central

Booth, Frank W.; Roberts, Christian K.; Laye, Matthew J.

2014-01-01

Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause vs. treatment; physical activity and inactivity mechanisms differ; gene-environment interaction [including aerobic training adaptations, personalized medicine, and co-twin physical activity]; and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [Accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, non-alcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, preeclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longer-term sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life. PMID:23798298

Chronic and episodic stress predict physical symptom bother following breast cancer diagnosis.

PubMed

Harris, Lauren N; Bauer, Margaret R; Wiley, Joshua F; Hammen, Constance; Krull, Jennifer L; Crespi, Catherine M; Weihs, Karen L; Stanton, Annette L

2017-12-01

Breast cancer patients often experience adverse physical side effects of medical treatments. According to the biobehavioral model of cancer stress and disease, life stress during diagnosis and treatment may negatively influence the trajectory of women's physical health-related adjustment to breast cancer. This longitudinal study examined chronic and episodic stress as predictors of bothersome physical symptoms during the year after breast cancer diagnosis. Women diagnosed with breast cancer in the previous 4 months (N = 460) completed a life stress interview for contextual assessment of chronic and episodic stress severity at study entry and 9 months later. Physical symptom bother (e.g., pain, fatigue) was measured at study entry, every 6 weeks through 6 months, and at nine and 12 months. In multilevel structural equation modeling (MSEM) analyses, both chronic stress and episodic stress occurring shortly after diagnosis predicted greater physical symptom bother over the study period. Episodic stress reported to have occurred prior to diagnosis did not predict symptom bother in MSEM analyses, and the interaction between chronic and episodic stress on symptom bother was not significant. Results suggest that ongoing chronic stress and episodic stress occurring shortly after breast cancer diagnosis are important predictors of bothersome symptoms during and after cancer treatment. Screening for chronic stress and recent stressful life events in the months following diagnosis may help to identify breast cancer patients at risk for persistent and bothersome physical symptoms. Interventions to prevent or ameliorate treatment-related physical symptoms may confer added benefit by addressing ongoing non-cancer-related stress in women's lives.

Lack of exercise is a major cause of chronic diseases.

PubMed

Booth, Frank W; Roberts, Christian K; Laye, Matthew J

2012-04-01

Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause versus treatment; physical activity and inactivity mechanisms differ; gene-environment interaction (including aerobic training adaptations, personalized medicine, and co-twin physical activity); and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, nonalcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, pre-eclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longer-term sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life. © 2012 American Physiological Society. Compr Physiol 2:1143-1211, 2012.

Chronic and episodic stress predict physical symptom bother following breast cancer diagnosis

PubMed Central

Bauer, Margaret R.; Wiley, Joshua F.; Hammen, Constance; Krull, Jennifer L.; Crespi, Catherine M.; Weihs, Karen L.; Stanton, Annette L.

2017-01-01

Breast cancer patients often experience adverse physical side effects of medical treatments. According to the biobehavioral model of cancer stress and disease, life stress during diagnosis and treatment may negatively influence the trajectory of women’s physical health-related adjustment to breast cancer. This longitudinal study examined chronic and episodic stress as predictors of bothersome physical symptoms during the year after breast cancer diagnosis. Women diagnosed with breast cancer in the previous 4 months (N = 460) completed a life stress interview for contextual assessment of chronic and episodic stress severity at study entry and 9 months later. Physical symptom bother (e.g., pain, fatigue) was measured at study entry, every 6 weeks through 6 months, and at nine and 12 months. In multilevel structural equation modeling (MSEM) analyses, both chronic stress and episodic stress occurring shortly after diagnosis predicted greater physical symptom bother over the study period. Episodic stress reported to have occurred prior to diagnosis did not predict symptom bother in MSEM analyses, and the interaction between chronic and episodic stress on symptom bother was not significant. Results suggest that ongoing chronic stress and episodic stress occurring shortly after breast cancer diagnosis are important predictors of bothersome symptoms during and after cancer treatment. Screening for chronic stress and recent stressful life events in the months following diagnosis may help to identify breast cancer patients at risk for persistent and bothersome physical symptoms. Interventions to prevent or ameliorate treatment-related physical symptoms may confer added benefit by addressing ongoing non-cancer-related stress in women’s lives. PMID:28528393

Putting Physical Activity While Experiencing Low Back Pain in Context: Balancing the Risks and Benefits.

PubMed

Darlow, Ben; Perry, Meredith; Dean, Sarah; Mathieson, Fiona; Baxter, G David; Dowell, Anthony

2016-02-01

To analyze attitudes and beliefs about movement and physical activity in people with low back pain (LBP) and compare these beliefs between people with acute and chronic LBP. Qualitative inductive analysis of data collected via face-to-face semistructured interviews. Interviews were audio-recorded and transcribed verbatim. Participants were purposively recruited from 1 region of New Zealand. Persons with LBP (N=23), consisting of individuals with acute LBP (<6wk; n=12) and chronic LBP (>3mo; n=11). Not applicable. Themes that emerged from participant interview transcripts using analysis based on Interpretative Description. Participants with acute and chronic LBP made judgments about physical activity and rest using the same conceptual model. Concerns about creating more pain, tissue damage, or impairment influenced the physical activity judgments of most participants with acute and chronic LBP. These perceived risks were balanced against the perceived benefits, the most important of which were psychological or social rather than physical. Judgments made by those with acute and chronic LBP were context dependent and influenced by the nature and duration of pain, the type of physical activity, the importance of the activity, and the participant's previous experience. Participants with acute pain who had not experienced back pain previously often expressed more uncertainty, whereas those with chronic LBP appeared to have developed cognitive rules that determined physical activity decisions. Exploring the perceived risks, benefits, and contextual factors that influence decisions about physical activity and rest may help clinicians to understand the behavior of patients with acute and chronic LBP. Clinicians may best support their patients to engage in physical activity by providing an informed assessment of risks and an explanation about the range of potential benefits. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Gender differences in the impact of mental disorders and chronic physical conditions on health-related quality of life among non-demented primary care elderly patients.

PubMed

Baladón, Luisa; Rubio-Valera, Maria; Serrano-Blanco, Antoni; Palao, Diego J; Fernández, Ana

2016-06-01

This paper aims to estimate the comorbidity of mental disorders and chronic physical conditions and to describe the impact of these conditions on health-related quality of life (HRQoL) in a sample of older primary care (PC) attendees by gender. Cross-sectional survey, conducted in 77 PC centres in Catalonia (Spain) on 1192 patients over 65 years old. Using face-to-face interviews, we assessed HRQoL (SF-12), mental disorders (SCID and MINI structured clinical interviews), chronic physical conditions (checklist), and disability (Sheehan disability scale). We used multivariate quantile regressions to model which factors were associated with the physical component summary-short form 12 and mental component summary-short form 12. The most frequent comorbidity in both men and women was mood disorder with chronic pain and arthrosis. Mental disorders mainly affected 'mental' QoL, while physical disorders affected 'physical' QoL. Mental disorders had a greater impact on HRQoL than chronic physical conditions, with mood and adjustment disorders being the most disabling conditions. There were some gender differences in the impact of mental and chronic physical conditions on HRQoL. Anxiety disorders and pain had an impact on HRQoL but only in women. Respiratory diseases had an effect on the MCS in women, but only affected the PCS in men. Mood and adjustment disorders had the greatest impact on HRQoL. The impact profile of mental and chronic physical conditions differs between genders. Our results reinforce the need for screening for mental disorders (mainly depression) in older patients in PC.

A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain.

PubMed

Kroska, Emily B

2016-10-01

The fear-avoidance model of chronic pain has established avoidance as a predictor of negative outcomes in chronic pain patients. Avoidance, or deliberate attempts to suppress or prevent unwanted experiences (e.g., pain), has been studied extensively, with multiple reviews implicating this behavior as a predictor of disability, physical disuse, and depression. Despite hundreds of studies examining the associations between different components of this model (i.e., catastrophizing, fear, avoidance, depression), the association between fear-avoidance and pain intensity has remained unclear. The present study seeks to clarify this association across samples. The present analyses synthesize the literature (articles from PsycInfo, PubMed, and ProQuest) to determine if fear-avoidance and pain intensity are consistently correlated across studies, samples, and measures. Eligible studies measured pain intensity and fear-avoidance cross-sectionally in chronic pain patients. The search resulted in 118 studies eligible for inclusion. A random-effects model was used to estimate the weighted mean effect size. Comprehensive Meta-Analysis software was used for all analyses. Moderation analyses elucidate the variables that affect the strength of this association. Meta-regression and meta-ANOVA analyses were conducted to examine moderating variables. Moderator variables include demographic characteristics, pain characteristics, study characteristics, and national cultural characteristics (using Hofstede's cultural dimensions). Publication bias was examined using the funnel plot and the p-curve. Results indicate a small-to-moderate positive association between fear-avoidance and pain intensity. The results were stable across characteristics of the sample, including mean age, gender distribution, marital status, and duration of pain. Moderation analyses indicate that the measures utilized and cultural differences affect the strength of this association. Weaker effect sizes were observed for studies that utilized measures of experiential avoidance when compared to studies that utilized pain-specific fear-avoidance measures. Studies that utilized multiple measures of fear-avoidance had stronger effect sizes than studies that utilized a single measure of fear-avoidance. Three of Hofstede's cultural dimensions moderated the association, including Power Distance Index, Individualism versus Collectivism, and Indulgence versus Restraint. The present meta-analysis synthesizes the results from studies examining the association between fear-avoidance and pain intensity among individuals with chronic pain. The positive association indicates that those with increased fear-avoidance have higher pain intensity, and those with higher pain intensity have increased fear-avoidance. Findings indicate that cultural differences and measurement instruments are important to consider in understanding the variables that affect this association. The significant cultural variations may indicate that it is important to consider the function of avoidance behavior in different cultures in an effort to better understand each patient's cultural beliefs, as well as how these beliefs are related to pain and associated coping strategies. The results from the current meta-analysis can be used to inform interventions for patients with chronic pain. In particular, those with more intense pain or increased fear-avoidance should be targeted for prevention and intervention work. Within the intervention itself, avoidance should be undermined and established as an ineffective strategy to manage pain in an effort to prevent disability, depression, and physical deconditioning. Copyright © 2016 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Massage Impact on Pain in Opioid-dependent Patients in Substance Use Treatment

PubMed Central

Wiest, Katharina L.; Asphaug, Victoria J.; Carr, Kathryn E.; Gowen, Emily A.; Hartnett, Timothy T.

2015-01-01

Background: Chronic pain is a common cause of health care utilization and high levels of pain are pronounced in individuals engaged in methadone maintenance treatment. Although massage has been demonstrated to alleviate chronic pain symptoms, its use as an adjunctive therapy to modify pain during opioid-replacement treatment is absent from the literature. Purpose: To consider the efficacy of Swedish massage in reducing pain in opioid-dependent patients with chronic pain receiving methadone treatment. Setting: Trial was conducted at a nonprofit methadone treatment center serving low-income patients. Research Design: A randomized clinical trial with randomized to either 1) massage plus treatment-as-usual (TAU) (n = 27) or 2) TAU (n = 24). Durability of treatment effect was evaluated at Week 12. Intervention: Eight weekly 50-minute Swedish massage sessions plus TAU or TAU alone. Main Outcome Measures: Pain, anxiety, depression, physical functioning, decreased substance use, and improvement in treatment engagement. Results: Randomized participants were comparable at Baseline for demographic, pain, physical, and emotional variables. Massage group reported improved pain scores; worst pain had a clinically significant 2-point improvement while the other pain scores did not. Overall improvements were not observed in treatment engagement or levels of anxiety, depression, or physical functioning. A subgroup of the participants, who felt they could be pain-free, consistently reported improvements in pain from Baseline to Week 8, and this was most pronounced and clinically significant in the massage group. Conclusions: These preliminary findings do not support an overall clinically significant positive effect of Swedish massage on reduction in pain ratings or improvement in anxiety, depression, or treatment engagement in a substance-using, opioid-dependent population with chronic pain. Future nonpharmacologic pain research in marginalized substance-using populations may wish to consider some of the challenges and limitations faced in this project. PMID:25780471

Factors influencing changes in health related quality of life of caregivers of persons with multiple chronic conditions.

PubMed

Duggleby, Wendy; Williams, Allison; Ghosh, Sunita; Moquin, Heather; Ploeg, Jenny; Markle-Reid, Maureen; Peacock, Shelley

2016-05-27

The majority of care for older adults with multiple chronic conditions (MCC) is provided by family (including friends) caregivers. Although caregivers have reported positive benefits to caregiving they also experience decreases in their physical and mental health. As there is a critical need for supportive interventions for this population, it is important to know what influences the health of family caregivers of persons with MCC. This research examined relationships among the changes from baseline to 6 months in health related quality of life (SF12v2) of family caregivers caring for older adults with multiple chronic conditions and the following factors: a) demographic variables, b) gender identity [Bem Sex Role Inventory (BSRI)] c) changes in general self-efficacy [General Self Efficacy Scale (GSES) (baseline to 6 months) and d)) changes in caregiver burden [Zarit Burden Inventory (ZBI)] baseline to 6 months. Specific hypothesis were based on a conceptual framework generated from a literature review. This is a secondary analysis of a study of 194 family caregivers who were recruited from two Canadian provinces Alberta and Ontario. Data were collected in-person, by telephone, by Skype or by mail at two time periods spaced 6 months apart. The sample size for this secondary analysis was n = 185, as 9 participants had dropped out of the study at 6 months. Changes in the scores between the two time periods were calculated for SF12v2 physical component score (PCS) and mental component score (MCS) and the other main variables. Generalized Linear Modeling was then used to determine factors associated with changes in HRQL. Participants who had significantly positive increases in their MCS (baseline to 6 months) reported lower burden (ZBI, p < 0.001), and higher general self-efficacy (GSES, p < 0.001) and Masculine BSRI (p = 0.025). There were no significant associations among variables and changes in PCS (baseline to 6 months). Our findings suggest that a masculine gender identity (which incorporates assertive and instrumental approaches to caregiving), and confidence in the ability to deal with difficult situations was positively related to improvement in mental health for caregivers of persons with MCC. Decreases in perceptions of burden in this populations was also associated with improvements in mental health. Further research is needed to explore ways to support caregivers of older persons with multiple chronic conditions living at home.

Pulmonary function and the risk of functional limitation in chronic obstructive pulmonary disease.

PubMed

Eisner, Mark D; Iribarren, Carlos; Yelin, Edward H; Sidney, Stephen; Katz, Patricia P; Ackerson, Lynn; Lathon, Phenius; Tolstykh, Irina; Omachi, Theodore; Byl, Nancy; Blanc, Paul D

2008-05-01

The authors' objective was to analyze the impact of respiratory impairment on the risk of physical functional limitations among adults with chronic obstructive pulmonary disease (COPD). They hypothesized that greater pulmonary function decrement would result in a broad array of physical functional limitations involving organ systems remote from the lung, a key step in the pathway leading to overall disability. The authors used baseline data from the Function, Living, Outcomes, and Work (FLOW) study, a prospective cohort study of adults with COPD recruited from northern California in 2005-2007. They studied the impact of pulmonary function impairment on the risk of functional limitations using validated measures: lower extremity function (Short Physical Performance Battery), submaximal exercise performance (6-Minute Walk Test), standing balance (Functional Reach Test), skeletal muscle strength (manual muscle testing with dynamometry), and self-reported functional limitation (standardized item battery). Multiple variable analysis was used to control for confounding by age, sex, race, height, educational attainment, and cigarette smoking. Greater pulmonary function impairment, as evidenced by lower forced expiratory volume in 1 second (FEV(1)), was associated with poorer Short Physical Performance Battery scores and less distance walked during the 6-Minute Walk Test. Lower forced expiratory volume in 1 second was also associated with weaker muscle strength and with a greater risk of self-reported functional limitation (p < 0.05). In conclusion, pulmonary function impairment is associated with multiple manifestations of physical functional limitation among COPD patients. Longitudinal follow-up can delineate the impact of these functional limitations on the prospective risk of disability, guiding preventive strategies that could attenuate the disablement process.

Incorporating physical activity measures into environmental monitoring of national parks: an example from Yosemite.

PubMed

Walden-Schreiner, Chelsey; Leung, Yu-Fai; Floyd, Myron F

2014-09-01

To address increasing prevalence of obesity and associated chronic disease, recent national initiatives have called upon federal agencies to promote healthy lifestyles and provide opportunities for physical activity. In response, the U.S. National Park Service has developed strategies promoting health through physical activity in addition to its well-established biodiversity and landscape conservation mission. Incorporating physical activity measures with routine environmental monitoring would help identify areas where parks can promote active pursuits with minimal environmental impact. This study provides one example of how protocols developed for visitor and environmental monitoring can generate data to evaluate physical activity. Researchers implemented an observational study in high-use meadows of Yosemite National Park during the summer of 2011. Variables measured include the spatial location of visitors and activity type. Metabolic equivalents (METs) were assigned to activity categories and analyzed for average energy expenditure. Mean METs values indicated sedentary to light physical activity across the meadows, with greater means in areas with boardwalks or paved pathways. Data leveraged in this study provide park managers an example of adapting existing monitoring programs to incorporate indicators relevant to physical activity evaluation and how physical activity may impact resource conditions in national parks.

Past trauma and present functioning of patients attending a women's psychiatric clinic.

PubMed

Borins, E F; Forsythe, P J

1985-04-01

A women's psychiatric clinic, incorporated within a university teaching general hospital and staffed entirely by women, was opened in March of 1980. The authors studied a sample of 100 women who came to the clinic and characterized them by demographic variables, psychiatric diagnoses, health problems, chronic illness, death in the family, and traumatic incidents. Death in the family before she was 18 was found to predict a woman's subsequent request for or completion of sterilization. Physical or sexual abuse was significantly related to abortion, and abortion and trauma were significantly correlated.

Autonomic nervous system function, activity patterns, and sleep after physical or cognitive challenge in people with chronic fatigue syndrome.

PubMed

Cvejic, Erin; Sandler, Carolina X; Keech, Andrew; Barry, Benjamin K; Lloyd, Andrew R; Vollmer-Conna, Uté

2017-12-01

To explore changes in autonomic functioning, sleep, and physical activity during a post-exertional symptom exacerbation induced by physical or cognitive challenge in participants with chronic fatigue syndrome (CFS). Thirty-five participants with CFS reported fatigue levels 24-h before, immediately before, immediately after, and 24-h after the completion of previously characterised physical (stationary cycling) or cognitive (simulated driving) challenges. Participants also provided ratings of their sleep quality and sleep duration for the night before, and after, the challenge. Continuous ambulatory electrocardiography (ECG) and physical activity was recorded from 24-h prior, until 24-h after, the challenge. Heart rate (HR) and HR variability (HRV, as high frequency power in normalized units) was derived from the ECG trace for periods of wake and sleep. Both physical and cognitive challenges induced an immediate exacerbation of the fatigue state (p<0.001), which remained elevated 24-h post-challenge. After completing the challenges, participants spent a greater proportion of wakeful hours lying down (p=0.024), but did not experience significant changes in sleep quality or sleep duration. Although the normal changes in HR and HRV during the transition from wakefulness to sleep were evident, the magnitude of the increase in HRV was significantly lower after completing the challenge (p=0.016). Preliminary evidence of reduced nocturnal parasympathetic activity, and increased periods of inactivity, were found during post-exertional fatigue in a well-defined group of participants with CFS. Larger studies employing challenge paradigms are warranted to further explore the underlying pathophysiological mechanisms of post-exertional fatigue in CFS. Copyright © 2017 Elsevier Inc. All rights reserved.

The Outcomes of Manipulation or Mobilization Therapy Compared with Physical Therapy or Exercise for Neck Pain: A Systematic Review

PubMed Central

Schroeder, Josh; Kaplan, Leon; Fischer, Dena J.; Skelly, Andrea C.

2013-01-01

Study Design Systematic review. Study Rationale Neck pain is a prevalent condition. Spinal manipulation and mobilization procedures are becoming an accepted treatment for neck pain. However, data on the effectiveness of these treatments have not been summarized. Objective To compare manipulation or mobilization of the cervical spine to physical therapy or exercise for symptom improvement in patients with neck pain. Methods A systematic review of the literature was performed using PubMed, the National Guideline Clearinghouse Database, and bibliographies of key articles, which compared spinal manipulation or mobilization therapy with physical therapy or exercise in patients with neck pain. Articles were included based on predetermined criteria and were appraised using a predefined quality rating scheme. Results From 197 citations, 7 articles met all inclusion and exclusion criteria. There were no differences in pain improvement when comparing spinal manipulation to exercise, and there were inconsistent reports of pain improvement in subjects who underwent mobilization therapy versus physical therapy. No disability improvement was reported between treatment groups in studies of acute or chronic neck pain patients. No functional improvement was found with manipulation therapy compared with exercise treatment or mobilization therapy compared with physical therapy groups in patients with acute pain. In chronic neck pain subjects who underwent spinal manipulation therapy compared to exercise treatment, results for short-term functional improvement were inconsistent. Conclusion The data available suggest that there are minimal short- and long-term treatment differences in pain, disability, patient-rated treatment improvement, treatment satisfaction, health status, or functional improvement when comparing manipulation or mobilization therapy to physical therapy or exercise in patients with neck pain. This systematic review is limited by the variability of treatment interventions and lack of standardized outcomes to assess treatment benefit. PMID:24436697

Changes in the degree of motor variability associated with experimental and chronic neck-shoulder pain during a standardised repetitive arm movement.

PubMed

Madeleine, Pascal; Mathiassen, Svend Erik; Arendt-Nielsen, Lars

2008-03-01

The aim of the present study was to investigate the effect of experimental and chronic neck-shoulder pain on the magnitude of cycle-to-cycle variability of task timing, kinematics and muscle activation during repetitive arm movement performed for 3 or 5 min. In an experimental part, acute muscle pain was induced in healthy subjects by intramuscular injection of hypertonic saline in trapezius (n = 10) and infraspinatus (n = 10) muscles. In a clinical part, workers with (n = 12) and without (n = 6) chronic neck-shoulder pain were compared. Cycle-to-cycle standard deviations of task duration, arm and trunk movement in 3D and surface electromyographic (EMG) root mean square activity were computed to assess the degree of variability. The variability in task timing increased in presence of both experimental and chronic pain (P < 0.05) compared with non-painful conditions. Experimental pain increased the variability of the starting position of the arm (P < 0.05), the arm range of motion (P < 0.01), the arm and trunk movement area (P < 0.01) and the acceleration of the arm (P < 0.01). In the chronic pain condition, the variability of arm and trunk acceleration (P < 0.01) and EMG activity (P < 0.05) was decreased compared with healthy controls. These results indicate that pain alters the magnitude of motor variability, and that the transition from acute to chronic pain is accompanied by changes in motor patterns. Experimental pain likely resulted in a quest for a motor solution reducing nociceptive influx, while chronic pain was characterised by a diminished motor flexibility.

Diminished kinesthetic and visual motor imagery ability in adults with chronic low back pain.

PubMed

La Touche, Roy; Grande-Alonso, Mónica; Cuenca-Martínez, Ferran; Gónzalez-Ferrero, Luis; Suso-Martí, Luis; Paris-Alemany, Alba

2018-06-14

Low back pain (LBP) is the most prevalent musculoskeletal problem among adults. It has been observed that patients with chronic pain have maladaptive neuroplastic changes and difficulty in imagination processes. To assess the ability of patients with chronic LBP (CLBP) to generate kinesthetic and visual motor images and the time they spent on this mental task compared with asymptomatic participants. Prospective, A cross-sectional study. Primary health care center in Madrid, Spain. A total of 200 participants were classified into two groups: asymptomatic participants (n = 100) and patients with CLBP (n = 100). After consenting to participate, all recruited participants received a sociodemographic questionnaire, a set of self-report measures and completed the Revised Movement Imagery Questionnaire (MIQ-R). Visual and Kinesthetic Motor Imagery Ability using the Revised Movement Imagery Questionnaire (MIQ-R). A mental chronometry using a stopwatch and psychosocial variables using self-reported questionnaires. Our results indicated that patients with CLBP had difficulty generating kinesthetic and visual motor images and also took a longer time to imagine them. A regression analysis indicated that in the CLBP group, the predictor variable for fear of activity and coping symptom self-efficacy was visual motor imagery (explaining 16.2% of the variance); however, the predictor variable for LBP disability and pain management self-efficacy was kinesthetic motor imagery (explaining 17.8% of the variance). It appears that patients with CLBP have greater difficulty generating visual and kinesthetic motor images compared with asymptomatic participants, and they also need more time to perform these mental tasks. II. Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Blood-brain-barrier disruption in chronic canine hypothyroidism.

PubMed

Pancotto, Theresa; Rossmeisl, John H; Panciera, David L; Zimmerman, Kurt L

2010-12-01

Central nervous system (CNS) manifestations of hypothyroidism have been associated with cerebrovascular complications. Reports of cerebrospinal fluid (CSF) abnormalities are rare in hypothyroid dogs. The aim of this study was to determine if chronic hypothyroidism causes blood-brain-barrier (BBB) abnormalities that are detectable using indirect CSF biomarkers. The study included 18 normal, euthyroid, female mixed-breed dogs. Hypothyroidism was induced by (131) iodine administration in 9 dogs; 9 served as untreated controls. Evaluations included physical and neurologic examination, complete CSF analysis, serum and CSF protein electrophoresis, measurement of plasma vascular endothelial growth factor (VEGF) and serum S-100B concentrations, and calculation of CSF albumin quota (AQ) and were conducted at baseline and 6, 12, and 18 months after induction of hypothyroidism. Data were analyzed using repeated measures ANOVA. At baseline, differences between groups were not detected for any variable. Throughout the study, controls dogs remained free of neurologic disease and had test variables that remained within reference intervals. Two hypothyroid dogs developed CNS signs during the study, and evidence of cerebrovascular disease was found at necropsy. At 12 and 18 months, the CSF total protein, VEGF, S-100B, and fractional albumin concentrations, and AQ were significantly higher (P<.04) in hypothyroid dogs than controls. Among test variables assayed in serum or plasma, the only significant difference was a higher S-100B concentration in hypothyroid dogs (P=.003) at 18 months. BBB integrity is disrupted in chronic hypothyroidism. Significant increases in CSF concentrations of VEGF and S100-B in hypothyroid dogs indicate dysfunction in both endothelial and glial elements of the BBB. ©2010 American Society for Veterinary Clinical Pathology.

The Fear-Avoidance Components Scale (FACS): Responsiveness to Functional Restoration Treatment in a Chronic Musculoskeletal Pain Disorder (CMPD) Population.

PubMed

Neblett, Randy; Mayer, Tom G; Williams, Mark J; Asih, Sali; Cuesta-Vargas, Antonio I; Hartzell, Meredith M; Gatchel, Robert J

2017-12-01

To assess the clinical validity and factor structure of the Fear-Avoidance Components Scale (FACS), a new fear-avoidance measure. In this study, 426 chronic musculoskeletal pain disorder patients were admitted to a Functional Restoration Program (FRP). They were categorized into 5 FACS severity levels, from subclinical to extreme, at admission, and again at discharge. Associations with objective lifting performance and other patient-reported psychosocial measures were determined at admission and discharge, and objective work outcomes for this predominantly disabled cohort, were assessed 1 year later. Those patients in the severe and extreme FACS severity groups at admission were more likely to "drop out" of treatment than those in the lower severity groups (P=0.05). At both admission and discharge, the FACS severity groups were highly and inversely correlated with objective lifting performance and patient-reported fear-avoidance-related psychosocial variables, including kinesiophobia, pain intensity, depressive symptoms, perceived disability, perceived injustice, and insomnia (Ps<0.001). All variables showed improvement at FRP discharge. Patients in the extreme FACS severity group at discharge were less likely to return to, or retain, work 1 year later (P≤0.02). A factor analysis identified a 2-factor solution. Strong associations were found among FACS scores and other patient-reported psychosocial and objective lifting performance variables at both admission and discharge. High discharge-FACS scores were associated with worse work outcomes 1 year after discharge. The FACS seems to be a valid and clinically useful measure for predicting attendance, physical performance, distress, and relevant work outcomes in FRP treatment of chronic musculoskeletal pain disorder patients.

Positive Psychological Wellbeing Is Required for Online Self-Help Acceptance and Commitment Therapy for Chronic Pain to be Effective

PubMed Central

Trompetter, Hester R.; Bohlmeijer, Ernst T.; Lamers, Sanne M. A.; Schreurs, Karlein M. G.

2016-01-01

The web-based delivery of psychosocial interventions is a promising treatment modality for people suffering from chronic pain, and other forms of physical and mental illness. Despite the promising findings of first studies, patients may vary in the benefits they draw from self-managing a full-blown web-based psychosocial treatment. We lack knowledge on moderators and predictors of change during web-based interventions that explain for whom web-based interventions are especially (in)effective. In this study, we primarily explored for which chronic pain patients web-based Acceptance and Commitment Therapy (ACT) was (in)effective during a large three-armed randomized controlled trial. Besides standard demographic, physical and psychosocial factors we focused on positive mental health. Data from 238 heterogeneously diagnosed chronic pain sufferers from the general Dutch population following either web-based ACT (n = 82), or one of two control conditions [web-based Expressive Writing (EW; n = 79) and Waiting List (WL; n = 77)] were analysed. ACT and EW both consisted of nine modules and lasted nine to 12 weeks. Exploratory linear regression analyses were performed using the PROCESS macro in SPSS. Pain interference at 3-month follow-up was predicted from baseline moderator (characteristics that influence the outcome of specific treatments in comparison to other treatments) and predictor (characteristics that influence outcome regardless of treatment) variables. The results showed that none of the demographic or physical characteristics moderated ACT treatment changes compared to both control conditions. The only significant moderator of change compared to both EW and WL was baseline psychological wellbeing, and pain intensity was a moderator of change compared to EW. Furthermore, higher pain interference, depression and anxiety, and also lower levels of emotional well-being predicted higher pain interference in daily life 6 months later. These results suggest that web-based self-help ACT may not be allocated to chronic pain sufferers experiencing low levels of mental resilience resources such as self-acceptance, goals in life, and environmental mastery. Other subgroups are identified that potentially need specific tailoring of (web-based) ACT. Emotional and psychological wellbeing should receive much more attention in subsequent studies on chronic pain and illness. PMID:27014159

Complexity of Tropical Pacific Ecosystem and Biogeochemistry: Diurnal to Decadal, Plankters to Penguins

NASA Astrophysics Data System (ADS)

Murtugudde, R. G.; Wang, X.; Valsala, V.; Karnauskas, K. B.

2016-12-01

Tropical Pacific spans nearly 50% of the global tropics allowing to have its own mind in terms of climate variability and physical-biogeochemical interactions. While the El Niño-Southern Oscillation (ENSO) and its flavors get much attention, it is fairly clear by now that any further improvements in ENSO prediction skills and reliability of global warming projections must begin to observe and represent bio-physical interactions in the climate and Earth System models. Coupled climate variability over the tropical Pacific has a global reach with its diurnal to decadal timescales being manifest in ecosystem and biogechemistry. Zonal and meridional contrasts in biogeochemistry across the tropical Pacific is closely related to seasonal variability, ENSO diversity and the PDO. Apparent dominance of ocean dynamic controls on biogeochemistry belies the potential biogeochemical feedbacks on ocean dynamics which may well explain some of the chronic biases in the state-of-the-art climate models. The east Pacific cold-tongue is the most productive open ocean region in the world and home to a unique physical-biogeochmical laboratory, viz., the Galapagos. The Galapagos islands not only control the coupled climate variability via their ability to terminate the equatorial undercurrent but also offer a clear example of a biological loophole in terms of their impact on local upwelling and an expanding penguin habitat in the face of global warming. The complex bio-physical interactions in the cold-tongue and their influence on climate predictions and projections require a holisti thinking on future observing systems. Tropical Pacific offers a natural laboratory for designing a robust and sustained physical-biogeochemical observation system that can effectively bridge climate predictions and projections into a unified framework for subseasonal to multidecadal timescales. Such a system will be a foundation for establishing similar systems over the rest of the World ocean to seemlessly merge climate predictions and projections with the need to constantly monitor climate impacts on marine resources. This talk will focus on the zonal contrasts of the ocean dynamics and biogechemistry across the tropical Pacific to make a case for integrated physical-biogeochemical observations for climate predictions and projections.

Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome.

PubMed

Magistro, Giuseppe; Wagenlehner, Florian M E; Grabe, Magnus; Weidner, Wolfgang; Stief, Christian G; Nickel, J Curtis

2016-02-01

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition that causes severe symptoms, bother, and quality-of-life impact in the 8.2% of men who are believed to be affected. Research suggests a complex pathophysiology underlying this syndrome that is mirrored by its heterogeneous clinical presentation. Management of patients diagnosed with CP/CPPS has always been a formidable task in clinical practice. Due to its enigmatic etiology, a plethora of clinical trials failed to identify an efficient monotherapy. A comprehensive review of published randomized controlled trials (RCTs) on the treatment of CP/CPPS and practical best evidence recommendations for management. Medline and the Cochrane database were screened for RCTs on the treatment of CP/CPPS from 1998 to December 2014, using the National Institutes of Health Chronic Prostatitis Symptom Index as an objective outcome measure. Published data in concert with expert opinion were used to formulate a practical best evidence statement for the management of CP/CPPS. Twenty-eight RCTs identified were eligible for this review and presented. Trials evaluating antibiotics, α-blockers, anti-inflammatory and immune-modulating substances, hormonal agents, phytotherapeutics, neuromodulatory drugs, agents that modify bladder function, and physical treatment options failed to reveal a clear therapeutic benefit. With its multifactorial pathophysiology and its various clinical presentations, the management of CP/CPPS demands a phenotypic-directed approach addressing the individual clinical profile of each patient. Different categorization algorithms have been proposed. First studies applying the UPOINTs classification system provided promising results. Introducing three index patients with CP/CPPS, we present practical best evidence recommendations for management. Our current understanding of the pathophysiology underlying CP/CPPS resulting in this highly variable syndrome does not speak in favor of a monotherapy for management. No efficient monotherapeutic option is available. The best evidence-based management of CP/CPPS strongly suggests a multimodal therapeutic approach addressing the individual clinical phenotypic profile. Chronic prostatitis/chronic pelvic pain syndrome presents a variable syndrome. Successful management of this condition is challenging. It appears that a tailored treatment strategy addressing individual patient characteristics is more effective than one single therapy. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Contributions of physical function and satisfaction with social roles to emotional distress in chronic pain: a Collaborative Health Outcomes Information Registry (CHOIR) study.

PubMed

Sturgeon, John A; Dixon, Eric A; Darnall, Beth D; Mackey, Sean C

2015-12-01

Individuals with chronic pain show greater vulnerability to depression or anger than those without chronic pain, and also show greater interpersonal difficulties and physical disability. The present study examined data from 675 individuals with chronic pain during their initial visits to a tertiary care pain clinic using assessments from Stanford University's Collaborative Health Outcomes Information Registry (CHOIR). Using a path modeling analysis, the mediating roles of Patient-Reported Outcomes Measurement Information Systems (PROMIS) Physical Function and PROMIS Satisfaction with Social Roles and Activities were tested between pain intensity and PROMIS Depression and Anger. Pain intensity significantly predicted both depression and anger, and both physical function and satisfaction with social roles mediated these relationships when modeled in separate 1-mediator models. Notably, however, when modeled together, ratings of satisfaction with social roles mediated the relationship between physical function and both anger and depression. Our results suggest that the process by which chronic pain disrupts emotional well-being involves both physical function and disrupted social functioning. However, the more salient factor in determining pain-related emotional distress seems to be disruption of social relationships, than global physical impairment. These results highlight the particular importance of social factors to pain-related distress, and highlight social functioning as an important target for clinical intervention in chronic pain.

The impact of chronic physical illness, maternal depressive symptoms, family functioning, and self-esteem on symptoms of anxiety and depression in children.

PubMed

Ferro, Mark A; Boyle, Michael H

2015-01-01

The present study extends earlier research identifying an increased risk of anxiety among children with chronic physical illness (CwCPI) by examining a more complete model that explains how physical illness leads to increased symptoms of anxiety and depression. We tested a stress-generation model linking chronic physical illness to symptoms of anxiety and depression in a population-based sample of children aged 10 to 15 years. We hypothesized that having a chronic physical illness would be associated with more symptoms of anxiety and depression, increased levels of maternal depressive symptoms, more family dysfunction, and lower self-esteem; and, that maternal depressive symptoms, family dysfunction, and child self-esteem would mediate the influence of chronic physical illness on symptoms of anxiety and depression. Data came from the National Longitudinal Survey of Children and Youth (N = 10,646). Mediating processes were analyzed using latent growth curve modeling. Childhood chronic physical illness was associated with increases in symptoms of anxiety and depression, β = 0.20, p < 0.001. Mediating effects were also observed such that chronic physical illness resulted in increases in symptoms of maternal depression and family dysfunction, leading to declines in child self-esteem, and in turn, increases in symptoms of anxiety and depression. CwCPI are at-risk for symptoms of anxiety and depression. Some of this elevated risk appears to work through family processes and child self-esteem. This study supports the use of family-centered care approaches among CwCPI to minimize burden on families and promote healthy psychological development for children.

[Clinical, functional and older socio-familiar profile of the community in a district of Lima, Peru].

PubMed

Varela-Pinedo, Luis; Chávez-Jimeno, Helver; Tello-Rodríguez, Tania; Ortiz-Saavedra, Pedro; Gálvez-Cano, Miguel; Casas-Vasquez, Paola; Aliaga-Díaz, Elizabeth; Ciudad-Fernandez, Luis

2015-10-01

To determine the clinical, functional and socio-familiar profile of seniors from a community in a district of Lima, Peru. Descriptive cross-sectional study of a sample of 501 people aged 60 and over living in the San Martin de Porres district. We used a structured questionnaire in which clinical, functional and socio-familiar variables were recorded. A physical evaluation was carried out to assess performance based measures and serum samples were taken for hematological and biochemical examination. The data were presented with descriptive statistics such as frequencies and percentages for categorical variables and means and standard deviations for the numeric variables. A total of 501 older adults were evaluated. The mean age was 71.5 years (±8.9 years). The most common chronic disease was arterial hypertension at 40.9%, followed by rheumatic diseases with 36.9%. 27.7% had some degree of partial or total dependence in activities of daily living, 16.2% had cognitive impairment, 8% lived alone, 58.5% had or were at risk of having a social problem.61% self-rated their health as normal, while 16% rated it as bad or very bad. Seniors in the community of San Martin de Porres in Lima have frequent problems of functional dependence, have or are at risk of social problems, chronic illness and a high frequency of geriatric syndromes and problems.

Gender differences in chronic fatigue syndrome.

PubMed

Faro, Mònica; Sàez-Francás, Naia; Castro-Marrero, Jesús; Aliste, Luisa; Fernández de Sevilla, Tomás; Alegre, José

2016-01-01

Chronic fatigue syndrome (CFS) is a chronic condition that predominantly affects women. To date, there are few epidemiologic studies on CFS in men. The objective of the study was to assess whether there are gender-related differences in CFS, and to define a clinical phenotype in men. A prospective, cross-sectional cohort study was conducted including CFS patients at the time of diagnosis. Sociodemographic data, clinical variables, comorbid phenomena, fatigue, pain, anxiety/depression, and health quality of life, were assessed in the CFS population. A comparative study was also conducted between genders. The study included 1309 CFS patients, of which 119 (9.1%) were men. The mean age and symptoms onset were lower in men than women. The subjects included 30% single men vs. 15% single women, and 32% of men had specialist work vs. 20% of women. The most common triggering factor was an infection. Widespread pain, muscle spasms, dizziness, sexual dysfunction, Raynaud's phenomenon, morning stiffness, migratory arthralgias, drug and metals allergy, and facial oedema were less frequent in men. Fibromyalgia was present in 29% of men vs. 58% in women. The scores on physical function, physical role, and overall physical health of the SF-36 were higher in men. The sensory and affective dimensions of pain were lower in men. The clinical phenotype of the men with CFS was young, single, skilled worker, and infection as the main triggering agent. Men had less pain and less muscle and immune symptoms, fewer comorbid phenomena, and a better quality of life. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Psychological interventions for mental health disorders in children with chronic physical illness: a systematic review.

PubMed

Bennett, Sophie; Shafran, Roz; Coughtrey, Anna; Walker, Susan; Heyman, Isobel

2015-04-01

Children with chronic physical illness are significantly more likely to develop common psychiatric symptoms than otherwise healthy children. These children therefore warrant effective integrated healthcare yet it is not established whether the known, effective, psychological treatments for symptoms of common childhood mental health disorders work in children with chronic physical illness. EMBASE, MEDLINE, PsycINFO and CINAHL databases were searched with predefined terms relating to evidence-based psychological interventions for psychiatric symptoms in children with chronic physical illness. We included all studies (randomised and non-randomised designs) investigating interventions aimed primarily at treating common psychiatric symptoms in children with a chronic physical illness in the review. Two reviewers independently assessed the relevance of abstracts identified, extracted data and undertook quality analysis. Ten studies (209 children, including 70 in control groups) met the criteria for inclusion in the review. All studies demonstrated some positive outcomes of cognitive behavioural therapy for the treatment of psychiatric symptoms in children with chronic physical illness. Only two randomised controlled trials, both investigating interventions for symptoms of depression, were found. There is preliminary evidence that cognitive behavioural therapy has positive effects in the treatment of symptoms of depression and anxiety in children with chronic physical illness. However, the current evidence base is weak and fully powered randomised controlled trials are needed to establish the efficacy of psychological treatments in this vulnerable population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Inflammation, aging, and adiposity: implications for physical therapists.

PubMed

Addison, Odessa; LaStayo, Paul C; Dibble, Leland E; Marcus, Robin L

2012-01-01

Physical therapists treat older individuals, characterized as both a needy and expanding population. Frailty, a predisability condition with links to chronic inflammatory conditions, is estimated to affect 7% of individuals older than 60 years and 40% of people older than 80 years. Chronic inflammation is one of the most important physiologic correlates of the frailty syndrome and high levels of proinflammatory cytokines, related to both aging and increasing adiposity in older individuals are related to an increased risk of mortality, sarcopenia, reduced muscle strength and decreased mobility. The purpose of this narrative review is to inform the physical therapist of the effects of aging and increasing adiposity on chronic inflammation and the association of inflammation with muscle loss, strength, and mobility impairments in older adults; and to review the current evidence to provide clinical recommendations on physical activity and exercise regimes that may mitigate chronic inflammation in older adults. As physical therapists help manage and treat an increasingly older population, understanding how the inflammatory milieu changes with aging and increasing adiposity and how these changes can be impacted by physical therapists via exercise and physical activity is critical. Exercise is a potent preventive intervention strategy and countermeasure for chronic inflammation and adiposity. Exercise can also benefit the frail older individual by combating the negative effects of chronic inflammation and optimally balancing the production of pro and anti-inflammatory cytokines. In addition to providing an anti-inflammatory environment within muscle to mitigate the effects of chronic inflammation, exercise has the added benefit of improving muscle mass and function and decreasing adiposity in older adults.

All Fatigue is Not Created Equal: The Association of Fatigue and Its Subtypes on Pain Interference in Orofacial Pain.

PubMed

Boggero, Ian A; Rojas-Ramirez, Marcia V; Carlson, Charles R

2017-03-01

Fatigue is known to be a pathway through which depression, psychological distress, pain intensity, and sleep disturbance influence pain interference, but the independent effects of fatigue on pain interference after controlling for these variables remains unknown. In addition, no study to date has tested whether fatigue subtypes of general fatigue, mental fatigue, emotional fatigue, physical fatigue, or vigor differentially predict pain interference. The current study tested these associations using archival medical data of 2133 chronic orofacial pain patients, who completed a battery of psychological questionnaires at the time of their first appointment at an orofacial pain clinic. Hierarchical linear regression analysis revealed that after controlling for depression, psychological distress, sleep disturbance, pain intensity, and demographic variables, fatigue predicted higher pain interference (B=0.70, SE=0.17, P<0.001, η=0.01). Physical fatigue (B=1.70, SE=0.48, P<0.001, η=0.01) and vigor (B=-3.24, SE=0.47, P<0.001, η=0.03) were independently associated with pain interference after controlling for the aforementioned variables. The findings suggest that fatigue is an important independent predictor of pain interference and not merely a mediator. These findings also suggest that not all fatigue is created equal. Interventions aimed at reducing pain interference should target specific fatigue symptoms of physical fatigue and vigor. Future research investigating the independent associations of fatigue subtypes on pain outcomes may help clarify the nature of the interrelationships between pain and fatigue.

Physical activity level at work and risk of chronic low back pain: A follow-up in the Nord-Trøndelag Health Study.

PubMed

Heuch, Ingrid; Heuch, Ivar; Hagen, Knut; Zwart, John-Anker

2017-01-01

Physical activity in leisure time seems to reduce the risk of low back pain, but it is not known whether occupational activity, as recorded in a representative working population, produces a higher or lower risk. To study associations between physical activity level at work and risk of chronic low back pain. Associations were examined in a Norwegian prospective study using data from the HUNT2 and HUNT3 surveys carried out in the whole county of Nord-Trøndelag. Participants were 7580 women and 7335 men who supplied information about physical activity level at work. Levels considered were sedentary work, work involving walking but no heavy lifting, work involving walking and heavy lifting, and particularly strenuous physical work. Nobody in the cohort was affected by chronic low back pain at baseline. After 11 years, participants reported whether they suffered from chronic low back pain. Generalized linear modelling with adjustment for potential confounders was applied to assess associations with risk factors. In age-adjusted analyses both women and men showed statistically significant associations between physical activity at work and risk of chronic low back pain, suggesting positive relationships. For particularly strenuous physical work the relative risk of chronic low back pain was 1.30 (95% CI: 1.00-1.71) in women and 1.36 (95% CI 1.17-1.59) in men, compared to sedentary work. Women still showed a general association with activity level after adjustment for education, leisure time physical activity, BMI, smoking and occupational category. In men, the higher risk was only maintained for particularly strenuous work. In this cohort, women had a higher risk of chronic low back pain with work involving walking and heavy lifting or particularly strenuous work, compared to sedentary work. Men participating in particularly strenuous work also experienced a higher risk of chronic low back pain.

Physical modalities in chronic pain management.

PubMed

Rakel, Barbara; Barr, John O

2003-09-01

The following conclusions can be made based on review of the evidence: There is limited but positive evidence that select physical modalities are effective in managing chronic pain associated with specific conditions experienced by adults and older individuals. Overall, studies have provided the most support for the modality of therapeutic exercise. Different physical modalities have similar magnitudes of effects on chronic pain. Therefore, selection of the most appropriate physical modality may depend on the desired functional outcome for the patient, the underlying impairment, and the patient's preference or prior experience with the modality. Certain patient characteristics may decrease the effectiveness of physical modalities, as has been seen with TENS. These characteristics include depression, high trait anxiety, a powerful others locus of control, obesity, narcotic use, and neuroticism. The effect on pain by various modalities is generally strongest in the short-term period immediately after the intervention series, but effects can last as long as 1 year after treatment (e.g., with massage). Most research has tested the effect of physical modalities on chronic low back pain and knee OA. The effectiveness of physical modalities for other chronic pain conditions needs to be evaluated more completely. Older and younger adults often experience similar effects on their perception of pain from treatment with physical modalities. Therefore, use of these modalities for chronic pain in older adults is appropriate, but special precautions need to be taken. Practitioners applying physical modalities need formal training that includes the risks and precautions for these modalities. If practitioners lack formal training in the use of physical modalities, or if modality use is not within their scope of practice, it is important to consult with and refer patients to members of the team who have this specialized training. Use of a multidisciplinary approach to chronic pain management is of value for all adults and older individuals in particular [79-81]. Historically, physical therapists have been trained to evaluate and treat patients with the range of physical modalities discussed in this article. Although members of the nursing staff traditionally have used some of these modalities (e.g. some forms of heat or cold and massage), increasing numbers of nurses now are being trained to apply more specialized procedures (e.g., TENS). Healthcare professionals must be knowledgeable about the strength of evidence underlying the use of physical modalities for the management of chronic pain. Based on the limited research evidence available (especially related to assistive devices, orthotics, and thermal modalities), it often is difficult to accept or exclude select modalities as having a potential role in chronic pain management for adults and older individuals. Improved research methodologies are needed to address physical modality effectiveness better.

Factors associated with physical inactivity in transportation in Brazilian adults living in a low socioeconomic area.

PubMed

Sa, Thiago Herick; Salvador, Emanuel Péricles; Florindo, Alex Antonio

2013-08-01

Physical inactivity in transportation is negatively related to many health outcomes. However, little is known about the correlates of this condition among people living in regions of low socioeconomic level. Cross-sectional study aimed to assess factors associated with physical inactivity in transportation among adults in the Eastern Zone of São Paulo, Brazil. Home-based interviews were conducted between May 2007 and January 2008 on a probabilistic sample of the adult population (≥18 years), totaling 368 men and 522 women. Factors associated with physical inactivity in transportation (less than 10 minutes per week of walking or cycling) were assessed using multivariate Poisson regression with hierarchical selection of variables. Physical inactivity in transportation was associated with the presence of vehicles in the household in men (PR = 2.96) and women (PR = 2.42), with linear trend for both sexes (P < .001 and P = .004, respectively), even after adjusting for age, schooling level and chronic diseases (this last factor, only among women). Presence of vehicles in the household was associated positively with physical inactivity in transportation, both for men and for women. This should be taken into consideration in drawing up public policies for promoting physical activity.

[Occupation-, transportation- and leisure-related physical activity: gender inequalities in Santander, Colombia].

PubMed

Hormiga-Sánchez, Claudia M; Alzate-Posada, Martha L; Borrell, Carme; Palència, Laia; Rodríguez-Villamizar, Laura A; Otero-Wandurraga, Johanna A

2016-04-01

Objectives To estimate the prevalence of occupation-, transportation- and leisure-related physical activity, its compliance with recommendations, and to explore its association with demographic and socioeconomic variables in men and women of the Department of Santander (Colombia). Methods The sample consisted of 2421 people between 15 and 64 years of age, participants in the Risk Factors for Chronic Diseases of Santander cross-sectional study, developed in 2010. The Global Physical Activity Questionnaire was used for data collection. Age-adjusted prevalence ratios were calculated and multivariate analysis models were built by sex using robust Poisson regression. Results The prevalence of occupational and leisure physical activity and compliance with recommendations were lower in women. Sexual division of labor and a low socioeconomic level negatively influenced physical activity in women, limiting the possibility of practice of those principally engaged in unpaid work at home. Young or single men and those living in higher socioeconomic areas were more likely to practice physical activity in leisure time and meet recommendations. Conclusion Physical activity surveillance and related public policies should take into account the inequalities between the practice of men and women related to their socioeconomic conditions and the sexual division of labor.

Personal and macro-systemic factors as predictors of quality of life in chronic schizophrenia.

PubMed

Fontanil-Gómez, Yolanda; Alcedo Rodríguez, María A; Gutiérrez López, María I

2017-05-01

The goal of this research was to establish possible predictive factors for both subjective and externally assessed quality of life in people with chronic schizophrenia. Sixty-eight people with schizophrenia took part in the study and were assessed using the World Health Organisation Quality of Life Assessment - Brief Version (WHOQOL-BREF), the Quality of Life Scale (QLS), the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the Global Assessment of Functioning (GAF), the Social Functioning Scale (SFS) tests. Correlations and multiple regression analysis were conducted to determine possible predictors of quality of life. The residential environment (rural/urban), diagnosis, age at onset of disorder, global functioning and social functioning explained 68% of the total variance based on proxies’ assessment quality of life. Living arrangements and social functioning emerged as predictor variables for subjective quality of life, explaining a 47.3% of the total variance. Socio-cultural factors, such as social integration or the quality of interpersonal relationships, have more influence on these peoples’ physical and psychological health than certain personal factors, such as psychopathology. It is therefore advisable to pay attention to the environment and macro-systemic variables when developing intervention plans to improve their quality of life.

Longitudinal Monitoring of Patients With Chronic Low Back Pain During Physical Therapy Treatment Using the STarT Back Screening Tool.

PubMed

Medeiros, Flávia Cordeiro; Costa, Leonardo Oliveira Pena; Added, Marco Aurélio Nemitalla; Salomão, Evelyn Cassia; Costa, Lucíola da Cunha Menezes

2017-05-01

Study Design Preplanned secondary analysis of a randomized clinical trial. Background The STarT Back Screening Tool (SBST) was developed to screen and to classify patients with low back pain into subgroups for the risk of having a poor prognosis. However, this classification at baseline does not take into account variables that can influence the prognosis during treatment or over time. Objectives (1) To investigate the changes in risk subgroup measured by the SBST over a period of 6 months, and (2) to assess the long-term predictive ability of the SBST when administered at different time points. Methods Patients with chronic nonspecific low back pain (n = 148) receiving physical therapy care as part of a randomized trial were analyzed. Pain intensity, disability, global perceived effect, and the SBST were collected at baseline, 5 weeks, 3 months, and 6 months. Changes in SBST risk classification were calculated. Hierarchical linear regression models adjusted for potential confounders were built to analyze the predictive capabilities of the SBST when administered at different time points. Results A large proportion of patients (60.8%) changed their risk subgroup after receiving physical therapy care. The SBST improved the prediction for all 6-month outcomes when using the 5-week risk subgroup and the difference between baseline and 5-week subgroup, after controlling for potential confounders. The SBST at baseline did not improve the predictive ability of the models after adjusting for confounders. Conclusion This study shows that many patients change SBST risk subgroup after receiving physical therapy care, and that the predictive ability of the SBST in patients with chronic low back pain increases when administered at different time points. Level of Evidence Prognosis, 2b. J Orthop Sports Phys Ther 2017;47(5):314-323. Epub 29 Mar 2017. doi:10.2519/jospt.2017.7199.

A study of chronic fatigue in Norwegian cervical cancer survivors.

PubMed

Steen, Rita; Dahl, Alv A; Hess, Siri Lothe; Kiserud, Cecilie E

2017-09-01

Chronic fatigue after treatment is a common adverse event in cancer patients, but there are few studies in long-term survivors of cervical cancer. The aim of this investigation was to explore the prevalence of chronic fatigue and its association with various clinical and treatment-related factors in a population-based cohort of Norwegian cervical cancer survivors treated by any modality. All patients, treated for cervical cancer from 2000 through 2007 in the Health Region of South-Eastern Norway, cancer-free, alive and aged ≤75years by the end 2013 (n=822) received a questionnaire covering chronic fatigue and other clinical variables. 461 of 822 survivors (56%) completed the questionnaire and 382 entered the analyses. Chronic fatigue was reported by 23% (95% confidence interval 19%-27%) with a median age of 52years (range 32-75) at survey, 11years (range 7-15) after diagnosis. Among survivors treated by minimal invasive- or radical surgery, 19% had chronic fatigue, while the prevalence was 28% in those treated with radiation and concomitant chemotherapy (chemoradiation). The chronic fatigue group reported significantly more cardiovascular disease, obesity, less physical activity, more treatment-related symptom experience, more menopausal symptoms, higher levels of anxiety and depressive symptoms, and poorer quality of life than the non-fatigued group. In multivariate analysis only increased level of depression and poorer global quality of life were significantly associated with chronic fatigue. Chronic fatigue was reported by 23% of long-term survivors after cervical cancer at a mean of 11years after treatment. Some of the associated factors are amenable to prevention and/or treatment and should be subjects of attention at follow-up. Copyright © 2017 Elsevier Inc. All rights reserved.

Elder Abuse and Chronic Pain: Cross-Sectional and Longitudinal Results from the Preventing Elder Abuse and Neglect Initiative.

PubMed

Yunus, Raudah M; Hairi, Noran N; Choo, Wan Y; Tan, Maw P; Hairi, Farizah; Sooryanarayana, Rajini; Ismail, Norliana; Kandiben, Shatanapriya; Peramalah, Devi; Ali, Zainudin M; Ahmad, Sharifah N; Razak, Inayah A; Othman, Sajaratulnisah; Mydin, Fadzilah Hm; Chinna, Karuthan; Bulgiba, Awang

2018-03-30

To examine the cross-sectional and longitudinal relationships between elder abuse and neglect (EAN) and chronic pain in rural older Malaysians. Two-year prospective cohort study. Kuala Pilah, a district in Negeri Sembilan approximately 100 km from the capital city, Kuala Lumpur. Community-dwelling older adults aged 60 and older. Using a multistage cluster sampling strategy, 1,927 respondents were recruited and assessed at baseline, of whom 1,189 were re-assessed 2 years later. EAN was determined using the modified Conflict Tactic Scale, and chronic pain was assessed through self-report using validated questions. The prevalence of chronic pain was 20.4%. Cross-sectional results revealed 8 variables significantly associated with chronic pain-age, education, income, comorbidities, self-rated health, depression, gait speed, and EAN. Abused elderly adults were 1.52 times as likely to have chronic pain (odds ratio=1.52, 95% confidence interval (CI)=1.03-2.27), although longitudinal analyses showed no relationship between EAN and risk of chronic pain (risk ratio=1.14, 95% CI=0.81-1.60). This lack of causal link was consistent when comparing analysis with complete cases with that of imputed data. Our findings indicate no temporal relationship between EAN and chronic pain but indicated cross-sectional associations between the two. This might indicate that, although EAN does not lead to chronic pain, individuals with greater physical limitations are more vulnerable to abuse. Our study also shows the importance of cohort design in determining causal relationships between EAN and potentially linked health outcomes. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Sport-2-Stay-Fit study: Health effects of after-school sport participation in children and adolescents with a chronic disease or physical disability.

PubMed

Zwinkels, Maremka; Verschuren, Olaf; Lankhorst, Kristel; van der Ende-Kastelijn, Karin; de Groot, Janke; Backx, Frank; Visser-Meily, Anne; Takken, Tim

2015-01-01

Children and adolescents with a chronic disease or physical disability have lower fitness levels compared to their non-disabled peers. Low physical fitness is associated with reduced physical activity, increased cardiovascular diseases, and lower levels of both cognitive and psychosocial functioning. Moreover, children and adolescents with a chronic disease or physical disability participate less in both recreational and competitive sports. A variety of intervention studies have shown positive, but only temporary, effects of training programs. Next to issues related to the chronic condition itself, various personal and environmental factors play a key role in determining the extent to which they participate in sports or physical activities. Due to these barriers, sport participation in the immediate after-school hours seems to be a feasible solution to get these children and adolescents physical active structurally. To investigate if an after school sport program can sustain the positive effects of an intervention, a standardized interval training will be given to improve physical fitness levels. High-intensity Interval Training (HIT) is superior to moderate-intensity continuous training in improving physical fitness in patients with chronic diseases. Therefore, the Sport-2-Stay-Fit study will investigate whether after school sport participation can increase the sustainability of a HIT program in children and adolescents with a chronic disease or physical disability. The Sport-2-Stay-Fit study is a clinical controlled trial. A total of 74 children and adolescents in the age of 6-19 years with a chronic disease or physical disability will be included. This could be either a cardiovascular, pulmonary, metabolic, musculoskeletal or neuromuscular disorder. Both children and adolescents who are ambulatory or propelling a manual wheelchair will be included. All participants will follow a HIT program of eight weeks to improve their physical fitness level. Thereafter, the intervention group will participate in sport after school for six months, while the control group receives assessment only. Measurements will take place before the HIT, directly after, as well as, six months later. The primary objective is anaerobic fitness. Secondary objectives are agility, aerobic fitness, strength, physical activity, cardiovascular health, cognitive functioning, and psychosocial functioning. If effective, after school sport participation following a standardized interval training could be implemented on schools for special education to get children and adolescents with a chronic disease or physical disability active on a structural basis. This trial is registered at the Dutch Trial Register #NTR4698.

The role of psychosocial processes in the development and maintenance of chronic pain disorders

PubMed Central

Edwards, Robert R.; Dworkin, Robert H.; Sullivan, Mark D.; Turk, Dennis; Wasan, Ajay D.

2016-01-01

The recently-proposed ACTTION-APS Pain Taxonomy provides an evidence-based, multidimensional, chronic pain classification system. Psychosocial factors play a crucial role within several dimensions of the Taxonomy. In this paper, we discuss the evaluation of psychosocial factors that influence the diagnosis and trajectory of chronic pain disorders. We review studies in individuals with a variety of persistent pain conditions, and describe evidence that psychosocial variables play key roles in conferring risk for the development of pain, in shaping long-term pain-related adjustment, and in modulating pain treatment outcomes. We consider both “general” psychosocial variables such as negative affect, childhood trauma, and social support, as well as “pain-specific” psychosocial variables that include pain-related catastrophizing, self-efficacy for managing pain, and pain-related coping. Collectively, the complexity and profound variability in chronic pain highlights the need to better understand the multidimensional array of interacting forces that determine the trajectory of chronic pain conditions. PMID:27586832

Prevalence and determinants of fatigue in patients with moderate to severe chronic GvHD.

PubMed

Im, A; Mitchell, S A; Steinberg, S M; Curtis, L; Berger, A; Baird, K; Kuzmina, Z; Joe, G; Comis, L E; Juckett, M; Avila, D; Baruffaldi, J; Masuch, L; Pirsl, F; Pavletic, S Z

2016-05-01

Although fatigue is common after allogeneic hematopoietic cell transplantation, little is known about fatigue in patients with chronic GvHD (cGvHD). The aim of this study was to explore factors associated with fatigue in cGvHD. Data were drawn from a sequentially recruited, cross-sectional study of adults with moderate or severe cGvHD (n=263). Respondents were classified as fatigued or not fatigued based on their response to a single item regarding loss of energy from the Lee cGvHD Symptom Scale. In univariate analysis, factors significantly associated with fatigue included performance status, number of prior cGvHD therapies, cGvHD symptom bother, self-assessed physical and mental health, nutritional status, walk velocity and self-reported physical activity. There were no significant associations between fatigue and disease-related cGvHD variables. Multivariable logistic regression demonstrated that being less active and having pulmonary and/or muscle/joint symptoms were independently associated with fatigue. In conclusion, clinically significant fatigue was prevalent in more than one-third of subjects with cGvHD, and was disabling. Absence of association with measures of cGvHD severity underscores the need to elucidate the pathogenesis of fatigue and its relationship with inflammatory activity. Pulmonary and muscle/joint symptoms and physical inactivity represent potential targets for intervention in clinical studies.

Applying the Chronic Care Model to Support Ostomy Self-Management: Implications for Oncology Nursing Practice

PubMed Central

Ercolano, Elizabeth; Grant, Marcia; McCorkle, Ruth; Tallman, Nancy J.; Cobb, Martha D.; Wendel, Christopher; Krouse, Robert

2017-01-01

Background Each year at least 40,000 individuals receive an ostomy due to cancer. Living with an ostomy requires daily site and equipment care, lifestyle changes, emotional management, and social role adjustments. The Chronic Care Ostomy Self-management Training Program (CCOSMTP) offers an ostomy self-management curriculum; emphasizing problem-solving, self-efficacy, reframing cognitive responses, and goal setting. Objectives The qualitative method of content analysis was employed to categorize self-reported goals of ostomates identified during a nurse-led feasibility trial testing the CCOSMTP. Methods Thirty-eight ostomates identified goals at three CCOSMTP sessions. The goals were classified according to the City of Hope Health-Related Qualify of Life Model, a validated multi-dimensional framework, describing physical, psychological, social and spiritual ostomy-related effects. Nurse experts coded the goals independently and then collaborated to reach 100% consensus on the goals’ classification. Findings One-hundred and eighteen goals were identified by 38 participants. Eighty-seven goals (77.2%) were physical goals, related to the care of the skin, placement of the pouch/bag and management of leaks. There were 26 social goals (22.0%) addressing engagement in social/recreation roles and daily activities and five (0.8%) psychological goals on confidence and controlling negative thinking. While ostomy cancer survivors’ goals are variable, physical goals are most common in self-management training. PMID:27206293

Physical fitness level affects perception of chronic stress in military trainees.

PubMed

Tuch, Carolin; Teubel, Thomas; La Marca, Roberto; Roos, Lilian; Annen, Hubert; Wyss, Thomas

2017-12-01

This study investigated whether physical fitness affects the perception of chronic stress in military trainees while controlling for established factors influencing stress perception. The sample consisted of 273 men (20.23 ± 1.12 years, 73.56 ± 10.52 kg, 1.78 ± 0.06 m). Physical fitness was measured by progressive endurance run (maximum oxygen uptake; VO 2 max), standing long jump, seated shot put, trunk muscle strength, and one leg standing test. Perceived stress was measured using the Perceived Stress Questionnaire in Weeks 1 and 11 of basic military training (BMT). VO 2 max and four influencing variables (perceived stress in Week 1, neuroticism, transformational leadership style, and education level) explained 44.44% of the variance of the increase in perceived stress during 10 weeks of BMT (R 2  = 0.444, F = 23.334, p < .001). The explained variance of VO 2 max was 4.14% (R 2  = 0.041), with a Cohen's f 2 effect size of 0.045 (assigned as a small effect by Cohen, ). The results indicate a moderating influence of good aerobic fitness on the varied level of perceived stress. We conclude that it is advisable to provide conscripts with a specific endurance training program prior to BMT for stress prevention reasons. Copyright © 2016 John Wiley & Sons, Ltd.

Quality of life in chronic renal patients on hemodialysis or peritoneal dialysis: a comparative study in a referral service of Curitiba - PR.

PubMed

Gonçalves, Fernanda Aguiar; Dalosso, Ingrid Fernandes; Borba, Jéssica Maria Camargo; Bucaneve, Juliana; Valerio, Nayra Maria Prado; Okamoto, Cristina Terumy; Bucharles, Sergio Gardano Elias

2015-01-01

Chronic kidney disease (CKD) compromises the health and routine of the patient. On the fifth stage of CKD, the patient becomes eligible to start renal replacement therapy: hemodialysis (HD), peritoneal dialysis (PD) or kidney transplantation. The type of CKD treatment is essential to improving quality of life of the patient. To compare the quality of life of CKD stage 5 patients who perform HD and home PD. Cross-sectional study with data collection, by convenience, through the application of socioeconomic and KDQOL SF-36 questionnaires in HD and PD patients of the Pro-Renal Foundation and satellite clinics in Curitiba-PR. The sample was 338 patients, 222 HD and 116 PD. Average age: 54.4 years for HD group (± 15.28) and 58.00 for the DP group (± 13.99). The variables: work status (p < 0.05), encouragement by dialysis staff (p < 0.01) and patient satisfaction (p < 0.001) were in favor of DP; while physical functioning (p < 0.05) and emotional function (p < 0.01) were to HD. Objectively, PD was more favorable regarding quality of life, for the large number of items with significant results when compared to HD. However, the two variables of greatest significance found in HD (physical functioning and emotional functioning) ended up having a much greater impact on well-being and daily-life of the patient in the environment external to the clinic than those who were higher in DP, making HD the most favorable for patient quality of life.

The neuropathology of chronic traumatic encephalopathy.

PubMed

McKee, Ann C; Stein, Thor D; Kiernan, Patrick T; Alvarez, Victor E

2015-05-01

Repetitive brain trauma is associated with a progressive neurological deterioration, now termed as chronic traumatic encephalopathy (CTE). Most instances of CTE occur in association with the play of sports, but CTE has also been reported in association with blast injuries and other neurotrauma. Symptoms of CTE include behavioral and mood changes, memory loss, cognitive impairment and dementia. Like many other neurodegenerative diseases, CTE is diagnosed with certainty only by neuropathological examination of brain tissue. CTE is a tauopathy characterized by the deposition of hyperphosphorylated tau (p-tau) protein as neurofibrillary tangles, astrocytic tangles and neurites in striking clusters around small blood vessels of the cortex, typically at the sulcal depths. Severely affected cases show p-tau pathology throughout the brain. Abnormalities in phosphorylated 43 kDa TAR DNA-binding protein are found in most cases of CTE; beta-amyloid is identified in 43%, associated with age. Given the importance of sports participation and physical exercise to physical and psychological health as well as disease resilience, it is critical to identify the genetic risk factors for CTE as well as to understand how other variables, such as stress, age at exposure, gender, substance abuse and other exposures, contribute to the development of CTE. © 2015 International Society of Neuropathology.

The Neuropathology of Chronic Traumatic Encephalopathy

PubMed Central

McKee, Ann C.; Stein, Thor D.; Kiernan, Patrick T.; Alvarez, Victor E.

2015-01-01

Repetitive brain trauma is associated with a progressive neurological deterioration, now termed as chronic traumatic encephalopathy (CTE). Most instances of CTE occur in association with the play of sports, but CTE has also been reported in association with blast injuries and other neurotrauma. Symptoms of CTE include behavioral and mood changes, memory loss, cognitive impairment and dementia. Like many other neurodegenerative diseases, CTE is diagnosed with certainty only by neuropathological examination of brain tissue. CTE is a tauopathy characterized by the deposition of hyperphosphorylated tau (p-tau) protein as neurofibrillary tangles, astrocytic tangles and neurites in striking clusters around small blood vessels of the cortex, typically at the sulcal depths. Severely affected cases show p-tau pathology throughout the brain. Abnormalities in phosphorylated 43 kDa TAR DNA-binding protein are found in most cases of CTE; beta-amyloid is identified in 43%, associated with age. Given the importance of sports participation and physical exercise to physical and psychological health as well as disease resilience, it is critical to identify the genetic risk factors for CTE as well as to understand how other variables, such as stress, age at exposure, gender, substance abuse and other exposures, contribute to the development of CTE. PMID:25904048

Access to Care and Satisfaction Among Health Center Patients With Chronic Conditions.

PubMed

Shi, Leiyu; Lee, De-Chih; Haile, Geraldine Pierre; Liang, Hailun; Chung, Michelle; Sripipatana, Alek

This study examined access to care and satisfaction among health center patients with chronic conditions. Data for this study were obtained from the 2009 Health Center Patient Survey. Dependent variables of interest included 5 measures of access to and satisfaction with care, whereas the main independent variable was number of chronic conditions. Results of bivariate analysis and multiple logistic regressions showed that patients with chronic conditions had significantly higher odds of reporting access barriers than those without chronic conditions. Our results suggested that additional efforts and resources are necessary to address the needs of health center patients with chronic conditions.

Personality, Coping, and Well-Being for People Living with Chronic Hepatitis C.

PubMed

Cellar, Douglas F; Voster, Devon; Fetters, Rachel; Twitchell, Emily; Harper, Gary W; Scott, Cotler

2016-04-01

The present study examined the relationships between personality, coping strategies, and health ratings to extend past research to people living with chronic hepatitis C (HCV). Participants were 35 people (11 men, 24 women; M age = 49.6 yr., SD = 10.6) living with chronic hepatitis C for an average of 9.0 yr. (SD = 6.0) since diagnosis. Participants provided descriptions of stressful situations and responded to a personality inventory, Ways of Coping Questionnaire scales (planful problem solving and escape-avoidance) and SF36 Health Survey scales measuring physical functioning and mental health. The stressful situations were judgmentally clustered into seven dimensions (diagnosis/mortality, disclosure, stigma, social and work role functioning, compounding problems, and no stress). Correlational analyses indicated strong negative relationships between escape-avoidance coping and health measures. Emotional Stability and Extraversion were positively related to both health variables, and Extraversion was negatively related to escape-avoidance coping. The results suggest that research from other contexts that has examined these relationships tended to generalize to people living with HCV. © The Author(s) 2016.

Sexual behavior among adolescents reporting chronic conditions: a French national survey.

PubMed

Choquet, M; Du Pasquier Fediaevsky, L; Manfredi, R

1997-01-01

To compare sexual behavior in adolescents with a physical handicap or a chronic illness (HCI, n = 604) to a healthy group (HG, n = 7,332). Data drawn from a French national health survey carried out among 7,936 adolescents (mean age = 16.2 years) were used. A self-report questionnaire concerning health behavior, sexual behavior, and chronic illness was used in 136 public secondary schools. HCI and HG groups were compared on reported sexual behavior as well as on information (on sexuality, AIDS, and pregnancy) given by the parents. Logistic regression was performed for boys and girls to explore the relationship of health status (HCI or HG) to sexual intercourse, adjusted for sociodemographic variables. Fifty-two percent of HCI boys and 38% of HCI girls reported sexual intercourse (vs. 42% of HG boys and 28% of HG girls). The HCI girls reported more often than HG girls changing partners, pregnancy, and use of oral contraceptives. The HCI boys reported more often than HG boys receiving information on sexuality from their parents. French HCI adolescents were found to be at high risk for pregnancy and sexually transmitted diseases (STD).

[Impact of disabling chronic pain: results of a cross-sectional population study with face-to-face interview].

PubMed

Cabrera-Leon, Andrés; Cantero-Braojos, Miguel Ángel

2017-11-16

To assess the impact of disabling chronic pain (DCP) on quality of life, work, consumption of medication and usage of health services. Cross-sectional population study with face-to-face interview. Andalusian Health Survey (2011 edition). 6,507 people over the age of 16 (p=q=0.5; confidence level=95%; sampling error=1.49, design effect=1.52). Not applicable. Dependent variable: DCP: population limited in their activity by any of the CP specified in the survey. quality of life, absence from work, consumption of medication and utilization of health services. Compared to a population without CP, DCP impact is 6 points less on the mental quality of life and 12 points on the physical one, medication consumption is triple, health services utilization is almost double, and long absence from work is triple. On the other hand, a population with nondisabling chronic pain (nDCP) presents similar results to a population without CP. We have considered DCP as another CP category because of its huge impact, as is shown in our study, on the study variables. On the contrary, the population with nDCP does not obtain significant impact differences when compared to the population without CP. Therefore, we believe that Primary Care and Public Health should lead different prevention strategies for DCP as well as for the identification of the nDCP population to decrease its possible deterioration towards DCP. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Primary care nursing activities with patients affected by physical chronic disease and common mental disorders: a qualitative descriptive study.

PubMed

Girard, Ariane; Hudon, Catherine; Poitras, Marie-Eve; Roberge, Pasquale; Chouinard, Maud-Christine

2017-05-01

To describe nursing activities in primary care with patients affected by physical chronic disease and common mental disorders. Patients in primary care who are affected by physical chronic disease and common mental disorders such as anxiety and depression require care and follow-up based on their physical and mental health condition. Primary care nurses are increasingly expected to contribute to the care and follow-up of this growing clientele. However, little is known about the actual activities carried out by primary care nurses in providing this service in the Province of Quebec (Canada). A qualitative descriptive study was conducted. Data were obtained through semistructured individual interviews with 13 nurses practising among patients with physical chronic disease in seven Family Medicine Groups in Quebec (Canada). Participants described five activity domains: assessment of physical and mental health condition, care planning, interprofessional collaboration, therapeutic relationship and health promotion. The full potential of primary care nurses is not always exploited, and some activities could be improved. Evidence for including nurses in collaborative care for patients affected by physical chronic disease and common mental disorders has been shown but is not fully implemented in Family Medicine Groups. Future research should emphasise collaboration among mental health professionals, primary care nurses and family physicians in the care of patients with physical chronic disease and common mental disorders. Primary care nurses would benefit from gaining more knowledge about common mental disorders and from identifying the resources they need to contribute to managing them in an interdisciplinary team. © 2016 John Wiley & Sons Ltd.

Education for patients with chronic kidney disease in Taiwan: a prospective repeated measures study.

PubMed

Yen, Miaofen; Huang, Jeng-Jong; Teng, Hsiu-Lan

2008-11-01

To investigate the physical, knowledge and quality of life outcomes of an educational intervention for patients with early stage chronic kidney disease. A comprehensive predialysis education care team can be effective in slowing the progression of chronic kidney disease. A single group repeated measures design was used to evaluate the effects of the intervention. Participants were recruited through health department community health screen data banks. A predialysis, team-delivered educational intervention covering renal function health care, dietary management of renal function and the effects of Chinese herb medication on renal function was designed and implemented. Data were collected at baseline, six and 12 months. Study outcomes included physical indicators, knowledge (renal function protection, use of Chinese herbs and renal function and diet) and quality of life. Data were analysed using repeated measure anova to test for change over time in outcome variables. Sixty-six persons participated in this study. The predialysis educational intervention showed significant differences at the three time points in overall knowledge scores, waist-hip ratio, body mass index and global health status. Knowledge measures increased at month 6 and decreased at month 12. The primary indicator of renal function, glomerular filtration rate, remained stable throughout the 12 months of follow-up, despite the relatively older mean age of study participants. A predialysis education care team can provide effective disease-specific knowledge and may help retard deterioration of renal function in persons with early-stage chronic kidney disease. The intervention dose may need to be repeated every six months to maintain knowledge effects. A predialysis educational program with disease-specific knowledge and information is feasible and may provide positive outcomes for patients. Topics on the uses of Chinese herbs should be included for people who are likely to use alternative therapies.

Psychological Neuromodulatory Treatments for Young People with Chronic Pain

PubMed Central

Miró, Jordi; Castarlenas, Elena; de la Vega, Rocío; Roy, Rubén; Solé, Ester; Tomé-Pires, Catarina; Jensen, Mark P.

2016-01-01

The treatment of young people with chronic pain is a complex endeavor. Many of these youth do not obtain adequate relief from available interventions. Psychological neuromodulatory treatments have been shown to have potential benefit for adults with chronic pain. Here, we review and summarize the available information about the efficacy of three promising psychological neuromodulatory treatments—neurofeedback, meditation and hypnosis—when provided to young people with chronic pain. A total of 16 articles were identified and reviewed. The findings from these studies show that hypnotic treatments are effective in reducing pain intensity for a variety of pediatric chronic pain problems, although research suggests variability in outcomes as a function of the specific pain problem treated. There are too few studies evaluating the efficacy of neurofeedback or meditation training in young people with chronic pain to draw firm conclusions regarding their efficacy. However, preliminary data indicate that these treatments could potentially have positive effects on a variety of outcomes (e.g., pain intensity, frequency of pain episodes, physical and psychological function), at least in the short term. Clinical trials are needed to evaluate the effects of neurofeedback and meditation training, and research is needed to identify the moderators of treatment benefits as well as better understand the mechanisms underlying the efficacy of all three of these treatments. The findings from such research could enhance overall treatment efficacy by: (1) providing an empirical basis for better patient-treatment matching; and (2) identifying specific mechanisms that could be targeted with treatment. PMID:27929419

Chronic Diffuse Pain and Functional Gastrointestinal Disorders After Traumatic Stress: Pathophysiology Through a Polyvagal Perspective

PubMed Central

Kolacz, Jacek; Porges, Stephen W.

2018-01-01

Chronic diffuse pain disorders, such as fibromyalgia, and functional gastrointestinal disorders (FGIDs), such as irritable bowel syndrome, place substantial burden on those affected and on the medical system. Despite their sizable impact, their pathophysiology is poorly understood. In contrast to an approach that focuses on the correlation between heart rate variability (HRV) and a specific organ or symptom, we propose that a bio-evolutionary threat-related autonomic response—as outlined in the Polyvagal Theory—may serve as a plausible explanation of how HRV, particularly respiratory sinus arrhythmia (RSA), would index the pathophysiology of these disorders. Evidence comes from: (1) the well-documented atypical autonomic regulation of the heart common to fibromyalgia and irritable bowel syndrome reflected in dampened RSA, (2) the neural architecture that integrates the heart, pain pathways, and the gastrointestinal tract, (3) the common physical co-morbidities shared by chronic diffuse pain and FGIDs, many of which are functionally regulated by the autonomic nervous system, (4) the elevated risk of chronic diffuse pain and FGIDs following traumatic stress or abuse, (5) and the elevated risk of chronic diffuse pain and FGIDs in individuals with anxiety and panic disorders. This novel conceptualization points to a pathogenesis rooted in changes to brain-body autonomic feedback loops in response to evolutionarily-salient threat cues, providing an integrated biopsychosocial model of chronic diffuse pain and FGIDs and suggesting new, non-pharmacological treatment strategies. PMID:29904631

Biobehavioral pain profile in individuals with chronic spine pain.

PubMed

Matteliano, Deborah; Scherer, Yvonne Krall; Chang, Yu-Ping

2014-03-01

Pain in the spine is the most frequently described pain problem in primary care, afflicting at least 54 million Americans. When spinal pain becomes chronic, the prognosis for recovery is poor, often leading to disability and reduced quality of life. Clinical treatment is inadequate, often focusing on physical pathology alone. To improve treatment outcomes for chronic pain as recommended by current guidelines, the Biobehavioral Pain Profile (BPP), which includes six pain response subscales, was developed to guide cognitive behavioral therapy (CBT). The purpose of this study was to describe the BPP in 100 individuals with chronic spine pain and examine the associations between the BPP and important clinical outcomes, including chronic pain, disability, and quality of life. Participants reported a high level of pain, a low quality of life, and a high level of disability despite receiving treatment with opioids. Scores on BPP subscales including evaluating loss of control, past and current experience, physiologic responsivity, and thoughts of disease progression were elevated, indicating a need for CBT. Five of the six BPP subscales had a significant association with quality of life, chronic pain, and disability with the thought of disease progression being a strong factor for most of the clinical outcome variables. By identifying BPP, clinicians can provide appropriate treatments to improve individuals' quality of life and prevent further disability. Further study using the BPP to guide CBT is needed. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Response of rat body composition to simultaneous exercise and centrifugation at 3.14g

NASA Technical Reports Server (NTRS)

Pitts, G. C.; Oyama, J.

1982-01-01

A study is described calling into question the hypothesis that an increased physical load during chronic centrifugation contributes to the body composition changes observed in centrifuged rats. Considering fat-free and fat-free dry masses of the total body and carcass, it is seen that centrifugation combined with either wheel running or restraint reduced these masses to approximately 85% of the respective 1-g values, that is, the same result with either sedentary rats or rats running several hundred meters per day. It is pointed out that if an effect of a centrifugation-induced load is present but hidden by opposing factors, an analysis of variance should reveal it as an interaction between acceleration and other variables; however, no such interactions are found here. Tables are included emphasizing the pervasive influence of chronic centrifugation after only 12 days exposure.

Health Behaviors of Native Hawaiian and Pacific Islander Adults in California

PubMed Central

Moy, Karen L.; Sallis, James F.; Trinidad, Dennis R.; Ice, Christa L.; McEligot, Archana J.

2013-01-01

Smoking, diet and physical activity are associated with chronic diseases, but representative prevalence data on these behaviors for Native Hawaiian and Pacific Islander (NHPI) adults are scarce. Data from the 2005 California Health Interview Survey were analyzed for self-identified NHPI and non-Hispanic white (NHW) adults. Ethnic and NHPI gender differences were examined for socio-demographic variables, obesity and health behaviors. Compared to NHW, NHPI displayed higher prevalence of obesity (p<0.001), smoking (p<0.05) and consumption of unhealthy foods and beverages (p<0.05). NHPI males were more likely than females to smoke (p<0.001). NHPI adults appear to be at higher risk for chronic disease than NHW due to obesity, smoking and intake of unhealthy foods and beverages. Culturally-specific health promotion interventions are needed to reduce risks among the underrepresented NHPI population. PMID:22426559

Physical Activity Protects the Human Brain against Metabolic Stress Induced by a Postprandial and Chronic Inflammation.

PubMed

Pruimboom, Leo; Raison, Charles L; Muskiet, Frits A J

2015-01-01

In recent years, it has become clear that chronic systemic low-grade inflammation is at the root of many, if not all, typically Western diseases associated with the metabolic syndrome. While much focus has been given to sedentary lifestyle as a cause of chronic inflammation, it is less often appreciated that chronic inflammation may also promote a sedentary lifestyle, which in turn causes chronic inflammation. Given that even minor increases in chronic inflammation reduce brain volume in otherwise healthy individuals, the bidirectional relationship between inflammation and sedentary behaviour may explain why humans have lost brain volume in the last 30,000 years and also intelligence in the last 30 years. We review evidence that lack of physical activity induces chronic low-grade inflammation and, consequently, an energy conflict between the selfish immune system and the selfish brain. Although the notion that increased physical activity would improve health in the modern world is widespread, here we provide a novel perspective on this truism by providing evidence that recovery of normal human behaviour, such as spontaneous physical activity, would calm proinflammatory activity, thereby allocating more energy to the brain and other organs, and by doing so would improve human health.

Affective reactivity to daily stressors and long-term risk of reporting a chronic physical health condition

PubMed Central

Piazza, Jennifer R.; Charles, Susan T.; Sliwinski, Martin J.; Mogle, Jacqueline; Almeida, David M.

2013-01-01

Background Daily stressors, such as an argument with a spouse or an impending deadline, are associated with short-term changes in physical health symptoms. Whether these minor hassles have long-term physical health ramifications, however, is largely unknown. Purpose The current study examined whether exposure and reactivity to daily stressors is associated with long-term risk of reporting a chronic physical health condition. Methods Participants (N = 435) from the National Study of Daily Experiences completed a series of daily diary interviews between 1995 and 1996 and again 10 years later. Results Greater affective (i.e., emotional) reactivity to daily stressors at Time 1 was associated with an increased risk of reporting a chronic physical health condition at Time 2. Conclusion Results indicate that how people respond to the daily stressors in their lives is predictive of future chronic health conditions. PMID:23080393

Adult attachment and approaches to activity engagement in chronic pain

PubMed Central

Andrews, Nicole E; Meredith, Pamela J; Strong, Jenny; Donohue, Genevieve F

2014-01-01

BACKGROUND: The way in which individuals with chronic pain habitually approach activity engagement has been shown to impact daily functioning, with both avoidance of one’s daily activities and overactivity (activity engagement that significantly exacerbates pain) associated with more pain, higher levels of physical disability and poorer psychological functioning. OBJECTIVE: To provide insight into the development of maladaptive habitual approaches to activity engagement in chronic pain by applying an attachment theory framework. METHODS: A sample of 164 adults with chronic pain completed selfreport measures of attachment, approach to activity and pain cognitions. Mediation analyses were undertaken to examine the direct association between attachment variables and maladaptive approaches to activity, and to test for the mediating role of pain cognitions (catastrophizing and thought suppression). RESULTS: Results demonstrated that higher levels of secure attachment were associated with lower levels of activity avoidance, which was fully mediated by lower levels of pain catastrophizing; higher levels of preoccupied or fearful attachment were directly associated with higher levels overactivity; higher levels of preoccupied attachment were associated with higher levels of activity avoidance, which was partially mediated by higher levels of pain catastrophizing; and higher levels of fearful attachment were indirectly associated with higher levels of activity avoidance through higher levels of catastrophizing. CONCLUSIONS: These results provide preliminary support for the suggestion that insecure attachment may be a source of vulnerability to the development of disabling activity patterns in chronic pain. PMID:25337857

Chronic disease risk factors among hotel workers.

PubMed

Gawde, Nilesh Chandrakant; Kurlikar, Prashika R

2016-01-01

Non-communicable diseases have emerged as a global health issue. Role of occupation in pathogenesis of non-communicable diseases has not been explored much especially in the hospitality industry. Objectives of this study include finding risk factor prevalence among hotel workers and studying relationship between occupational group and chronic disease risk factors chiefly high body mass index. A cross-sectional study was conducted among non-managerial employees from classified hotels in India. The study participants self-administered pre-designed pilot-tested questionnaires. The risk factor prevalence rates were expressed as percentages. Chi-square test was used for bi-variate analysis. Overweight was chosen as 'outcome' variable of interest and binary multi-logistic regression analysis was used to identify determinants. The prevalence rates of tobacco use, alcohol use, inadequate physical activity and inadequate intake of fruits and vegetables were 32%, 49%, 24% and 92% respectively among hotel employees. Tobacco use was significantly common among those in food preparation and service, alcohol use among those in food service and security and leisure time physical activity among front office workers. More than two-fifths (42.7%) were overweight. Among the hotel workers, those employed in food preparation and security had higher odds of 1.650 (CI: 1.025 - 2.655) and 3.245 (CI: 1.296 - 8.129) respectively of being overweight. Prevalence of chronic disease risk factors is high among hotel workers. Risk of overweight is significantly high in food preparation and security departments and workplace interventions are necessary to address these risks.

Better or Worse: a Study of Day-to-Day Changes over Five Months of Rosen Method Bodywork Treatment for Chronic Low Back Pain.

PubMed

Fogel, Alan

2013-01-01

Fluctuations of good days and bad days-in physical symptoms and emotional states-are common for individuals with chronic illness. This pilot study examines these fluctuations during bodywork treatment. We analyzed changes in daily self-reports over a period of five months for five individuals who received weekly treatments of Rosen Method Bodywork (RMB), which uses touch and words to enhance body awareness of physical sensations and emotional states. Five subjects (aged 31-56) who had chronic low back pain (CLBP) received 16 weekly treatments given by three experienced RMB practitioners. Pre- and posttreatment assessments covered demographics, disability, and pain. Clients also completed daily bedtime assessments of pain, fatigue, emotional state, and sense of control during the entire treatment period. All clients reported reductions in pain and/or disability in post- compared to pretreatment. In spite of a high level of day-to-day variability in the daily assessments, there were significant reductions in pain and fatigue, and significant increases in positive emotional state and sense of control across the treatment period. In reaching this end, however, some clients had slow and steady improvements, some improved more rapidly, while others got worse before they got better. The natural course of healing-with its inevitable fluctuations in symptoms-is part of a process leading to successful treatment outcomes. Rosen Method Bodywork may be especially helpful in developing and accepting both sensory and emotional body awareness changes that facilitate overall improvement.

Chronic disease risk factors among American Indian/Alaska Native women of reproductive age.

PubMed

Amparo, Pamela; Farr, Sherry L; Dietz, Patricia M

2011-11-01

The magnitude of chronic conditions and risk factors among American Indian/Alaska Native women of reproductive age is unknown. The objective of our study was to estimate this magnitude. We analyzed data for 2,821 American Indian/Alaska Native women and 105,664 non-Hispanic white women aged 18 to 44 years from the 2005 and 2007 Behavioral Risk Factor Surveillance System. We examined prevalence of high cholesterol, high blood pressure, diabetes, body mass index (kg/m(2)) ≥25.0, physical inactivity, smoking, excessive alcohol consumption, and frequent mental distress, and the cumulative number of these chronic conditions and risk factors (≥3, 2, 1, or 0). In a multivariable, multinomial logistic regression model, we examined whether American Indian/Alaska Native race was associated with the cumulative number of chronic conditions and risk factors. American Indian/Alaska Native women, compared with white women, had significantly higher rates of high blood pressure, diabetes, obesity, smoking, and frequent mental distress. Of American Indian/Alaska Native women, 41% had 3 or more chronic conditions or risk factors compared with 27% of white women (χ(2), P < .001). After adjustment for income, education, and other demographic variables, American Indian/Alaska Native race was not associated with having either 1, 2, or 3 or more chronic conditions or risk factors. Three out of every 5 American Indian/Alaska Native women aged 18 to 44 years have 3 or more chronic conditions or risk factors. Improving economic status and education for AI/AN women could help eliminate disparities in health status.

Diagnosis and management of neuropathic pain: a balanced approach to treatment.

PubMed

Nicholson, Bruce D

2003-12-01

To provide nurse practitioners with a conceptual framework from which to diagnose and manage chronic neuropathic pain, specifically postherpetic neuralgia (PHN). A current review of the available treatment options for the management of neuropathic pain and PHN is provided. A comprehensive literature review was conducted. Clinical articles, meta-analyses, and reviews were selected for their relevance to the diagnosis and management of chronic neuropathic pain and PHN. Managing patients with chronic neuropathic pain is a common clinical challenge due to variability in individual symptoms, mechanisms, and treatment responses. In patients with PHN, a balanced treatment approach focusing on efficacy, safety, and tolerability is recommended. With appropriate treatment, most patients are able to achieve clinically significant relief from neuropathic pain. Diagnosis and management of neuropathic pain syndromes is challenging. Because of the complexity of chronic pain, successful long-term treatment can be especially difficult (Nicholson, 2003b). While most acute pain is nociceptive (i.e., a response to noxious stimuli), chronic pain can be nociceptive, neuropathic, or of mixed origin. PHN is a chronic pain syndrome that can last for years, causing physical and social disability and psychological distress (Kanazi, 2000). Despite major recent advances in the treatment of PHN, many patients remain refractory to current therapy (Dworkin, 2003). For practicing clinicians, including nurse practitioners, viewing pain as a disease rather than a symptom is the first step towards its successful management. Understanding the pathophysiology of chronic pain and emerging treatment paradigms for the management of neuropathic pain and PHN is critical to optimal care.

Treatment of chronic back pain by sensory discrimination training. A Phase I RCT of a novel device (FairMed) vs. TENS.

PubMed

Barker, Karen L; Elliott, Christopher J; Sackley, Catherine M; Fairbank, Jeremy C T

2008-06-28

The causes of chronic low back pain (CLBP) remain obscure and effective treatment of symptoms remains elusive. A mechanism of relieving chronic pain based on the consequences of conflicting unpleasant sensory inputs to the central nervous system has been hypothesised. As a result a device was generated to deliver sensory discrimination training (FairMed), and this randomised controlled trial compared therapeutic effects with a comparable treatment modality, TENS. 60 patients with CLBP were recruited from physiotherapy referrals to a single-blinded, randomised controlled, non-inferiority trial. They were randomised to receive either FairMed or TENS and asked to use the allocated device for 30 minutes, twice a day, for 3 weeks. The primary outcome variable measured at 0 and 3 weeks was pain intensity measured using a visual analogue scale averaged over 7 days. Secondary outcome measures were Oswestry Disability Index, 3 timed physical tests, 4 questionnaires assessing different aspects of emotional coping and a global measure of patient rating of change. Data were analysed for the difference in change of scores between groups using one-way ANOVA. Baseline characteristics of the two groups were comparable. The primary outcome, change in pain intensity (VAS) at 3 weeks showed a mean difference between groups of -0.1, (non significant p = 0.82). The mean difference in change in ODI scores was 0.4; (non significant p = 0.85). Differences in change of physical functioning showed that no significant difference in change of scores for any of these test (p = 0.58 - 0.90). Changes in scores of aspects of emotional coping also demonstrated no significant difference in change scores between the groups (p = 0.14 - 0.94). FairMed was not inferior to TENS treatment. The findings have implications for further research on current chronic pain theories and treatments. Further work to explore these mechanisms is important to expand our understanding of chronic pain and the role of neuro-modulation.

Vital signs: disability and physical activity--United States, 2009-2012.

PubMed

Carroll, Dianna D; Courtney-Long, Elizabeth A; Stevens, Alissa C; Sloan, Michelle L; Lullo, Carolyn; Visser, Susanna N; Fox, Michael H; Armour, Brian S; Campbell, Vincent A; Brown, David R; Dorn, Joan M

2014-05-09

Adults with disabilities are less active and have higher rates of chronic disease than the general population. Given the health benefits of physical activity, understanding physical activity, its relationship with chronic disease, and health professional recommendations for physical activity among young to middle-age adults with disabilities could help increase the effectiveness of health promotion efforts. Data from the 2009-2012 National Health Interview Survey (NHIS) were used to estimate the prevalence of, and association between, aerobic physical activity (inactive, insufficiently active, or active) and chronic diseases (heart disease, stroke, diabetes, and cancer) among adults aged 18-64 years by disability status and type (hearing, vision, cognitive, and mobility). The prevalence of, and association between, receiving a health professional recommendation for physical activity and level of aerobic physical activity was assessed using 2010 data. Overall, 11.6% of U.S. adults aged 18-64 years reported a disability, with estimates for disability type ranging from 1.7% (vision) to 5.8% (mobility). Compared with adults without disabilities, inactivity was more prevalent among adults with any disability (47.1% versus 26.1%) and for adults with each type of disability. Inactive adults with disabilities were 50% more likely to report one or more chronic diseases than those who were physically active. Approximately 44% of adults with disabilities received a recommendation from a health professional for physical activity in the past 12 months. Almost half of adults with disabilities are physically inactive and are more likely to have a chronic disease. Among adults with disabilities who visited a health professional in the past 12 months, the majority (56%) did not receive a recommendation for physical activity. These data highlight the need for increased physical activity among persons with disabilities, which might require support across societal sectors, including government and health care.

Chronic social isolation and chronic variable stress during early development induce later elevated ethanol intake in adult C57BL/6J mice.

PubMed

Lopez, Marcelo F; Doremus-Fitzwater, Tamara L; Becker, Howard C

2011-06-01

Experience with stress situations during early development can have long-lasting effects on stress- and anxiety-related behaviors. Importantly, this can also favor drug self-administration. These studies examined the effects of chronic social isolation and/or variable stress experiences during early development on subsequent voluntary ethanol intake in adult male and female C57BL/6J mice. The experiments were conducted to evaluate the effect of chronic isolation between weaning and adulthood (Experiment 1), chronic isolation during adulthood (Experiment 2), and chronic variable stress (CVS) alone or in combination with chronic social isolation between weaning and adulthood (Experiment 3) on subsequent voluntary ethanol intake. Mice were born in our facility and were separated into two housing conditions: isolate housed (one mouse/cage) or group housed (four mice/cage) according to sex. Separate groups were isolated for 40 days starting either at time of weaning postnatal day 21 (PD 21) (early isolation, Experiments 1 and 3) or at adulthood (PD 60: late isolation, Experiment 2). The effects of housing condition on subsequent ethanol intake were assessed starting at around PD 65 in Experiments 1 and 3 or PD 105 days in Experiment 2. In Experiment 3, starting at PD 32, isolate-housed and group-housed mice were either subjected to CVS or left undisturbed. CVS groups experienced random presentations of mild stressors for 14 days, including exposure to an unfamiliar open field, restraint, physical shaking, and forced swim, among others. All mice were tested for ethanol intake for 14 days using a two-bottle choice (ethanol 15% vol/vol vs. water) for a 2-h limited access procedure. Early social isolation resulted in greater ethanol intake compared with the corresponding group-housed mice (Experiment 1). In contrast, social isolation during adulthood (late isolation) did not increase subsequent ethanol intake compared with the corresponding group-housed mice (Experiment 2). For mice that did not experience CVS, early social isolation resulted in greater ethanol intake compared with group-housed mice (Experiment 3). CVS subsequently resulted in a significant increase in ethanol intake in group-housed mice, but CVS failed to further increase ethanol intake in mice that experienced chronic social isolation early in life (Experiment 3). Overall, female mice consumed more ethanol than males, whether isolated (early or late) or group housed. These results indicate that early but not late social isolation can subsequently influence ethanol consumption in C57BL/6J mice. Thus, the developmental timing of chronic social isolation appears to be an important factor in defining later effects on ethanol self-administration behavior. In addition, experience with CVS early in life results in elevated ethanol intake later in adulthood. Taken together, these results emphasize the important role of early stress experiences that modulate later voluntary ethanol intake during adulthood. Copyright © 2011 Elsevier Inc. All rights reserved.

Chronic physical conditions in older adults with mental illness and/ or substance use disorders.

PubMed

Lin, Wen-Chieh; Zhang, Jianying; Leung, Gary Y; Clark, Robin E

2011-10-01

To examine the association between mental illness and chronic physical conditions in older adults and investigate whether co-occurring substance use disorders (SUDs) are associated with greater risk of chronic physical conditions beyond mental illness alone. A retrospective cross-sectional study. Medicare and Medicaid programs in Massachusetts. Massachusetts Medicare and Medicaid members aged 65 and older as of January 1, 2005 (N = 679,182). Diagnoses recorded on Medicare and Medicaid claims were used to identify mental illness, SUDs, and 15 selected chronic physical conditions. Community-dwelling older adults with mental illness or SUDs had higher adjusted risk for 14 of the 15 selected chronic physical conditions than those without these disorders; the only exception was eye diseases. Moreover, those with co-occurring SUDs and mental illness had the highest adjusted risk for 11 of these chronic conditions. For residents of long-term care facilities, mental illness and SUDs were only moderately associated with the risk of chronic physical conditions. Community-dwelling older adults with mental illness or SUDs, particularly when they co-occurred, had substantially greater medical comorbidity than those without these disorders. For residents of long-term care facilities, the generally uniformly high medical comorbidity may have moderated this relationship, although their high prevalence of mental illness and SUDs signified greater healthcare needs. These findings strongly suggest the imminent need for integrating general medical care, mental health services, and addiction health services for older adults with mental illness or SUDs. © 2011, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society.

Protocol for the "four steps to control your fatigue (4-STEPS)" randomised controlled trial: a self-regulation based physical activity intervention for patients with unexplained chronic fatigue

PubMed Central

2012-01-01

Background Unexplained Chronic Fatigue is a medical condition characterized by the presence of persistent, severe and debilitating medically unexplained fatigue, leading to impaired functioning and lower quality of life. Research suggests that physical activity can contribute to the reduction of fatigue and other somatic symptoms and can thus significantly improve physical functioning and quality of life in these patients. Based on the self-regulation (SR) theory of behaviour change, we developed a brief physical activity program for patients suffering from unexplained chronic fatigue which focuses on the training of self-regulation skills, the "4-STEPS to control your fatigue" program. Methods/Design This is a multi-centre, randomised controlled trial (RCT) that will be carried out in local primary care centres and at the Portuguese Fibromyalgia and Chronic Fatigue Syndrome Patients Association. Patients aged between 18 and 65 and fulfilling operationalized criteria for Idiopathic Chronic Fatigue (ICF) and Chronic Fatigue Syndrome (CFS) will be recruited and randomly allocated to standard care (SC) or standard care plus a self-regulation based physical activity program (4-STEPS). Patients will be assessed at baseline, after the intervention (3 months) and at 12 months follow-up. The primary outcome is fatigue severity. Discussion The results of the RCT will provide information about the effectiveness of a brief self-regulation intervention for promoting physical activity in patients with unexplained chronic fatigue. If the program proves to be effective, it may be considered as an adjunctive treatment for these patients. Trial Registration ISRCTN: ISRCTN70763996 PMID:22429404

When work and satisfaction with life do not go hand in hand: health barriers and personal resources in the participation of people with chronic physical disabilities.

PubMed

van Campen, Cretien; Cardol, Mieke

2009-07-01

People with chronic physical disabilities participate less in both paid and voluntary work and are less satisfied with their lives than people without health problems. Governments and scientists have suggested that participation in employment is the main road to well-being. We analysed national survey data on the participation in work and satisfaction with life, comparing people with a chronic illness and a physical disability (n=603) to people with a chronic illness but without a physical disability (n=1199) and the general population (n=6128) in the Netherlands. The results show that the relationship between happiness and work is different for people with a chronic illness and a physical disability, as compared to the other two populations. Fewer people with a chronic illness and disability were categorized as 'satisfied people with work' (i.e. participating in work and satisfied with their life), while most people belonged to a group of 'satisfied people without work' and, surprisingly, not to the expected group of 'dissatisfied people without work'. In order to explain this exceptional distribution we modelled satisfied participation in work as an outcome of a balance between personal resources and barriers. By means of discriminant regression analysis, we identified the severity of motor disability as the main barrier, and education level and age, as the main resource factors that distinguish between 'satisfied people with work' and others among the group of people with a chronic illness and a physical disability.

A literature review on self-care of chronic illness: definition, assessment and related outcomes.

PubMed

Ausili, Davide; Masotto, Matteo; Dall'Ora, Chiara; Salvini, Lorena; Di Mauro, Stefania

2014-01-01

Chronic illnesses care represents a challenging issue for people well-being and future health systems' sustainability. Promotion of self-care is considered a key point for chronically ill patients' care. The aim of this literature was to explore: how self-care of chronic illness has been theoretically defined; how self-care can be assessed in clinical and research settings; what associations exist between self-care and health outcomes of chronically ill patients. A wide range of definitions and terminologies related to self-care of chronic illness has been found in the literature. Although some common elements useful to explain the concept of self-care have been identified, the physical, cognitive, emotional and social processes underlying self-care remain controversial and poorly defined. Valid and reliable disease-specific assessment tools have been developed and used in a growing number of studies; however, the lack of utilization of standardized instruments in clinical practice has been referred by many authors. Significant correlations between self-care of chronic illness and outcome measures e.g. general health status, quality of life and healthcare costs, are reported by a limited number of studies. Supporting patient self-care is recognized as a crucial factor in chronic illness care. A deeper analysis of variables and processes influencing self-care could help for a full description of the phenomenon. A systematic evaluation of self-care in health professionals' everyday clinical practice is strongly recommended. The development of general non-disease-specific assessment tools could facilitate the evaluation of complex patients, especially those with multiple co-morbidities. Although self-care has been recognized as a vital intermediate outcome, further large-scale studies clarifying the association between self-care and patients' and health systems' outcomes are needed.

A diagnostic model for chronic hypersensitivity pneumonitis

PubMed Central

Johannson, Kerri A; Elicker, Brett M; Vittinghoff, Eric; Assayag, Deborah; de Boer, Kaïssa; Golden, Jeffrey A; Jones, Kirk D; King, Talmadge E; Koth, Laura L; Lee, Joyce S; Ley, Brett; Wolters, Paul J; Collard, Harold R

2017-01-01

The objective of this study was to develop a diagnostic model that allows for a highly specific diagnosis of chronic hypersensitivity pneumonitis using clinical and radiological variables alone. Chronic hypersensitivity pneumonitis and other interstitial lung disease cases were retrospectively identified from a longitudinal database. High-resolution CT scans were blindly scored for radiographic features (eg, ground-glass opacity, mosaic perfusion) as well as the radiologist’s diagnostic impression. Candidate models were developed then evaluated using clinical and radiographic variables and assessed by the cross-validated C-statistic. Forty-four chronic hypersensitivity pneumonitis and eighty other interstitial lung disease cases were identified. Two models were selected based on their statistical performance, clinical applicability and face validity. Key model variables included age, down feather and/or bird exposure, radiographic presence of ground-glass opacity and mosaic perfusion and moderate or high confidence in the radiographic impression of chronic hypersensitivity pneumonitis. Models were internally validated with good performance, and cut-off values were established that resulted in high specificity for a diagnosis of chronic hypersensitivity pneumonitis. PMID:27245779

Physical activity is related to lower levels of pain, fatigue and depression in individuals with spinal-cord injury: a correlational study.

PubMed

Tawashy, A E; Eng, J J; Lin, K H; Tang, P F; Hung, C

2009-04-01

This was a prospective cross-sectional study for people with chronic spinal cord injury (SCI). To (1) evaluate the intensity level and nature of physical activity in community-dwelling individuals living with SCI, and (2) explore the relation between descriptive individual variables (for example, lesion level), secondary complications and participation in physical activity. Urban community setting. A total of 49 subjects with SCI who used a manual wheelchair for primary mode of mobility (mean years since injury, 11.8; mean age, 43.7 years; 67% paraplegia) completed the physical activity recall assessment for people with SCI (PARA-SCI). Approximately 50% of reported physical activity among individuals with SCI is due to activities of daily living. The amount of physical activity was not related to lesion level, age, body mass index or waistline size. Greater heavy-intensity activity was related to lower levels of pain and fatigue and higher levels of self-efficacy, whereas higher amounts of mild-intensity activity and total activity were related to less depressive symptoms. Activities of daily living are a large component for physical activity among individuals with SCI. It appears that greater physical activity is associated with less secondary complications (pain, fatigue and depression) in individuals with SCI.

Improving Access to Care for Warfighters: Virtual Worlds Technology to Enhance Primary Care Training in Post-Traumatic Stress and Motivational Interviewing

DTIC Science & Technology

2017-10-01

chronic mental and physical health problems. Therefore, the project aims to: (1) iteratively design a new web-based PTS and Motivational Interviewing...result in missed opportunities to intervene to prevent chronic mental and physical health problems. The project aims are to: (1) iteratively design a new...intervene to prevent chronic mental and physical health problems. We propose to: (1) Iteratively design a new web-based PTS and Motivational

The Role of Anger in Psychosocial Subgrouping for Patients with Low Back Pain

PubMed Central

Nisenzon, Anne N.; George, Steven Z.; Beneciuk, Jason M.; Wandner, Laura D.; Torres, Calia; Robinson, Michael E.

2014-01-01

Low back pain (LBP) is a common and costly condition that often becomes chronic if not properly addressed. Recent research has shown that psychosocial symptoms can complicate LBP, necessitating more comprehensive screening measures. The present study investigated the role of psychosocial factors, including anger regulation, in pain and disability using a screening measure designed for LBP treated with physical therapy. One-hundred and three LBP patients initiating physical therapy completed an established screening measure to assess risk for developing chronic pain, as well as psychosocial measures assessing anger, depression, anxiety, fear-avoidance, and pain-catastrophizing before and after four weeks of treatment. Dependent variables were pain intensity, physical impairment, and patient-reported disability. Risk subgrouping based on anger and other psychosocial measures was examined using established screening methods and through employing an empirical statistical approach. Analyses revealed that risk subgroups differed according to corresponding levels of negative affect, as opposed to anger alone. General psychosocial distress also predicted disability post-treatment, but, interestingly, did not have a strong relationship to pain. Subsequent hierarchical agglomerative clustering procedures divided patients into overall High and Low Distress groups, with follow-up analyses revealing that the High Distress group had higher baseline measures of pain, disability, and impairment. Findings suggest that anger may be part of generalized negative affect rather than a unique predictor when assessing risk for pain and disability in LBP treatment. Continued research in the area of screening for psychosocial prognostic indicators in LBP may ultimately guide treatment protocols in physical therapy for more comprehensive patient care. PMID:24281272

Comparing Self-Reported Versus Objectively Measured Physical Activity Behavior: A Preliminary Investigation of Older Filipino American Women

ERIC Educational Resources Information Center

Atienza, Audie A.; King, Abby C.

2005-01-01

The importance of examining health behaviors, such as physical activity, among Filipino Americans is highlighted by their higher rates of chronic disease. As physical inactivity has been linked to chronic diseases (U.S. Department of Health and Human Services, 1996), this study investigated the physical activity levels of older Filipinas. This…

Association between chronic oral inflammatory burden and physical fitness in males: a cross-sectional observational study.

PubMed

Hoppe, C B; Oliveira, J A P; Grecca, F S; Haas, A N; Gomes, M S

2017-08-01

To evaluate the association between chronic oral inflammatory burden (OIB) - as the combination of periodontal and endodontic disease load - and physical fitness. One hundred and twelve nonsmoker male police officers who performed a standardized physical fitness test (PFT) were analysed. Participants underwent oral clinical and periapical radiographic examinations. Periodontal disease was assessed by probing depth (PD) and clinical attachment loss (AL). For radiographic analysis, both apical periodontitis (AP) and root canal treatment (RCT) variables were analysed. Endodontic Burden (EB) was calculated merging the total number of teeth with AP and/or RCT per individual. OIB was calculated combining EB and AL. The outcome of physical fitness was dichotomized according to whether the highest PFT score was 'achieved' or 'not-achieved'. Multivariable logistic regression models were adjusted for age, body mass index and frequency of daily exercise. There was no significant association between AP, RCT and EB with physical fitness whereas PD, AL and OIB were significantly associated with low physical fitness (P < 0.05). Multivariate regression analysis revealed that individuals with OIB = EB ≥ 3 and AL ≥ 4 mm had a 81% lower chance of reaching the highest PFT score (OR = 0.19, 95%CI = 0.04-0.87, P = 0.03) compared to individuals with EB < 3 and and no AL ≥ 4 mm. Individuals with unfavourable periodontal parameters but with low EB (OIB = EB < 3 & AL ≥ 4 mm) showed no significant differences on the chance to reach the highest PFT score compared to participants with favourable periodontal status and low EB (OIB = EB < 3 & no AL ≥ 4 mm). The OIB - higher levels of EB in periodontal patients - was independently associated with poor physical fitness in males. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Cross-sectional and prospective relationship between physical activity and chronic diseases in European older adults.

PubMed

Marques, Adilson; Peralta, Miguel; Martins, João; de Matos, Margarida Gaspar; Brownson, Ross C

2017-05-01

This study examined the relationship between physical activity (PA) and chronic diseases in European older adults, using a prospective analysis with data from 2011 and 2013. Participants were 37,524 older adults (16,204 men) who responded to the fourth (in 2011) and fifth (in 2013) wave of SHARE project, from 13 European countries. Participants' answers to interview questions about the presence of chronic conditions and PA. The cross-sectional and prospective association between PA and the number of chronic diseases was assessed using general linear models. Among men and women, moderate or vigorous physical activity (MVPA) in 2011 was associated with fewer reported chronic diseases in 2011 and 2013. In prospective analysis, MVPA in 2011 was inversely associated with the number of chronic diseases in 2013 in the unadjusted model. In the adjusted model MVPA more than once a week remained as a significant predictor of fewer chronic diseases. PA should be prescribed to older adults in order to prevent and reduce the number of chronic diseases, and, when possible, vigorous intensity PA should be recommended.

Spirituality and Religiousness are Associated With Fewer Depressive Symptoms in Individuals With Medical Conditions.

PubMed

Lucette, Aurelie; Ironson, Gail; Pargament, Kenneth I; Krause, Neal

2016-01-01

The increased prevalence of depressive symptoms among adults diagnosed with chronic health issues has been largely documented. Research is needed to clarify the effect of religiousness/spirituality in relation to chronic health conditions and depression, to establish whether these variables can serve as protective factors. Self-report data from a nationwide study of spirituality and health were used. Individuals with at least 1 chronic illness (N = 1696) formed the subsample for this study. Religiousness/spirituality variables included frequency of church attendance, prayer, religious meaning, religious hope, general meaning, general hope, peace, and view of God. Other variables included depressive symptoms and demographics (age, gender, ethnicity, and education). A series of hierarchical regression analyses revealed that chronic conditions were consistently associated with more depressive symptoms. Greater religiousness/spirituality was significantly associated with fewer depressive symptoms, contributing 16% of the variance above demographics and the number of chronic illnesses. The religiousness/spirituality variables conferring the greatest protection against depression were psychospiritual variables (general meaning and general hope, followed by peace). Also significant but making a smaller contribution to less depression were church attendance, religious meaning, religious hope, and positive view of God. Only prayer did not relate significantly to less depression. Maintaining a sense of spirituality or religiousness can benefit well-being of individuals diagnosed with a chronic health condition, especially having meaning, maintaining hope, and having a sense of peace. Patients could potentially benefit from being offered the resources that support their spiritual/religious practices and beliefs as they cope with chronic illness. Copyright © 2016. Published by Elsevier Inc.

The relationship of sociodemographic and psychological variables with chronic pain variables in a low-income population.

PubMed

Newman, Andrea K; Van Dyke, Benjamin P; Torres, Calia A; Baxter, Jacob W; Eyer, Joshua C; Kapoor, Shweta; Thorn, Beverly E

2017-09-01

Chronic pain is a pervasive condition that is complicated by economic, educational, and racial disparities. This study analyzes key factors associated with chronic pain within an understudied and underserved population. The sample is characterized by a triple disparity with respect to income, education/literacy, and racial barriers that substantially increase the vulnerability to the negative consequences of chronic pain. The study examined the pretreatment data of 290 participants enrolled in the Learning About My Pain trial, a randomized controlled comparative effectiveness trial of psychosocial interventions (B.E.T., Principal Investigator, Patient-Centered Outcomes Research Institute Contract No. 941; clinicaltrials.gov identifier NCT01967342) for chronic pain. Hierarchical multiple regression analyses evaluated the relationships among sociodemographic (sex, age, race, poverty status, literacy, and education level) and psychological (depressive symptoms and pain catastrophizing) variables and pain interference, pain severity, and disability. The indirect effects of depressive symptoms and pain catastrophizing on the sociodemographic and pain variables were investigated using bootstrap resampling. Reversed mediation models were also examined. Results suggested that the experience of chronic pain within this low-income sample is better accounted for by psychological factors than sex, age, race, poverty status, literacy, and education level. Depressive symptoms and pain catastrophizing mediated the relationships between age and pain variables, whereas pain catastrophizing mediated the effects of primary literacy and poverty status. Some reversed models were equivalent to the hypothesized models, suggesting the possibility of bidirectionality. Although cross-sectional findings cannot establish causality, our results highlight the critical role psychological factors play in individuals with chronic pain and multiple health disparities.

Classifying Patients with Chronic Pelvic Pain into Levels of Biopsychosocial Dysfunction Using Latent Class Modeling of Patient Reported Outcome Measures

PubMed Central

Fenton, Bradford W.; Grey, Scott F.; Tossone, Krystel; McCarroll, Michele; Von Gruenigen, Vivian E.

2015-01-01

Chronic pelvic pain affects multiple aspects of a patient's physical, social, and emotional functioning. Latent class analysis (LCA) of Patient Reported Outcome Measures Information System (PROMIS) domains has the potential to improve clinical insight into these patients' pain. Based on the 11 PROMIS domains applied to n=613 patients referred for evaluation in a chronic pelvic pain specialty center, exploratory factor analysis (EFA) was used to identify unidimensional superdomains. Latent profile analysis (LPA) was performed to identify the number of homogeneous classes present and to further define the pain classification system. The EFA combined the 11 PROMIS domains into four unidimensional superdomains of biopsychosocial dysfunction: Pain, Negative Affect, Fatigue, and Social Function. Based on multiple fit criteria, a latent class model revealed four distinct classes of CPP: No dysfunction (3.2%); Low Dysfunction (17.8%); Moderate Dysfunction (53.2%); and High Dysfunction (25.8%). This study is the first description of a novel approach to the complex disease process such as chronic pelvic pain and was validated by demographic, medical, and psychosocial variables. In addition to an essentially normal class, three classes of increasing biopsychosocial dysfunction were identified. The LCA approach has the potential for application to other complex multifactorial disease processes. PMID:26355825

Secondary mediation and regression analyses of the PTClinResNet database: determining causal relationships among the International Classification of Functioning, Disability and Health levels for four physical therapy intervention trials.

PubMed

Mulroy, Sara J; Winstein, Carolee J; Kulig, Kornelia; Beneck, George J; Fowler, Eileen G; DeMuth, Sharon K; Sullivan, Katherine J; Brown, David A; Lane, Christianne J

2011-12-01

Each of the 4 randomized clinical trials (RCTs) hosted by the Physical Therapy Clinical Research Network (PTClinResNet) targeted a different disability group (low back disorder in the Muscle-Specific Strength Training Effectiveness After Lumbar Microdiskectomy [MUSSEL] trial, chronic spinal cord injury in the Strengthening and Optimal Movements for Painful Shoulders in Chronic Spinal Cord Injury [STOMPS] trial, adult stroke in the Strength Training Effectiveness Post-Stroke [STEPS] trial, and pediatric cerebral palsy in the Pediatric Endurance and Limb Strengthening [PEDALS] trial for children with spastic diplegic cerebral palsy) and tested the effectiveness of a muscle-specific or functional activity-based intervention on primary outcomes that captured pain (STOMPS, MUSSEL) or locomotor function (STEPS, PEDALS). The focus of these secondary analyses was to determine causal relationships among outcomes across levels of the International Classification of Functioning, Disability and Health (ICF) framework for the 4 RCTs. With the database from PTClinResNet, we used 2 separate secondary statistical approaches-mediation analysis for the MUSSEL and STOMPS trials and regression analysis for the STEPS and PEDALS trials-to test relationships among muscle performance, primary outcomes (pain related and locomotor related), activity and participation measures, and overall quality of life. Predictive models were stronger for the 2 studies with pain-related primary outcomes. Change in muscle performance mediated or predicted reductions in pain for the MUSSEL and STOMPS trials and, to some extent, walking speed for the STEPS trial. Changes in primary outcome variables were significantly related to changes in activity and participation variables for all 4 trials. Improvement in activity and participation outcomes mediated or predicted increases in overall quality of life for the 3 trials with adult populations. Variables included in the statistical models were limited to those measured in the 4 RCTs. It is possible that other variables also mediated or predicted the changes in outcomes. The relatively small sample size in the PEDALS trial limited statistical power for those analyses. Evaluating the mediators or predictors of change between each ICF level and for 2 fundamentally different outcome variables (pain versus walking) provided insights into the complexities inherent across 4 prevalent disability groups.

Relationship between Self-efficacy and Physical Activity, Medication Adherence in Chronic Disease Patients

PubMed Central

Daniali, Seyde Shahrbanoo; Darani, Firooze Mostafavi; Eslami, Ahmad Ali; Mazaheri, Mohammad

2017-01-01

Background: The global epidemic of unhealthy lifestyle causes to increase chronic disease. It has been proven that psychological factors such as self-efficacy are responsible to success in the process of lifestyle change. Low self-efficacy is usually related to low level of physical activity and medication adherence. Objective of the study was to investigate the effects of self-efficacy, other physical symptoms on physical activity and medication adherence in patients with chronic illness in public health centers. Materials and Methods: A cross-sectional study was conducted on 483 patients with chronic diseases attended to governmental health care centers in Isfahan. Participants were chosen by systematic random sampling. Inclusion criteria were having a chronic illness at least 6-month ago while prescription of medication and willing to take part in the survey. The parts of Stanford Self-management Questionnaire were used. Data were analyzed by SPSS 18 software using the descriptive and analytic statistics. P < 0.05 was considered significant. Results: Mean age of participants was 54.8 (7.22) years. The half of participants had low self-efficacy and 87.2% had low physical activity. Nearly 80% of patients had a good medication adherence. There was a significant relationship between self-efficacy and physical activity (P = 0.336, β = 1.01, P < 0.001). Conclusion: Although chronic disease patients had a good medication adherence, other self-care behaviors such as physical activity has been neglected. It is seemed that concentration on psychological factors such as self-efficacy should be considered as a proximal factor to improve self-care. PMID:28603704

Intraspecies Variability Affects Heterotypic Biofilms of Porphyromonas gingivalis and Prevotella intermedia: Evidences of Strain-Dependence Biofilm Modulation by Physical Contact and by Released Soluble Factors

PubMed Central

Barbosa, Graziela Murta; Colombo, Andrea Vieira; Rodrigues, Paulo Henrique; Simionato, Maria Regina Lorenzetti

2015-01-01

It is well known that strain and virulence diversity exist within the population structure of Porphyromonas gingivalis. In the present study we investigate intra- and inter-species variability in biofilm formation of Porphyromonas gingivalis and partners Prevotella intermedia and Prevotella nigrescens. All strains tested showed similar hydrophobicity, except for P. gingivalis W83 which has roughly half of the hydrophobicity of P. gingivalis ATCC33277. An intraspecies variability in coaggregation of P. gingivalis with P. intermedia was also found. The association P. gingivalis W83/P. intermedia 17 produced the thickest biofilm and strain 17 was prevalent. In a two-compartment system P. gingivalis W83 stimulates an increase in biomass of strain 17 and the latter did not stimulate the growth of P. gingivalis W83. In addition, P. gingivalis W83 also stimulates the growth of P. intermedia ATCC25611 although strain W83 was prevalent in the association with P. intermedia ATCC25611. P. gingivalis ATCC33277 was prevalent in both associations with P. intermedia and both strains of P. intermedia stimulate the growth of P. gingivalis ATCC33277. FISH images also showed variability in biofilm structure. Thus, the outcome of the association P. gingivalis/P. intermedia seems to be strain-dependent, and both soluble factors and physical contact are relevant. The association P. gingivalis-P. nigrescens ATCC33563 produced larger biomass than each monotypic biofilm, and P. gingivalis was favored in consortia, while no differences were found in the two-compartment system. Therefore, in consortia P. gingivalis-P. nigrescens physical contact seems to favor P. gingivalis growth. The intraspecies variability found in our study suggests strain-dependence in ability of microorganisms to recognize molecules in other bacteria which may further elucidate the dysbiosis event during periodontitis development giving additional explanation for periodontal bacteria, such as P. gingivalis and P. intermedia, among others, to persist and establish chronic infections in the host. PMID:26406499

Intraspecies Variability Affects Heterotypic Biofilms of Porphyromonas gingivalis and Prevotella intermedia: Evidences of Strain-Dependence Biofilm Modulation by Physical Contact and by Released Soluble Factors.

PubMed

Barbosa, Graziela Murta; Colombo, Andrea Vieira; Rodrigues, Paulo Henrique; Simionato, Maria Regina Lorenzetti

2015-01-01

It is well known that strain and virulence diversity exist within the population structure of Porphyromonas gingivalis. In the present study we investigate intra- and inter-species variability in biofilm formation of Porphyromonas gingivalis and partners Prevotella intermedia and Prevotella nigrescens. All strains tested showed similar hydrophobicity, except for P. gingivalis W83 which has roughly half of the hydrophobicity of P. gingivalis ATCC33277. An intraspecies variability in coaggregation of P. gingivalis with P. intermedia was also found. The association P. gingivalis W83/P. intermedia 17 produced the thickest biofilm and strain 17 was prevalent. In a two-compartment system P. gingivalis W83 stimulates an increase in biomass of strain 17 and the latter did not stimulate the growth of P. gingivalis W83. In addition, P. gingivalis W83 also stimulates the growth of P. intermedia ATCC25611 although strain W83 was prevalent in the association with P. intermedia ATCC25611. P. gingivalis ATCC33277 was prevalent in both associations with P. intermedia and both strains of P. intermedia stimulate the growth of P. gingivalis ATCC33277. FISH images also showed variability in biofilm structure. Thus, the outcome of the association P. gingivalis/P. intermedia seems to be strain-dependent, and both soluble factors and physical contact are relevant. The association P. gingivalis-P. nigrescens ATCC33563 produced larger biomass than each monotypic biofilm, and P. gingivalis was favored in consortia, while no differences were found in the two-compartment system. Therefore, in consortia P. gingivalis-P. nigrescens physical contact seems to favor P. gingivalis growth. The intraspecies variability found in our study suggests strain-dependence in ability of microorganisms to recognize molecules in other bacteria which may further elucidate the dysbiosis event during periodontitis development giving additional explanation for periodontal bacteria, such as P. gingivalis and P. intermedia, among others, to persist and establish chronic infections in the host.

Associations between Motivational Orientations and Chronically Accessible Outcomes in Leisure-Time Physical Activity: Are Appearance-Related Outcomes Controlling in Nature?

ERIC Educational Resources Information Center

McLachlan, Sarah; Hagger, Martin S.

2010-01-01

This study aimed to explore relations between chronically accessible outcomes in physical activity and scaled measures of motivational orientations from a self-determination perspective. Methods from construct and attitude accessibility research and the Levesque and Pelletier (2003) study were used to identify participants' chronically accessible…

Child Abuse and Chronic Pain in a Community Survey of Women

ERIC Educational Resources Information Center

Walsh, Christine A.; Jamieson, Ellen; MacMillan, Harriet; Boyle, Michael

2007-01-01

This study examined the relationship between a self-reported history of child physical and sexual abuse and chronic pain among women (N = 3381) in a provincewide community sample. Chronic pain was significantly associated with physical abuse, education, and age of the respondents and was unrelated to child sexual abuse alone or in combination with…

Hair as a Meaningful Measure of Baseline Cortisol Levels over Time in Dogs

PubMed Central

Bryan, Heather M; Adams, Amanda G; Invik, Rosemary M; Wynne-Edwards, Katherine E; Smits, Judit EG

2013-01-01

Cortisol measurements of hair are becoming a valuable tool in monitoring chronic stress. To further validate this approach in domestic dogs, we compared the variability of cortisol immunoreactivity in hair with that in saliva and feces of dogs housed under constant social and physical conditions. Fecal (n = 268), and hair (n = 21) samples were collected over 3 mo from 7 dogs housed in a kennel and kept for training veterinary students in minimally invasive procedures. Salivary samples (n = 181) were collected 3 times daily twice weekly during the last month of the study. Hair and salivary samples were analyzed by enzyme immunoassay and feces by radioimmunoassay. HPLC coupled with tandem mass spectrometry was used to confirm the presence of cortisol in 3 hair samples. Variability of cortisol was compared across sample types by using repeated-measures ANOVA followed by paired t tests. Within dogs, cortisol immunoreactivity was less variable in hair than in saliva or feces. Averaged over time, the variability of fecal samples approached that of hair when feces were collected at least 4 times monthly. As predicted, the stable social and environmental condition of the dogs maintained repeatability over time and supported the hypothesis that data from hair samples reflect baseline cortisol levels. These findings indicate that determining cortisol immunoreactivity in hair is a more practical approach than is using samples of saliva or feces in monitoring the effects of long-term stressors such as social or physical environments and disease progression. PMID:23562104

Effective physical treatment for chronic low back pain.

PubMed

Maher, C G

2004-01-01

It is now feasible to adopt an evidence-based approach when providing physical treatment for patients with chronic LBP. A summary of the efficacy of a range of physical treatments is provided in Table 1. The evidence-based primary care options are exercise, laser, massage, and spinal manipulation; however, the latter three have small or transient effects that limit their value as therapies for chronic LBP. In contrast, exercise produces large reductions in pain and disability, a feature that suggests that exercise should play a major role in the management of chronic LBP. Physical treatments, such as acupuncture, backschool, hydrotherapy, lumbar supports, magnets, TENS, traction, ultrasound, Pilates therapy, Feldenkrais therapy, Alexander technique, and craniosacral therapy are either of unknown value or ineffective and so should not be considered. Outside of primary care, multidisciplinary treatment or functional restoration is effective; however, the high cost probably means that these programs should be reserved for patients who do not respond to cheaper treatment options for chronic LBP. Although there are now effective treatment options for chronic LBP, it needs to be acknowledged that the problem of chronic LBP is far from solved. Though treatments can provide marked improvements in the patient's condition, the available evidence suggests that the typical chronic LBP patient is left with some residual pain and disability. Developing new, more powerful treatments and refining the current group of known effective treatments is the challenge for the future.

Horticultural therapy for patients with chronic musculoskeletal pain: results of a pilot study.

PubMed

Verra, M L; Verra, Martin L; Angst, Felix; Beck, Trudi; Lehmann, Susanne; Brioschi, Roberto; Schneiter, Renata; Aeschlimann, Andre

2012-01-01

Therapists can use horticultural therapy as an adjuvant therapy in a non threatening context, with the intent of bringing about positive effects in physical health, mental health, and social interaction. Very few experimental studies exist that test its clinical effectiveness. To determine whether the addition of horticultural therapy to a pain-management program improved physical function, mental health, and ability to cope with pain. The research team designed a prospective, nonrandomized, controlled cohort study, enrolling all patients consecutively referred to the Zurzach Interdisciplinary Pain Program (ZISP) who met the studys criteria. The team divided them into two cohorts based on when medical professionals referred them: before (control group) or after (intervention group) introduction of a horticultural therapy program. The setting was the rehabilitation clinic (RehaClinic) in Bad Zurzach, Switzerland. Seventy-nine patients with chronic musculoskeletal pain (fibromyalgia or chronic, nonspecific back pain) participated in the study. The research team compared a 4-week, inpatient, interdisciplinary pain-management program with horticultural therapy (intervention, n = 37) with a pain-management program without horticultural therapy (control, n = 42). The horticultural therapy program consisted of seven sessions of group therapy, each of 1-hour duration. The research team assessed the outcome using the Medical Outcome Study Short Form-36 (SF-36), the West Haven-Yale Multidimensional Pain Inventory (MPI), the Hospital Anxiety and Depression Scale (HADS), the Coping Strategies Questionnaire (CSQ ), and two functional performance tests. The team tested participants on entry to and discharge from the 4-week pain-management program. Between-group differences in sociodemographic and outcome variables were not significant on participants entry to the pain-management program. On discharge, the research team measured small to moderate outcome effects (effect size [ES] up to 0.71) within both groups. The study found significantly larger improvements for the horticultural therapy group vs the control group in SF-36 role physical (ES = 0.71 vs 0.22; P = .018); SF-36 mental health (ES = 0.46 vs 0.16; P = .027); HADS anxiety (ES = 0.26 vs 0.03; P = .043); and CSQ pain behavior (ES = 0.30 vs -0.05; P = .032). The addition of horticultural therapy to a pain management program improved participants' physical and mental health and their coping ability with respect to chronic musculoskeletal pain.

Physical activity, psychiatric distress, and interest in exercise group participation among individuals seeking methadone maintenance treatment with and without chronic pain.

PubMed

Beitel, Mark; Stults-Kolehmainen, Matthew; Cutter, Christopher J; Schottenfeld, Richard S; Eggert, Kathy; Madden, Lynn M; Kerns, Robert D; Liong, Christopher; Ginn, Joel; Barry, Declan T

2016-03-01

Physical activity may improve chronic pain, anxiety, and depression, which are prevalent among patients in methadone maintenance treatment (MMT), but relatively little is known about the physical activity levels or interest in exercise of patients in MMT. We used a brief self-report instrument to assess physical activity levels, chronic pain, psychiatric distress, and interest in exercise group participation among 303 adults seeking MMT. Most (73%) reported no moderate or vigorous intensity physical activity in the past week; 27% met recommended physical activity levels, and 24% reported interest in exercise group participation. Participants with (compared to those without) chronic pain had higher levels of psychiatric distress and were less likely to meet recommended levels of physical activity (p < .05), but did not differ significantly in their interest in participating in an exercise group. Participants who met recommended levels of physical activity in the past week were more likely to be men and had lower levels of depression than others (p < .05). Low levels of physical activity and low interest in exercise group participation among patients entering MMT point to the need for and likely challenges of implementing exercise interventions in MMT. © American Academy of Addiction Psychiatry.

What is the role of lifestyle behaviour change associated with non-communicable disease risk in managing musculoskeletal health conditions with special reference to chronic pain?

PubMed

Dean, Elizabeth; Söderlund, Anne

2015-04-13

Other than activity and exercise, lifestyle practices such as not smoking and healthy nutrition, well established for preventing and managing lifestyle-related non-communicable diseases (i.e., heart disease, cancer, hypertension, stroke, obstructive lung disease, diabetes, and obesity), are less emphasized in the physical therapy guidelines for addressing chronic pain, e.g., back pain. This state-of-the-art review examines the relationships between lifestyle behaviours and musculoskeletal health, with special reference to chronic pain, and their clinical and research implications. A state-of-the-art review was conducted to synthesize evidence related to lifestyle factors (not smoking, healthy diet, healthy weight, optimal sleep and manageable stress, as well as physical activity) and musculoskeletal health, with special reference to chronic pain. The findings support that health behaviour change competencies (examination/assessment and intervention/treatment) may warrant being included in first-line management of chronic pain, either independently or in conjunction with conventional physical therapy interventions. To address knowledge gaps in the literature however three lines of clinical trial research are indicated: 1) to establish the degree to which traditional physical therapy interventions prescribed for chronic pain augment the benefits of lifestyle behaviour change; 2) to establish the degree to which adopting healthier lifestyle practices, avoids or reduces the need for conventional physical therapy; and 3) to establish whether patients/clients with healthier lifestyles and who have chronic pain, respond more favourably to conventional physical therapy interventions than those who have less healthy lifestyles. Lifestyle behaviour change is well accepted in addressing lifestyle-related non-communicable diseases. Compelling evidence exists however supporting the need for elucidation of the role of negative lifestyle behaviours on the incidence of chronic pain, and the role of positive lifestyle behaviours on its incidence and effective management. Addressing lifestyle behaviour change in patients/clients with chronic pain, e.g., back pain, as a first-line intervention might not only constitute a novel approach, but also reduce the socioeconomic burden related to chronic pain as well as non-communicable diseases.

Prevalence of suicidal ideation in patients with chronic non-cancer pain referred to a behaviorally based pain program.

PubMed

Cheatle, Martin D; Wasser, Thomas; Foster, Carolyn; Olugbodi, Akintomi; Bryan, Jessica

2014-01-01

Patients with chronic pain often experience co-occurring depression and in some cases suicidal ideation. It is critical to discover risk factors for suicide in this vulnerable patient population. To assess the prevalence of suicidal ideation and identify potential risk factors in patients with chronic non-cancer pain. Retrospective chart review. Four hundred and sixty-six patients with chronic non-cancer pain referred to a behaviorally based pain program in a community health system. Data collected included pain intensity and level of pain interference (Brief Pain Inventory), pain duration, pain site, depression level (Beck Depression Inventory Fast Screen for Medical Patients), anxiety (Beck Anxiety Inventory), personal and family psychiatric and substance use disorder history, level of isolation, and demographic data. Univariate and logistic regression analyses were performed. Results showed a high rate of suicidal ideation in this patient population (28%). Univariate analyses stratified by level of suicide (no suicidal ideation or passive/active suicidal ideation) revealed statistically significant group differences on pain location (extremity P = 0.046, generalized P = 0.047), work disruption (P = 0.049), social withdrawal (P < 0.001), pre-pain history of depression (P < 0.001), family history of depression (P < 0.001), and history of sexual/physical abuse (P < 0.001). Logistic regression revealed that history of sexual/physical abuse (Beta = 0.825; P = 0.020; OR = 2.657 [95% CI = 1.447 - 4.877]), family history of depression (Beta = 0.471; P = 0.006; OR = 1.985 [95% CI = 1.234 - 3.070]), and being socially withdrawn (Beta = 0.482; P < 0.001; OR = 2.226 [95% CI = 1.431 - 3.505]) were predictive of suicidal ideation. Measure of depression was not included in data analysis to reduce effect of co-linearity. Also the study population was a specialty pain clinic allowing for possible subject selection bias. Results of this study are consistent with the prevailing literature on pain and suicide demonstrating a high prevalence of suicidal ideation in the chronic pain population. Novel predictive variables were also identified that will provide the basis for developing a risk stratification model that can be further tested prospectively in chronic pain patients.

Virtual socialization in adults with spina bifida.

PubMed

Chan, Wendy M; Dicianno, Brad E

2011-03-01

To use spina bifida (SB) as a model of chronic physical disability to study the associations of virtual socialization, friendships, and quality of life (QOL) in adults. Cross-sectional survey. Subjects were recruited from residential living facilities, outpatient clinics, and the University of Pittsburgh Medical Center (UPMC) research registry. Inclusion criteria were age between 18 and 80 years and clinical diagnoses of SB cystica (myelomeningocele) and hydrocephalus. The exclusion criterion was the diagnosis of SB occulta. Sixty-three eligible adults were enrolled, and all completed the study. The survey via questionnaire was performed in person or over the telephone. Data collected included the World Health Organization's Medical Outcomes Study 26-item Short Form, Economic Self-Sufficiency from the Craig Handicap Assessment and Reporting Technique Short Form, virtual socializing habits, and number of friends. Three linear regression models were performed, each with a unique dependent variable: number of friends, psychological QOL, or social QOL. The following independent variables were included in all models: age, gender, ethnicity, economic self-sufficiency, marital status, education level, lesion level, health status, user group, collection method, and time spent virtually socializing. In addition, each regression model included the dependent variables from the other 2 models in its independent variables. Increased degree of virtual socialization (VS) was associated with a greater number of friends (P = .003, r = .684). Mean (standard deviation) numbers of friends by VS groups were the following: users, n = 4.9 ± 2.7; semi-users, n = 3.8 ± 2.7; and nonusers, n = 2.1 ± 2.3, which represent a 2.3 times greater number of friends between the users and nonusers. The effect of virtual socialization on QOL was also positive, however, not statistically significant. People with chronic physical disabilities, such as SB, are at high risk for peer rejection and long-term social avoidance. Users of the most immersive forms of virtual socialization, have more real world friends than both semi-users and nonusers. Any form of VS, whether immersive or real time, may improve the opportunity for meaningful social encounters. Prospective intervention studies are needed to elucidate whether a causal positive relationship between virtual socialization and friendships exists. Further research is needed to clarify virtual socialization's impact on QOL; however, the upward trend in all 4 domains of QOL across user groups suggests similar potential benefits. Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Changes in Disability, Physical/Mental Health States and Quality of Life during an 8-Week Multimodal Physiotherapy Programme in Patients with Chronic Non-Specific Neck Pain: A Prospective Cohort Study

PubMed Central

Cuesta-Vargas, Antonio Ignacio; González-Sánchez, Manuel

2015-01-01

Aim The aim of this study was to analyse the effect of an 8-week multimodal physiotherapy programme (MPP), integrating physical land-based therapeutic exercise (TE), adapted swimming and health education, as a treatment for patients with chronic non-specific neck pain (CNSNP), on disability, general health/mental states and quality of life. Methods 175 CNSNP patients from a community-based centre were recruited to participate in this prospective study. Intervention: 60-minute session (30 minutes of land-based exercise dedicated to improving mobility, motor control, resistance and strengthening of the neck muscles, and 30 minutes of adapted swimming with aerobic exercise keeping a neutral neck position using a snorkel). Health education was provided using a decalogue on CNSNP and constant repetition of brief advice by the physiotherapist during the supervision of the exercises in each session. Study outcomes: primary: disability (Neck Disability Index); secondary: physical and mental health states and quality of life of patients (SF-12 and EuroQoL-5D respectively). Differences between baseline data and that at the 8-week follow-up were calculated for all outcome variables. Results Disability showed a significant improvement of 24.6% from a mean (SD) of 28.2 (13.08) at baseline to 16.88 (11.62) at the end of the 8-week intervention. All secondary outcome variables were observed to show significant, clinically relevant improvements with increase ranges between 13.0% and 16.3% from a mean of 0.70 (0.2) at baseline to 0.83 (0.2), for EuroQoL-5D, and from a mean of 40.6 (12.7) at baseline to 56.9 (9.5), for mental health state, at the end of the 8-week intervention. Conclusion After 8 weeks of a MPP that integrated land-based physical TE, health education and adapted swimming, clinically-relevant and statistically-significant improvements were observed for disability, physical and mental health states and quality of life in patients who suffer CNSNP. The clinical efficacy requires verification using a randomised controlled study design. Trial Registration ClinicalTrials.gov NCT02046876 PMID:25710539

Physical Activity Protects the Human Brain against Metabolic Stress Induced by a Postprandial and Chronic Inflammation

PubMed Central

Pruimboom, Leo; Raison, Charles L.; Muskiet, Frits A. J.

2015-01-01

In recent years, it has become clear that chronic systemic low-grade inflammation is at the root of many, if not all, typically Western diseases associated with the metabolic syndrome. While much focus has been given to sedentary lifestyle as a cause of chronic inflammation, it is less often appreciated that chronic inflammation may also promote a sedentary lifestyle, which in turn causes chronic inflammation. Given that even minor increases in chronic inflammation reduce brain volume in otherwise healthy individuals, the bidirectional relationship between inflammation and sedentary behaviour may explain why humans have lost brain volume in the last 30,000 years and also intelligence in the last 30 years. We review evidence that lack of physical activity induces chronic low-grade inflammation and, consequently, an energy conflict between the selfish immune system and the selfish brain. Although the notion that increased physical activity would improve health in the modern world is widespread, here we provide a novel perspective on this truism by providing evidence that recovery of normal human behaviour, such as spontaneous physical activity, would calm proinflammatory activity, thereby allocating more energy to the brain and other organs, and by doing so would improve human health. PMID:26074674

Does health status influence acceptance of illness in patients with chronic respiratory diseases?

PubMed

Kurpas, D; Mroczek, B; Brodowski, J; Urban, M; Nitsch-Osuch, A

2015-01-01

The level of illness acceptance correlates positively with compliance to the doctor's recommendations, and negatively with the frequency and intensity of complications of chronic diseases. The purpose of this study was to determine the influence of the clinical condition on the level of illness acceptance, and to find variables which would have the most profound effect on the level of illness acceptance in patients with chronic respiratory diseases. The study group consisted of 594 adult patients (mean age: 60 ± 15 years) with mixed chronic respiratory diseases, recruited from patients of 136 general practitioners. The average score in the Acceptance of Illness Scale was 26.2 ± 7.6. The low level of illness acceptance was noted in 174 (62.6 %) and high in 46 (16.6 %) patients. Analysis of multiple regressions was used to examine the influence of explanatory variables on the level of illness acceptance. The variables which shaped the level of illness acceptance in our patients included: improvement of health, intensity of symptoms, age, marital status, education level, place of residence, BMI, and the number of chronic diseases. All above mentioned variables should be considered during a design of prevention programs for patients with mixed chronic respiratory diseases.

Using a Vulnerability-Stress-Adaptation Framework to Predict Physical Aggression Trajectories in Newlywed Marriage

ERIC Educational Resources Information Center

Langer, Amie; Lawrence, Erika; Barry, Robin A.

2008-01-01

The authors used a vulnerability-stress-adaptation framework to examine personality traits and chronic stress as predictors of the developmental course of physical aggression in the early years of marriage. Additionally, personality traits and physical aggression were examined as predictors of the developmental course of chronic stress. Data from…

An Empathetic Approach to Physical Education Teacher Education

ERIC Educational Resources Information Center

Monahan, Tony

2010-01-01

The current crisis in societal obesity and other inactivity-related chronic health disorders has become a widespread concern in the United States. Physical Education (PE) with its propensity for physical activity has the potential to provide solutions to many chronic health issues. However, a large body of literature suggests that generations of…

[Physical treatment modalities for chronic leg ulcers].

PubMed

Dissemond, J

2010-05-01

An increasing numbers of physical treatment options are available for chronic leg ulcer. In this review article, compression therapy, therapeutic ultrasound, negative pressure therapy, extracorporeal shock wave therapy, electrostimulation therapy, electromagnetic therapy, photodynamic therapy, water-filtered infrared-A-radiation and hydrotherapy are discussed in terms of their practical applications and the underlying evidence. With the exception of compression therapy for most of these treatments, good scientific data are not available. However this is a widespread problem in the treatment of chronic wounds. Nevertheless, several of the described methods such as negative pressure therapy represent one of the gold standards in practical treatment of patients with chronic leg ulcers. Although the use of physical treatment modalities may improve healing in patients with chronic leg ulcers, the diagnosis and treatment of the underlying causes are essential for long-lasting success.

Physical agents used in the management of chronic pain by physical therapists.

PubMed

Allen, Roger J

2006-05-01

Evidence supporting the use of specific physical agents in the management of chronic pain conditions is not definitive; it is largely incomplete and sometimes contradictory. However, the use of agents in chronic pain management programs is common. Within the broad use of physical agents, they are rarely the sole modality of treatment. A 1995 American Physical Therapy Association position statement asserts that "Without documentation which justifies the necessity of the exclusive use of physical agents/modalities, the use of physical agents/modalities, in the absence of other skilled therapeutic or educational intervention, should not be considered physical therapy". Physical agents may serve as useful adjunctive modalities of pain relief or to enhance the effectiveness of other elements in therapy geared toward resolution of movement impairments and restoration of physical function. Given that a conclusive aggregate of findings is unlikely to exist for all permutations of patient conditions, combined with interacting therapeutic modalities, an evidence-based approach to pain management is not always possible or beneficial to the patient. In the face of inconclusive evidence, a theory-based approach may help determine if the therapeutic effect ofa given physical agent has the possibility of being a useful clinical tool in the context of treating a particular patient's mechanism of pain generation. Until controlled efficacy findings are definitive, careful individual patient response monitoring of thoughtful theoretical application of adjunctive physical agents may be a prudent approach to the management of chronic pain.

Physical activity in the prevention of the most frequent chronic diseases: an analysis of the recent evidence.

PubMed

Kruk, Joanna

2007-01-01

Physical activity is widely recognized as a means for the primary prevention of chronic diseases as well as in patients' treatment and rehabilitation. Moreover, activity has beneficial effects on an individual's health and well-being. Despite the benefits of regular physical activity, the percentage of physically inactive adults in the world is high. Environmental and policy approaches aimed to increase physical activity require continual stress of the epidemiological evidence from studies investigating disease mechanisms as well as controlled clinical trials. To update the evidence that physical activity/exercise is important for reducing the chronic diseases (cardiovascular and heart, diabetes, cancer, obesity, osteoporosis, and fall-related injuries, depression and emotional stress) and for mechanisms that may operate in the relation between physical activity and a disease risk. Research studies published from 2004 through to March 2007 were identified through a review of the literature available on the NLM PubMed, Medline, Current Contents, and Elsevier-Science Direct databases. Recent evidence on physical activity/exercise and reduction of chronic major diseases incidence and rehabilitation of patients replicates previous findings. The strongest evidence exists for colon cancer, breast cancer, and cardiovascular diseases. The maximal magnitudes of the risk reduction reported were: 75% for breast cancer, 49% for cardiovascular and heart diseases, 35% for diabetes, 22% for colorectal cancer. Increased physical activity also prevented the weight gain associated with aging at least 2-times greater in individuals who were more active compared with those who were inactive. Limited new findings has been reported for the beneficial role of physical activity in fall-related injures, depression and emotional distress. Recent evidence confirms previous findings that engaging in moderate physical activity is very important for the primary prevention of chronic diseases, decreasing all causes of mortality and that exercise is one of the determinants for physical and psychological well-being. The current evidence provides further support that physical activity can suppress concentrations of 17 alpha-estradiol in women.

A psychological intervention to promote acceptance and adherence to non-invasive ventilation in people with chronic obstructive pulmonary disease: study protocol of a randomised controlled trial.

PubMed

Volpato, Eleonora; Banfi, Paolo; Pagnini, Francesco

2017-02-06

People with chronic obstructive pulmonary disease (COPD) sometimes experience anxiety, depression and comorbid cognitive deficits. Rather than being merely a consequence of symptom-related physical impairments these additional problems may be part of the clinical course of the condition. The relationship between the physical and psychological aspects of the condition is illustrated by the patterns of use of non-invasive ventilation (NIV); NIV is often rejected or used inappropriately, resulting in clinical deterioration and an increase in health care costs. The study aims to analyse the effects of psychological support on the acceptance of, and adherence to, NIV. The primary outcome will be a latent variable related to indices of use of NIV equipment and adherence to treatment regime; while survival rates and psychological variables will constitute the secondary outcomes. A two-arm randomised controlled trial will be conducted. We aim to recruit 150 COPD patients for whom NIV is indicated. The experimental group will receive a brief course of psychological support that will include counselling, relaxation and mindfulness-based exercises. In some cases, it will also include neuropsychological rehabilitation exercises. Support will be delivered via four to eight meetings at the HD Respiratory Rehabilitation Unit, at home or via telemedicine. Controls will receive standard care and watch educational videos related to the management of their disease. This investigation will gain insight about the role of a psychological intervention as part of a treatment plan during the process of adaptation to NIV in COPD patients. ClinicalTrials.gov, ID: NCT02499653 . Registered on 14 July 2015.

Wii-Workouts on Chronic Pain, Physical Capabilities and Mood of Older Women: A Randomized Controlled Double Blind Trial.

PubMed

Monteiro-Junior, Renato Sobral; de Souza, Cíntia Pereira; Lattari, Eduardo; Rocha, Nuno Barbosa Ferreira; Mura, Gioia; Machado, Sérgio; da Silva, Elirez Bezerra

2015-01-01

Chronic Low Back Pain (CLBP) is a public health problem and older women have higher incidence of this symptom, which affect body balance, functional capacity and behavior. The purpose of this study was to verifying the effect of exercises with Nintendo Wii on CLBP, functional capacity and mood of elderly. Thirty older women (68 ± 4 years; 68 ± 12 kg; 154 ± 5 cm) with CLBP participated in this study. Elderly individuals were divided into a Control Exercise Group (n = 14) and an Experimental Wii Group (n = 16). Control Exercise Group did strength exercises and core training, while Experimental Wii Group did ones additionally to exercises with Wii. CLBP, balance, functional capacity and mood were assessed pre and post training by the numeric pain scale, Wii Balance Board, sit to stand test and Profile of Mood States, respectively. Training lasted eight weeks and sessions were performed three times weekly. MANOVA 2 x 2 showed no interaction on pain, siting, stand-up and mood (P = 0.53). However, there was significant difference within groups (P = 0.0001). ANOVA 2 x 2 showed no interaction for each variable (P > 0.05). However, there were significant differences within groups in these variables (P < 0.05). Tukey's post-hoc test showed significant difference in pain on both groups (P = 0.0001). Wilcoxon and Mann-Whitney tests identified no significant differences on balance (P > 0.01). Capacity to Sit improved only in Experimental Wii Group (P = 0.04). In conclusion, physical exercises with Nintendo Wii Fit Plus additional to strength and core training were effective only for sitting capacity, but effect size was small.

Self-reported physical activity in patients on chronic hemodialysis: correlates and barriers.

PubMed

Bossola, Maurizio; Pellu, Valentina; Di Stasio, Enrico; Tazza, Luigi; Giungi, Stefania; Nebiolo, Pier Eugenio

2014-01-01

The knowledge of the barriers that are associated with decreased physical activity (PA) in patients on chronic hemodialysis (PCH) may be of primary importance for the nephrologists. Thus, we aimed to assess the barriers associated with the absent or reduced PA in PCH of a Mediterranean country. Patients were invited to answer the question 'How often do you exercise during your leisure time?'. Also, patients included in the study were asked to answer questions regarding barriers to physical activity lower than desired. We studied 105 patients. Forty (38.1%) patients reported to never exercise, 6 (5.7%) reported to exercise less than once/week, 4 (3.8%) once/week, 23 (21.9%) two to three times/week, 12 (11.4%) four to five times/week and 20 (19%) daily. Overall, 46 (43.8%) patients never exercised or exercised less than once/week ('inactive') and 59 (56.2%) did exercise more often ('active'). At the multivariate analysis, reduced walking ability, fatigue on the non-dialysis days, and shortness of breath were independently and negatively associated with PA. The same results were found when the reduced model of the multivariate logistic backward regression was built introducing in the model also clinical and laboratory variables. In PCH, fatigue on the non-dialysis days, reduced walking ability, and shortness of breath are barriers independently associated to decreased PA. Knowledge about the causes and mechanisms that generate these barriers has to be acquired. © 2014 S. Karger AG, Basel.

Balance, dizziness and proprioception in patients with chronic whiplash associated disorders complaining of dizziness: A prospective randomized study comparing three exercise programs.

PubMed

Treleaven, Julia; Peterson, Gunnel; Ludvigsson, Maria Landén; Kammerlind, Ann-Sofi; Peolsson, Anneli

2016-04-01

Dizziness and unsteadiness are common symptoms following a whiplash injury. To compare the effect of 3 exercise programs on balance, dizziness, proprioception and pain in patients with chronic whiplash complaining of dizziness. A sub-analysis of a randomized study. One hundred and forty subjects were randomized to either a physiotherapist-guided neck-specific exercise (NSE), physiotherapist-guided neck-specific exercise, with a behavioural approach (NSEB) or prescription of general physical activity (PPA) group. Pre intervention, 3, 6 and 12 months post baseline they completed the University of California Los Angeles Dizziness Questionnaire (UCLA-DQ), Visual Analogue Scales (VAS) for, dizziness at rest and during activity and physical measures (static and dynamic clinical balance tests and head repositioning accuracy (HRA)). There were significant time by group differences with respect to dizziness during activity and UCLA-Q favouring the physiotherapy led neck specific exercise group with a behavioural approach. Within group analysis of changes over time also revealed significant changes in most variables apart from static balance. Between and within group comparisons suggest that physiotherapist led neck exercise groups including a behavioural approach had advantages in improving measures of dizziness compared with the general physical activity group, although many still complained of dizziness and balance impairment. Future studies should consider exercises specifically designed to address balance, dizziness and cervical proprioception in those with persistent whiplash. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Levels of physical activity in patients with severe psoriasis: a cross-sectional questionnaire study.

PubMed

Torres, Tiago; Alexandre, José Manuel; Mendonça, Denisa; Vasconcelos, Carlos; Silva, Berta Martins; Selores, Manuela

2014-04-01

Psoriasis is a chronic inflammatory disease associated with increased cardiovascular mortality, secondary to the increased prevalence of cardiovascular risk factors and premature atherosclerosis. Physical activity is a vital component in prevention and management of cardiovascular disease. Few studies have examined the level of physical activity in psoriasis patients, using validated questionnaires or other objective assessment tools. The aim of this study was to analyze and compare physical activity undertaken by patients with severe psoriasis and healthy controls, using the International Physical Activity Questionnaire-Short Form (IPAQ-S), a validated instrument for assessing physical activity. Ninety patients with severe plaque-type psoriasis and 160 healthy subjects were enrolled in the present study. Physical activity was evaluated using IPAQ-S. Psoriasis patients had reduced levels of physical activity compared with non-psoriasis patients, regardless of sex or whether the variable was continuous or categorical. The odds ratio for low-level physical activity for psoriasis patients, compared with controls, was 3.42 (95% CI 1.47-7.91), indicating that this severe psoriasis population did not undertake recommended levels of physical activity. Psoriasis patients exhibit decreased levels of physical activity, possibly for both psychological and physiological reasons. The lack of physical activity may contribute to the increased risk of cardiovascular disease in psoriasis patients, in addition to the intrinsic risks related to systemic inflammation and psoriasis-linked comorbidities. Regular physical activity should be encouraged in all psoriasis patients because of its beneficial effects on systemic inflammation and cardiometabolic comorbidities associated with psoriasis.

Effects of short-term active video game play on community adults: under International Classification of Functioning, Disability and Health consideration.

PubMed

Tseng, Wei-Che; Hsieh, Ru-Lan

2013-06-01

The effects of active video game play on healthy individuals remain uncertain. A person's functional health status constitutes a dynamic interaction between components identified in the International Classification of Functioning, Disability, and Health (ICF). The aim of this study was to investigate the short-term effects of active video game play on community adults using the ICF. Sixty community adults with an average age of 59.3 years and without physical disabilities were recruited. Over 2 weeks, each adult participated in six sessions of active video game play lasting 20 minutes each. Participants were assessed before and after the intervention. Variables were collected using sources related to the ICF components, including the Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory, Biodex Stability System, chair- rising time, Frenchay Activity Index, Rivermead Mobility Index, Chronic Pain Grade Questionnaire, Work Ability Index, and World Health Organization Quality of Life-Brief Version. Compared to baseline data, significantly reduced risk of a fall measured by Biodex Stability System and improvements in disability scores measured by the Chronic Pain Grade Questionnaire were noted. There was no significant change in the other variables measured. Short-term, active video game play reduces fall risks and ameliorates disabilities in community adults.

Economic rationality in choosing between short-term bad-health choices and longer-term good-health choices.

PubMed

Campbell, David

2013-11-08

Non-contagious, chronic disease has been identified as a global health risk. Poor lifestyle choices, such as smoking, alcohol, drug and solvent abuse, physical inactivity, and unhealthy diet have been identified as important factors affecting the increasing incidence of chronic disease. The following focuses on the circumstance affecting the lifestyle or behavioral choices of Aboriginal and Torres Strait Islander peoples in remote-/very remote Australia. Poor behavioral choices are the result of endogenous characteristics that are influenced by a range of stressful exogenous variables making up the psychosocial determinants including social disenfranchisement, cultural loss, insurmountable tasks, the loss of volitional control and resource constraints. It is shown that poor behavioral choices can be economically rational; especially under highly stressful conditions. Stressful circumstances erode individual capacity to commit to long-term positive health alternatives such as self-investment in education. Policies directed at removing the impediments and providing incentives to behaviors involving better health choices can lead to reductions in smoking and alcohol consumption and improved health outcomes. Multijurisdictional culturally acceptable policies directed at distal variables relating to the psychosocial determinants of health and personal mastery and control can be cost effective. While the content of this paper is focused on the conditions of colonized peoples, it has broader relevance.

A cognitive dual task affects gait variability in patients suffering from chronic low back pain.

PubMed

Hamacher, Dennis; Hamacher, Daniel; Schega, Lutz

2014-11-01

Chronic pain and gait variability in a dual-task situation are both associated with higher risk of falling. Executive functions regulate (dual-task) gait variability. A possible cause explaining why chronic pain increases risk of falling in an everyday dual-task situation might be that pain interferes with executive functions and results in a diminished dual-task capability with performance decrements on the secondary task. The main goal of this experiment was to evaluate the specific effects of a cognitive dual task on gait variability in chronic low back pain (CLBP) patients. Twelve healthy participants and twelve patients suffering from CLBP were included. The subjects were asked to perform a cognitive single task, a walking single task and a motor-cognitive dual task. Stride variability of trunk movements was calculated. A two-way ANOVA was performed to compare single-task walking with dual-task walking and the single cognitive task performance with the motor-cognitive dual-task performance. We did not find any differences in both of the single-task performances between groups. However, regarding single-task walking and dual-task walking, we observed an interaction effect indicating that low back pain patients show significantly higher gait variability in the dual-task condition as compared to controls. Our data suggest that chronic pain reduces motor-cognitive dual-task performance capability. We postulate that the detrimental effects are caused by central mechanisms where pain interferes with executive functions which, in turn, might contribute to increased risk of falling.

Variability in negative emotions among individuals with chronic low back pain: relationships with pain and function.

PubMed

Gerhart, James I; Burns, John W; Bruehl, Stephen; Smith, David A; Post, Kristina M; Porter, Laura S; Schuster, Erik; Buvanendran, Asokumar; Fras, Anne Marie; Keefe, Francis J

2017-11-13

Chronic pain is associated with elevated negative emotions, and resources needed to adaptively regulate these emotions can be depleted during prolonged pain. Studies of links between pain, function, and negative emotions in people with chronic pain, however, have focused almost exclusively on relationships among mean levels of these factors. Indexes that may reflect aspects of emotion regulation have typically not been analyzed. We propose that 1 index of emotion regulation is variability in emotion over time as opposed to average emotion over time. The sample was 105 people with chronic low back pain and 105 of their pain-free spouses. They completed electronic diary measures 5x/d for 14 consecutive days, producing 70 observations per person from which we derived estimates of within-subject variance in negative emotions. Location-scale models were used to simultaneously model predictors of both mean level and variance in patient negative emotions over time. Patients reported significantly more variability in negative emotions compared to their spouses. Patients who reported higher average levels of pain, pain interference, and downtime reported significantly higher levels of variability in negative emotions. Spouse-observed pain and pain behaviors were also associated with greater variability in patients' negative emotions. Test of the inverse associations between negative emotion level and variability in pain and function were significant but weaker in magnitude. These findings support the notion that chronic pain may erode negative emotion regulation resources, to the potential detriment of intra- and inter-personal function.

Chronic Interpersonal Stress Predicts Activation of Pro- and Anti- Inflammatory Signaling Pathways Six Months Later

PubMed Central

Miller, Gregory; Rohleder, Nicolas; Cole, Steve W.

2009-01-01

OBJECTIVE Chronic interpersonal difficulties have a detrimental influence on mental and physical health, but little is known about the mechanisms underlying this phenomenon. METHODS 103 healthy young women (mean age = 17) were administered a structured interview to assess the degree of chronic interpersonal stress in their lives. At the same time blood was drawn to measure systemic inflammation, the expression of signaling molecules that regulate immune activation, and leukocyte production of the cytokine interleukin-6 following ex vivo stimulation with lipopolysaccharide. All of the immunologic assessments were repeated six months later. RESULTS To the extent subjects were high in chronic interpersonal stress at baseline, their leukocytes displayed greater increases in mRNA for the pro-inflammatory transcription factor nuclear factor-kappa B (NF-κB) over the next six months. They also showed larger increases in mRNA for inhibitor of kappaB, a molecule that sequesters NF-κB in the cytoplasm and minimizes its pro-inflammatory activities. Chronic interpersonal stress at baseline was unrelated to changes in biomarkers of systemic inflammation, but was associated with increasingly pronounced interleukin-6 responses to lipopolysaccharide. These associations were independent of demographics, lifestyle variables, and depressive symptoms. CONCLUSIONS These findings suggest that chronic interpersonal difficulties accentuate expression of pro- and anti-inflammatory signaling molecules. While this process does not result in systemic inflammation under quiescent conditions, it does accentuate leukocytes’ inflammatory response to microbial challenge. These dynamics may underlie the excess morbidity associated with social stress, particularly in inflammation-sensitive diseases like depression and atherosclerosis. PMID:19073750

Prediction models of health-related quality of life in different neck pain conditions: a cross-sectional study.

PubMed

Beltran-Alacreu, Hector; López-de-Uralde-Villanueva, Ibai; Calvo-Lobo, César; La Touche, Roy; Cano-de-la-Cuerda, Roberto; Gil-Martínez, Alfonso; Fernández-Ayuso, David; Fernández-Carnero, Josué

2018-01-01

The main aim of the study was to predict the health-related quality of life (HRQoL) based on physical, functional, and psychological measures in patients with different types of neck pain (NP). This cross-sectional study included 202 patients from a primary health center and the physiotherapy outpatient department of a hospital. Patients were divided into four groups according to their NP characteristics: chronic (CNP), acute whiplash (WHIP), chronic NP associated with temporomandibular dysfunction (NP-TMD), or chronic NP associated with chronic primary headache (NP-PH). The following measures were performed: Short Form-12 Health Survey (SF-12), Neck Disability Index (NDI), visual analog scale (VAS), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BECK), and cervical range of movement (CROM). The regression models based on the SF-12 total HRQoL for CNP and NP-TMD groups showed that only NDI was a significant predictor of the worst HRQoL (48.9% and 48.4% of the variance, respectively). In the WHIP group, the regression model showed that BECK was the only significant predictor variable for the worst HRQoL (31.7% of the variance). Finally, in the NP-PH group, the regression showed that the BECK, STAI, and VAS model predicted the worst HRQoL (75.1% of the variance). Chronic nonspecific NP and chronic NP associated with temporomandibular dysfunction were the main predictors of neck disability. In addition, depression, anxiety, and pain were the main predictors of WHIP or primary headache associated with CNP.

Hypermobility, the Ehlers-Danlos syndromes and chronic pain.

PubMed

Syx, Delfien; De Wandele, Inge; Rombaut, Lies; Malfait, Fransiska

2017-01-01

Chronic widespread pain is a common complaint among individuals affected by generalised joint hypermobility. In the absence of other conditions that cause chronic pain, these individuals are usually diagnosed with joint hypermobility syndrome (JHS). JHS is a multifactorial trait with a strong genetic basis, but no specific genetic markers. Clinical overlap of JHS is seen with heritable connective tissue disorders, particularly with the Ehlers-Danlos syndrome, hypermobile type (hEDS). The Ehlers-Danlos syndromes (EDS) comprise a heterogeneous group of rare monogenic conditions that are characterised by joint hypermobility, skin and vascular fragility and generalised connective tissue friability, and are caused by genetic defects in an array of extracellular matrix genes. The genetic basis of hEDS remains however unknown, in contrast to other well-described EDS subtypes. In view of the considerable clinical overlap with JHS, many consider it and hEDS to be a single clinical entity. Clinical experience and a limited number of clinical studies show that chronic pain also is common in EDS patients, especially in hEDS. The specific underlying causes and mechanisms of pain in JHS and EDS remain poorly understood. Factors likely contributing to the generation and chronicity of pain include nociceptive pain, directly based on structural changes in affected joints, muscle and connective tissue; neuropathic pain; impaired proprioception and muscle weakness; and central sensitisation. These mechanisms are not mutually exclusive, and likely more than one mechanism may be present. Furthermore, anxiety, depression, and other variables may influence the phenotype. Chronic pain in JHS and EDS patients often is inadequately controlled by traditional analgesics and physical therapy. In view of the high prevalence of these underrecognised conditions, future studies addressing the nature and mediators of chronic pain are needed in order to potentially identify novel targets for therapeutic intervention and optimise treatment.

Physical Activity Level of Korean Adults with Chronic Diseases: The Korean National Health and Nutritional Examination Survey, 2010-2012.

PubMed

Jin, Ho-Seong; An, Ah-Reum; Choi, Ho-Chun; Lee, Sang-Hyun; Shin, Dong-Heon; Oh, Seung-Min; Seo, Young-Gyun; Cho, Be-Long

2015-11-01

Proper physical activities are known to be helpful in the prevention and management of chronic diseases. However, the physical activity level of patients with chronic diseases is low. Therefore, this study aimed to investigate the physical activity compliance of patients with hypertension, diabetes, and dyslipidemia in Korea. This study analyzed the 2010-2012 Fifth Korean National Health and Nutrition Examination Survey data. We included 13,873 individuals in the analysis. The level of physical activity compliance was measured by performing multivariate logistic regression analyses. In the univariate analysis, the subjects with hypertension or diabetes tended to comply with the physical activity guidelines less faithfully than their healthy counterparts. The proportion of subjects with hypertension who were insufficiently physically active was 65.4% among the men and 75.8% among the women. For diabetes, the proportions were 66.7% and 76.8%, respectively. No significant difference was found between the subjects with dyslipidemia and their healthy counterparts. In the multivariate logistic regression analysis, no significant difference in physical activity compliance was observed between the subjects with hypertension, diabetes, or dyslipidemia and their healthy counterparts for both sexes. The patients with hypertension or diabetes tended to have lower physical activity prevlaence than their healthy counterparts. However, for dyslipidemia, no significant difference was found between the two groups. Given the significance of physical activities in the management of chronic diseases, the physical activities of these patients need to be improved.

Chronic back pain and associated work and non-work variables among farmworkers from Starr County, Texas.

PubMed

Shipp, Eva M; Cooper, Sharon P; del Junco, Deborah J; Delclos, George L; Burau, Keith D; Tortolero, Susan; Whitworth, Ryan E

2009-01-01

This study estimated the prevalence of chronic back pain among migrant farmworker family members and identified associated work and non-work variables. Migrant farmworkers (n = 390 from 267 families) from Starr County, Texas were interviewed in their home once a year for 2 years. The original survey included items measuring demographics, smoking, sleep, farm work, and chronic back pain. For this cross-sectional analysis, multi-level logistic regression was used to identify associated work and other variables associated with chronic back pain while accounting for intraclass correlations due to repeated measures and multiple family members. The prevalence of chronic back pain during the last migration season ranged from 9.5% among the youngest children to 33.3% among mothers. Variables significantly associated with chronic back pain were age (odds ratio [OR], 1.03, per year increase), depressive symptoms while migrating (OR, 8.72), fewer than 8 hours of sleep at home in Starr County (OR, 2.26), fairly bad/very bad quality of sleep while migrating (OR, 3.25), sorting crops at work (OR, 0.18), and working tree crops (OR, 11.72). The role of work exposures, depressive symptoms, and sleep in chronic back pain among farmworkers warrants further examination. Refinements in outcome and exposure assessments are also needed given the lack of a standardized case definition and the variety of tasks and crops involved in farm work in the United States.

Chronic stress and decreased physical exercise: impact on weight for African American women.

PubMed

Moore-Greene, Gracie M; Gross, Susan M; Silver, Kristi D; Perrino, Carrol S

2012-01-01

African American women continue to have the highest prevalence of obesity in the United States and in the state of Maryland they are disproportionately affected by overweight and obesity. There are many contributing factors including chronic stress and the use of health behaviors such as physical exercise that play a role in increased weight for African American women. We examined the relationship of stress to weight and the role of physical exercise in African American paraprofessional women. Cross-sectional study African American paraprofessionals were asked about their perspectives regarding association with chronic stress and physical exercise. The three most salient stressors for the women were finances (33%), work (28%) and family/friends (19%). Ninety percent of the women were overweight or obese. Significant predictors of increased BMI were lack of physical exercise (P = .004) and health compared to others (P = .006). Ethnic discrimination was a form of chronic stress (r = .319) but was not correlated with BMI (r = .095). Decreased physical exercise (P = .02) mediated the relationship between chronic stress and BMI. Findings regarding finance and work stress suggest the need for employers to consider the impact of job strain when implementing employee health programs to decrease stress and improve health. A focus on decreased physical exercise, unhealthy eating habits and misperceptions regarding increased risk for obesity related diseases with health status may be helpful to include in intervention strategies to decrease obesity for this population.

Assessment of physical function and participation in chronic pain clinical trials: IMMPACT/OMERACT recommendations.

PubMed

Taylor, Ann M; Phillips, Kristine; Patel, Kushang V; Turk, Dennis C; Dworkin, Robert H; Beaton, Dorcas; Clauw, Daniel J; Gignac, Monique A M; Markman, John D; Williams, David A; Bujanover, Shay; Burke, Laurie B; Carr, Daniel B; Choy, Ernest H; Conaghan, Philip G; Cowan, Penney; Farrar, John T; Freeman, Roy; Gewandter, Jennifer; Gilron, Ian; Goli, Veeraindar; Gover, Tony D; Haddox, J David; Kerns, Robert D; Kopecky, Ernest A; Lee, David A; Malamut, Richard; Mease, Philip; Rappaport, Bob A; Simon, Lee S; Singh, Jasvinder A; Smith, Shannon M; Strand, Vibeke; Tugwell, Peter; Vanhove, Gertrude F; Veasley, Christin; Walco, Gary A; Wasan, Ajay D; Witter, James

2016-09-01

Although pain reduction is commonly the primary outcome in chronic pain clinical trials, physical functioning is also important. A challenge in designing chronic pain trials to determine efficacy and effectiveness of therapies is obtaining appropriate information about the impact of an intervention on physical function. The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) and Outcome Measures in Rheumatology (OMERACT) convened a meeting to consider assessment of physical functioning and participation in research on chronic pain. The primary purpose of this article is to synthesize evidence on the scope of physical functioning to inform work on refining physical function outcome measurement. We address issues in assessing this broad construct and provide examples of frequently used measures of relevant concepts. Investigators can assess physical functioning using patient-reported outcome (PRO), performance-based, and objective measures of activity. This article aims to provide support for the use of these measures, covering broad aspects of functioning, including work participation, social participation, and caregiver burden, which researchers should consider when designing chronic pain clinical trials. Investigators should consider the inclusion of both PROs and performance-based measures as they provide different but also important complementary information. The development and use of reliable and valid PROs and performance-based measures of physical functioning may expedite development of treatments, and standardization of these measures has the potential to facilitate comparison across studies. We provide recommendations regarding important domains to stimulate research to develop tools that are more robust, address consistency and standardization, and engage patients early in tool development.

Vital Signs: Disability and Physical Activity — United States, 2009–2012

PubMed Central

Carroll, Dianna D.; Courtney-Long, Elizabeth A.; Stevens, Alissa C.; Sloan, Michelle L.; Lullo, Carolyn; Visser, Susanna N.; Fox, Michael H.; Armour, Brian S.; Campbell, Vincent A.; Brown, David R.; Dorn, Joan M.

2014-01-01

Background Adults with disabilities are less active and have higher rates of chronic disease than the general population. Given the health benefits of physical activity, understanding physical activity, its relationship with chronic disease, and health professional recommendations for physical activity among young to middle-age adults with disabilities could help increase the effectiveness of health promotion efforts. Methods Data from the 2009–2012 National Health Interview Survey (NHIS) were used to estimate the prevalence of, and association between, aerobic physical activity (inactive, insufficiently active, or active) and chronic diseases (heart disease, stroke, diabetes, and cancer) among adults aged 18–64 years by disability status and type (hearing, vision, cognitive, and mobility). The prevalence of, and association between, receiving a health professional recommendation for physical activity and level of aerobic physical activity was assessed using 2010 data. Results Overall, 11.6% of U.S. adults aged 18–64 years reported a disability, with estimates for disability type ranging from 1.7% (vision) to 5.8% (mobility). Compared with adults without disabilities, inactivity was more prevalent among adults with any disability (47.1% versus 26.1%) and for adults with each type of disability. Inactive adults with disabilities were 50% more likely to report one or more chronic diseases than those who were physically active. Approximately 44% of adults with disabilities received a recommendation from a health professional for physical activity in the past 12 months. Conclusions Almost half of adults with disabilities are physically inactive and are more likely to have a chronic disease. Among adults with disabilities who visited a health professional in the past 12 months, the majority (56%) did not receive a recommendation for physical activity. Implications for Public Health These data highlight the need for increased physical activity among persons with disabilities, which might require support across societal sectors, including government and health care. PMID:24807240

[Physical factors in the treatment and rehabilitation of patients with chronic prostatitis complicated by impotence].

PubMed

Karpukhin, I V; Bogomol'nyĭ, V A

1999-01-01

103 patients with chronic prostatitis complicated by erectile impotence were given combined treatment including shock-wave massage, mud applications, local vacuum magnetotherapy. This combination was found to stimulate copulative function, urodynamics of the lower urinary tracts, to produce an antiinflammatory effect. These benefits allow to recommend the above physical factors for management of chronic prostatitis patients with copulative dysfunction.

Integrating co-morbid depression and chronic physical disease management: identifying and resolving failures in self-regulation.

PubMed

Detweiler-Bedell, Jerusha B; Friedman, Michael A; Leventhal, Howard; Miller, Ivan W; Leventhal, Elaine A

2008-12-01

Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes.

Integrating Co-Morbid Depression and Chronic Physical Disease Management: Identifying and Resolving Failures in Self-Regulation

PubMed Central

Detweiler-Bedell, Jerusha B.; Friedman, Michael A.; Leventhal, Howard; Miller, Ivan W.; Leventhal, Elaine A.

2008-01-01

Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes. PMID:18848740

Loneliness and Cognitive Function in Older Adults: Findings From the Chinese Longitudinal Healthy Longevity Survey

PubMed Central

Chen, Shu-Lin; Tu, Xin; Conwell, Yeates

2017-01-01

Objectives: To examine the relationship between loneliness and cognitive function and to explore the mediating role of physical health on the loneliness–cognition relationship in Chinese older adults (OAs). Method: Data came from a nationally representative sample of 14,199 Chinese OAs (aged 65+) from 2002, 2005, 2008, and 2011 waves of the Chinese Longitudinal Healthy Longevity Survey. A latent variable cross-lagged panel model combined with mediation analysis was used to determine the relationship between loneliness and cognitive function and the mediating effect of increase in the number of chronic conditions (ΔNCCs) on the ascertained loneliness–cognition relationship. Results: Severe loneliness at prior assessment points was significantly associated with poorer cognitive function at subsequent assessments, and vice versa. The ΔNCCs partially mediated this prospective reciprocal relationships, accounting for 2.58% of the total effect of loneliness on cognition and 4.44% of the total effect of cognition on loneliness, respectively. Discussion: Loneliness may predict subsequent cognitive decline, and vice versa. This loneliness–cognition relationship is partially explained by their impact on physical health. Multidisciplinary interventions aimed at reducing loneliness and cognitive decline per se and their associated risk factors as well as improving chronic illness management would be beneficial for emotional well-being and cognitive health in OAs. PMID:27013536

Suicidal ideation is associated with individual differences in prescription opioid craving and cue-reactivity among chronic pain patients.

PubMed

Garland, Eric L; Riquino, Michael R; Priddy, Sarah E; Bryan, Craig J

2017-01-01

Given that chronic pain patients experience significant rates of suicidal ideation and suicide attempts, access to prescription opioids compounds the risk of death by suicide. These patients may experience heightened opioid craving and exhibit increased cue-reactivity to stimuli associated with past opioid use when suicidal ideation produces negative affective states. Because both opioids and suicidal behavior are used to alleviate emotional and physical pain through a process of negative reinforcement, elucidating factors that mediate this association may yield insight into suicide risk among chronic pain patients. This study examined the relationship between suicidal ideation and opioid craving and cue-reactivity, and tested opioid self-medication as a mediator of associations between those factors after controlling for the impact of pain severity. A sample of 115 chronic pain patients provided demographic and clinical information on the Obsessive Compulsive Drug Use Scale, the Current Opioid Misuse Measure, and the Brief Pain Inventory before completing an opioid dot probe task in which heart rate variability was recorded. As hypothesized, suicidal ideation was positively correlated with subjective opioid craving and physiological cue-reactivity. Self-medication significantly mediated the association between suicidal ideation, craving, and cue-reactivity. As opioids relieve the emotional pain linked with suicidal thoughts, chronic pain patients with higher levels of suicidal ideation may experience more intense opioid craving and exhibit heightened physiological cue-reactivity when compared to patients with low levels of suicidal ideation.

[Effects of a Multi-disciplinary Approached, Empowerment Theory Based Self-management Intervention in Older Adults with Chronic Illness].

PubMed

Park, Chorong; Song, Misoon; Cho, Belong; Lim, Jaeyoung; Song, Wook; Chang, Heekyung; Park, Yeon-Hwan

2015-04-01

The purpose of this study was to develop a multi-disciplinary self-management intervention based on empowerment theory and to evaluate the effectiveness of the intervention for older adults with chronic illness. A randomized controlled trial design was used with 43 Korean older adults with chronic illness (Experimental group=22, Control group=21). The intervention consisted of two phases: (1) 8-week multi-disciplinary, team guided, group-based health education, exercise session, and individual empowerment counseling, (2) 16-week self-help group activities including weekly exercise and group discussion to maintain acquired self-management skills and problem-solving skills. Baseline, 8-week, and 24-week assessments measured health empowerment, exercise self-efficacy, physical activity, and physical function. Health empowerment, physical activity, and physical function in the experimental group increased significantly compared to the control group over time. Exercise self-efficacy significantly increased in experimental group over time but there was no significant difference between the two groups. The self-management program based on empowerment theory improved health empowerment, physical activity, and physical function in older adults. The study finding suggests that a health empowerment strategy may be an effective approach for older adults with multiple chronic illnesses in terms of achieving a sense of control over their chronic illness and actively engaging self-management.

Independent and combined influence of homeownership, occupation, education, income, and community poverty on physical health in persons with arthritis.

PubMed

Callahan, Leigh F; Martin, Kathryn Remmes; Shreffler, Jack; Kumar, Deepak; Schoster, Britta; Kaufman, Jay S; Schwartz, Todd A

2011-05-01

To examine the independent and combined influence of individual- and community-level socioeconomic status (SES) measures on physical health status outcomes in people with self-reported arthritis. From 2004-2005, 968 participants completed a telephone survey assessing health status, chronic conditions, community characteristics, and sociodemographic variables. Individual-level SES measures used included homeownership, occupation (professional or not), educational attainment (less than high school, high school degree, and more than high school), and income (<$15,000, $15,000-$45,000, and >$45,000). Community poverty (2000 US Census block group percentage of individuals living below the poverty line [low, medium, and high]) was used as a community-level SES measure. Outcomes were physical functioning (Medical Outcomes Study Short Form 12 version 2 physical component summary [PCS]), functional disability (Health Assessment Questionnaire [HAQ]), and the Centers for Disease Control and Prevention (CDC) Health-Related Quality of Life (HRQOL) Healthy Days physical and limited activity days, and were analyzed via multivariable regressions. When entered separately, all individual-level SES variables were significantly (P < 0.01) associated with poorer PCS, HAQ, and CDC HRQOL scores. A higher magnitude of effect was seen for household income, specifically <$15,000 per year in final models with all 4 individual SES measures and community poverty. The magnitude of effect for education is reduced and marginally significant for the PCS and number of physically unhealthy days. No effects were seen for occupation, homeownership, and community poverty. Findings confirm that after adjusting for important covariates, lower individual- and community-level SES measures are associated with poorer physical health outcomes, while household income is the strongest predictor (as measured by both significance and effect) of poorer health status in final models. Studies not having participant-reported income available should make use of other SES measures, as they do independently predict physical health. Copyright © 2011 by the American College of Rheumatology.

Job strain and health-related quality of life in a national sample.

PubMed

Lerner, D J; Levine, S; Malspeis, S; D'Agostino, R B

1994-10-01

Studies of the health effects of job strain have focused on morbidity and mortality as outcomes. This is the first study to examine the relationship of job strain to more comprehensive health status measures that encompass health-related quality of life. In a national cross-sectional survey, 1319 working men and women, aged 18 through 64 years, completed a modified version of the Job Content Questionnaire that classified workers' jobs into four categories: high strain, passive, low strain, and active. Subjects also completed the Medical Outcomes Study Short-Form Health Survey and a health distress scale. Logistic regression analyses were employed that controlled for age, race/ethnicity, gender, and education. Both work and nonwork variables were included. Job strain was significantly associated with five of nine components of health-related quality of life: physical functioning, role functioning related to physical health, vitality, social functioning, and mental health. Job strain made a modest yet statistically significant contribution beyond the effects of chronic illness and psychosocial variables. The results provide justification for further investigating the role of job strain as an independent risk factor for health-related quality of life.

Chronic disease risk factors among hotel workers

PubMed Central

Gawde, Nilesh Chandrakant; Kurlikar, Prashika R.

2016-01-01

Context: Non-communicable diseases have emerged as a global health issue. Role of occupation in pathogenesis of non-communicable diseases has not been explored much especially in the hospitality industry. Aims: Objectives of this study include finding risk factor prevalence among hotel workers and studying relationship between occupational group and chronic disease risk factors chiefly high body mass index. Settings and Design: A cross-sectional study was conducted among non-managerial employees from classified hotels in India. Materials and Methods: The study participants self-administered pre-designed pilot-tested questionnaires. Statistical analysis used: The risk factor prevalence rates were expressed as percentages. Chi-square test was used for bi-variate analysis. Overweight was chosen as ‘outcome’ variable of interest and binary multi-logistic regression analysis was used to identify determinants. Results: The prevalence rates of tobacco use, alcohol use, inadequate physical activity and inadequate intake of fruits and vegetables were 32%, 49%, 24% and 92% respectively among hotel employees. Tobacco use was significantly common among those in food preparation and service, alcohol use among those in food service and security and leisure time physical activity among front office workers. More than two-fifths (42.7%) were overweight. Among the hotel workers, those employed in food preparation and security had higher odds of 1.650 (CI: 1.025 – 2.655) and 3.245 (CI: 1.296 – 8.129) respectively of being overweight. Conclusions: Prevalence of chronic disease risk factors is high among hotel workers. Risk of overweight is significantly high in food preparation and security departments and workplace interventions are necessary to address these risks PMID:27390474

Better or Worse: a Study of Day-to-Day Changes over Five Months of Rosen Method Bodywork Treatment for Chronic Low Back Pain

PubMed Central

Fogel, Alan

2013-01-01

Background Fluctuations of good days and bad days—in physical symptoms and emotional states—are common for individuals with chronic illness. This pilot study examines these fluctuations during bodywork treatment. Purpose We analyzed changes in daily self-reports over a period of five months for five individuals who received weekly treatments of Rosen Method Bodywork (RMB), which uses touch and words to enhance body awareness of physical sensations and emotional states. Subjects and Design Five subjects (aged 31–56) who had chronic low back pain (CLBP) received 16 weekly treatments given by three experienced RMB practitioners. Measures Pre- and posttreatment assessments covered demographics, disability, and pain. Clients also completed daily bedtime assessments of pain, fatigue, emotional state, and sense of control during the entire treatment period. Results All clients reported reductions in pain and/or disability in post- compared to pretreatment. In spite of a high level of day-to-day variability in the daily assessments, there were significant reductions in pain and fatigue, and significant increases in positive emotional state and sense of control across the treatment period. In reaching this end, however, some clients had slow and steady improvements, some improved more rapidly, while others got worse before they got better. Conclusions The natural course of healing—with its inevitable fluctuations in symptoms—is part of a process leading to successful treatment outcomes. Rosen Method Bodywork may be especially helpful in developing and accepting both sensory and emotional body awareness changes that facilitate overall improvement. PMID:24000305

Associations between vigorous physical activity and chronic diseases in older adults: a study in 13 European countries.

PubMed

Marques, Adilson; Peralta, Miguel; Sarmento, Hugo; Martins, João; González Valeiro, Miguel

2018-05-14

This study aimed to assess cross-sectional and prospective relationships between vigorous physical activity (VPA) and the risk of major chronic diseases among European older adults. Participants were 37 524 older adults who responded to the fourth (in 2011) and fifth (in 2013) wave of the SHARE project, from 13 European countries. Participants answered interview questions about the presence of chronic conditions and VPA. The cross-sectional and prospective association between PA and the number of chronic diseases was assessed using logistic regression models. Among men and women, the prevalence of chronic diseases was significantly lower among those who reported VPA once a week or more than once a week. For men, VPA once a week was prospectively related with lower odds of heart attack, chronic lung disease, Parkinson's disease and Alzheimer's disease. VPA more than once a week was prospectively related with lower odds of having all chronic diseases. Women who engaged in VPA once a week presented lower odds of having chronic diseases, except for hypertension, high blood cholesterol and cancer. For VPA more than once a week, cancer was the only disease not associated with physical activity. VPA is associated with reduced risk of chronic diseases in men and women. Even the practice of VPA once a week seems to be sufficient to reduce risks of chronic diseases.

Measuring meaning and peace with the FACIT-spiritual well-being scale: distinction without a difference?

PubMed

Peterman, Amy H; Reeve, Charlie L; Winford, Eboni C; Cotton, Sian; Salsman, John M; McQuellon, Richard; Tsevat, Joel; Campbell, Cassie

2014-03-01

The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp; Peterman, Fitchett, Brady, Hernandez, & Cella, 2002) has become a widely used measure of spirituality; however, there remain questions about its specific factor structure and the validity of scores from its separate scales. Specifically, it remains unclear whether the Meaning and Peace scales denote distinct factors. The present study addresses previous limitations by examining the extent to which the Meaning and Peace scales relate differentially to a variety of physical and mental health variables across 4 sets of data from adults with a number of chronic health conditions. Although a model with separate but correlated factors fit the data better, discriminant validity analyses indicated limited differences in the pattern of associations each scale showed with a wide array of commonly used health and quality-of-life measures. In total, the results suggest that people may distinguish between the concepts of Meaning and Peace, but the observed relations with health outcomes are primarily due to variance shared between the 2 factors. Additional research is needed to better understand the separate and joint role of Meaning and Peace in the quality of life of people with chronic illness. 2014 APA

Chronic Obstructive Pulmonary Disease: Diagnosis and Management.

PubMed

Gentry, Shari; Gentry, Barry

2017-04-01

The diagnosis of chronic obstructive pulmonary disease (COPD) should be suspected in patients with risk factors (primarily a history of smoking) who report dyspnea at rest or with exertion, chronic cough with or without sputum production, or a history of wheezing. COPD may be suspected based on findings from the history and physical examination, but must be confirmed by spirometry to detect airflow obstruction. Findings that are most helpful to rule in COPD include a smoking history of more than 40 pack-years, a self-reported history of COPD, maximal laryngeal height, and age older than 45 years. The combination of three clinical variables-peak flow rate less than 350 L per minute, diminished breath sounds, and a smoking history of 30 pack-years or more-is another good clinical predictor, whereas the absence of all three of these signs essentially rules out airflow obstruction. Pharmacotherapy and smoking cessation are the mainstays of treatment, and pulmonary rehabilitation, long-term oxygen therapy, and surgery may be considered in select patients. Current guidelines recommend starting monotherapy with an inhaled bronchodilator, stepping up to combination therapy as needed, and/or adding inhaled corticosteroids as symptom severity and airflow obstruction progress.

Measuring Meaning and Peace With the FACIT–Spiritual Well-Being Scale: Distinction Without a Difference?

PubMed Central

Peterman, Amy H.; Reeve, Charlie L.; Winford, Eboni C.; Salsman, John M.; Tsevat, Joel; Cotton, Sian; McQuellon, Richard; Campbell, Cassie

2014-01-01

The Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale (FACIT–Sp; Peterman, Fitchett, Brady, Hernandez, & Cella, 2002) has become a widely used measure of spirituality; however, there remain questions about its specific factor structure and the validity of scores from its separate scales. Specifically, it remains unclear whether the Meaning and Peace scales denote distinct factors. The present study addresses previous limitations by examining the extent to which the Meaning and Peace scales relate differentially to a variety of physical and mental health variables across 4 sets of data from adults with a number of chronic health conditions. Although a model with separate but correlated factors fit the data better, discriminant validity analyses indicated limited differences in the pattern of associations each scale showed with a wide array of commonly used health and quality-of-life measures. In total, the results suggest that people may distinguish between the concepts of Meaning and Peace, but the observed relations with health outcomes are primarily due to variance shared between the 2 factors. Additional research is needed to better understand the separate and joint role of Meaning and Peace in the quality of life of people with chronic illness. PMID:24188147

Victimization, Smoking, and Chronic Physical Health Problems Among Sexual Minority Women

PubMed Central

Simoni, Jane M.

2014-01-01

Background Sexual minority women (SMW) have been shown to be at increased risk for abuse, smoking, and chronic physical health problems compared with heterosexual women. In the general population, abuse and smoking are associated with physical health problems. However, there has been little research on their associations among SMW. Purpose The current study examined a mediational model of abuse, smoking, and self-reported physical health conditions in a national sample of SMW. Methods Participants (N=1,224) were recruited via the Internet and completed measures of childhood trauma, adult sexual assault, smoking, body mass index, and chronic medical conditions. Results Structural equation modeling demonstrated that childhood abuse was associated with adult sexual assault, smoking, and physical health problems, but smoking was not a significant mediator. Conclusions The results highlight the impact of childhood abuse on physical health problems among SMW and the need to examine other health behaviors that may mediate this relation. PMID:21735343

The role of neuropsychological performance in the relationship between chronic pain and functional physical impairment.

PubMed

Pulles, Wiesje L J A; Oosterman, Joukje M

2011-12-01

  In this study, the relationship between pain intensity, neuropsychological, and physical function in adult chronic pain patients was examined.   Thirty participants with chronic pain completed neuropsychological tests tapping mental processing speed, memory, and executive function. Pain intensity was measured with three visual analog scales and the Pain Rating Index of the McGill Pain Questionnaire. A grip strength test, the 6-minute walk test, the Unipedal Stance Test and the Lifting Low Test were administered in order to obtain a performance-based measure of physical capacity. Self-reported physical ability was assessed with the Disability Rating Index and the Short Form-36 Physical Functioning, and Role Physical scales. Psychosocial function was examined using the Mental Health and Role Emotional subscales of the Short Form-36.   The study was set in two outpatient physical therapy clinics in The Netherlands.   The analysis showed that a lower mental processing speed was related to a higher level of pain, as well as to a lower performance-based and self-reported physical functioning. In addition, both performance-based and self-reported physical function revealed an inverse correlation with pain intensity. Psychosocial function turned out to be an important mediator of the relationship between pain and self-reported, but not performance-based, physical function. Mental processing speed, on the other hand, was found to mediate the relationship between pain and performance-based physical functioning.   The results suggest that in chronic pain patients, mental processing speed mediates the relationship between pain and physical function. Wiley Periodicals, Inc.

Motor-Evoked Pain Increases Force Variability in Chronic Jaw Pain.

PubMed

Wang, Wei-En; Roy, Arnab; Misra, Gaurav; Archer, Derek B; Ribeiro-Dasilva, Margarete C; Fillingim, Roger B; Coombes, Stephen A

2018-06-01

Musculoskeletal pain changes how people move. Although experimental pain is associated with increases in the variability of motor output, it is not clear whether motor-evoked pain in clinical conditions is also associated with increases in variability. In the current study, we measured jaw force production during a visually guided force paradigm in which individuals with chronic jaw pain and control subjects produced force at 2% of their maximum voluntary contraction (low target force level) and at 15% of their maximum voluntary contraction (high target force level). State measures of pain were collected before and after each trial. Trait measures of pain intensity and pain interference, self-report measures of jaw function, and measures of depression, anxiety, and fatigue were also collected. We showed that the chronic jaw pain group exhibited greater force variability compared with controls irrespective of the force level, whereas the accuracy of force production did not differ between groups. Furthermore, predictors of force variability shifted from trait measures of pain intensity and pain interference at the low force level to state measures of pain intensity at the high force level. Our observations show that motor-evoked jaw pain is associated with increases in force variability that are predicted by a combination of trait measures and state measures of pain intensity and pain interference. Chronic jaw pain is characterized by increases in variability during force production, which can be predicted by pain intensity and pain interference. This report could help clinicians better understand the long-term consequences of chronic jaw pain on the motor system. Copyright © 2018 The American Pain Society. Published by Elsevier Inc. All rights reserved.

Factors associated with generic health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD): a cross-sectional study.

PubMed

Brandl, Magdalena; Böhmer, Merle M; Brandstetter, Susanne; Finger, Tamara; Fischer, Wiebke; Pfeifer, Michael; Apfelbacher, Christian

2018-02-01

Health-related quality of life (HRQOL) is impaired in chronic obstructive pulmonary disease (COPD) patients, but determining factors for HRQOL are still not unequivocal. This study measures HRQOL among patients with COPD and aims to determine factors associated with HRQOL. Data for cross-sectional analyses were obtained from the baseline of a cohort study. The study population includes adult COPD patients (disease duration ≥3 months), recruited from primary and secondary care settings in Germany, without acute psychiatric/neurologic disease (exception: affective/ anxiety disorders). HRQOL was assessed using the Short-Form 12 (SF-12) Health Survey Questionnaire, comprising a physical and mental component. Independent variables encompass socio-demographic, disease-specific, treatment-related and psychological factors. Multivariable linear regression analyses were conducted. In total, 206 COPD patients (60.7% male; mean age: 65.3 years) took part in the study. In multivariable analysis, the physical component score showed a significant negative association with the COPD Assessment Test (CAT) (P<0.001) and a higher total number of prescribed medications (P=0.001). A higher forced expiratory volume in 1 second (FEV1) value in percent predicted was significantly related to the physical component score in a positive manner (P=0.006). The mental component score was significantly associated with elevated patient-reported symptoms of anxiety (P=0.002) or depression (P<0.001), measured by the hospital anxiety and depression scale (HADS) in a negative way. Like for the physical component score (P<0.001), a worse CAT score was significantly associated with a lower mental component score (P=0.033). Focusing on patient reported outcomes and screening for depression and anxiety with potential successive treatment might be promising approaches to improve HRQOL in patients with COPD.

Caregiver Stress and Physical Health: The Case for Stress Management Therapy

ERIC Educational Resources Information Center

Long, C.; Krisztal, E.; Rabinowitz, Y.; Gillispie, Z.; Oportot, M.; Tse, C.; Singer, L.; Gallagher-Thompson, D.

2004-01-01

It is well known that providing care for a loved one with memory problems puts a person at risk for both mental and physical health problems. In the last several decades, research on chronic stress suggests that the body's physical response to stress becomes severely dysregulated as a result of chronic stress lifestyles such as caregiving. This…

Physical Exercise Restores the Generation of Newborn Neurons in an Animal Model of Chronic Epilepsy

PubMed Central

Mendonça, Fabricio N.; Santos, Luiz E. C.; Rodrigues, Antônio M.; Gomes da Silva, Sérgio; Arida, Ricardo M.; da Silveira, Gilcélio A.; Scorza, Fulvio A.; Almeida, Antônio-Carlos G.

2017-01-01

Neurogenesis impairment is associated with the chronic phase of the epilepsy in humans and also observed in animal models. Recent studies with animal models have shown that physical exercise is capable of improving neurogenesis in adult subjects, alleviating cognitive impairment and depression. Here, we show that there is a reduction in the generation of newborn granule cells in the dentate gyrus of adult rats subjected to a chronic model of epilepsy during the postnatal period of brain development. We also show that the physical exercise was capable to restore the number of newborn granule cells in this animals to the level observed in the control group. Notably, a larger number of newborn granule cells exhibiting morphological characteristics indicative of correct targeting into the hippocampal circuitry and the absence of basal dendrite projections was also observed in the epileptic animals subjected to physical exercise compared to the epileptic animals. The results described here could represent a positive interference of the physical exercise on the neurogenesis process in subjects with chronic epilepsy. The results may also help to reinterpret the benefits of the physical exercise in alleviating symptoms of depression and cognitive dysfunction. PMID:28298884

No short-term savings in health care expenditures for physically active adults.

PubMed

Chevan, Julia; Roberts, Dawn E

2014-06-01

The purpose of this study was to investigate the association of physical activity and health care expenditures in a nationally representative sample of non-disabled adults. This was a secondary analysis of data from 8843 adults. Physical activity measures were derived from participants in the 2006 and 2007 National Health Interview Survey. Demographic and expenditure variables came from the Medical Expenditure Panel Survey data files for panels 12 (2007-2008) and 13 (2008-2009). Multivariable regression models were used to determine the association between levels of physical activity participation and total health care expenditures, drug expenditures, and out-of-pocket health care expenditures. Unadjusted data revealed lower health care expenditures among those whose activity level met the CDC guidelines with greater savings apparent among those who exercised above recommended guidelines. However, in the models that adjusted for age, sex, race, income and health status these differences disappeared. In the short-term, the amount of physical activity undertaken by an adult may have little effect on the expenditures for health services, drugs and the money expended directly out-of-pocket. However, given the benefits of physical activity in terms of chronic disease prevention there are very likely long-term expenditure savings to be had. Copyright © 2014 Elsevier Inc. All rights reserved.

Building spatial layout that supports healthier behavior of office workers: a new performance mandate for sustainable buildings.

PubMed

Hua, Ying; Yang, Eunhwa

2014-01-01

The pursuit of efficiency and the permeation of communication technologies in modern workplace have increased prolonged sitting and physical inactivity among the white-collar workforce. Physical inactivity is a major risk factor for developing various chronic diseases and obesity. This study intends to understand the impact of physical environment on both voluntary and imperative physical activity levels in an office building, and to collect evidence for design suggestions to encourage office workers' activity level on a daily basis. This study examined how proximity from individual workstations to various shared service and amenity spaces in the workplace (e.g., meeting spaces, copy areas, kitchens, restrooms, elevators, and stairs) is associated with office workers' physical activity level (e.g., sedentary and non-sedentary behavior) and their environmental and job satisfaction. To objectively measure physical activity, twenty-six office workers, in a three-story office building, wore accelerometers for three consecutive days at work. Environmental and job satisfaction of office workers was measured by a questionnaire. Proximity variables were measured using the floor plans of the subject building. Participants on average were sedentary for 80% of the time during the study. Proximity to several service and amenity areas was positively associated with step counts and job satisfaction.

'Football is good for your sleep': favorable sleep patterns and psychological functioning of adolescent male intense football players compared to controls.

PubMed

Brand, Serge; Beck, Johannes; Gerber, Markus; Hatzinger, Martin; Holsboer-Trachsler, Edith

2009-11-01

It is commonly assumed that physical activity exerts a favorable impact on sleep, although scientific evidence is lacking. This study investigated the impact of football sports on the sleep patterns of 36 male chronic and intense football players and 34 controls. Participants completed a sleep log for seven consecutive days. Compared to controls, football players reported shorter sleep onset latency, fewer awakenings, higher scores of sleep quality and a lower variability of sleep from weekdays to weekends. The findings suggest that football sports activity is positively associated with both quantitative and qualitative dimensions of sleep.

Effects of an exercise programme for chronically ill and mobility-restricted elderly with structured support by the general practitioner's practice (HOMEfit) - study protocol of a randomised controlled trial

PubMed Central

2011-01-01

Background Exercise programmes can be administered successfully as therapeutic agents to patients with a number of chronic diseases and help to improve physical functioning in older adults. Usually, such programmes target either healthy and mobile community-dwelling seniors or elderly individuals living in nursing institutions or special residences. Chronically ill or mobility-restricted individuals, however, are difficult to reach when they live in their own homes. A pilot study has shown good feasibility of a home-based exercise programme that is delivered to this target group through cooperation between general practitioners and exercise therapists. A logical next step involves evaluation of the effects of the programme. Methods/design The study is designed as a randomised controlled trial. We plan to recruit 210 patients (≥ 70 years) in about 15 general practices. The experimental intervention (duration 12 weeks)-a multidimensional home-based exercise programme-is delivered to the participant by an exercise therapist in counselling sessions at the general practitioner's practice and on the telephone. It is based on methods and strategies for facilitating behaviour change according to the Health Action Process Approach (HAPA). The control intervention-baseline physical activities-differs from the experimental intervention with regard to content of the counselling sessions as well as to content and frequency of the promoted activities. Primary outcome is functional lower body strength measured by the "chair-rise" test. Secondary outcomes are: physical function (battery of motor tests), physical activity (step count), health-related quality of life (SF-8), fall-related self-efficacy (FES-I), and exercise self-efficacy (SSA-Scale). The hypothesis that there will be differences between the two groups (experimental/control) with respect to post-interventional chair-rise time will be tested using an ANCOVA with chair-rise time at baseline, treatment group, and study centre effects as explanatory variables. Analysis of the data will be undertaken using the principle of intention-to-treat. Trial registration Current Controlled Trials ISRCTN17727272. PMID:22188781

Web-Based Mindfulness Interventions for People With Physical Health Conditions: Systematic Review

PubMed Central

Toivonen, Kirsti I; Zernicke, Kristin

2017-01-01

Background Mindfulness-based interventions (MBIs) are becoming increasingly popular for helping people with physical health conditions. Expanding from traditional face-to-face program delivery, there is growing interest in Web-based application of MBIs, though Web-based MBIs for people with physical health conditions specifically have not been thoroughly reviewed to date. Objective The objective of this paper was to review Web-based MBIs for people with physical health conditions and to examine all outcomes reported (eg, efficacy or effectiveness for physical changes or psychological changes; feasibility). Methods Databases PubMed, PsycINFO, Science Direct, CINAHL Plus, and Web of Science were searched. Full-text English papers that described any Web-based MBI, examining any outcome, for people with chronic physical health conditions were included. Randomized, nonrandomized, controlled, and uncontrolled trials were all included. Extracted data included intervention characteristics, population characteristics, outcomes, and quality indicators. Intervention characteristics (eg, synchronicity and guidance) were examined as potential factors related to study outcomes. Results Of 435 publications screened, 19 published papers describing 16 studies were included. They examined Web-based MBIs for people with cancer, chronic pain or fibromyalgia, irritable bowel syndrome (IBS), epilepsy, heart disease, tinnitus, and acquired brain injury. Overall, most studies reported positive effects of Web-based MBIs compared with usual care on a variety of outcomes including pain acceptance, coping measures, and depressive symptoms. There were mixed results regarding the effectiveness of Web-based MBIs compared with active control treatment conditions such as cognitive behavioral therapy. Condition-specific symptoms (eg, cancer-related fatigue and IBS symptoms) targeted by treatment had the largest effect size improvements following MBIs. Results are inconclusive regarding physical variables. Conclusions Preliminary evidence suggests that Web-based MBIs may be helpful in alleviating symptom burden that those with physical health conditions can experience, particularly when interventions are tailored for specific symptoms. There was no evidence of differences between synchronous versus asynchronous or facilitated versus self-directed Web-based MBIs. Future investigations of Web-based MBIs should evaluate the effects of program adherence, effects on mindfulness levels, and whether synchronous or asynchronous, or facilitated or self-directed interventions elicit greater improvements. PMID:28860106

Predictors of osteodystrophy in patients with chronic nonalcoholic pancreatitis with or without diabetes.

PubMed

Sudeep, Krishna; Chacko, Ashok; Thomas, Nihal; Selvakumar, Ratnasamy; George, Biju; Paul, Thomas Vizhalil; Seshadri, Mandalam S

2011-01-01

To study bone mineral content (BMC), bone mineral density (BMD), vitamin D status, and bone mineral variables in patients with chronic nonalcoholic pancreatitis and to determine the relationship between pancreatic dysfunction and these variables. Thirty-one eligible nonalcoholic men with proven chronic pancreatitis and 35 male control subjects were studied. Biochemical data, variables of malabsorption, and BMD of the lumbar spine were evaluated. In patients with chronic pancreatitis, the mean body mass index (BMI) was 18.46 kg/m² and the median 25-hydroxyvitamin D value was 15.5 (range, 5.0 to 52.0) ng/mL. A T-score of less than -2.5 was found in a higher proportion of study patients (9 of 31, 29%) than of control subjects (3 of 35, 9%). BMI correlated significantly with BMC (r = 0.426; P = .017). There was an inverse correlation between stool fat and BMC (r = -0.47; P = .03) in patients with chronic pancreatitis and steatorrhea. There was no significant correlation between serum 25-hydroxyvitamin D or biochemical variables and BMD. Patients with steatorrhea had a significantly lower BMC than did those without steatorrhea, and this difference could not be accounted for by differences in BMI, presence of diabetes, or hypovitaminosis D. Pancreatic osteodystrophy is a novel entity consisting of osteopenia, osteoporosis, and osteomalacia in patients with chronic pancreatitis. The inverse correlation between stool fat and BMC in patients with chronic pancreatitis, the strong positive correlation between BMI and BMC, and the lack of difference in BMC between subjects with vitamin D sufficiency and those with vitamin D deficiency suggest that long-standing malabsorption with attendant chronic undernutrition is the major factor contributing to the changes in BMC.

Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: a pragmatic, cluster randomized, controlled trial.

PubMed

Hurley, M V; Walsh, N E; Mitchell, H; Nicholas, J; Patel, A

2012-02-01

Chronic joint pain is a major cause of pain and disability. Exercise and self-management have short-term benefits, but few studies follow participants for more than 6 months. We investigated the long-term (up to 30 months) clinical and cost effectiveness of a rehabilitation program combining self-management and exercise: Enabling Self-Management and Coping of Arthritic Knee Pain Through Exercise (ESCAPE-knee pain). In this pragmatic, cluster randomized, controlled trial, 418 people with chronic knee pain (recruited from 54 primary care surgeries) were randomized to usual care (pragmatic control) or the ESCAPE-knee pain program. The primary outcome was physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] function), with a clinically meaningful improvement in physical function defined as a ≥15% change from baseline. Secondary outcomes included pain, psychosocial and physiologic variables, costs, and cost effectiveness. Compared to usual care, ESCAPE-knee pain participants had large initial improvements in function (mean difference in WOMAC function -5.5; 95% confidence interval [95% CI] -7.8, -3.2). These improvements declined over time, but 30 months after completing the program, ESCAPE-knee pain participants still had better physical function (difference in WOMAC function -2.8; 95% CI -5.3, -0.2); lower community-based health care costs (£-47; 95% CI £-94, £-7), medication costs (£-16; 95% CI £-29, £-3), and total health and social care costs (£-1,118; 95% CI £-2,566, £-221); and a high probability (80-100%) of being cost effective. Clinical and cost benefits of ESCAPE-knee pain were still evident 30 months after completing the program. ESCAPE-knee pain is a more effective and efficient model of care that could substantially improve the health, well-being, and independence of many people, while reducing health care costs. Copyright © 2012 by the American College of Rheumatology.

Associations of physical activity energy expenditure with nutritional-inflammatory markers in hemodialysis patients.

PubMed

Santos, Clarcson P; Silva, Luciana F; Lopes, Marcelo B; Martins, Márcia T S; Kraychete, Angiolina C; Silva, Fernanda A; Martins, Maria T S; Matos, Cácia M; Lopes, Gildete B; Lopes, Antonio A

2017-11-24

Sedentariness, high inflammation status and malnutrition are highly prevalent in end-stage kidney disease patients on maintenance hemodialysis (MHD). This study investigated associations of weekly physical activity energy expenditure (PAEE) with clinical and anthropometric markers of nutrition and inflammation. The analysis was performed using baseline cross-sectional data of 640 patients enrolled in the prospective cohort "The Prospective Study of the Prognosis of Patients Treated Chronically by Hemodialysis" (PROHEMO) developed in Salvador, BA, Brazil. The long version of the International Physical Activity Questionnaire was used to determine a summary measure of PAEE, the metabolic equivalent of task (MET), taking into account physical activities related to occupation, recreation, travel, sports, and housework. PAEE was the predictor variable. To assess associations of PAEE with outcomes, the sex-age-specific median MET was used. The malnutrition-inflammation score (MIS) with range of 0 to 30 (higher is worse), conicity index as indicator of abdominal adiposity and C-reactive protein (CRP) were the nutritional-inflammatory outcomes. The mean age of the patients was 48.9 ± 13.8 y, 60.3% were males, 16.7% diabetic, 88.1% nonwhite. In multivariable logistic regression models with adjustments for sociodemographic variables and comorbidities, PAEE ≤median was associated with MIS ≥6 (odds ratio [OR] = 1.57; 95% confidence interval [CI] = 1.08, 2.29), conicity index ≥1.3 (OR = 1.52, 95% CI = 1.03, 2.23) and CRP >1.30 mg/dL (OR = 1.69, 95% CI = 1.08, 2.84). Greater physical activity assessed by PAEE was associated with indicators of better nutritional and inflammation status. These results indicate opportunities for improving outcomes in MHD patients by counseling and treatment intervention.

Physical activity during work and leisure show contrasting associations with fear-avoidance beliefs: cross-sectional study among more than 10,000 wage earners of the general working population.

PubMed

Tribian, Annika; Vinstrup, Jonas; Sundstrup, Emil; Jay, Kenneth; Bös, Klaus; Andersen, Lars L

2018-01-26

The association between different types of physical activity and fear-avoidance beliefs remains unclear. This study investigates the association between work-related and leisure-time physical activity with fear-avoidance beliefs in the general working population. Currently employed wage earners (n=10,427) from the 2010 round of the Danish Work Environment Cohort Study replied to questions about work, lifestyle and health. General linear models controlling for lifestyle, psychosocial work factors, education, pain, medication-use and chronic diseases tested associations of work-related and leisure-time physical activity (explanatory variables) with fear-avoidance beliefs (outcome variable, scale 0-100). The level of fear-avoidance was 41.7 (SD 27.3), 38.0 (SD 26.9) and 54.3 (SD 27.7) among the general working population, a subgroup of pain-free individuals, and a subgroup with back disease, respectively. In the general working population, the level of fear-avoidance among those with low, moderate and high physical activity during leisure were 47 [95% confidence intervals (CI) 45-49], 44 (95% CI 42-46) and 43 (95% CI 41-45), and physical activity at work were 40 (95% CI 39-42), 44 (95% CI 42-46) and 49 (95% CI 48-51), respectively. Individuals with back disease and a high level of physical activity at work showed the overall highest level of fear-avoidance whereas pain-free individuals with a low level of physical activity at work showed the overall lowest level of fear-avoidance. Physical activity during work and leisure shows contrasting associations with fear-avoidance beliefs. While high physical activity during leisure is associated with lower levels, high physical activity at work is associated with higher levels of fear-avoidance. The present results may reflect some deeply rooted negative beliefs about pain and work in the population. On the societal level, campaigns may be a possible way forward as these have shown to improve beliefs about musculoskeletal pain and work.

[Psychosocial functioning in non-psychiatric acute and chronic inpatients: depression, alexithymia and lack of assertiveness].

PubMed

Arancibia, Marcelo; Behar, Rosa; Marín, Sofía; Inzunza, Nicolás; Madrid, Eva

2016-11-01

Depression, alexithymia, and lack of assertiveness interfere with individual psychosocial functioning and may result in longer hospitalization stay and poorer therapeutic results. To analyze the psychosocial functioning in acute and chronic patients and its association with psychological, clinical and sociodemographic variables. We performed a cross-sectional study that included 80 inpatients of both sexes with organic pathology, aged between 18 to 70 years old, without any current psychiatric disorder. Clinical and sociodemographic data were collected from a semi-structured interview and hospital records. Beck Depression Inventory-IA, Toronto Alexithymia Scale-20 and Rathus Assertiveness Scale were administered. Fifty five percent of patients had some degree of depression, 33% alexithymia and 34% lack of assertiveness. The levels of depression, alexithymia and lack of assertiveness in chronic patients were significantly higher than those observed in acute patients. Women and participants older than 60 years exhibited the highest degrees of depression. Alexithymia and lack of assertiveness were associated with a lower educational level. A negative significant correlation between alexithymia and assertiveness scores was observed among acute patients. Participants with chronic diseases had a lower psychosocial functioning. Less educated patients showed more alexithymic and less assertive features. We emphasized the need of a better management of these aspects by the health team, since social functioning might interfere with the outcome of physical illnesses.

Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: developing a roadmap to improving quality care.

PubMed

Davison, Sara N; Levin, Adeera; Moss, Alvin H; Jha, Vivekanand; Brown, Edwina A; Brennan, Frank; Murtagh, Fliss E M; Naicker, Saraladevi; Germain, Michael J; O'Donoghue, Donal J; Morton, Rachael L; Obrador, Gregorio T

2015-09-01

Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Current paradigms of care for this highly vulnerable population are variable, prognostic and assessment tools are limited, and quality of care, particularly regarding conservative and palliative care, is suboptimal. The KDIGO Controversies Conference on Supportive Care in CKD reviewed the current state of knowledge in order to define a roadmap to guide clinical and research activities focused on improving the outcomes of people living with advanced CKD, including those on dialysis. An international group of multidisciplinary experts in CKD, palliative care, methodology, economics, and education identified the key issues related to palliative care in this population. The conference led to a working plan to address outstanding issues in this arena, and this executive summary serves as an output to guide future work, including the development of globally applicable guidelines.

Vigorous-intensity leisure-time physical activity and risk of major chronic disease in men.

PubMed

Chomistek, Andrea K; Cook, Nancy R; Flint, Alan J; Rimm, Eric B

2012-10-01

Although studies have shown health benefits for moderate-intensity physical activity, there is limited evidence to support beneficial effects for high amounts of vigorous activity among middle-age and older men. The objective of this study was to examine the relationship between vigorous-intensity physical activity, compared with moderate-intensity activity, and risk of major chronic disease in men. We prospectively examined the associations between vigorous- and moderate-intensity physical activity and risk of major chronic disease among 44,551 men age 40-75 yr in 1986. Leisure-time physical activity was assessed biennially by questionnaire. During 22 yr of follow-up, we documented 14,162 incident cases of major chronic disease, including 4769 cardiovascular events, 6449 cancer events, and 2944 deaths from other causes. The HR of major chronic disease comparing ≥ 21 to 0 MET.h.wk(-1) of exercise was 0.86 (95% confidence interval (CI), 0.81-0.91) for vigorous-intensity activity and 0.85 (95% CI, 0.80-0.90) for moderate activity. For cardiovascular disease (CVD), the corresponding HRs were 0.78 (95% CI, 0.70-0.86) and 0.80 (95% CI, 0.72-0.88), respectively. When examined separately, running, tennis, and brisk walking were inversely associated with CVD risk. Furthermore, more vigorous activity was associated with lower disease risk; the HR comparing >70 to 0 MET.h.wk(-1) of vigorous-intensity exercise was 0.79 (95% CI, 0.68-0.92; P < 0.0001 for trend) for major chronic disease and 0.73 (95% CI, 0.56-0.96; P < 0.0001 for trend) for CVD. Vigorous- and moderate-intensity physical activities were associated with lower risk of major chronic disease and CVD. Increasing amounts of vigorous activity remained inversely associated with disease risk, even among men in the highest categories of exercise.

Factors associated with self-esteem in persons with morbid obesity and in persons with chronic obstructive pulmonary disease: a cross-sectional study.

PubMed

Bonsaksen, Tore; Fagermoen, May Solveig; Lerdal, Anners

2015-01-01

Living with chronic illnesses can be stressful and may negatively impact persons' self-esteem. Personal factors, like self-efficacy and illness perceptions, and also factors related to the environment, activity, and participation may be associated with self-esteem in chronic illness populations. This cross-sectional comparative study explored sociodemographic variables, work, physical activity, illness perceptions, and general self-efficacy in relation to self-esteem in persons with morbid obesity and in persons with chronic obstructive pulmonary disease (COPD). The study had a cross-sectional design. A total of 223 eligible participants were recruited from patient education courses, and data were collected at baseline. Self-esteem was measured with The Rosenberg self-esteem scale; the general self-efficacy scale was used to measure self-efficacy, and brief illness perception questionnaire was also used. This is an instrument assessing cognitions about the illness and emotional responses towards it. Multivariate linear regression was used in the statistical analyses. In obese participants (n = 134), higher self-esteem was associated with lower emotional response, a shorter timeline, and higher general self-efficacy. In COPD participants (n = 89), higher self-esteem was associated with higher general self-efficacy. The independent variables accounted for 42.9% (morbid obesity) and 49.4% (COPD) of the self-esteem variance. In participants in both illness groups, higher self-efficacy was associated with increased self-esteem. A shorter timeline and lower emotional response to illness was related to higher self-esteem only for the obese participants. The results indicate that believing in one's capacity to cope with everyday challenges is important for self-esteem in persons with morbid obesity and in persons with COPD, whereas illness perceptions related to the duration of illness and the coping with emotions also is important for self-esteem in persons with morbid obesity.

Systematic Review: Bullying Involvement of Children With and Without Chronic Physical Illness and/or Physical/Sensory Disability-a Meta-Analytic Comparison With Healthy/Nondisabled Peers.

PubMed

Pinquart, Martin

2017-04-01

To compare levels of victimization and perpetration associated with bullying among children and adolescents with and without chronic physical illnesses and/or physical or sensory disabilities. In total, 107 studies were identified using a systematic search in electronic databases and cross-referencing. A random-effects meta-analysis was computed. Children and adolescents with chronic physical illness or disability were more likely to be victims of bullying in general (odds ratio [OR] = 1.65), particularly physical bullying (OR = 1.47), relational bullying (OR = 1.47), verbal bullying (OR = 1.67), cyberbullying (OR = 1.39), and illness-specific teasing (OR = 5.29). They were also more likely to be bullies in general (OR = 1.28), as well physical (OR = 1.38) and relational bullies (OR = 1.13). The effect sizes varied across different illnesses and disabilities and, in part, by visibility of the disease, school type, and year of assessment. Although most between-group differences tend to be small, some form of intervention is needed to reduce bullying among children and adolescents with chronic physical illnesses and/or physical or sensory disabilities, and illness-specific weight- and appearance-related teasing in particular. © The Author 2016. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

A diagnostic model for chronic hypersensitivity pneumonitis.

PubMed

Johannson, Kerri A; Elicker, Brett M; Vittinghoff, Eric; Assayag, Deborah; de Boer, Kaïssa; Golden, Jeffrey A; Jones, Kirk D; King, Talmadge E; Koth, Laura L; Lee, Joyce S; Ley, Brett; Wolters, Paul J; Collard, Harold R

2016-10-01

The objective of this study was to develop a diagnostic model that allows for a highly specific diagnosis of chronic hypersensitivity pneumonitis using clinical and radiological variables alone. Chronic hypersensitivity pneumonitis and other interstitial lung disease cases were retrospectively identified from a longitudinal database. High-resolution CT scans were blindly scored for radiographic features (eg, ground-glass opacity, mosaic perfusion) as well as the radiologist's diagnostic impression. Candidate models were developed then evaluated using clinical and radiographic variables and assessed by the cross-validated C-statistic. Forty-four chronic hypersensitivity pneumonitis and eighty other interstitial lung disease cases were identified. Two models were selected based on their statistical performance, clinical applicability and face validity. Key model variables included age, down feather and/or bird exposure, radiographic presence of ground-glass opacity and mosaic perfusion and moderate or high confidence in the radiographic impression of chronic hypersensitivity pneumonitis. Models were internally validated with good performance, and cut-off values were established that resulted in high specificity for a diagnosis of chronic hypersensitivity pneumonitis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Mental versus physical fatigue after subarachnoid hemorrhage: differential associations with outcome.

PubMed

Buunk, Anne M; Groen, Rob J M; Wijbenga, Rianne A; Ziengs, Aaltje L; Metzemaekers, Jan D M; van Dijk, J Marc C; Spikman, Jacoba M

2018-06-20

Fatigue is a major consequence of subarachnoid hemorrhage (SAH), but the specific characteristics are unclear. Our objective was to investigate the nature of post-SAH fatigue (mental or physical) and to determine the relationship with functional outcome in the chronic stage. Also, the possible influence of mood disorders and acute SAH-related factors (SAH type and external cerebrospinal fluid (CSF) drainage) on the presence of fatigue was investigated. Patients with an aneurysmal SAH (aSAH) or angiographically negative SAH (anSAH) were assessed 3 to 10 years post-SAH (N = 221). Questionnaires were used to investigate mental and physical fatigue and mood. Functional outcome was examined with the Glasgow Outcome Scale Extended (GOSE). Between-group comparisons and binary logistic regression analysis were performed. Frequencies of mental and physical fatigue were 48.4% and 38.5% respectively, with prevalence of mental fatigue being significantly higher. A two-way ANOVA with SAH type and external CSF drainage as independent variables and mental fatigue as dependent variable, showed a significant main effect of CSF drainage only (p < 0.001). Only mental fatigue explained a significant part of the variance in long-term functional outcome (Model χ 2 = 52.99, p < 0.001; Nagelkerke R² = 0.32). Mental fatigue after SAH is a serious burden to the patient and is associated with impaired long-term functional outcome. Distinguishing different aspects of fatigue is relevant as mental post-SAH fatigue might be a target for treatment aimed to improve long-term outcome. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Quality of working life issues of employees with a chronic physical disease: a systematic review.

PubMed

de Jong, Merel; de Boer, Angela G E M; Tamminga, Sietske J; Frings-Dresen, Monique H W

2015-03-01

To assess issues that contribute to the Quality of Working Life (QWL) of employees with a chronic physical disease. A systematic literature search was conducted using the databases PubMed, PsycINFO and EMBASE. Experiences and perceptions during the working life of employees with a chronic physical disease were extracted and synthesized into issues that contributed to their QWL. We organized these synthesized QWL issues into higher order themes and categories with qualitative data analysis software. From a total of 4,044 articles identified by the search, 61 articles were included. Data extraction and data synthesis resulted in an overview of 73 QWL issues that were classified into 30 themes. The following five categories of themes were identified: (1) job characteristics with issues such as job flexibility and work-site access; (2) the social structure and environment containing issues about disclosure, discrimination, misunderstanding, and awareness by employers or colleagues; (3) organizational characteristics with issues such as requesting work accommodations; (4) individual work perceptions including issues about enjoyment and evaluating work or life priorities; and (5) effect of the disease and treatment including issues about cognitive and physical health and work ability. This systematic review offers an extensive overview of issues that might contribute to the QWL of employees with a chronic physical disease. This overview may function as a starting point for occupational support, such as monitoring and evaluating the QWL of employees with a chronic physical disease during return-to-work and work continuation processes.

Chronic Low Back Pain in Young Korean Urban Males: The Life-Time Prevalence and Its Impact on Health Related Quality of Life

PubMed Central

Shim, Jae-Hyun; Yoon, Sang-Young; Lee, Chang-Hoon; Doh, Jae-Won; Bae, Hack-Gun

2014-01-01

Objective We assessed the life-time prevalence (LTP) of chronic low back pain (LBP) in young Korean males. We also evaluated the relationship between lumbar spinal lesions and their health related quality-of-life (HRQOL). Methods A cross-sectional, self-reported survey was conducted in Korean males (aged 19-year-old) who underwent physical examinations for the conscript. We examined 3331 examinees in November 2014. We included 2411 subjects, who accepted to participate this study without any comorbidities. We interviewed using simple binary questions for their LBP experience and chronicity. HRQOL was assessed by Short-Form Health-Survey-36 (SF-36) in chronic LBP and healthy control groups. Radiological assessment was performed in chronic LBP group to determine whether there were any pathological causes of their symptoms. Results The LTP of chronic LBP was 13.4%. Most (71.7%) of them didn't have any lumbar spinal lesions (i.e., non-specific chronic LBP). The SF-36 subscale and summary scores were significantly lower in subjects with chronic LBP. Between specific and non-specific chronic LBP group, all physical and mental subscale scores were significantly lower in specific chronic LBP group, except mental health (MH) subscale score. In MH subscale and mental component summary score, statistical significant differences didn't appear between two groups (p=0.154, 0.126). Conclusion In Korean males 19 years of age, the LTP of chronic LBP was 13.4%, and more than two-thirds were non-specific chronic LBP. Chronic LBP had a significant impact on HRQOL. The presence of lumbar spinal pathoanatomical lesions affected mainly on the physical aspect of HRQOL. It influenced little on the mental health. PMID:25628807

Sarcopenia in patients with chronic kidney disease not yet on dialysis: Analysis of the prevalence and associated factors

PubMed Central

Oliveira, Dílmerson; Barbosa, Sérgio Ribeiro; Corrêa, José Otávio do Amaral; Colugnati, Fernando Antônio Basile; Mansur, Henrique Novais; Fernandes, Natália Maria da Silva; Bastos, Marcus Gomes

2017-01-01

Introduction Sarcopenia is a chronic condition that is associated with aging and characterized by a reduction of muscle mass, strength, and function. Sarcopenia is prevalent in patients with chronic kidney disease (CKD) and associated with increased morbidity and mortality, as well as cardiovascular complications. Objectives To investigate the prevalence of sarcopenia in patients with CKD not yet on dialysis and its correlation with clinical and laboratory variables and inflammatory markers. Methods A total of 100 patients of both sexes aged over 18 were evaluated. Sarcopenia was defined using the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) and of the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project. Sociodemographic and clinical data, activities of daily living, functional capacity, and physical activity were also evaluated. Inflammation was assessed by the serum levels of high-sensitivity C-reactive protein (hsCRP) and interleukin (IL) 4 and 6. Results The prevalence of sarcopenia was 11.9% and 28.7% using the EWGSOP and FNIH criteria, respectively. Sarcopenia was more prevalent in the more advanced stages of CKD (34.5% in stages 2 and 3A; and 65.5% in stages 3B, 4, and 5) and associated with worse performance in activities of daily living (p = 0.049), lower walking speeds (p < 0.001), and higher body mass indexes (BMIs) (p = 0.001) in the non-adjusted model. In addition, patients with sarcopenia had lower functional capacity (p = 0.012) and higher prevalence of physical inactivity (p = 0.041) compared with patients without sarcopenia. After adjustment for confounding variables, sarcopenia was still significantly correlated with walking speed (p = 0.004) and BMI (p = 0.002). HsCRP levels were inversely correlated with appendicular lean mass adjusted for BMI (p = 0.007) and were also positively associated with BMI (p = 0.001). IL4 levels were positively correlated with walking speed (p = 0.007) and lean mass in the lower limbs (p = 0.022). Conclusions Sarcopenia is common in patients with CKD, particularly in the most advanced stages of the disease. We observed an association between the levels of inflammatory markers and peripheral lean body mass, physical performance, and BMI. This association between sarcopenia and modifiable factors highlights the importance of early diagnosis and the implementation of therapeutic measures to minimize adverse outcomes in patients with CKD not yet on dialysis. PMID:28448584

The efficacy of a multimodal physical activity intervention with supervised exercises, health coaching and an activity monitor on physical activity levels of patients with chronic, nonspecific low back pain (Physical Activity for Back Pain (PAyBACK) trial): study protocol for a randomised controlled trial.

PubMed

Oliveira, Crystian B; Franco, Márcia R; Maher, Chris G; Tiedemann, Anne; Silva, Fernanda G; Damato, Tatiana M; Nicholas, Michael K; Christofaro, Diego G D; Pinto, Rafael Z

2018-01-15

Physical activity plays an important role in the management of chronic low back pain (LBP). Engaging in an active lifestyle is associated with a better prognosis. Nevertheless, there is evidence to suggest that patients with chronic LBP are less likely to meet recommended physical activity levels. Furthermore, while exercise therapy has been endorsed by recent clinical practice guidelines, evidence from systematic reviews suggests that its effect on pain and disability are at best moderate and not sustained over time. A limitation of current exercises programmes for chronic LBP is that these programmes are not designed to change patients' behaviour toward an active lifestyle. Therefore, we will investigate the short- and long-term efficacy of a multimodal intervention, consisting of supervised exercises, health coaching and use of an activity monitor (i.e. Fitbit Flex) compared to supervised exercises plus sham coaching and a sham activity monitor on physical activity levels, pain intensity and disability, in patients with chronic, nonspecific LBP. This study will be a two-group, single-blind, randomised controlled trial. One hundred and sixty adults with chronic, nonspecific LBP will be recruited. Participants allocated to both groups will receive a group exercise programme. In addition, the intervention group will receive health coaching sessions (i.e. assisting the participants to achieve their physical activity goals) and an activity monitor (i.e. Fitbit Flex). The participants allocated to the control group will receive sham health coaching (i.e. encouraged to talk about their LBP or other problems, but without any therapeutic advice from the physiotherapist) and a sham activity monitor. Outcome measures will be assessed at baseline and at 3, 6 and 12 months post randomisation. The primary outcomes will be physical activity, measured objectively with an accelerometer, as well as pain intensity and disability at 3 months post randomisation. Secondary outcomes will be physical activity, pain intensity and disability at 6 and 12 months post randomisation as well as other self-report measures of physical activity and sedentary behaviour, depression, quality of life, pain self-efficacy and weight-related outcomes at 3, 6, and 12 months post randomisation. This study is significant as it will be the first study to investigate whether a multimodal intervention designed to increase physical activity levels reduces pain and disability, and increases physical activity levels compared to a control intervention in patients with chronic LBP. ClinicalTrials.gov, ID: NCT03200509 . Registered on 28 June 2017.

Relationship of Sleep Duration with Sociodemographic Characteristics, Lifestyle, Mental Health, and Chronic Diseases in a Large Chinese Adult Population

PubMed Central

Wang, Shibin; Li, Bo; Wu, Yanhua; Ungvari, Gabor S.; Ng, Chee H.; Fu, Yingli; Kou, Changgui; Yu, Yaqin; Sun, Hong-Qiang; Xiang, Yu-Tao

2017-01-01

Study Objectives: Pattern of sleep duration and its correlates have rarely been reported in China. This study examined the sleep duration and its relationship with sociodemographic variables, lifestyle, mental health, and chronic diseases in a large Chinese adult population. Methods: This cross-sectional study used multistage stratified cluster sampling. A total of 17,320 participants from Jilin province were selected and interviewed using standardized assessment tools. Basic socio-demographic and clinical data were collected. Sleep duration was classified as short (< 7 h per day), long (> 9 h per day) and medium sleep (7–9 h per day). Results: The mean age of the sample was 42.60 ± 10.60 y, with 51.4% being female. The mean sleep duration was 7.31 ± 1.44 h. Short and long sleepers accounted for 30.9% and 6.9% of the sample, respectively. Multinomial logistic regression analysis revealed that older age, current smoking, irregular meal pattern, lack of physical exercise, poor mental health, and chronic diseases or multimorbidity were positively associated with short sleep. Being married and living in rural areas were, however, negatively associated with short sleep. In addition, living in rural area, current smoking, current alcohol use and lack of physical exercise were positively associated with long sleep, while older age and lower education were negatively associated with long sleep. Conclusion: Given the high frequency of short sleep and its negative effect on health, health professionals should pay more attention to sleep patterns in general health care. Nationwide epidemiologic surveys in China are needed to further explore the relationship between sleep duration and health. Citation: Wang S, Li B, Wu Y, Ungvari GS, Ng CH, Fu Y, Kou C, Yu Y, Sun HQ, Xiang YT. Relationship of sleep duration with sociodemographic characteristics, lifestyle, mental health and chronic diseases in a large Chinese adult population. J Clin Sleep Med. 2017;13(3):377–384. PMID:27998377

Effects of 12 weeks combined aerobic and resistance exercise on heart rate variability in type 2 diabetes mellitus patients.

PubMed

Kang, Seol-Jung; Ko, Kwang-Jun; Baek, Un-Hyo

2016-07-01

[Purpose] This study evaluated the effects of 12 weeks combined aerobic and resistance exercise on heart rate variability in patients with Type 2 diabetes mellitus. [Subjects and Methods] The subjects were 16 female patients with Type 2 diabetes mellitus selected among the participants of a chronic disease management exercise class at C Region Public Health Center in South Korea. Subjects were randomly assigned to the exercise group (n=8; age, 55.97 ± 7.37) or the control group (n=8; age, 57.53 ± 4.63) The exercise group performed aerobic and resistance exercises for 60 minutes per day, 3 times per week for 12 weeks. Anthropometric measurements, biochemical markers, physical fitness, and heart rate variability were examined. [Results] After 12 weeks of exercise, weight, body fat percentage, waist circumference, blood glucose, insulin resistance, glycated hemoglobin level, systolic blood pressure, and diastolic blood pressure significantly decreased and cardiorespiratory fitness and muscular strength significantly increased in the exercise group. Although heart rate variability measures showed favorable changes with the exercise program, none were significant. [Conclusion] Although the exercise program did not show notable changes in heart rate variability in patients with Type 2 diabetes within the timeframe of the study, exercise may contribute to the prevention and control of cardiovascular autonomic neuropathy.

Vegetarian and Omnivorous Nutrition - Comparing Physical Performance.

PubMed

Craddock, Joel C; Probst, Yasmine C; Peoples, Gregory E

2016-06-01

Humans consuming vegetarian-based diets are observed to have reduced relative risk for many chronic diseases. Similarly, regular physical activity has also been shown to assist in preventing, and reducing the severity of these conditions. Many people, including athletes, acknowledge these findings and are adopting a vegetarian-based diet to improve their health status. Furthermore, athletes are incorporating this approach with the specific aim of optimizing physical performance. To examine the evidence for the relationship between consuming a predominately vegetarian-based diet and improved physical performance, a systematic literature review was performed using the SCOPUS database. No date parameters were set. The keywords vegetarian OR vegan AND sport OR athlete OR training OR performance OR endurance were used to identify relevant literature. Included studies (i) directly compared a vegetarian-based diet to an omnivorous/mixed diet, (ii) directly assessed physical performance, not biomarkers of physical performance, and (iii) did not use supplementation emulating a vegetarian diet. Reference lists were hand searched for additional studies. Seven randomized controlled trials and one cross-sectional study met the inclusion criteria. No distinguished differences between vegetarian-based diets and omnivorous mixed diets were identified when physical performance was compared. Consuming a predominately vegetarian-based diet did not improve nor hinder performance in athletes. However, with only 8 studies identified, with substantial variability among the studies' experimental designs, aims and outcomes, further research is warranted.

Effects of a Structured Physical Activity Program on Habitual Physical Activity and Body Composition in Patients With Chronic Kidney Disease and in Kidney Transplant Recipients.

PubMed

Masajtis-Zagajewska, Anna; Muras, Katarzyna; Nowicki, Michał

2018-05-16

In this study, we compared the effects of an individualized physical activity program on lifestyle, metabolic profile, body composition, and quality of life in kidney transplant recipients and patients with chronic kidney disease. Our study included 24 kidney transplant recipients and 15 patients with chronic kidney disease at stage 3/4. Body composition (impedance spectroscopy) and habitual physical activity (accelerometry) assessed at baseline were used to prepare the individualized physical activity program. Participants received repeated training, which was supervised during the first 2 weeks, followed by short message service reminders. Measurements were repeated after 1 and 3 months. Time spent daily on physical activity and total energy expenditure increased in kidney transplant recipients (from 126 ± 87 to 200 ± 132 min/day [P = .001] and from 1.73 ± 0.37 to 2.24 ± 0.59 cal/min [P < .001]) and in patients with chronic kidney disease (from 79 ± 78 to 109 ± 114 min/day [P < .001] and from 1.5 ± 0.5 to 1.92 ± 0.47 cal/min [P < .001]). Adipose mass (40.8 ± 11.5 vs 38.5 ± 10.3 kg; P = .01), total body water (38.1 ± 9.1 vs 37.3 ± 9.7 L; P = .01), and fat tissue index (14.3 ± 3.7 vs 13.5 ± 3.1 kg/m2; P = .009) decreased significantly only in kidney transplant recipients. Body cell mass decreased in patients with chronic kidney disease. Significant changes of estimated glomerular filtration rates were observed in kidney transplant recipients. Increased physical activity achieved through structured exercise programs induced beneficial effects on metabolic profile and body composition in patients with chronic kidney disease, with even greater benefits in kidney transplant recipients.

Unraveling dynamics of human physical activity patterns in chronic pain conditions

NASA Astrophysics Data System (ADS)

Paraschiv-Ionescu, Anisoara; Buchser, Eric; Aminian, Kamiar

2013-06-01

Chronic pain is a complex disabling experience that negatively affects the cognitive, affective and physical functions as well as behavior. Although the interaction between chronic pain and physical functioning is a well-accepted paradigm in clinical research, the understanding of how pain affects individuals' daily life behavior remains a challenging task. Here we develop a methodological framework allowing to objectively document disruptive pain related interferences on real-life physical activity. The results reveal that meaningful information is contained in the temporal dynamics of activity patterns and an analytical model based on the theory of bivariate point processes can be used to describe physical activity behavior. The model parameters capture the dynamic interdependence between periods and events and determine a `signature' of activity pattern. The study is likely to contribute to the clinical understanding of complex pain/disease-related behaviors and establish a unified mathematical framework to quantify the complex dynamics of various human activities.

Relational coordination promotes quality of chronic care delivery in Dutch disease-management programs.

PubMed

Cramm, Jane Murray; Nieboer, Anna Petra

2012-01-01

Previous studies have shown that relational coordination is positively associated with the delivery of hospital care, acute care, emergency care, trauma care, and nursing home care. The effect of relational coordination in primary care settings, such as disease-management programs, remains unknown. This study examined relational coordination between general practitioners and other professionals in disease-management programs and assessed the impact of relational coordination on the delivery of chronic illness care. Professionals (n = 188; response rate = 57%) in 19 disease-management programs located throughout the Netherlands completed surveys that assessed relational coordination and chronic care delivery. We used a cross-sectional study design. Our study demonstrated that the delivery of chronic illness care was positively related to relational coordination. We found positive relationships with community linkages (r = .210, p < .01), self-management support (r = .217, p < .01), decision support (r = .190, p < .01), delivery system design (r = .278, p < .001), and clinical information systems (r = .193, p < .01). Organization of the health delivery system was not significantly related to relational coordination. The regression analyses showed that even after controlling for all background variables, relational coordination still significantly affected chronic care delivery (β = .212, p ≤ .01). As expected, our findings showed a lower degree of relational coordination among general practitioners than between general practitioners and other core disease-management team members: practice nurses (M = 2.69 vs. 3.73; p < .001), dieticians (M = 2.69 vs. 3.07; p < .01), physical therapists (M = 2.69 vs. 3.06; p < .01), medical specialists (M = 2.69 vs. 3.16; p < .01), and nurse practitioners (M = 2.69 vs. 3.19; p < .001). The enhancement of relational coordination among core disease-management professionals with different disciplines is expected to improve chronic illness care delivery.

Prevalence of Chronic Disabling Noncancer Pain and Associated Demographic and Medical Variables: A Cross-Sectional Survey in the General German Population.

PubMed

Häuser, Winfried; Schmutzer, Gabriele; Hilbert, Anja; Brähler, Elmar; Henningsen, Peter

2015-10-01

In population surveys, up to 30% of participants reported chronic pain. Reports of chronic pain do not necessarily imply disability associated with pain. We assessed the prevalence of chronic disabling noncancer pain and associated demographic and medical variables in a sample of the general German population. A cross-sectional survey was conducted with 4360 people aged 14 years and above, who were representative of the German population. Measures were obtained for demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (based on a chronic pain grade questionnaire), and disease load (based on the self-reported comorbidity questionnaire). Responses were received from 2508 people. The prevalence of chronic pain was 28.3% (95% [confidence interval] CI, 26.5%-30.1%). In all, 7.3% (95% CI, 5.9%-8.7%) of participants met the criteria of chronic disabling noncancer pain. Chronic disabling noncancer pain was associated with age above 65 years (odds ratios [OR]=4.81 [95% CI, 1.57-14.79]), low family income (OR=2.54 [95% CI, 1.36-4.74]), obesity (OR=3.58 [95% CI, 2.21-5.79]), heart disease (OR=2.23 [95% CI, 3.69-11.40]), stomach disease (OR=4.24 [95% CI, 2.12-8.49]), and rheumatic disease (OR=3.67 [95% CI, 2.16-6.23]) when compared with no chronic pain. Chronic disabling noncancer pain was associated with low family income (OR=2.29 [95% CI, 1.23-4.27]), obesity (OR=2.14 [95% CI, 1.30-3.52]), and depression (OR=3.26 [95% CI, 1.90-5.66]) when compared with chronic nondisabling noncancer pain. Prevalence rates of chronic disabling pain in the general population rather than prevalence rates of chronic pain might provide evidence in support of pain specialist care. The association of chronic disabling noncancer pain with mental disorders highlights the need for psychosocial services in chronic pain management.

Impact of Multimorbidity on Disability and Quality of Life in the Spanish Older Population

PubMed Central

Garin, Noe; Olaya, Beatriz; Moneta, Maria Victoria; Miret, Marta; Lobo, Antonio; Ayuso-Mateos, Jose Luis; Haro, Josep Maria

2014-01-01

Background Population aging is closely related to high prevalence of chronic conditions in developed countries. In this context, health care policies aim to increase life span cost-effectively while maintaining quality of life and functional ability. There is still, however, a need for further understanding of how chronic conditions affect these health aspects. The aim of this paper is to assess the individual and combined impact of chronic physical and mental conditions on quality of life and disability in Spain, and secondly to show gender trends. Methods Cross-sectional data were collected from the COURAGE study. A total of 3,625 participants over 50 years old from Spain were included. Crude and adjusted multiple linear regressions were conducted to detect associations between individual chronic conditions and disability, and between chronic conditions and quality of life. Separate models were used to assess the influence of the number of diseases on the same variables. Additional analogous regressions were performed for males and females. Results All chronic conditions except hypertension were statistically associated with poor results in quality of life and disability. Depression, anxiety and stroke were found to have the greatest impact on outcomes. The number of chronic conditions was associated with substantially lower quality of life [β for 4+ diseases: −18.10 (−20.95,−15.25)] and greater disability [β for 4+ diseases: 27.64 (24.99,30.29]. In general, women suffered from higher rates of multimorbidity and poorer results in quality of life and disability. Conclusions Chronic conditions impact greatly on quality of life and disability in the older Spanish population, especially when co-occurring diseases are added. Multimorbidity considerations should be a priority in the development of future health policies focused on quality of life and disability. Further studies would benefit from an expanded selection of diseases. Policies should also deal with gender idiosyncrasy in certain cases. PMID:25375890

VISIT-TO-VISIT VARIABILITY OF BLOOD PRESSURE AND DEATH, ESRD AND CARDIOVASCULAR EVENTS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

PubMed Central

CHANG, Tara I.; TABADA, Grace H.; YANG, Jingrong; TAN, Thida X.; GO, Alan S.

2016-01-01

OBJECTIVES Visit-to-visit variability of blood pressure is an important independent risk factor for premature death and cardiovascular events, but relatively little is known about this phenomenon in patients with chronic kidney disease not yet on dialysis. METHODS We conducted a retrospective study in a community-based cohort of 114,900 adults with chronic kidney disease stages 3–4 (estimated glomerular filtration rate 15–59 mL/min per 1.73 m2). We hypothesized that visit-to-visit variability of blood pressure would be independently associated with higher risks of death, incident treated end-stage renal disease, and cardiovascular events. We defined systolic visit-to-visit variability of blood pressure using three metrics: (1) coefficient of variation (2) standard deviation of the mean systolic blood pressure, and (3) average real variability. RESULTS The highest versus the lowest quintile of the coefficient of variation was associated with higher adjusted rates of death (hazard ratio 1.22; 95% confidence interval 1.11–1.34) and hemorrhagic stroke (hazard ratio 1.91, confidence interval 1.36–2.68). Visit-to-visit variability of blood pressure was inconsistently associated with heart failure, and was not significantly associated with acute coronary syndrome and ischemic stroke. Results were similar when using the other two visit-to-visit variability of blood pressure. Visit-to-visit variability of blood pressure had inconsistent associations with end-stage renal disease, perhaps due to the relatively low incidences of this outcome. CONCLUSIONS Higher visit-to-visit variability of blood pressure is independently associated with higher rates of death and hemorrhagic stroke in patients with moderate to advanced chronic kidney disease not yet on dialysis. PMID:26599220

Intimate partner violence against women in Maputo city, Mozambique

PubMed Central

2012-01-01

Background There is limited research about IPV against women and associated factors in Sub-Saharan Africa, not least Mozambique. The objective of this study was to examine the occurrence, severity, chronicity and “predictors” of IPV against women in Maputo City (Mozambique). Methods Data were collected during a 12 month-period (consecutive cases, with each woman seen only once) from 1,442 women aged 15–49 years old seeking help for abuse by an intimate partner at the Forensic Services at the Maputo Central Hospital, Maputo City, Mozambique. Interviews were conducted by trained female interviewers, and data collected included demographics and lifestyle variables, violence (using the previously validated Revised Conflict Tactics Scale (CTS2), and control (using the Controlling Behaviour Scale Revised (CBS-R). The data were analysed using bivariate and multivariate methods. Results The overall experienced IPV during the past 12 months across severity (one or more types, minor and severe) was 70.2% (chronicity, 85.8 ± 120.9).a Severe IPV varied between 26.3-45.9% and chronicity between 3.1 ± 9.1-12.8 ± 26.9, depending on IPV type. Severity and chronicity figures were higher in psychological aggression than in the other IPV types. Further, 26.8% (chronicity, 55.3 ± 117.6) of women experienced all IPV types across severity. The experience of other composite IPV types across severity (4 combinations of 3 types of IPV) varied between 27.1-42.6% and chronicity between 35.7 ± 80.3-64.9 ± 110.9, depending on the type of combination. The combination psychological aggression, physical assault and sexual coercion had the highest figures compared with the other combinations. The multiple regressions showed that controlling behaviours, own perpetration and co-occurring victimization were more important in “explaining” the experience of IPV than other variables (e.g. abuse as a child). Conclusions In our study, controlling behaviours over/by partner, own perpetration, co-occurring victimization and childhood abuse were more important factors in “explaining” sustained IPV. More investigation into women’s IPV exposure and its “predictors” is warranted in Sub-Saharan Africa, particularly Mozambique. PMID:23241146

Proximity to Urban Parks and Mental Health

PubMed Central

Sturm, Roland; Cohen, Deborah

2014-01-01

Background Urban parks have received attention in recent years as a possible environmental factor that could encourage physical activity, prevent obesity, and reduce the incidence of chronic conditions. Despite long hypothesized benefits of parks for mental health, few park studies incorporate mental health measures. Aims of the Study To test the association between proximity to urban parks and psychological distress. Methods Cross-sectional analysis of individual health survey responses. Data were collected for a study of capital improvements of neighborhood parks in Los Angeles. A survey was fielded on a sample of residential addresses, stratified by distance from the park (within 400m, 800m, 1.6 km, and 3.2km; N=1070). We used multiple regression to estimate the relationship between the psychological distress as measured by the MHI-5 (outcome variable) and distance to parks (main explanatory variable), controlling for observed individual characteristics. Results Mental health is significantly related to residential distance from parks, with the highest MHI-5 scores among residents within short walking distance from the park (400m) and decreasing significantly over the next distances. The number of visits and physical activity minutes are significantly and independently related to distance, although controlling for them does not reduce the association between distance and mental health. Discussion and Limitations This paper provides a new data point for an arguably very old question, but for which empirical data are sparse for the US. A nearby urban park is associated with the same mental health benefits as decreasing local unemployment rates by 2 percentage points, suggesting at least the potential of environmental interventions to improve mental health. The analysis is cross-sectional, making it impossible to control for important confounders, including residential selection. Implications for Health Policy Mental health policy has traditionally focused on individual-centered interventions. Just as health policy for preventable chronic illnesses has shifted attention to modifiable environmental determinants, population mental health may benefit substantially from environmental interventions. Implications for Future Research Policy evaluations should incorporate mental health measures when assessing neighborhood improvement programs and physical environments. Many recent and ongoing studies have excluded mental health measure in the belief that they are too burdensome for respondents or irrelevant. If a causal relationship is confirmed, then ameliorating neighborhood conditions and physical environments could represent a scalable way to improve mental health issues for large populations. PMID:24864118

Community health assessment using self-organizing maps and geographic information systems

PubMed Central

Basara, Heather G; Yuan, May

2008-01-01

Background From a public health perspective, a healthier community environment correlates with fewer occurrences of chronic or infectious diseases. Our premise is that community health is a non-linear function of environmental and socioeconomic effects that are not normally distributed among communities. The objective was to integrate multivariate data sets representing social, economic, and physical environmental factors to evaluate the hypothesis that communities with similar environmental characteristics exhibit similar distributions of disease. Results The SOM algorithm used the intrinsic distributions of 92 environmental variables to classify 511 communities into five clusters. SOM determined clusters were reprojected to geographic space and compared with the distributions of several health outcomes. ANOVA results indicated that the variability between community clusters was significant with respect to the spatial distribution of disease occurrence. Conclusion Our study demonstrated a positive relationship between environmental conditions and health outcomes in communities using the SOM-GIS method to overcome data and methodological challenges traditionally encountered in public health research. Results demonstrated that community health can be classified using environmental variables and that the SOM-GIS method may be applied to multivariate environmental health studies. PMID:19116020

The influence of posttraumatic stress disorder numbing and hyperarousal symptom clusters in the prediction of physical health status in veterans with chronic tobacco dependence and posttraumatic stress disorder.

PubMed

Harder, Laura H; Chen, Shuo; Baker, Dewleen G; Chow, Bruce; McFall, Miles; Saxon, Andrew; Smith, Mark W

2011-12-01

Smoking and PTSD are predictors of poor physical health status. This study examined the unique contribution of PTSD symptoms in the prediction of the SF-36 physical health status subscales accounting for cigarette smoking, chronic medical conditions, alcohol and drug use disorders, and depression. This study examined baseline interview and self-report data from a national tobacco cessation randomized, controlled trial (Veterans Affairs Cooperative Study 519) that enrolled tobacco-dependent veterans with chronic PTSD (N = 943). A series of blockwise multiple regression analyses indicated that PTSD numbing and hyperarousal symptom clusters explained a significant proportion of the variance across all physical health domains except for the Physical Functioning subscale, which measures impairments in specific physical activities. Our findings further explain the impact of PTSD on health status by exploring the way PTSD symptom clusters predict self-perceptions of health, role limitations, pain, and vitality.

Factors associated with free adult preventive health care utilization among physically disabled people in Taiwan: nationwide population-based study.

PubMed

Yen, Suh-May; Kung, Pei-Tseng; Tsai, Wen-Chen

2014-12-05

Few previous studies have specifically addressed the health care utilization situation of the physically disabled. This study aimed to investigate the utilization of free adult preventive health care for physically disabled people and its' affecting factors. The data was obtained from three nationwide databases from 2006 to 2008. This study comprised 329,264 physically disabled people in Taiwan above the age of 40 who had eligible health checks during 2008. We employed descriptive statistics to analyze the use and rate of free preventive health care use by physically disabled adults. Logistic regression analysis was used to explore the factors that affect physically disabled adults' use of free adult preventive health care. 16.37% of the physically disabled adults used free adult preventive health care. Women (17.66%), married (17.16%), a junior high education level (17.89%), and mildly disabled adults (18.77%) had the highest use rate among various participant subgroups. The variables that significantly influenced the use of free adult preventive health care by the physically disabled included gender, age, education, marital status, urbanization of the residence areas, monthly payroll, aboriginal status, catastrophic illnesses status, relevant chronic diseases, and severity of disability. Physically disabled using preventive health care tend to be low. Governments should use the media to reinforce propagation and education of these services to specific, low-utilization groups, and encourage doctors to actively provide preventive health care to communities.

Predictors of Self-Reported Physical Symptoms in Low-Income, Inner-City African American Women: The Role of Optimism, Depressive Symptoms, and Chronic Illness

ERIC Educational Resources Information Center

Jones, Deborah J.; O'Connell, Cara; Gound, Mary; Heller, Laurie; Forehand, Rex

2004-01-01

In this study we examined the association of optimism and depressive symptoms with self-reported physical symptoms in 241 low-income, inner-city African American women with or without a chronic illness (HIV). Although optimism was not a unique predictor of self-reported physical symptoms over and above depressive symptoms, optimism interacted with…

Effectiveness of Physical Therapy as an Adjunctive Treatment for Trauma-induced Chronic Torticollis in Raptors.

PubMed

Nevitt, Benjamin N; Robinson, Narda; Kratz, Gail; Johnston, Matthew S

2015-03-01

Management of trauma-induced chronic torticollis in raptors has historically been challenging. Euthanasia is common in affected birds because of their inability to maintain normal cervical position, although they may be able to function normally. To assess effectiveness of physical therapy of the neck and head as an adjunct treatment for this condition, a case-control study was done in raptors admitted to the Rocky Mountain Raptor Program from 2003 to 2010. Eleven cases were identified with a diagnosis of chronic torticollis resulting from traumatic brain injury. Five cases were treated with physical therapy of the head and neck, and 6 control cases did not receive any physical therapy for the torticollis. Of the control cases, 0 of 6 had resolution of the torticollis, 0 of 6 were released, and 5 of 6 were euthanatized. Of the treated cases, 4 of 5 had complete resolution of the torticollis and 5 of 5 were released. Resolution of torticollis differed significantly between cases receiving physical therapy and controls. These results indicate that physical therapy should be used as an adjunctive therapy in cases of chronic torticollis induced by trauma in raptors because it results in better resolution of the torticollis and increased likelihood of release.

Correlation between physical activity, fitness, and musculoskeletal injuries in police officers.

PubMed

Nabeel, Ismail; Baker, Beth A; McGrail, Michael P; Flottemesch, Thomas J

2007-09-01

In order to explore the correlation between physical activity, fitness, and injury among police officers, a cross section of active-duty members of the Minneapolis Police Department were surveyed about their level of fitness, physical activity, and prevalence of injury and chronic pain within the past year. In the study, officers with the highest self-reported fitness levels were less likely to experience sprains (OR 0.27, 95% CI 0.08-0.88), back pain (OR 0.48, 95% CI 0.09-0.88), and chronic pain (OR 0.21, 95% CI 0.06-0.73) than those who considered themselves less fit. Officers who were the most physically active were about a third as likely to report back pain (OR 0.37, 95% CI 0.10-0.73) and less than half as likely to report chronic pain (OR 0.42, 95% CI 0.19-0.91) as those who engaged in less activity. And officers with a BMI greater than 35 were 3 times more likely to report back pain (OR 3.36, 95% CI 1.17-9.66) than those whose BMI fell in the normal range (18-25). Thus, officers who engage in higher levels of physical activity and are more physically fit have a lower prevalence of musculoskeletal injuries and chronic pain.

The pattern of physical comorbidity and the psychosocial determinants of depression: a prospective cohort study on a representative sample of family practice attendees in Slovenia.

PubMed

Selič, Polona; Svab, Igor; Rifel, Janez; Pavlič, Danica Rotar; Cerne, Anja; King, Michael; Nazareth, Irwin

2011-09-01

Objectives This study aims to present the patterns of physical comorbidity in depressed patients and factors strongly associated with depression in a representative sample of Slovenian family practice attendees.Methods Medical data was obtained for 911 general practice attendees. Of them, 221 (24.3%) were diagnosed as depressed. The depressive states of the subjects were evaluated using the Composite International Diagnostic Interview (CIDI). Physical comorbidity was assessed with a questionnaire covering the most common health problems in the Slovenian adult population. Several psycho-social factors were also analysed.Results Those variables significantly related to ICD depression were included in multivariate binary logistic regression analysis, adjusted by age, gender and education. The calculation included the chi-square, odds ratio (OR) with confidence interval (95% CI) and P-value. A P-value < 0.05 was marked as statistically significant.Conclusions There was no significant difference in the number of concurrent chronic diseases in depressed and non-depressed subjects. The risk of depression was increased by the presence of several concomitant factors. The burden of somatic co-morbidity was shown to be smaller than the impact of psychosocial determinants, which also acted as protective factors: the feeling of safety at home and the absence of problems in intimate relationships. The abuse of alcohol and drugs by a family member and current poor financial situation were strongly associated with depression. The impact of concurrent incontinence and chronic bowel disease was also important, though somewhat weaker.

Functional Capacity and Quality of Life in Patients with Chronic Kidney Disease In Pre-Dialytic Treatment and on Hemodialysis--A Cross sectional study.

PubMed

Fassbinder, Tânia Regina Cavinatto; Winkelmann, Eliane Roseli; Schneider, Juliana; Wendland, Juliana; Oliveira, Olvânia Basso de

2015-01-01

Chronic kidney disease (CKD) infers directly in functional capacity, independence and therefore quality of life (QOL). To compare the physical fitness and quality of life of patients with chronic kidney disease submitted on hemodialysis (G1) and predialysis treatment (G2). A cross-sectional study, 54 patients with CKD, 27 of the G1 group (58.15 ± 10.84 years), 27 of G2 group (62.04 ± 16.56 years). There were cardiovascular risk factors, anthropometric measurements, respiratory muscle strength was measured by the inspiratory pressure (MIP) and expiratory (MEP) maximum measured in the manometer, six-minute walk (TC6'), cardiopulmonary exercise test, sit and stand one minute test (TSL1') and the Short-Form Questionary (SF-36) to assess QOL. The patients presented disease of stage between 2 and 5. It was applied the Kolmogorov-Smirnov normality test and used the t (Student) test or the U (Mann Whitney) test to compare the means of quantitative variables and the chi-square Pearson test and Fisher's exact test for qualitative variables. Pearson's or Spearman's test was used to identify correlations. No statistically significant difference was found between G1 and G2 in VO2peak (p = 0,259) in TC6' (p = 0,433) in the MIPmáx (p = 0,158) and found only in the MEPmáx (p = 0,024) to G1. The scores of the SF-36 in both groups showed a worse health status as evidenced by the low score in scores for QOL. Patients with CKD had reduced functional capacity and QOL, and hemodialysis, statistically, didn't have showed negative repercussions when compared with pre-dialysis patients.

Arthritis and suicide attempts: findings from a large nationally representative Canadian survey.

PubMed

Fuller-Thomson, Esme; Ramzan, Natasha; Baird, Stephanie L

2016-09-01

The objectives of this study were (1) to determine the odds of suicide attempts among those with arthritis compared with those without and to see what factors attenuate this association and (2) to identify which factors are associated with suicide attempts among adults with arthritis. Secondary data analysis of the nationally representative 2012 Canadian Community Health Survey-Mental Health (CCHS-MH) was performed. For objective 1, those with and without arthritis were included (n = 21,744). For objective 2, only individuals who had arthritis (n = 4885) were included. A series of binary logistic regression analyses of suicide attempts were conducted for each objective, with adjustments for socio-demographics, childhood adversities, lifetime mental health and chronic pain. After full adjustment for the above listed variables, the odds of suicide attempts among adults with arthritis were 1.46. Among those with arthritis, early adversities alone explained 24 % of the variability in suicide attempts. After full adjustment, the odds of suicide attempts among those with arthritis were significantly higher among those who had experienced childhood sexual abuse (OR = 3.77), chronic parental domestic violence (OR = 3.97) or childhood physical abuse (1.82), those who had ever been addicted to drugs or alcohol (OR = 1.76) and ever had a depressive disorder (OR = 3.22) or an anxiety disorder (OR = 2.34) and those who were currently in chronic pain (OR = 1.50). Younger adults with arthritis were more likely to report having attempted suicide. Future prospective research is needed to uncover plausible mechanisms through which arthritis and suicide attempts are linked.

Benchmark duration of work hours for development of fatigue symptoms in Japanese workers with adjustment for job-related stress.

PubMed

Suwazono, Yasushi; Dochi, Mirei; Kobayashi, Etsuko; Oishi, Mitsuhiro; Okubo, Yasushi; Tanaka, Kumihiko; Sakata, Kouichi

2008-12-01

The objective of this study was to calculate benchmark durations and lower 95% confidence limits for benchmark durations of working hours associated with subjective fatigue symptoms by applying the benchmark dose approach while adjusting for job-related stress using multiple logistic regression analyses. A self-administered questionnaire was completed by 3,069 male and 412 female daytime workers (age 18-67 years) in a Japanese steel company. The eight dependent variables in the Cumulative Fatigue Symptoms Index were decreased vitality, general fatigue, physical disorders, irritability, decreased willingness to work, anxiety, depressive feelings, and chronic tiredness. Independent variables were daily working hours, four subscales (job demand, job control, interpersonal relationship, and job suitability) of the Brief Job Stress Questionnaire, and other potential covariates. Using significant parameters for working hours and those for other covariates, the benchmark durations of working hours were calculated for the corresponding Index property. Benchmark response was set at 5% or 10%. Assuming a condition of worst job stress, the benchmark duration/lower 95% confidence limit for benchmark duration of working hours per day with a benchmark response of 5% or 10% were 10.0/9.4 or 11.7/10.7 (irritability) and 9.2/8.9 or 10.4/9.8 (chronic tiredness) in men and 8.9/8.4 or 9.8/8.9 (chronic tiredness) in women. The threshold amounts of working hours for fatigue symptoms under the worst job-related stress were very close to the standard daily working hours in Japan. The results strongly suggest that special attention should be paid to employees whose working hours exceed threshold amounts based on individual levels of job-related stress.

DNA Methylation Signature of Childhood Chronic Physical Aggression in T Cells of Both Men and Women

PubMed Central

Guillemin, Claire; Provençal, Nadine; Suderman, Matthew; Côté, Sylvana M.; Vitaro, Frank; Hallett, Michael; Tremblay, Richard E.; Szyf, Moshe

2014-01-01

Background High frequency of physical aggression is the central feature of severe conduct disorder and is associated with a wide range of social, mental and physical health problems. We have previously tested the hypothesis that differential DNA methylation signatures in peripheral T cells are associated with a chronic aggression trajectory in males. Despite the fact that sex differences appear to play a pivotal role in determining the development, magnitude and frequency of aggression, most of previous studies focused on males, so little is known about female chronic physical aggression. We therefore tested here whether or not there is a signature of physical aggression in female DNA methylation and, if there is, how it relates to the signature observed in males. Methodology/Principal Findings Methylation profiles were created using the method of methylated DNA immunoprecipitation (MeDIP) followed by microarray hybridization and statistical and bioinformatic analyses on T cell DNA obtained from adult women who were found to be on a chronic physical aggression trajectory (CPA) between 6 and 12 years of age compared to women who followed a normal physical aggression trajectory. We confirmed the existence of a well-defined, genome-wide signature of DNA methylation associated with chronic physical aggression in the peripheral T cells of adult females that includes many of the genes similarly associated with physical aggression in the same cell types of adult males. Conclusions This study in a small number of women presents preliminary evidence for a genome-wide variation in promoter DNA methylation that associates with CPA in women that warrant larger studies for further verification. A significant proportion of these associations were previously observed in men with CPA supporting the hypothesis that the epigenetic signature of early life aggression in females is composed of a component specific to females and another common to both males and females. PMID:24475181

The Relation Between Child Versus Parent Report of Chronic Fatigue and Language/Literacy Skills in School-Age Children with Cochlear Implants.

PubMed

Werfel, Krystal L; Hendricks, Alison Eisel

2016-01-01

Preliminary evidence suggests that children with hearing loss experience elevated levels of chronic fatigue compared with children with normal hearing. Chronic fatigue is associated with decreased academic performance in many clinical populations. Children with cochlear implants as a group exhibit deficits in language and literacy skills; however, the relation between chronic fatigue and language and literacy skills for children with cochlear implants is unclear. The purpose of this study was to explore subjective ratings of chronic fatigue by children with cochlear implants and their parents, as well as the relation between chronic fatigue and language and literacy skills in this population. Nineteen children with cochlear implants in grades 3 to 6 and one of their parents separately completed a subjective chronic fatigue scale, on which they rated how much the child experienced physical, sleep/rest, and cognitive fatigue over the past month. In addition, children completed an assessment battery that included measures of speech perception, oral language, word reading, and spelling. Children and parents reported different levels of chronic child physical and sleep/rest fatigue. In both cases, parents reported significantly less fatigue than did children. Children and parents did not report different levels of chronic child cognitive fatigue. Child report of physical fatigue was related to speech perception, language, reading, and spelling. Child report of sleep/rest and cognitive fatigue was related to speech perception and language but not to reading or spelling. Parent report of child fatigue was not related to children's language and literacy skills. Taken as a whole, results suggested that parents under-estimate the fatigue experienced by children with cochlear implants. Child report of physical fatigue was robustly related to language and literacy skills. Children with cochlear implants are likely more accurate at reporting physical fatigue than cognitive fatigue. Clinical practice should take fatigue into account when developing treatment plans for children with cochlear implants, and research should continue to develop a comprehensive model of fatigue in children with cochlear implants.

Social stress, obesity, and depression among women: clarifying the role of physical activity.

PubMed

Lincoln, Karen D

2017-07-01

This study examined the role of stress in the association among physical activity, obesity, and depression among women. The extent to which physical activity moderated these relationships was also examined. Data from the National Survey of American Life (N = 3235) and multivariable regression analyses were used to examine the effects of chronic stress, material hardship, racial discrimination, and physical activity on obesity and depression among African American, Caribbean Black and White women. Stress was not related to body mass index (BMI) for African American or White women, but chronic stress was associated with higher BMI for Caribbean Black women. Stress was associated with depressive symptoms, but there was variation by the type of stressor under consideration. Physical activity was associated with fewer depressive symptoms and lower BMI, but the relationships varied by type of stressor and race/ethnicity. Physical activity moderated the effect of chronic stress on depressive symptoms and BMI, but only for African American women who reported high levels of chronic stress. Among White women, physical activity moderated the effect of racial discrimination on BMI for those who reported experiencing both high and low levels of discrimination. This study was the first to document physical activity as a moderator in the relationship among stress, depression, and obesity using a nationally representative sample of racially/ethnically diverse women. Findings provide insight into the role of stress in relation to depression and obesity while highlighting heterogeneity among Black Americans.

Quality of life among pediatric patients with cancer: Contributions of time since diagnosis and parental chronic stress.

PubMed

Hamner, Taralee; Latzman, Robert D; Latzman, Natasha E; Elkin, T David; Majumdar, Suvankar

2015-07-01

Pediatric cancer is associated with a host of negative psychosocial consequences; however, outcomes vary extensively suggesting a need to better understand this variation. Empirical research suggests a positive association between time since diagnosis (TSD) and Quality of Life (QoL). In addition to TSD, family stressors have been found to be particularly important in predicting QoL among children. The current study examined parental chronic stress beyond TSD in explanation of QoL functioning among a sample of pediatric patients with cancer. Participants included 43 pediatric patients aged 5-18 years (M(age) = 10.2 ± 3.6) who were undergoing oncological treatment. Parents reported on TSD, child's QoL, and their own chronic stress. TSD was associated with greater physical functioning (r = 0.30, P < 0.05). Parental chronic stress was associated with poorer emotional (r = -0.54, P < 0.01), physical (r = -0.41, P < 0.01), and social functioning (r = -0.44, P < 0.01). Further, hierarchal linear regression analyzes indicated parental chronic stress contributed incrementally beyond TSD in the explanation of physical (β = -0.37, t = -2.58, P < 0.01), emotional (β = -0.47, t = -3.51, P < 0.00), and social functioning (β = -0.38, t = -2.67, P < 0.01). Parental chronic stress is associated with reduced levels of emotional, physical, and social functioning among pediatric patients. Future research is needed to further investigate the process by which chronic stress within the family interferes with adaptive coping among pediatric patients. In addition, clinical services may benefit from increased consideration of family factors, such as parental chronic stress, during oncological treatment. © 2015 Wiley Periodicals, Inc.

Guidelines and Procedures for Meeting the Specialized Physical Health Care Needs of Pupils.

ERIC Educational Resources Information Center

Lunden, Janet, Ed.

This monograph presents the California State guidelines for providing physical health care services within the public school setting. Part I addresses administrative concerns. Included are sections on: education and chronic illness; professional roles; referral and evaluation; guidelines and procedures for transporting chronically ill pupils;…

The Effectiveness of an Online Fitness Course

ERIC Educational Resources Information Center

Dennis, Karen Kae

2011-01-01

Given the current trends of physical inactivity, overweight and obesity rates, and chronic disease prevalence, understanding appropriate levels of physical activity, healthful nutrition, and risk reduction for chronic-disease is crucial. The purpose of this study was to identify perceptions of the effectiveness of an online personal health and…

Quality of Life and School Absenteeism in Children with Chronic Illness

ERIC Educational Resources Information Center

Emerson, Natacha D.; Distelberg, Brian; Morrell, Holly E. R.; Williams-Reade, Jackie; Tapanes, Daniel; Montgomery, Susanne

2016-01-01

Objective: Children and adolescents with a chronic illness (CI) tend to demonstrate diminished physical and social functioning, which contribute to school attendance issues. We investigated the role of social and physical functioning in reducing school absenteeism in children participating in Mastering Each New Direction (MEND), a family-based…

Increasing Recreational Physical Activity in Patients With Chronic Low Back Pain: A Pragmatic Controlled Clinical Trial.

PubMed

Ben-Ami, Noa; Chodick, Gabriel; Mirovsky, Yigal; Pincus, Tamar; Shapiro, Yair

2017-02-01

Study Design Prospective, pragmatic, nonrandomized controlled clinical trial. Background Clinical guidelines recommend physical activity for the treatment of chronic low back pain. But engaging patients in physical activity has proven difficult. Known obstacles to physical activity include low self-efficacy and fear avoidance. Objectives This study tested the effectiveness of an enhanced transtheoretical model intervention (ETMI) aimed at increasing recreational physical activity in patients with chronic low back pain, in comparison to usual physical therapy. Methods Patients (n = 220) referred to physical therapy for chronic low back pain were allocated to ETMI or to a control group. The ETMI was delivered by physical therapists and based on behavior-change principles, combined with increased reassurance, therapeutic alliance, and exposure to reduce fear avoidance. The primary outcome was back pain-related disability (Roland-Morris Disability Questionnaire). Secondary outcomes included pain intensity, mental and physical health, and levels of physical activity. Results Intention-to-treat analysis in 189 patients at 12 months indicated that patients in the ETMI group had significantly lower disability compared to usual physical therapy. The difference in mean change from baseline between the interventions was 2.7 points (95% confidence interval: 0.9, 4.5) on the Roland-Morris Disability Questionnaire. At 12 months, worst pain, physical activity, and physical health were all significantly better in patients receiving ETMI. The average number of sessions was 3.5 for the ETMI group and 5.1 for controls. Conclusion Targeting obstacles to physical activity with an intervention that includes components to address self-efficacy and fear avoidance appears to be more effective than usual physical therapy care in reducing long-term disability. Further research is needed to explore the mechanisms that impact outcomes in this intervention package. Level of Evidence Therapy, level 2b. Registered June 7, 2012 at ClinicalTrials.gov (NCT01631344). J Orthop Sports Phys Ther 2017;47(2):57-66. doi:10.2519/jospt.2017.7057.

Association of Childhood Chronic Physical Aggression with a DNA Methylation Signature in Adult Human T Cells

PubMed Central

Guillemin, Claire; Vitaro, Frank; Côté, Sylvana M.; Hallett, Michael; Tremblay, Richard E.; Szyf, Moshe

2014-01-01

Background Chronic physical aggression (CPA) is characterized by frequent use of physical aggression from early childhood to adolescence. Observed in approximately 5% of males, CPA is associated with early childhood adverse environments and long-term negative consequences. Alterations in DNA methylation, a covalent modification of DNA that regulates genome function, have been associated with early childhood adversity. Aims To test the hypothesis that a trajectory of chronic physical aggression during childhood is associated with a distinct DNA methylation profile during adulthood. Methods We analyzed genome-wide promoter DNA methylation profiles of T cells from two groups of adult males assessed annually for frequency of physical aggression between 6 and 15 years of age: a group with CPA and a control group. Methylation profiles covering the promoter regions of 20 000 genes and 400 microRNAs were generated using MeDIP followed by hybridization to microarrays. Results In total, 448 distinct gene promoters were differentially methylated in CPA. Functionally, many of these genes have previously been shown to play a role in aggression and were enriched in biological pathways affected by behavior. Their locations in the genome tended to form clusters spanning millions of bases in the genome. Conclusions This study provides evidence of clustered and genome-wide variation in promoter DNA methylation in young adults that associates with a history of chronic physical aggression from 6 to 15 years of age. However, longitudinal studies of methylation during early childhood will be necessary to determine if and how this methylation variation in T cells DNA plays a role in early development of chronic physical aggression. PMID:24691403

Cannabis withdrawal in chronic, frequent cannabis smokers during sustained abstinence within a closed residential environment.

PubMed

Lee, Dayong; Schroeder, Jennifer R; Karschner, Erin L; Goodwin, Robert S; Hirvonen, Jussi; Gorelick, David A; Huestis, Marilyn A

2014-01-01

Chronic, frequent cannabis smokers may experience residual and offset effects, withdrawal, and craving when abstaining from the drug. We characterized the prevalence, duration, and intensity of these effects in chronic frequent cannabis smokers during abstinence on a closed research unit. Non-treatment-seeking participants (N = 29 on admission, 66% and 34% remaining after 2 and 4 weeks) provided subjective effects data. A battery of five instruments was computer-administered daily to measure psychological, sensory, and physical symptoms associated with cannabinoid intoxication and withdrawal. Plasma and oral fluid specimens were concurrently collected and analyzed for cannabinoids. Outcome variables were evaluated as change from admission (Day 0) with regression models. Most abstinence effects, including irritability and anxiety were greatest on Days 0-3 and decreased thereafter. Cannabis craving significantly decreased over time, whereas decreased appetite began to normalize on Day 4. Strange dreams and difficulty getting to sleep increased over time, suggesting intrinsic sleep problems in chronic cannabis smokers. Symptoms likely induced by residual drug effects were at maximum intensity on admission and positively correlated with plasma and oral fluid cannabinoid concentrations on admission but not afterward; these symptoms showed overall prevalence higher than cannabis withdrawal symptoms. The combined influence of residual/offset drug effects, withdrawal, and craving was observed in chronic cannabis smokers during monitored abstinence. Abstinence symptoms were generally more intense in the initial phase, implying importance of early intervention in cannabis quit attempts. Sleep disturbance persisting for an extended period suggests that hypnotic medications could be beneficial in treating cannabis dependence. © American Academy of Addiction Psychiatry.

Cannabis Withdrawal in Chronic, Frequent Cannabis Smokers during Sustained Abstinence within a Closed Residential Environment

PubMed Central

Lee, Dayong; Schroeder, Jennifer R.; Karschner, Erin L.; Goodwin, Robert S.; Hirvonen, Jussi; Gorelick, David A.; Huestis, Marilyn A.

2013-01-01

Objectives Chronic, frequent cannabis smokers may experience residual and offset effects, withdrawal, and craving when abstaining from the drug. We characterized the prevalence, duration, and intensity of these effects in chronic frequent cannabis smokers during abstinence on a closed research unit. Methods Non-treatment-seeking participants (N=29 on admission, 66% and 34% remaining after 2 and 4 weeks) provided subjective effects data. A battery of 5 instruments was computer-administered daily to measure psychological, sensory, and physical symptoms associated with cannabinoid intoxication and withdrawal. Plasma and oral fluid specimens were concurrently collected and analyzed for cannabinoids. Outcome variables were evaluated as change from admission (Day 0) with regression models. Results Most abstinence effects, including irritability and anxiety were greatest on Days 0–3 and decreased thereafter. Cannabis craving significantly decreased over time, whereas decreased appetite began to normalize on Day 4. Strange dreams and difficulty getting to sleep increased over time, suggesting intrinsic sleep problems in chronic cannabis smokers. Symptoms likely induced by residual drug effects were at maximum intensity on admission and positively correlated with plasma and oral fluid cannabinoid concentrations on admission but not afterward; these symptoms showed overall prevalence higher than cannabis withdrawal symptoms. Conclusions The combined influence of residual/offset drug effects, withdrawal and craving was observed in chronic cannabis smokers during monitored abstinence. Abstinence symptoms were generally more intense in the initial phase, implying importance of early intervention in cannabis quit attempts. Sleep disturbance persisting for an extended period suggests that hypnotic medications could be beneficial in treating cannabis dependence. PMID:24724880

Cross-Sectional and Prospective Relationship Between Low-to-Moderate-Intensity Physical Activity and Chronic Diseases in Older Adults From 13 European Countries.

PubMed

Marques, Adilson; Peralta, Miguel; Martins, João; Gouveia, Élvio Rúbio; Valeiro, Miguel González

2018-05-29

Assess the relationship between low-to-moderate-intensity physical activity (LMPA) in 2011 and chronic diseases in 2011 and 2013 among European older adults. Participants (16157 men, 21260 women) from 13 European countries were interviewed about the presence of chronic conditions and LMPA. The association between LMPA and number of chronic diseases was assessed using logistic regression models. Most of the older adults participated in LMPA more than once a week (81.9%), 8.4% participated once a week and 9.3% did not participated. The prevalence of chronic diseases was significantly lower among those who reported engaging in LMPA. LMPA in 2011 was related with lower odds of having several chronic diseases in 2013. Engaging in LMPA is associated with reduced risk for chronic diseases in European older men and women. Even the practice of LMPA once a week seems to be enough to diminish the risk of having chronic diseases.

Night-to-Night Sleep Variability in Older Adults With Chronic Insomnia: Mediators and Moderators in a Randomized Controlled Trial of Brief Behavioral Therapy (BBT-I)

PubMed Central

Chan, Wai Sze; Williams, Jacob; Dautovich, Natalie D.; McNamara, Joseph P.H.; Stripling, Ashley; Dzierzewski, Joseph M.; Berry, Richard B.; McCoy, Karin J.M.; McCrae, Christina S.

2017-01-01

Study Objectives: Sleep variability is a clinically significant variable in understanding and treating insomnia in older adults. The current study examined changes in sleep variability in the course of brief behavioral therapy for insomnia (BBT-I) in older adults who had chronic insomnia. Additionally, the current study examined the mediating mechanisms underlying reductions of sleep variability and the moderating effects of baseline sleep variability on treatment responsiveness. Methods: Sixty-two elderly participants were randomly assigned to either BBT-I or self-monitoring and attention control (SMAC). Sleep was assessed by sleep diaries and actigraphy from baseline to posttreatment and at 3-month follow-up. Mixed models were used to examine changes in sleep variability (within-person standard deviations of weekly sleep parameters) and the hypothesized mediation and moderation effects. Results: Variabilities in sleep diary-assessed sleep onset latency (SOL) and actigraphy-assessed total sleep time (TST) significantly decreased in BBT-I compared to SMAC (Pseudo R2 = .12, .27; P = .018, .008). These effects were mediated by reductions in bedtime and wake time variability and time in bed. Significant time × group × baseline sleep variability interactions on sleep outcomes indicated that participants who had higher baseline sleep variability were more responsive to BBT-I; their actigraphy-assessed TST, SOL, and sleep efficiency improved to a greater degree (Pseudo R2 = .15 to .66; P < .001 to .044). Conclusions: BBT-I is effective in reducing sleep variability in older adults who have chronic insomnia. Increased consistency in bedtime and wake time and decreased time in bed mediate reductions of sleep variability. Baseline sleep variability may serve as a marker of high treatment responsiveness to BBT-I. Clinical Trial Registration: ClinicalTrials.gov, Identifier: NCT02967185 Citation: Chan WS, Williams J, Dautovich ND, McNamara JP, Stripling A, Dzierzewski JM, Berry RB, McCoy KJ, McCrae CS. Night-to-night sleep variability in older adults with chronic insomnia: mediators and moderators in a randomized controlled trial of brief behavioral therapy (BBT-I). J Clin Sleep Med. 2017;13(11):1243–1254. PMID:28992829

Physical Exercise and Patients with Chronic Renal Failure: A Meta-Analysis.

PubMed

Qiu, Zhenzhen; Zheng, Kai; Zhang, Haoxiang; Feng, Ji; Wang, Lizhi; Zhou, Hao

2017-01-01

Chronic renal failure is a severe clinical problem which has some significant socioeconomic impact worldwide and hemodialysis is an important way to maintain patients' health state, but it seems difficult to get better in short time. Considering these, the aim in our research is to update and evaluate the effects of exercise on the health of patients with chronic renal failure. The databases were used to search for the relevant studies in English or Chinese. And the association between physical exercise and health state of patients with chronic renal failure has been investigated. Random-effect model was used to compare the physical function and capacity in exercise and control groups. Exercise is helpful in ameliorating the situation of blood pressure in patients with renal failure and significantly reduces VO 2 in patients with renal failure. The results of subgroup analyses show that, in the age >50, physical activity can significantly reduce blood pressure in patients with renal failure. The activity program containing warm-up, strength, and aerobic exercises has benefits in blood pressure among sick people and improves their maximal oxygen consumption level. These can help patients in physical function and aerobic capacity and may give them further benefits.

Physical Exercise and Patients with Chronic Renal Failure: A Meta-Analysis

PubMed Central

Qiu, Zhenzhen; Zheng, Kai; Zhang, Haoxiang; Feng, Ji; Wang, Lizhi

2017-01-01

Chronic renal failure is a severe clinical problem which has some significant socioeconomic impact worldwide and hemodialysis is an important way to maintain patients' health state, but it seems difficult to get better in short time. Considering these, the aim in our research is to update and evaluate the effects of exercise on the health of patients with chronic renal failure. The databases were used to search for the relevant studies in English or Chinese. And the association between physical exercise and health state of patients with chronic renal failure has been investigated. Random-effect model was used to compare the physical function and capacity in exercise and control groups. Exercise is helpful in ameliorating the situation of blood pressure in patients with renal failure and significantly reduces VO2 in patients with renal failure. The results of subgroup analyses show that, in the age >50, physical activity can significantly reduce blood pressure in patients with renal failure. The activity program containing warm-up, strength, and aerobic exercises has benefits in blood pressure among sick people and improves their maximal oxygen consumption level. These can help patients in physical function and aerobic capacity and may give them further benefits. PMID:28316986

Association between physical activity level and consumption of fruit and vegetables among adolescents in northeast Brazil

PubMed Central

Silva, Diego Augusto Santos; Silva, Roberto Jerônimo dos Santos

2015-01-01

OBJECTIVE: To determine the association between low levels of physical activity and consumption of fruits and vegetables among adolescents. METHODS: This cross-sectional study included 2,057 adolescents aged 13 to 18 years from the city of Aracaju, Northeastern Brazil. We analyzed the level of physical activity, consumption of fruits and vegetables by standardized and validated questionnaires. The control variables were sex, age, socioeconomic status, maternal education, alcohol consumption and smoking. For data analysis, univariate and multivariate logistic regression were used, with a significance level of 5%. RESULTS: The prevalence of low levels of physical activity was 81.9%; the inadequate consumption of fruits ocurred in 79.1% and the inadequate consumption of vegetables in 90.6%. Adolescents who consumed few fruits daily had an increase in 40% of chance of being insufficiently active and, for those who consumed few vegetable's the likelihood of being insufficiently active was 50% higher, compared to those who had adequate intake of these foods. CONCLUSIONS: Low levels of physical activity were associated with inadequate fruit and vegetable intake among adolescents in a city in northeastern Brazil. These findings suggest that insufficiently active adolescents have other unhealthy behaviors that may increase the risk of chronic diseases in adulthood. PMID:25887930

Muscle strengthening activity associates with reduced all-cause mortality in COPD.

PubMed

Loprinzi, Paul D; Sng, Eveleen; Walker, Jerome F

2017-06-01

Objective Emerging research suggests that aerobic-based physical activity may help to promote survival among chronic obstructive pulmonary disease patients. However, the extent to which engagement in resistance training on survival among chronic obstructive pulmonary disease patients is relatively unknown. Therefore, the purpose of this study was to examine the independent associations of muscle strengthening activities on all-cause mortality among a national sample of U.S. adults with chronic obstructive pulmonary disease. We hypothesize that muscle strengthening activities will be inversely associated with all-cause mortality. Methods Data from the 2003-2006 NHANES were employed, with follow-up through 2011. Aerobic-based physical activity was objectively measured via accelerometry, muscle strengthening activities engagement was assessed via self-report, and chronic obstructive pulmonary disease was assessed via physician-diagnosis. Results Analysis included 385 adults (20 + yrs) with chronic obstructive pulmonary disease, who represent 13.3 million chronic obstructive pulmonary disease patients in the USA. The median follow-up period was 78 months (IQR=64-90), with 82 chronic obstructive pulmonary disease patients dying during this period. For a two muscle strengthening activity sessions/week increase (consistent with national guidelines), chronic obstructive pulmonary disease patients had a 29% reduced risk of all-cause mortality (HR=0.71; 95% CI: 0.51-0.99; P = 0.04). Conclusion Participation in muscle strengthening activities, independent of aerobic-based physical activity and other potential confounders, is associated with greater survival among chronic obstructive pulmonary disease patients.

Role of religious involvement and spirituality in functioning among African Americans with cancer: testing a mediational model

PubMed Central

Holt, Cheryl L.; Wang, Min Qi; Caplan, Lee; Schulz, Emily; Blake, Victor; Southward, Vivian L.

2013-01-01

The present study tested a mediational model of the role of religious involvement, spirituality, and physical/emotional functioning in a sample of African American men and women with cancer. Several mediators were proposed based on theory and previous research, including sense of meaning, positive and negative affect, and positive and negative religious coping. One hundred patients were recruited through oncologist offices, key community leaders and community organizations, and interviewed by telephone. Participants completed an established measure of religious involvement, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-SP-12 version 4), the Positive and Negative Affect Schedule (PANAS), the Meaning in Life Scale, the Brief RCOPE, and the SF-12, which assesses physical and emotional functioning. Positive affect completely mediated the relationship between religious behaviors and emotional functioning. Though several other constructs showed relationships with study variables, evidence of mediation was not supported. Mediational models were not significant for the physical functioning outcome, nor were there significant main effects of religious involvement or spirituality for this outcome. Implications for cancer survivorship interventions are discussed. PMID:21222026

Multidisciplinary pain facility treatment outcome for pain-associated fatigue.

PubMed

Fishbain, David A; Lewis, John; Cole, Brandly; Cutler, Brian; Smets, Eve; Rosomoff, Hubert; Rosomoff, Rennee Steele

2005-01-01

Fatigue is frequently found in chronic pain patients (CPPs) and may be etiologically related to the presence of pain. Fishbain et al. have recently demonstrated that chronic low back pain (LBP) and chronic neck pain patients are more fatigued than controls. The purpose of this study was to determine whether chronic LBP- and chronic neck pain-associated fatigue responded to multidisciplinary multimodal treatment not specifically targeted to the treatment of fatigue. A total of 85 chronic LBP and 33 chronic neck pain patients completed the Multidimensional Fatigue Inventory (MFI), Neuropathic Pain Scale (NPS), and Beck Depression Inventory on admission. In addition, an information tool was completed on each CPP by the senior author. This tool listed demographic information, primary and secondary pain diagnoses, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) psychiatric diagnoses assigned, pain location, pain precipitating event, type of injury, years in pain, number of surgeries, type of surgery, type of pain pattern, opioids consumed per day in morphine equivalents, worker compensation status, and whether, according to the clinical examination, the CPP had a neuropathic pain component. At completion of the multidisciplinary multimodal treatment, each CPP again completed the MFI. Student's t-test was utilized to test for statistical changes on the MFI five scales from pre- to post-treatment. Pearson and point-biserial correlations were utilized to determine which variables significantly correlated with MFI change scores. Variables found significant at less than or equal to 0.01 were utilized in a stepwise aggression analysis to find variables predictive of change in MFI scores. Multidisciplinary pain facility. Chronic LBP and chronic neck pain patients. Multidisciplinary multimodal treatment significantly improved CPP fatigue as measured by the MFI. The available variables utilized to predict fatigue best explained only a small percentage (28.9%) of the variance. Improvement in fatigue was related to NPS-10 scale scores (neuropathic pain) and a previous diagnosis of fibromyalgia. Multidisciplinary multimodal pain facility treatment improves chronic LBP- and neck pain-associated fatigue. At the present time we cannot predict this improvement with significant accuracy.

Suicidality in chronic pain: predictors of suicidal ideation in fibromyalgia.

PubMed

Triñanes, Yolanda; González-Villar, Alberto; Gómez-Perretta, Claudio; Carrillo-de-la-Peña, María T

2015-04-01

Fibromyalgia (FM) has been associated with a higher prevalence of suicidal behavior. Nevertheless, much remains unknown about suicide risk factors for this chronic pain disorder. In the present study, the relationship of suicidal ideation in FM with a number of sociodemographic, clinical, and psychological variables was analyzed. One hundred seventeen women with Fibromyalgia were assessed. The procedure included the exploration of sleep problems (Pittsburgh Sleep Quality Index), depression (Beck Depression Inventory [BDI]), health-related quality of life (SF-36 and Fibromyalgia Impact Questionnaire), the core symptoms of FM (visual analogue scales), and algometry of tender points. Suicidal ideation was evaluated by item 9 of the BDI. Patients with presence vs. absence of suicidal ideation were compared in all the variables studied. The prevalence of suicidal ideation among FM patients was 32.5%. Significant differences between patients with vs. without suicidal ideas emerged mainly for the various indices of depression. Patients with suicidal ideation also reported higher levels of anxiety, more day dysfunction due to sleepiness and more limitations due to emotional and physical problems. Logistic regression analysis revealed that cognitive depression symptoms such as BDI Self-Blame cluster are the more closely related to suicide ideation. The presence of suicidal ideation in FM patients is closely related to comorbid depression, anxiety and to a higher impact of the disease in daily life. © 2014 World Institute of Pain.

The effect of pre-transplant pain and chronic disease self-efficacy on quality of life domains in the year following hematopoietic stem cell transplantation.

PubMed

O'Sullivan, Madeline L; Shelby, Rebecca A; Dorfman, Caroline S; Kelleher, Sarah A; Fisher, Hannah M; Rowe Nichols, Krista A; Keefe, Francis J; Sung, Anthony D; Somers, Tamara J

2018-04-01

Pain is common for hematopoietic stem cell transplant (HSCT) patients and may be experienced pre-transplant, acutely post-transplant, and for months or years following transplant. HSCT patients with persistent pain may be at risk for poor quality of life following transplant; however, the impact of pre-transplant pain on quality of life post-transplant is not well understood. Self-efficacy for chronic disease management is associated with quality of life among cancer patients and may impact quality of life for HSCT patients. The primary aim was to examine the effect of pre-transplant pain and self-efficacy on quality of life domains in the year following transplant. One hundred sixty-six HSCT patients completed questionnaires providing information on pain, self-efficacy, and quality of life prior to transplant, at discharge, and 3-, 6-, and 12-months post-transplant as part of a longitudinal, observational study. Linear mixed modeling examined the trajectories of these variables and the effect of pre-transplant pain and self-efficacy on post-transplant quality of life. Pain and social and emotional quality of life remained stable in the year following transplant while self-efficacy and physical and functional quality of life improved. Pre-transplant pain was significantly related to lower physical well-being post-transplant. Lower pre-transplant self-efficacy was related to lower quality of life across all domains post-transplant. Above and beyond the effect of pre-transplant pain, self-efficacy for managing chronic disease is important in understanding quality of life following transplant. Identifying patients with pain and/or low self-efficacy pre-transplant may allow for early intervention with self-management strategies.

Clinical features and natural history of acquired cold urticaria in a tertiary referral hospital: a 10-year prospective study.

PubMed

Katsarou-Katsari, A; Makris, M; Lagogianni, E; Gregoriou, S; Theoharides, T; Kalogeromitros, D

2008-12-01

Acquired cold urticaria (ACU) represents a heterogeneous group of disorders that share a common clinical feature: the development of urticaria or angioedema after cold exposure. We present epidemiological and clinical data of subjects with ACU, natural progression and we examine possible parameters that could correlate with disease severity. During a 10-year period in all subjects with ACU, detailed record of personal history, laboratory testing, cold stimulation testing (CST), atopy assessment and disease severity took place. In a re-evaluation visit at the end of the surveillance period, ACU progression was assessed from patients in a subjective way. Four thousand one hundred fifty-seven individuals with chronic urticaria were referred, and 352 (198 males, 154 females, 8.47% of patients with chronic urticaria) presented definite symptoms of physical urticarias, while 95 individuals (49 males, 46 females, 27% of patients with physical urticarias) were detected with ACU. Sixty-two participants were included in study analysis. Thirty-two patients (51.6%) were female; the mean age was 41.5 +/- 15.6 years, while the mean age at disease onset was 32.5 +/- 15.6 years; half were < or = 30 years old at disease onset. The mean duration of surveillance was 9.0 +/- 6.9 years. During this time interval, 18 patients (29.0%) showed the same or even worse symptomatology, 26 patients reported some improvement (41.9%), while in 18 patients, symptoms resolved completely (29.0%); the mean time to resolution was 5.6 +/- 3.5 years. Disease severity was the only variable statistically significantly related to disease progression (P = 0.004). Cold urticaria is a chronic persistent disorder with occasional severe clinical manifestations.

Relationship of Sleep Duration with Sociodemographic Characteristics, Lifestyle, Mental Health, and Chronic Diseases in a Large Chinese Adult Population.

PubMed

Wang, Shibin; Li, Bo; Wu, Yanhua; Ungvari, Gabor S; Ng, Chee H; Fu, Yingli; Kou, Changgui; Yu, Yaqin; Sun, Hong-Qiang; Xiang, Yu-Tao

2017-03-15

Pattern of sleep duration and its correlates have rarely been reported in China. This study examined the sleep duration and its relationship with sociodemographic variables, lifestyle, mental health, and chronic diseases in a large Chinese adult population. This cross-sectional study used multistage stratified cluster sampling. A total of 17,320 participants from Jilin province were selected and interviewed using standardized assessment tools. Basic socio-demographic and clinical data were collected. Sleep duration was classified as short (< 7 h per day), long (> 9 h per day) and medium sleep (7-9 h per day). The mean age of the sample was 42.60 ± 10.60 y, with 51.4% being female. The mean sleep duration was 7.31 ± 1.44 h. Short and long sleepers accounted for 30.9% and 6.9% of the sample, respectively. Multinomial logistic regression analysis revealed that older age, current smoking, irregular meal pattern, lack of physical exercise, poor mental health, and chronic diseases or multimorbidity were positively associated with short sleep. Being married and living in rural areas were, however, negatively associated with short sleep. In addition, living in rural area, current smoking, current alcohol use and lack of physical exercise were positively associated with long sleep, while older age and lower education were negatively associated with long sleep. Given the high frequency of short sleep and its negative effect on health, health professionals should pay more attention to sleep patterns in general health care. Nationwide epidemiologic surveys in China are needed to further explore the relationship between sleep duration and health. © 2017 American Academy of Sleep Medicine

Psychological, social, and environmental factors to meeting physical activity recommendations among Japanese adults.

PubMed

Shibata, Ai; Oka, Koichiro; Harada, Kazuhiro; Nakamura, Yoshio; Muraoka, Isao

2009-08-28

Although the benefits of the recommended level of physical activity on reducing chronic diseases are well-established, most of the Japanese population is not sufficiently active. Thus, examining correlates is an important prerequisite for designing relevant polices and effective programs. The present study investigated psychological, social, and environmental factors associated with meeting physical activity recommendations among Japanese adults. Data were analyzed for 1,932 men and women (43.6 +/- 13.0 years), who responded to an Internet-based cross-sectional survey. Self-reported measure of physical activity, psychological (self-efficacy, pros, and cons), social (social support, health professional advice), environmental (home fitness equipment, access to facilities, neighborhood safety, enjoyable scenery, frequently observing others exercising, residential area), and demographic (gender, age, marital status, educational level, household income level, employment status) variables were obtained. Based on the current national guidelines for exercise in Japan (23 METs.hour per week), respondents were divided into two categories-recommended and not recommended (insufficient and inactive)-according to their estimated weekly physical activity level. An adjusted logistic regression model was utilized. When adjusting for all other variables, self-efficacy (men: OR = 2.13; 95% CI: 1.55-2.94, women: OR = 2.72; 95% CI: 1.82-4.08) and possessing home fitness equipment (men: OR = 1.55; 95% CI: 1.14-2.10, women: OR = 1.41; 95% CI: 1.01-1.99) for both genders, social support (OR = 1.44; 95% CI: 1.06-1.97) for men, and enjoyable scenery (OR = 1.60; 95% CI: 1.09-2.36) for women were positively associated with attaining the recommended level of physical activity. In women, cons (OR = 0.47; 95% CI: 0.33-0.67) and living in rural areas (OR = 0.50; 95% CI: 0.25-0.97) were negatively associated with meeting the physical activity recommendations. In the psychological, social, and environmental domains, significant correlates of attaining the recommended level of physical activity were observed. Men and women had different patterns of psychological, social, and environmental correlates. These findings suggest that an intervention design that accounts for those correlates may more effectively promote physical activity among Japanese adults.

Rurality and ethnicity in adolescent physical illness: are children of the growing rural Latino population at excess health risk?

PubMed

Wickrama, K A S; Elder, Glen H; Todd Abraham, W

2007-01-01

This study's objectives are to: investigate potential additive and multiplicative influences of rurality and race/ethnicity on chronic physical illness in a nationally representative sample of youth; and examine intra-Latino processes using a Latino sub-sample. Specifically, we examine how rurality and individual psychosocial processes reflected by acculturation proxies (generational status and use of the English language at home) link to chronic physical illness of Latino youth. Finally, we examine whether these associations and the levels of chronic illness differ across Latino subgroups. Logistic-normal (binomial) modeling analyses examine multilevel influences on physical health using longitudinal data from a nationally representative sample (N = 13,905) of white, African American, Latino, Asian, and Native American adolescents between the ages of 12 and 19 participating in the National Longitudinal Study of Adolescent Health. Prevalence rates of certain chronic illnesses (obesity, asthma, and high cholesterol) among Latino adolescents exceed rates for the same illnesses among white adolescents. Comparisons between rural and non-rural youth reveal a rurality disadvantage in terms of any chronic illness likelihood among Latino, Asian, and Native American youth not evident among whites or African Americans. Among Latino youth (N = 2,505), Mexican Americans show lower health risk for any chronic illness compared to other Latino groups. However, third generation Latinos and those who primarily speak English at home experience higher risk for any chronic illness than do those of first or second generation status, with amplification of the risk linked to English use at home among Latino youth living in rural areas.

The immunomodulating role of exercise in metabolic disease.

PubMed

Lancaster, Graeme I; Febbraio, Mark A

2014-06-01

A lack of physical activity is linked to the development of many chronic diseases. It is now well established that the immune system and inflammation play a central role in the development of numerous chronic metabolic diseases including insulin resistance, type 2 diabetes, atherosclerosis, nonalcoholic fatty liver disease, and specific types of cancer. Physical exercise elicits potent anti-inflammatory effects that are likely to account for many of the salutary actions of regular exercise on chronic metabolic diseases. Here we review the anti-inflammatory and immunomodulatory mechanisms by which the beneficial effects of exercise on chronic metabolic diseases may be mediated. Copyright © 2014 Elsevier Ltd. All rights reserved.

Reduction of perception of chronic fatigue in an observational study of patients receiving 12 weeks of Kampo therapy.

PubMed

Sekiya, Nobuyasu; Shimada, Yutaka; Shintani, Takahiro; Tahara, Eiichi; Kouta, Kazufumi; Shibahara, Naotoshi; Terasawa, Katsutoshi

2005-10-01

The aim of this study was to observe the influence of Kampo therapy on latent chronic fatigue of patients with chronic diseases. One hundred and seventy-three (173) consecutive patients with chronic diseases came to our department for the first time. This was a prospective study. Patients were divided into two groups: a chronic fatigue group (CFG) and a nonchronic fatigue group (NCFG). Based on Kampo diagnosis, both groups were prescribed Kampo formulae as an extract or decoction for 12 weeks. By using questionnaires, patients were assessed concerning their physical and mental types of fatigue, their sleep situation, and their attitude toward work or housekeeping, both before and after 12 weeks of treatment, according to Kampo diagnosis. The mental fatigue, physical fatigue, and sleep scores of both groups, and the work score of CFG, were decreased. The rate of reduction of the fatigue score was significantly greater in CFG than in NCFG. The factor responsible for this difference in fatigue score was physical fatigue. A reduction of the perception of chronic fatigue was observed in patients receiving 12 weeks of Kampo therapy.

Barriers to physical activity in chronic hemodialysis patients: a single-center pilot study in an Italian dialysis facility.

PubMed

Fiaccadori, Enrico; Sabatino, Alice; Schito, Franco; Angella, Francesca; Malagoli, Martina; Tucci, Marco; Cupisti, Adamasco; Capitanini, Alessandro; Regolisti, Giuseppe

2014-01-01

In patients on chronic dialysis a sedentary lifestyle is a strong, yet potentially modifiable, predictor of mortality. The present single-center pilot study evaluated social, psychological and clinical barriers that may hinder physical activity in this population. We explored the association between barriers to physical activity and sedentarism in adult patients at a chronic dialysis facility in Parma, Italy. We used different questionnaries exploring participation in physical activity, physical functioning, patient attitudes and preferences, and barriers to physical activity perceived by either patients or dialysis doctors and nurses. We enrolled 104 patients, (67 males, 65%), mean age 69 years (79% of patients older than 60 years); median dialysis vintage 60 months (range 8-440); mean Charlson score 5.55, ADL (Activities of Daily Living) score 5.5. Ninety-two participants (88.5%) reported at least one barrier to physical activity. At multivariable analysis, after adjusting for age and sex, feeling to have too many medical problems (OR 2.99, 95% CI 1.27 to 7.07; P=0.012), chest pain (OR 10.78, 95% CI 1.28 to 90.28; P=0.029) and sadness (OR 2.59, 95% CI 1.10 to 6.09; P=0.030) were independently associated with physical inactivity. Lack of time for exercise counseling and the firm belief about low compliance/interest by the patients toward exercise were the most frequent barriers reported by doctors and nurses. We identified a number of patient-related and health personnel-related barriers to physical activity in patients on chronic dialysis. Solutions for these barriers should be addressed in future studies aimed at increasing the level of physical activity in this population. © 2014 S. Karger AG, Basel.

The Understanding and Interpretation of Innovative Technology-Enabled Multidimensional Physical Activity Feedback in Patients at Risk of Future Chronic Disease

PubMed Central

Western, Max J.; Peacock, Oliver J.; Stathi, Afroditi; Thompson, Dylan

2015-01-01

Background Innovative physical activity monitoring technology can be used to depict rich visual feedback that encompasses the various aspects of physical activity known to be important for health. However, it is unknown whether patients who are at risk of chronic disease would understand such sophisticated personalised feedback or whether they would find it useful and motivating. The purpose of the present study was to determine whether technology-enabled multidimensional physical activity graphics and visualisations are comprehensible and usable for patients at risk of chronic disease. Method We developed several iterations of graphics depicting minute-by-minute activity patterns and integrated physical activity health targets. Subsequently, patients at moderate/high risk of chronic disease (n=29) and healthcare practitioners (n=15) from South West England underwent full 7-days activity monitoring followed by individual semi-structured interviews in which they were asked to comment on their own personalised visual feedback Framework analysis was used to gauge their interpretation and of personalised feedback, graphics and visualisations. Results We identified two main components focussing on (a) the interpretation of feedback designs and data and (b) the impact of personalised visual physical activity feedback on facilitation of health behaviour change. Participants demonstrated a clear ability to understand the sophisticated personal information plus an enhanced physical activity knowledge. They reported that receiving multidimensional feedback was motivating and could be usefully applied to facilitate their efforts in becoming more physically active. Conclusion Multidimensional physical activity feedback can be made comprehensible, informative and motivational by using appropriate graphics and visualisations. There is an opportunity to exploit the full potential created by technological innovation and provide sophisticated personalised physical activity feedback as an adjunct to support behaviour change. PMID:25938455

[Clustering patterns of behavioral risk factors linked to chronic disease among young adults in two localities in Bogota, Colombia: importance of sex differences].

PubMed

Gómez Gutiérrez, Luis Fernando; Lucumí Cuesta, Diego Iván; Girón Vargas, Sandra Lorena; Espinosa García, Gladys

2004-01-01

The characterization of clustering behavioral risk factors may be used as a guideline for interventions aimed at preventing chronic diseases. This study determined the clustering patterns of some behavioral risk factors in young adults aged 18 to 29 years and established the factors associated with having two or more of them. Patterns of clustering by gender were established in four behavioral risk factors (low consumption of fruits and vegetables, physical inactivity in leisure time, current tobacco consumption and acute alcohol consumption), in 1465 young adults participants through a multistage probabilistic sample. Regression models identified the sociodemografic variables associated with having two or more of the aforementioned behavioral risk factors. Having one, 32.9% two and 17.7% three or four. Acute alcohol consumption was the risk factor most frequent in the combined risk factor patterns among males; physical inactivity during leisure time being the most frequent among females. Among the females, having two or more behavioral risk factors was linked to be separated or divorced, this having been linked to work having been the main activity over the past 30 days among males. The combinations of behavioral risk factors studied and the factors associated with clustering show different patterns among males and females. These findings stressed the need of designing interventions sensitive to gender differences.

Chronic Pelvic Pain in Women

MedlinePlus

... enlarged veins in the pelvis have no associated pain. Psychological factors. Depression, chronic stress or a history of sexual or physical abuse may increase your risk of chronic pelvic pain. Emotional distress makes pain worse, and living with ...

Balance confidence is related to features of balance and gait in individuals with chronic stroke

PubMed Central

Schinkel-Ivy, Alison; Wong, Jennifer S.; Mansfield, Avril

2016-01-01

Reduced balance confidence is associated with impairments in features of balance and gait in individuals with sub-acute stroke. However, an understanding of these relationships in individuals at the chronic stage of stroke recovery is lacking. This study aimed to quantify relationships between balance confidence and specific features of balance and gait in individuals with chronic stroke. Participants completed a balance confidence questionnaire and clinical balance assessment (quiet standing, walking, and reactive stepping) at 6 months post-discharge from inpatient stroke rehabilitation. Regression analyses were performed using balance confidence as a predictor variable and quiet standing, walking, and reactive stepping outcome measures as the dependent variables. Walking velocity was positively correlated with balance confidence, while medio-lateral centre of pressure excursion (quiet standing) and double support time, step width variability, and step time variability (walking) were negatively correlated with balance confidence. This study provides insight into the relationships between balance confidence and balance and gait measures in individuals with chronic stroke, suggesting that individuals with low balance confidence exhibited impaired control of quiet standing as well as walking characteristics associated with cautious gait strategies. Future work should identify the direction of these relationships to inform community-based stroke rehabilitation programs for individuals with chronic stroke, and determine the potential utility of incorporating interventions to improve balance confidence into these programs. PMID:27955809

Kinematic predictors of star excursion balance test performance in individuals with chronic ankle instability.

PubMed

Hoch, Matthew C; Gaven, Stacey L; Weinhandl, Joshua T

2016-06-01

The Star Excursion Balance Test has identified dynamic postural control deficits in individuals with chronic ankle instability. While kinematic predictors of Star Excursion Balance Test performance have been evaluated in healthy individuals, this has not been thoroughly examined in individuals with chronic ankle instability. Fifteen individuals with chronic ankle instability completed the anterior reach direction of the Star Excursion Balance Test and weight-bearing dorsiflexion assessments. Maximum reach distances on the Star Excursion Balance Test were measured in cm and normalized to leg length. Three-dimensional trunk, hip, knee, and ankle motion of the stance limb were recorded during each anterior reach trial using a motion capture system. Sagittal, frontal, and transverse plane displacement observed from trial initiation to the point of maximum reach was calculated for each joint or segment and averaged for analysis. Pearson product-moment correlations were performed to examine the relationships between kinematic variables, maximal reach, and weight-bearing dorsiflexion. A backward multiple linear regression model was developed with maximal reach as the criterion variable and kinematic variables as predictors. Frontal plane displacement of the trunk, hip, and ankle and sagittal plane knee displacement were entered into the analysis. The final model (p=0.004) included all three frontal plane variables and explained 81% of the variance in maximal reach. Maximal reach distance and several kinematic variables were significantly related to weight-bearing dorsiflexion. Individuals with chronic ankle instability who demonstrated greater lateral trunk displacement toward the stance limb, hip adduction, and ankle eversion achieved greater maximal reach. Copyright © 2016. Published by Elsevier Ltd.

Correlates of US adult physical activity and sedentary behavior patterns.

PubMed

Jones, Sydney A; Wen, Fang; Herring, Amy H; Evenson, Kelly R

2016-12-01

Physical activity and sedentary behavior patterns may be differentially associated with socio-demographic and health measures. We explored correlates of day-to-day patterns over a week in accelerometer measured physical activity and sedentary behavior to inform intervention development. Cross-sectional study. National Health and Nutrition Examination Survey (NHANES) adult participants (≥20 years) in 2003-2006 wore an accelerometer for 1 week. Accelerometer data from 7236 participants were used to derive latent classes describing day-to-day patterns over a week of physical activity and sedentary behavior. Correlates of each pattern were identified using multinomial logistic regression from 21 potential variables grouped into four domains: socio-demographic, acculturation, cardiovascular, and health history. Older age, female sex, higher body mass index, and history of chronic disease were consistently associated with lower odds of being in a more active compared to the least active class. In contrast, being employed, speaking Spanish at home, and having better self-rated health were associated with higher odds of being in a more active compared to the least active class. Correlates of physical activity and sedentary behavior patterns were identified from all domains (socio-demographic, acculturation, cardiovascular, and health history). Most correlates that were positively associated with physical activity were negatively associated with sedentary behavior. Better understanding of the correlates of physical activity and sedentary behavior patterns can inform interventions to promote physical activity and reduce sedentary behavior. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Reliability and Validity of an Internet-based Questionnaire Measuring Lifetime Physical Activity

PubMed Central

De Vera, Mary A.; Ratzlaff, Charles; Doerfling, Paul; Kopec, Jacek

2010-01-01

Lifetime exposure to physical activity is an important construct for evaluating associations between physical activity and disease outcomes, given the long induction periods in many chronic diseases. The authors' objective in this study was to evaluate the measurement properties of the Lifetime Physical Activity Questionnaire (L-PAQ), a novel Internet-based, self-administered instrument measuring lifetime physical activity, among Canadian men and women in 2005–2006. Reliability was examined using a test-retest study. Validity was examined in a 2-part study consisting of 1) comparisons with previously validated instruments measuring similar constructs, the Lifetime Total Physical Activity Questionnaire (LT-PAQ) and the Chasan-Taber Physical Activity Questionnaire (CT-PAQ), and 2) a priori hypothesis tests of constructs measured by the L-PAQ. The L-PAQ demonstrated good reliability, with intraclass correlation coefficients ranging from 0.67 (household activity) to 0.89 (sports/recreation). Comparison between the L-PAQ and the LT-PAQ resulted in Spearman correlation coefficients ranging from 0.41 (total activity) to 0.71 (household activity); comparison between the L-PAQ and the CT-PAQ yielded coefficients of 0.58 (sports/recreation), 0.56 (household activity), and 0.50 (total activity). L-PAQ validity was further supported by observed relations between the L-PAQ and sociodemographic variables, consistent with a priori hypotheses. Overall, the L-PAQ is a useful instrument for assessing multiple domains of lifetime physical activity with acceptable reliability and validity. PMID:20876666

Daytime activity and risk factors for late-life insomnia.

PubMed

Morgan, Kevin

2003-09-01

Laboratory evidence linking exercise with improved sleep quality raises the possibility that the lower levels of physical activity characteristic of older age groups may contribute to late-life insomnia. While support for this hypothesis appears to come from epidemiological surveys, few such studies have distinguished satisfactorily between social and physical activities which differ widely in terms of energy cost and theoretical significance. The present analyses were, therefore, designed to assess the independent influence of physical and social activity levels on the prevalence and natural history of late-life insomnia. Survivors from a nationally representative UK sample (n = 1042) of elderly people originally interviewed in 1985 were reassessed in 1989 (n = 690) and 1993 (n = 410). Detailed assessments of physical and social activities, mental and physical health status, and sleep quality were made at each survey wave. Logistic regression models, adjusted for age, sex and health status, were used to assess relationships between activity levels and the prevalence, remission/persistence, and incidence of late-life insomnia. Lower physical health, depressed mood and lower physical (but not social) activity levels consistently emerged as significant risk factors for prevalent, persistent and incident insomnia. Age was unrelated to insomnia variables in all the cross-sectional models, but did emerge as a significant risk for cumulative 4-8-year insomnia incidence. These findings suggest that, independent of those activities more closely associated with social engagement, higher levels of customary physical activity per se appear to be protective against incident and chronic late-life insomnia.

Physical activity behavior predicts endogenous pain modulation in older adults.

PubMed

Naugle, Kelly M; Ohlman, Thomas; Naugle, Keith E; Riley, Zachary A; Keith, NiCole R

2017-03-01

Older adults compared with younger adults are characterized by greater endogenous pain facilitation and a reduced capacity to endogenously inhibit pain, potentially placing them at a greater risk for chronic pain. Previous research suggests that higher levels of self-reported physical activity are associated with more effective pain inhibition and less pain facilitation on quantitative sensory tests in healthy adults. However, no studies have directly tested the relationship between physical activity behavior and pain modulatory function in older adults. This study examined whether objective measures of physical activity behavior cross-sectionally predicted pain inhibitory function on the conditioned pain modulation (CPM) test and pain facilitation on the temporal summation (TS) test in healthy older adults. Fifty-one older adults wore an accelerometer on the hip for 7 days and completed the CPM and TS tests. Measures of sedentary time, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) were obtained from the accelerometer. Hierarchical linear regressions were conducted to determine the relationship of TS and CPM with levels of physical activity, while controlling for demographic, psychological, and test variables. The results indicated that sedentary time and LPA significantly predicted pain inhibitory function on the CPM test, with less sedentary time and greater LPA per day associated with greater pain inhibitory capacity. Additionally, MVPA predicted pain facilitation on the TS test, with greater MVPA associated with less TS of pain. These results suggest that different types of physical activity behavior may differentially impact pain inhibitory and facilitatory processes in older adults.

Reliability and validity of an internet-based questionnaire measuring lifetime physical activity.

PubMed

De Vera, Mary A; Ratzlaff, Charles; Doerfling, Paul; Kopec, Jacek

2010-11-15

Lifetime exposure to physical activity is an important construct for evaluating associations between physical activity and disease outcomes, given the long induction periods in many chronic diseases. The authors' objective in this study was to evaluate the measurement properties of the Lifetime Physical Activity Questionnaire (L-PAQ), a novel Internet-based, self-administered instrument measuring lifetime physical activity, among Canadian men and women in 2005-2006. Reliability was examined using a test-retest study. Validity was examined in a 2-part study consisting of 1) comparisons with previously validated instruments measuring similar constructs, the Lifetime Total Physical Activity Questionnaire (LT-PAQ) and the Chasan-Taber Physical Activity Questionnaire (CT-PAQ), and 2) a priori hypothesis tests of constructs measured by the L-PAQ. The L-PAQ demonstrated good reliability, with intraclass correlation coefficients ranging from 0.67 (household activity) to 0.89 (sports/recreation). Comparison between the L-PAQ and the LT-PAQ resulted in Spearman correlation coefficients ranging from 0.41 (total activity) to 0.71 (household activity); comparison between the L-PAQ and the CT-PAQ yielded coefficients of 0.58 (sports/recreation), 0.56 (household activity), and 0.50 (total activity). L-PAQ validity was further supported by observed relations between the L-PAQ and sociodemographic variables, consistent with a priori hypotheses. Overall, the L-PAQ is a useful instrument for assessing multiple domains of lifetime physical activity with acceptable reliability and validity.

Complementary and alternative medical therapies for interstitial cystitis: an update from the United States

PubMed Central

Atchley, Megan Danielle; Shah, Nima M.

2015-01-01

The diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) has shifted from organ-specific to a multifactorial, multidisciplinary and individualized approach. Patients with refractory and debilitating symptoms may respond to complementary and alternative medical treatments (CAM). Through CAM therapies, practitioners assist the patient to be at the center of their care, empowering them to be emotionally and physically involved. Multi-disciplinary care, including urology, gynecology, gastroenterology, neurology, psychology, physiotherapy and pain medicine, is also identified to be the crux of adequate management of patients with chronic pelvic pain because of its variable etiology. The purpose of this review is to emphasize these changes and discuss management strategies. PMID:26816868

Complementary and alternative medical therapies for interstitial cystitis: an update from the United States.

PubMed

Atchley, Megan Danielle; Shah, Nima M; Whitmore, Kristene E

2015-12-01

The diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) has shifted from organ-specific to a multifactorial, multidisciplinary and individualized approach. Patients with refractory and debilitating symptoms may respond to complementary and alternative medical treatments (CAM). Through CAM therapies, practitioners assist the patient to be at the center of their care, empowering them to be emotionally and physically involved. Multi-disciplinary care, including urology, gynecology, gastroenterology, neurology, psychology, physiotherapy and pain medicine, is also identified to be the crux of adequate management of patients with chronic pelvic pain because of its variable etiology. The purpose of this review is to emphasize these changes and discuss management strategies.

Association between levels of physical activity and poor self-rated health in Korean adults: The Third Korea National Health and Nutrition Examination Survey (KNHANES), 2005.

PubMed

Han, M A; Kim, K S; Park, J; Kang, M G; Ryu, S Y

2009-10-01

To investigate the association between level of physical activity and poor self-rated health in Korean adults. A cross-sectional study was conducted on 7,800 adults aged > or =19 years who completed the Health Interview and the Health Behavior Surveys, issued during the Third National Health and Nutrition Examination Survey (2005). The association between self-rated health and physical activity was tested using Chi-squared test. Multiple logistic regression analysis was used to calculate the odds ratios of poor self-rated health for different levels of physical activity after adjusting for physical and chronic medical conditions. The prevalence of poor self-rated health was significantly lower as the level of physical activity increased, and odds ratios for poor self-rated health were significantly lower for higher levels of physical activity after adjusting for age, marital status, educational status, smoking, alcohol consumption, and the number of physical impairments and chronic medical conditions. The association was similar in different age groups and among healthy respondents and respondents with physical impairments or chronic medical conditions. Physical activity was positively associated with self-rated health in Koreans. The independent association between a lower level of physical activity and poor self-rated health supports public health programmes that encourage regular physical activity.

Group Outpatient Physical and Behavioral Therapy for Chronic Low Back Pain.

ERIC Educational Resources Information Center

Cohen, Michael J.; And Others

1983-01-01

Compared the effectiveness of behavioral (BT) or physical therapy (PT) for treating chronic low back pain (CLBP), for 13 BT patients and 12 PT patients. Treatments were conducted in a group outpatient setting. Posttreatment results showed general improvement for patients in both groups, but few treatment-specific differences in outcome measures.…

Health-related quality of life (HRQL) for individuals with self-reported chronic physical and/or mental health conditions: panel survey of an adult sample in the United States

PubMed Central

2012-01-01

Background In the US, approximately 53% of adults have at least one chronic condition. Comorbid physical and mental health conditions often have an incremental negative impact on health-related quality of life (HRQL). Primary study objectives were to quantify the impact on HRQL of a) ≥ 1 physical condition , b) ≥ 1 comorbid mental health conditions added to a physical one, c) ≥ 1 mental health condition, and d) ≥ 1 comorbid physical conditions added to at least one related to mental health. Decrements were based on a “Healthy” reference group reporting no chronic conditions. Methods Participants were sampled (n = 3877) from the US adult population as part of a 2009 normative survey. Demographics, number/ type of chronic conditions, and HRQL data were self-reported. HRQL was defined through SF-36v2® Physical Component Summary (PCS) scores and Mental Component Summary (MCS) scores. Participant “morbidity” groupings included Healthy; Physical Health Condition only, Mental Health Condition only, and Physical and Mental Health (Comorbid). PCS and MCS scores were also analyzed by physical disease clusters (e.g., cardiovascular, gastrointestinal). Multivariate regression models were used for all analyses. Results 81% of participants were Caucasian; 9% African American. Males and females were about equally represented; 63% were ≥ 45 years old. The average number of reported chronic conditions was 2.4 (SD = 2.4). Relative to the Healthy group, the Physical Condition group scored 6.4 (males) and 7.5 (females) points lower on PCS. The addition of a comorbid mental health condition resulted in a total reduction of 11 points in PCS and 15 points in MCS. Compared to the Healthy group, ≥ 1 mental health conditions was associated with MCS decrements of 11–12 points. A physical comorbidity led to additional decrements of 3–4 points for MCS, with a total of 15 points. Incremental HRQL burden defined by both MCS and PCS scores was relatively similar across the 5 defined physical disease clusters. Conclusion Results provide quantitative information for US adults on specific PCS and MCS score decrements associated with a comorbid condition related to mental health, as well as a comorbid condition related to physical health. PMID:23253258

Neighbourhood environments and obesity among adults: A multilevel analysis of an urban Brazilian context.

PubMed

Matozinhos, Fernanda Penido; Gomes, Crizian Saar; Andrade, Amanda Cristina de Souza; Mendes, Larissa Loures; Pessoa, Milene Cristine; Friche, Amélia Augusta de Lima; Velasquez-Melendez, Gustavo

2015-01-01

Objective. This study identified environmental variables associated with obesity in the adult population of a city in Brazil. Methods. It was conducted using the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey from 2008 to 2010. The body mass index (BMI) was calculated from the participants' self-reported weight and height. Obesity was defined as a BMI ≥ 30 kg/m2. The food establishments, georeferenced areas conducive to physical activity, total income of the neighbourhood, homicide rate and population density were used to characterise the environment. In addition, individual variables were considered. A multilevel logistic regression was performed. Results. A total of 5273 individuals were evaluated. The odds of obesity was found to be significantly decreased with increases in the number of establishments that sell healthy food, number of restaurants, number of places for physical activity and total income - in different models. In addition, these associations remained significant after adjustment for age, gender, education and consumption of meat with visible fat. Conclusions. This study contributes to a better understanding of the complex interaction between environmental and individual determinants of obesity and may aid in the development of effective interventions, such as the expansion of obesity control programmes.

Model selection for semiparametric marginal mean regression accounting for within-cluster subsampling variability and informative cluster size.

PubMed

Shen, Chung-Wei; Chen, Yi-Hau

2018-03-13

We propose a model selection criterion for semiparametric marginal mean regression based on generalized estimating equations. The work is motivated by a longitudinal study on the physical frailty outcome in the elderly, where the cluster size, that is, the number of the observed outcomes in each subject, is "informative" in the sense that it is related to the frailty outcome itself. The new proposal, called Resampling Cluster Information Criterion (RCIC), is based on the resampling idea utilized in the within-cluster resampling method (Hoffman, Sen, and Weinberg, 2001, Biometrika 88, 1121-1134) and accommodates informative cluster size. The implementation of RCIC, however, is free of performing actual resampling of the data and hence is computationally convenient. Compared with the existing model selection methods for marginal mean regression, the RCIC method incorporates an additional component accounting for variability of the model over within-cluster subsampling, and leads to remarkable improvements in selecting the correct model, regardless of whether the cluster size is informative or not. Applying the RCIC method to the longitudinal frailty study, we identify being female, old age, low income and life satisfaction, and chronic health conditions as significant risk factors for physical frailty in the elderly. © 2018, The International Biometric Society.

Effectiveness of dry needling versus a classical physiotherapy program in patients with chronic low-back pain: a single-blind, randomized, controlled trial.

PubMed

Tüzün, Emİne Handan; Gıldır, Sıla; Angın, Ender; Tecer, Büşra Hande; Dana, Kezban Öztürk; Malkoç, Mehtap

2017-09-01

[Purpose] We compared the effectiveness of dry needling with a classical physiotherapy program in patients with chronic low-back pain caused by lumbar disc hernia (LHNP). [Subjects and Methods] In total, 34 subjects were allocated randomly to the study (n=18) and control groups (n=16). In the study group, dry needling was applied using acupuncture needles. The control group performed a home exercise program in addition to hot pack, TENS, and ultrasound applications. Pain was assessed with the short form of the McGill Pain Questionnaire. The number of trigger points and their pressure sensitivity were evaluated with a physical examination (palpation). The Beck Depression Inventory was used to assess depression. The Tampa Kinesiophobia Scale was used to assess fear of movement. [Results] In the study group, the calculated Cohen's effect sizes were bigger than those in the control group in terms of pain, trigger point-related variables, and fear of movement. Effect sizes for reducing depressive symptoms were similar in both groups. [Conclusion] These results suggest that dry needling can be an effective treatment for reducing pain, number of trigger points, sensitivity, and kinesiophobia in patients with chronic low-back pain caused by lumbar disc hernia.

Maternal and Early-Life Circadian Disruption Have Long-Lasting Negative Consequences on Offspring Development and Adult Behavior in Mice.

PubMed

Smarr, Benjamin L; Grant, Azure D; Perez, Luz; Zucker, Irving; Kriegsfeld, Lance J

2017-06-12

Modern life involves chronic circadian disruption through artificial light and these disruptions are associated with numerous mental and physical health maladies. Because the developing nervous system is particularly vulnerable to perturbation, we hypothesized that early-life circadian disruption would negatively impact offspring development and adult function. Pregnant mice were subjected to chronic circadian disruption from the time of uterine implantation through weaning. To dissociate in utero from postnatal effects, a subset of litters was cross-fostered at birth from disrupted dams to control dams and vice versa. Postnatal circadian disruption was associated with reduced adult body mass, social avoidance, and hyperactivity. In utero disruption resulted in more pronounced social avoidance and hyperactivity, phenotypes not abrogated by cross-fostering to control mothers. To examine whether circadian disruption affects development by acting as an early life stressor, we examined birthweight, litter size, maternal cannibalism, and epigenetic modifications. None of these variables differed between control and disrupted dams, or resembled patterns seen following early-life stress. Our findings indicate that developmental chronic circadian disruption permanently affects somatic and behavioral development in a stage-of-life-dependent manner, independent of early life stress mechanisms, underscoring the importance of temporal structure during development, both in utero and early postnatal life.

Aging and death-associated changes in serum albumin variability over the course of chronic hemodialysis treatment.

PubMed

Nakazato, Yuichi; Kurane, Riichi; Hirose, Satoru; Watanabe, Akihisa; Shimoyama, Hiromi

2017-01-01

Several epidemiological studies have demonstrated associations between variability in a number of biological parameters and adverse outcomes. As the variability may reflect impaired homeostatic regulation, we assessed albumin variability over time in chronic hemodialysis (HD) patients. Data from 1346 subjects who received chronic HD treatment from May 2001 to February 2015 were analyzed according to three phases of HD treatment: post-HD initiation, during maintenance HD treatment, and before death. The serum albumin values were grouped according to the time interval from HD initiation or death, and the yearly trends for both the albumin levels and the intra-individual albumin variability (quantified by the residual coefficient of variation: Alb-rCV) were examined. The HD initiation and death-associated changes were also analyzed using generalized additive mixed models. Furthermore, the long-term trend throughout the maintenance treatment period was evaluated separately using linear regression models. Albumin levels and variability showed distinctive changes during each of the 3 periods. After HD initiation, albumin variability decreased and reached a nadir within a year. During the subsequent maintenance treatment period (interquartile range = 5.2-11.0 years), the log Alb-rCV showed a significant upward trend (mean slope: 0.011 ± 0.035 /year), and its overall mean was -1.49 ± 0.08 (equivalent to an Alb-rCV of 3.22%). During the 1-2 years before death, this upward trend clearly accelerated, and the mean log Alb-rCV in the last year of life was -1.36 ± 0.17. The albumin levels and variability were negatively correlated with each other and exhibited exactly opposite movements throughout the course of chronic HD treatment. Different from the albumin levels, albumin variability was not dependent on chronological age but was independently associated with an individual's aging and death process. The observed upward trend in albumin variability seems to be consistent with a presumed aging-related decline in homeostatic capacity.

Frailty among rural elderly adults

PubMed Central

2014-01-01

Background This study aimed to estimate the prevalence and associated factors related to frailty, by Fried criteria, in the elderly population in a rural area in the Andes Mountains, and to analyze the relationship of these with comorbidity and disability. Methods A cross-sectional study was undertaken involving 1878 participants 60 years of age and older. The frailty syndrome was diagnosed based on the Fried criteria (weakness, low speed, low physical activity, exhaustion, and weight loss). Variables were grouped as theoretical domains and, along with other potential confounders, were placed into five categories: (a) demographic and socioeconomic status, (b) health status, (c) self-reported functional status, (d) physical performance-based measures, and (e) psychosocial factors. Chi-square, ANOVA, and multinomial logistic regression analyses were used to test the prognostic value of frailty for the outcomes of interest. Results The prevalence of frailty was 12.2%. Factors associated with frailty were age, gender, health status variables that included self-perceived health and number of chronic conditions, functional covariate variables that included disability in activities in daily living (ADL), disabilities in instrumental ADL, chair stand time, and psychosocial variables that included depressive symptoms and cognitive impairment. Higher comorbidity and disability was found in frail elderly people. Only a subset of frail elderly people (10%) reported no disease or disability. Conclusions A relevant number of elderly persons living in rural areas in the Andes Mountains are frail. The prevalence of frailty is similar to that reported in other populations in the Latin American region. Our results support the use of modified Cardiovascular Health Study criteria to measure frailty in communities other than urban settings. Frailty in this study was strongly associated with comorbidities, and frailty and comorbidity predicted disability. PMID:24405584

A systematic review of the evidence for Canada's Physical Activity Guidelines for Adults

PubMed Central

2010-01-01

This systematic review examines critically the scientific basis for Canada's Physical Activity Guide for Healthy Active Living for adults. Particular reference is given to the dose-response relationship between physical activity and premature all-cause mortality and seven chronic diseases (cardiovascular disease, stroke, hypertension, colon cancer, breast cancer, type 2 diabetes (diabetes mellitus) and osteoporosis). The strength of the relationship between physical activity and specific health outcomes is evaluated critically. Literature was obtained through searching electronic databases (e.g., MEDLINE, EMBASE), cross-referencing, and through the authors' knowledge of the area. For inclusion in our systematic review articles must have at least 3 levels of physical activity and the concomitant risk for each chronic disease. The quality of included studies was appraised using a modified Downs and Black tool. Through this search we identified a total of 254 articles that met the eligibility criteria related to premature all-cause mortality (N = 70), cardiovascular disease (N = 49), stroke (N = 25), hypertension (N = 12), colon cancer (N = 33), breast cancer (N = 43), type 2 diabetes (N = 20), and osteoporosis (N = 2). Overall, the current literature supports clearly the dose-response relationship between physical activity and the seven chronic conditions identified. Moreover, higher levels of physical activity reduce the risk for premature all-cause mortality. The current Canadian guidelines appear to be appropriate to reduce the risk for the seven chronic conditions identified above and all-cause mortality. PMID:20459783

Effects of mindfulness meditation on chronic pain: a randomized controlled trial.

PubMed

la Cour, Peter; Petersen, Marian

2015-04-01

This randomized controlled clinical trial investigated the effects of mindfulness meditation on chronic pain. A total of 109 patients with nonspecific chronic pain were randomized to either a standardized mindfulness meditation program (mindfulness-based stress reduction [MBSR]) or to a wait list control. Pain, physical function, mental function, pain acceptance, and health-related quality of life were measured. The SF36 vitality scale was chosen as the primary outcome measure; the primary end point was after completing the MBSR course. Within a 2.5-year period, 43 of the 109 randomized patients completed the mindfulness program, while 47 remained in the control group. Data were compared at three time points: at baseline, after completion of the course/waiting period, and at the 6-month follow-up. Significant effect (Cohen's d = 0.39) was found on the primary outcome measure, the SF36 vitality scale. On the secondary variables, significant medium to large size effects (Cohen's d = 0.37-0.71) were found for lower general anxiety and depression, better mental quality of life (psychological well-being), feeling in control of the pain, and higher pain acceptance. Small (nonsignificant) effect sizes were found for pain measures. There were no significant differences in the measures just after the intervention vs the 6-month follow-up. A standardized mindfulness program (MBSR) contributes positively to pain management and can exert clinically relevant effects on several important dimensions in patients with long-lasting chronic pain. © 2014 American Academy of Pain Medicine.

Exhaled breath condensate pH and cysteinyl leukotriens in patients with chronic cough secondary to acid gastroesophageal reflux.

PubMed

Heffler, Enrico; Crimi, Claudia; Brussino, Luisa; Nicola, Stefania; Sichili, Stefania; Dughera, Luca; Rolla, Giovanni; Crimi, Nunzio

2016-12-22

Chronic cough is one of the most common clinical problems and it may be secondary to different stimuli and diseases, including low-level physical and chemical stimulation of the esophageal-bronchial reflex, suggestive of cough-reflex hyperresponsiveness, in patients with gastroesophageal reflux; however, it is still debated whether gastroesophageal reflux could induce airway inflammation and acidification. The aim of this study was to investigate airway pH and cysteynil-leukotrienes (Cys-LTs) concentration (a marker of airway inflammation) in exhaled breath condensate (EBC). Patients with chronic cough and for which all known causes, excluding gastroesophageal reflux, had been investigated and ruled out, were enrolled in the study. All patients underwent 24 h pH monitoring, and EBC was collected to assess pH and Cys-LTs concentration. Forty-five patients were included in the study and those with gastroesophageal reflux had significantly lower EBC-pH and higher concentration of EBC-Cys-LTs. There was a linear inverse correlation between EBC-pH values and EBC-Cys-LTs logarithmically transformed, and a multivariate analysis confirmed that the only significant determinat variable of EBC-Cys-LTs was the presence of gastroesophageal reflux. This study adds knowledge on possible mechanisms related to chronic cough associated with gastroesophageal reflux, which seems to be strictly dependent on airway acidification and the production of Cys-LTs, therefore suggesting an underlying neurogenic inflammation with tachykinins involvement.

Can a self-administered questionnaire identify workers with chronic or recurring low back pain?

PubMed Central

TAKEKAWA, Karina Satiko; GONÇALVES, Josiane Sotrate; MORIGUCHI, Cristiane Shinohara; COURY, Helenice Jane Cote Gil; SATO, Tatiana de Oliveira

2015-01-01

To verify if the Nordic Musculoskeletal Questionnaire (NMQ), Visual Analogue Scale (VAS), Roland-Morris Disability Questionnaire (RDQ) and physical examination of the lumbar spine can identify workers with chronic or recurring low back pain, using health history for reference. Fifty office workers of both sexes, aged between 19 and 55 yr, were evaluated using a standardized physical examination and the NMQ, VAS and RDQ. Discriminant analysis was performed to determine the discriminant properties of these instruments. A higher success rate (94%) was observed in the model including only the NMQ and in the model including the NMQ and the physical examination. The lowest success rate (82%) was observed in the model including the NMQ, RDQ and VAS. The NMQ was able to detect subjects with chronic or recurring low back pain with 100% sensitivity and 88% specificity. The NMQ appears to be the best instrument for identifying subjects with chronic or recurring low back pain. Thus, this self-reported questionnaire is suitable for screening workers for chronic or recurring low back pain in occupational settings. PMID:25810448

Biological mechanisms underlying the role of physical fitness in health and resilience

PubMed Central

Silverman, Marni N.; Deuster, Patricia A.

2014-01-01

Physical fitness, achieved through regular exercise and/or spontaneous physical activity, confers resilience by inducing positive psychological and physiological benefits, blunting stress reactivity, protecting against potentially adverse behavioural and metabolic consequences of stressful events and preventing many chronic diseases. In this review, we discuss the biological mechanisms underlying the beneficial effects of physical fitness on mental and physical health. Physical fitness appears to buffer against stress-related disease owing to its blunting/optimizing effects on hormonal stress responsive systems, such as the hypothalamic–pituitary–adrenal axis and the sympathetic nervous system. This blunting appears to contribute to reduced emotional, physiological and metabolic reactivity as well as increased positive mood and well-being. Another mechanism whereby regular exercise and/or physical fitness may confer resilience is through minimizing excessive inflammation. Chronic psychological stress, physical inactivity and abdominal adiposity have been associated with persistent, systemic, low-grade inflammation and exert adverse effects on mental and physical health. The anti-inflammatory effects of regular exercise/activity can promote behavioural and metabolic resilience, and protect against various chronic diseases associated with systemic inflammation. Moreover, exercise may benefit the brain by enhancing growth factor expression and neural plasticity, thereby contributing to improved mood and cognition. In summary, the mechanisms whereby physical fitness promotes increased resilience and well-being and positive psychological and physical health are diverse and complex. PMID:25285199

Biological mechanisms underlying the role of physical fitness in health and resilience.

PubMed

Silverman, Marni N; Deuster, Patricia A

2014-10-06

Physical fitness, achieved through regular exercise and/or spontaneous physical activity, confers resilience by inducing positive psychological and physiological benefits, blunting stress reactivity, protecting against potentially adverse behavioural and metabolic consequences of stressful events and preventing many chronic diseases. In this review, we discuss the biological mechanisms underlying the beneficial effects of physical fitness on mental and physical health. Physical fitness appears to buffer against stress-related disease owing to its blunting/optimizing effects on hormonal stress responsive systems, such as the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. This blunting appears to contribute to reduced emotional, physiological and metabolic reactivity as well as increased positive mood and well-being. Another mechanism whereby regular exercise and/or physical fitness may confer resilience is through minimizing excessive inflammation. Chronic psychological stress, physical inactivity and abdominal adiposity have been associated with persistent, systemic, low-grade inflammation and exert adverse effects on mental and physical health. The anti-inflammatory effects of regular exercise/activity can promote behavioural and metabolic resilience, and protect against various chronic diseases associated with systemic inflammation. Moreover, exercise may benefit the brain by enhancing growth factor expression and neural plasticity, thereby contributing to improved mood and cognition. In summary, the mechanisms whereby physical fitness promotes increased resilience and well-being and positive psychological and physical health are diverse and complex.

Mechanisms of physical activity limitation in chronic lung diseases.

PubMed

Vogiatzis, Ioannis; Zakynthinos, George; Andrianopoulos, Vasileios

2012-01-01

In chronic lung diseases physical activity limitation is multifactorial involving respiratory, hemodynamic, and peripheral muscle abnormalities. The mechanisms of limitation discussed in this paper relate to (i) the imbalance between ventilatory capacity and demand, (ii) the imbalance between energy demand and supply to working respiratory and peripheral muscles, and (iii) the factors that induce peripheral muscle dysfunction. In practice, intolerable exertional symptoms (i.e., dyspnea) and/or leg discomfort are the main symptoms that limit physical performance in patients with chronic lung diseases. Furthermore, the reduced capacity for physical work and the adoption of a sedentary lifestyle, in an attempt to avoid breathlessness upon physical exertion, cause profound muscle deconditioning which in turn leads to disability and loss of functional independence. Accordingly, physical inactivity is an important component of worsening the patients' quality of life and contributes importantly to poor prognosis. Identifying the factors which prevent a patient with lung disease to easily carry out activities of daily living provides a unique as well as important perspective for the choice of the appropriate therapeutic strategy.

Validation of the PROMIS® measures of self-efficacy for managing chronic conditions.

PubMed

Gruber-Baldini, Ann L; Velozo, Craig; Romero, Sergio; Shulman, Lisa M

2017-07-01

The Patient-Reported Outcomes Measurement Information System ® (PROMIS ® ) was designed to develop, validate, and standardize item banks to measure key domains of physical, mental, and social health in chronic conditions. This paper reports the calibration and validation testing of the PROMIS Self-Efficacy for Managing Chronic Conditions measures. PROMIS Self-Efficacy for Managing Chronic Conditions item banks comprise five domains, Self-Efficacy for Managing: Daily Activities, Symptoms, Medications and Treatments, Emotions, and Social Interactions. Banks were calibrated in 1087 subjects from two data sources: 837 patients with chronic neurologic conditions (epilepsy, multiple sclerosis, neuropathy, Parkinson disease, and stroke) and 250 subjects from an online Internet sample of adults with general chronic conditions. Scores were compared with one legacy scale: Self-Efficacy for Managing Chronic Disease 6-Item scale (SEMCD6) and five PROMIS short forms: Global Health (Physical and Mental), Physical Function, Fatigue, Depression, and Anxiety. The sample was 57% female, mean age = 53.8 (SD = 14.7), 76% white, 21% African American, 6% Hispanic, and 76% with greater than high school education. Full-item banks were created for each domain. All measures had good internal consistency and correlated well with SEMCD6 (r  = 0.56-0.75). Significant correlations were seen between the Self-Efficacy measures and other PROMIS short forms (r  > 0.38). The newly developed PROMIS Self-Efficacy for Managing Chronic Conditions measures include five domains of self-efficacy that were calibrated across diverse chronic conditions and show good internal consistency and cross-sectional validity.

Quality of life in patients receiving telemedicine enhanced chronic heart failure disease management: A meta-analysis.

PubMed

Knox, Liam; Rahman, Rachel J; Beedie, Chris

2017-08-01

Background Previous reviews have investigated the effectiveness of telemedicine in the treatment of heart failure (HF). Dependent variables have included hospitalisations, mortality rates, disease knowledge and health costs. Few reviews, however, have examined the variable of health-related quality of life (QoL). Methods Randomised controlled trials comparing the delivery methods of any form of telemedicine with usual care for the provision of HF disease-management were identified via searches of all relevant databases and reference lists. Studies had to report a quantitative measure for mental, physical or overall QoL in order to be included. Results A total of 33 studies were identified. However, poor reporting of data resulted in the exclusion of seven, leaving 26 studies with 7066 participants. Three separate, random effects meta-analyses were conducted for mental, physical and overall QoL. Telemedicine was not significantly more effective than usual care on mental and physical QoL (standardised mean difference (SMD) 0.03, (95% confidence interval (CI) -0.05-0.12), p = 0.45 and SMD 0.24, (95% CI -0.08-0.56), p = 0.14, respectively). However, when compared to usual care, telemedicine was associated with a small significant increase in overall QoL (SMD 0.23, (95% CI 0.09-0.37), p = 0.001). Moderator analyses indicated that telemedicine delivered over a long-duration (≥52 weeks) and via telemonitoring was most beneficial. Conclusion Compared to usual care, telemedicine significantly increases overall QoL in patients receiving HF disease management. Statistically non-significant but nonetheless positive trends were also observed for physical QoL. These findings provide preliminary support for the use of telemedicine in the management of heart failure without jeopardising patient well-being.

Comparison of hemodynamic and nutritional parameters between older persons practicing regular physical activity, nonsmokers and ex-smokers.

PubMed

Francisco, Cristina O; Ricci, Natalia A; Rebelatto, Marcelo N; Rebelatto, José R

2010-11-01

Sedentary lifestyle combined with smoking, contributes to the development of a set of chronic diseases and to accelerating the course of aging. The aim of the study was to compare the hemodynamic and nutritional parameters between elderly persons practicing regular physical activity, nonsmokers and ex-smokers. The sample was comprised of 40 elderly people practicing regular physical activity for 12 months, divided into a Nonsmoker Group and an Ex-smoker Group. During a year four trimestrial evaluations were performed, in which the hemodynamic (blood pressure, heart rate- HR and VO2) and nutritional status (measured by body mass index) data were collected. The paired t-test and t-test for independent samples were applied in the intragroup and intergroup analysis, respectively. The mean age of the groups was 68.35 years, with the majority of individuals in the Nonsmoker Group being women (n = 15) and the Ex-smoker Group composed of men (n = 11). In both groups the variables studied were within the limits of normality for the age. HR was diminished in the Nonsmoker Group in comparison with the Ex-smoker Group (p = 0.045) between the first and last evaluation. In the intragroup analysis it was verified that after one year of exercise, there was significant reduction in the HR in the Nonsmoker Group (p = 0.002) and a significant increase in VO2 for the Ex-smoker Group (p = 0.010). There are no significant differences between the hemodynamic and nutritional conditions in both groups. In elderly persons practicing regular physical activity, it was observed that the studied variables were maintained over the course of a year, and there was no association with the history of smoking, except for HR and VO2.

Chronic and Acute Relational Risk Factors for Dating Aggression in Adolescence and Young Adulthood

PubMed Central

Furman, Wyndol

2016-01-01

Dating aggression is a prevalent and costly public health concern. Using a relational risk framework, this study examined acute and chronic relational risk factors (negative interactions, jealousy, support, & relationship satisfaction) and their effects on physical and psychological dating aggression. The study also examined the interaction between chronic and acute risk, allowing us to assess how changes in acute risk have differing effects depending on whether the individual is typically at higher chronic risk. A sample of 200 youth (100 female) completed seven waves of data, which spanned nine years from middle adolescence to young adulthood (M age at Wave 1 = 15.83). Using hierarchical linear modeling, analyses revealed both acute (within-person) and chronic (between-person) levels in jealousy, negative interactions, and relationship satisfaction, were associated with physical and psychological dating aggression. Significant interactions between chronic and acute risk emerged in predicting physical aggression for negative interactions, jealousy, and relationship satisfaction such that those with higher levels of chronic risk are more vulnerable to increases in acute risk. These interactions between chronic and acute risk indicate that risk is not static, and dating aggression is particularly likely to occur at certain times for youth at high risk for dating aggression. Such periods of increased risk may provide opportunities for interventions to be particularly effective in preventing dating aggression or its consequences. Taken together, these findings provide support for the role of relational risk factors for dating aggression. They also underscore the importance of considering risk dynamically. PMID:26832727

Chronic and Acute Relational Risk Factors for Dating Aggression in Adolescence and Young Adulthood.

PubMed

Collibee, Charlene; Furman, Wyndol

2016-04-01

Dating aggression is a prevalent and costly public health concern. Using a relational risk framework, this study examined acute and chronic relational risk factors (negative interactions, jealousy, support, and relationship satisfaction) and their effects on physical and psychological dating aggression. The study also examined the interaction between chronic and acute risk, allowing us to assess how changes in acute risk have differing effects depending on whether the individual is typically at higher chronic risk. A sample of 200 youth (100 female) completed seven waves of data, which spanned 9 years from middle adolescence to young adulthood (M age at Wave 1 = 15.83). Using hierarchical linear modeling, analyses revealed both acute (within-person) and chronic (between-person) levels in jealousy, negative interactions, and relationship satisfaction, were associated with physical and psychological dating aggression. Significant interactions between chronic and acute risk emerged in predicting physical aggression for negative interactions, jealousy, and relationship satisfaction such that those with higher levels of chronic risk are more vulnerable to increases in acute risk. These interactions between chronic and acute risk indicate that risk is not static, and dating aggression is particularly likely to occur at certain times for youth at high risk for dating aggression. Such periods of increased risk may provide opportunities for interventions to be particularly effective in preventing dating aggression or its consequences. Taken together, these findings provide support for the role of relational risk factors for dating aggression. They also underscore the importance of considering risk dynamically.

Psychological predictors of pain severity, pain interference, depression, and anxiety in rheumatoid arthritis patients with chronic pain.

PubMed

Ryan, Seamus; McGuire, Brian

2016-05-01

Rheumatoid arthritis is a chronic and progressive autoimmune disorder with symptoms sometimes including chronic pain and depression. The current study aimed to explore some of the psychological variables which predict both pain-related outcomes (pain severity and pain interference) and psychological outcomes (depression and anxiety) amongst patients with rheumatoid arthritis experiencing chronic pain. In particular, this study aimed to establish whether either self-concealment, or the satisfaction of basic psychological needs (autonomy, relatedness, and competence), could explain a significant portion of the variance in pain outcomes and psychological outcomes amongst this patient group. Online questionnaires were completed by 317 rheumatoid arthritis patients with chronic pain, providing data across a number of predictor and outcome variables. Hierarchical multiple linear regressions indicated that the predictive models for each of the four outcome variables were significant, and had good levels of fit with the data. In terms of individual predictor variables, higher relatedness significantly predicted lower depression, and higher autonomy significantly predicted lower anxiety. The model generated by this study may identify factors to be targeted by future interventions with the goal of reducing depression and anxiety amongst patients with rheumatoid arthritis experiencing chronic pain. The findings of this study have shown that the autonomy and the relatedness of patients with rheumatoid arthritis play important roles in promoting psychological well-being. Targeted interventions could help to enhance the lives of patients despite the presence of chronic pain. What is already known about the subject? Amongst a sample of chronic pain patients who primarily had a diagnosis of fibromyalgia, it was found that higher levels of self-concealment were associated with higher self-reported pain levels and reduced well-being (as measured by anxiety/depression), and these associations were mediated by patients' needs for autonomy not being met (Uysal & Lu, Health Psychology, 2011, 30, 606). What does this study add? For the first time amongst a rheumatoid arthritis population experiencing chronic pain, we found that higher levels of relatedness significantly predicted lower depression. For the first time amongst the same population, we found that higher levels of autonomy significantly predicted lower anxiety. © 2015 The British Psychological Society.

Factors predicting health services use among older people in China: An analysis of the China Health and Retirement Longitudinal Study 2013.

PubMed

Gong, Cathy Honge; Kendig, Hal; He, Xiaojun

2016-02-18

Rapid population ageing in China is increasing the numbers of older people who are likely to require health services in response to higher levels of poor perceived health and chronic diseases. Understanding factors influencing health services use at late life will help to plan for increasing needs for health care, reducing inequalities in health services use and releasing severe pressures on a highly variable health care system that has constrained public resources and increasing reliance on health insurance and user payments. Drawing on the nationally representative China Health and Retirement Longitudinal Study 2013 data, we apply the Andersen healthcare utilization conceptual model to binary logistic regression multivariate analyses to examine the joint predictors of physical examinations, outpatient and inpatient care among the middle-aged and elderly in China. The multivariate analyses find that both physical examinations and inpatient care rates increase significantly by age when health deteriorates. Females are less likely to use inpatient care. Significant socio-economic variations exist in healthcare utilization. Older people with higher education, communist party membership, urban residence, non-agricultural household registration, better financial situation are more likely to have physical examinations or inpatient care. Factors influencing all three types of health care utilization are household expenditure, losing a partner, having multiple chronic diseases or perceiving poor health. With activities of daily living limitations or pain increases the probability of seeing a doctor while with functional loss increases the rates of having physical examinations, but being the ethnic minorities, no social health insurance, with depression, fair or poor memory could be a barrier to having physical examinations or seeing a doctor, which might delay the early diagnose of severe health problems among these groups. Not drinking, not smoking and regular physical exercises are adaptations after having health problems. As a rapidly ageing society, in order to address the increasing needs and inequalities in health care utilization, China is facing a massive challenge to reform the current health care system, improve equitable access to health insurance and financial affordability for the most disadvantaged, as well as to provide more health education and information to the general public.

Impact of school-based vegetable garden and physical activity coordinated health interventions on weight status and weight-related behaviors of ethnically diverse, low-income students: Study design and baseline data of the Texas, Grow! Eat! Go! (TGEG) cluster-randomized controlled trial.

PubMed

Evans, A; Ranjit, N; Hoelscher, D; Jovanovic, C; Lopez, M; McIntosh, A; Ory, M; Whittlesey, L; McKyer, L; Kirk, A; Smith, C; Walton, C; Heredia, N I; Warren, J

2016-09-13

Coordinated, multi-component school-based interventions can improve health behaviors in children, as well as parents, and impact the weight status of students. By leveraging a unique collaboration between Texas AgriLife Extension (a federal, state and county funded educational outreach organization) and the University of Texas School of Public Health, the Texas Grow! Eat! Go! Study (TGEG) modeled the effectiveness of utilizing existing programs and volunteer infrastructure to disseminate an enhanced Coordinated School Health program. The five-year TGEG study was developed to assess the independent and combined impact of gardening, nutrition and physical activity intervention(s) on the prevalence of healthy eating, physical activity and weight status among low-income elementary students. The purpose of this paper is to report on study design, baseline characteristics, intervention approaches, data collection and baseline data. The study design for the TGEG study consisted of a factorial group randomized controlled trial (RCT) in which 28 schools were randomly assigned to one of 4 treatment groups: (1) Coordinated Approach to Child Health (CATCH) only (Comparison), (2) CATCH plus school garden intervention [Learn, Grow, Eat & Go! (LGEG)], (3) CATCH plus physical activity intervention [Walk Across Texas (WAT)], and (4) CATCH plus LGEG plus WAT (Combined). The outcome variables include student's weight status, vegetable and sugar sweetened beverage consumption, physical activity, and sedentary behavior. Parents were assessed for home environmental variables including availability of certain foods, social support of student health behaviors, parent engagement and behavior modeling. Descriptive data are presented for students (n = 1369) and parents (n = 1206) at baseline. The sample consisted primarily of Hispanic and African American (53 % and 18 %, respectively) and low-income (i.e., 78 % eligible for Free and Reduced Price School Meals program and 43 % food insecure) students. On average, students did not meet national guidelines for vegetable consumption or physical activity. At baseline, no statistical differences for demographic or key outcome variables among the 4 treatment groups were observed. The TGEG study targets a population of students and parents at high risk of obesity and related chronic conditions, utilizing a novel and collaborative approach to program formulation and delivery, and a rigorous, randomized study design.

Chronic kidney disease-related physical frailty and cognitive impairment: a systemic review.

PubMed

Shen, Zhiyuan; Ruan, Qingwei; Yu, Zhuowei; Sun, Zhongquan

2017-04-01

The objective of this review was to assess chronic kidney disease-related frailty and cognitive impairment, as well as their probable causes, mechanisms and the interventions. Studies from 1990 to 2015 were reviewed to evaluate the relationship between chronic kidney disease and physical frailty and cognitive impairment. Of the 1694 studies from the initial search, longitudinal studies (n = 22) with the keywords "Cognitive and CKD" and longitudinal or cross-sectional studies (n = 5) with the keywords "Frailty and CKD" were included in final analysis. By pooling current research, we show clear evidence for a relationship between chronic kidney disease and frailty and cognitive impairment in major studies. Vascular disease is likely an important mediator, particularly for cognitive impairment. However, non-vascular factors also play an important role. Many of the other mechanisms that contribute to impaired cognitive function and increased frailty in CKD remain to be elucidated. In limited studies, medication therapy did not obtain the ideal effect. There are limited data on treatment strategies, but addressing the vascular disease risk factors earlier in life might decrease the subsequent burden of frailty and cognitive impairment in this population. Multidimensional interventions, which address both microvascular health and other factors, may have substantial benefits for both the cognitive impairments and physical frailty in this vulnerable population. Chronic kidney disease is a potential cause of frailty and cognitive impairment. Vascular and non-vascular factors are the possible causes. The mechanism of chronic kidney disease-induced physical frailty and cognitive impairment suggests that multidimensional interventions may be effective therapeutic strategies in the early stage of chronic kidney disease. Geriatr Gerontol Int 2017; 17: 529-544. © 2016 Japan Geriatrics Society.

An ICON Overview on Physical Modalities for Neck Pain and Associated Disorders

PubMed Central

Graham, Nadine; Gross, Anita R; Carlesso, Lisa C; Santaguida, P. Lina; MacDermid, Joy C; Walton, Dave; Ho, Enoch

2013-01-01

Introduction: Neck pain is common, can be disabling and is costly to society. Physical modalities are often included in neck rehabilitation programs. Interventions may include thermal, electrotherapy, ultrasound, mechanical traction, laser and acupuncture. Definitive knowledge regarding optimal modalities and dosage for neck pain management is limited. Purpose: To systematically review existing literature to establish the evidence-base for recommendations on physical modalities for acute to chronic neck pain. Methods: A comprehensive computerized and manual search strategy from January 2000 to July 2012, systematic review methodological quality assessment using AMSTAR, qualitative assessment using a GRADE approach and recommendation presentation was included. Systematic or meta-analyses of studies evaluating physical modalities were eligible. Independent assessment by at least two review team members was conducted. Data extraction was performed by one reviewer and checked by a second. Disagreements were resolved by consensus. Results: Of 103 reviews eligible, 20 were included and 83 were excluded. Short term pain relief - Moderate evidence of benefit: acupuncture, intermittent traction and laser were shown to be better than placebo for chronic neck pain. Moderate evidence of no benefit: pulsed ultrasound, infrared light or continuous traction was no better than placebo for acute whiplash associated disorder, chronic myofascial neck pain or subacute to chronic neck pain. There was no added benefit when hot packs were combined with mobilization, manipulation or electrical muscle stimulation for chronic neck pain, function or patient satisfaction at six month follow-up. Conclusions: The current state of the evidence favours acupuncture, laser and intermittent traction for chronic neck pain. Some electrotherapies show little benefit for chronic neck pain. Consistent dosage, improved design and long term follow-up continue to be the recommendations for future research. PMID:24155804

Female reproductive factors are associated with objectively measured physical activity in middle-aged women

PubMed Central

Kulmala, Janne; Aukee, Pauliina; Hakonen, Harto; Kujala, Urho M.; Lowe, Dawn A.; Kovanen, Vuokko; Tammelin, Tuija; Sipilä, Sarianna

2017-01-01

Physical activity improves health and may delay the onset of several chronic diseases. For women in particular, the rate of these diseases accelerates at middle age; therefore it is important to identify the determinants of health-enhancing physical activity during midlife in this population. In this study, we focused on determinants that are unique to the female sex, such as childbearing and menopause. The main objective was to characterize the level of physical activity and differences between active and inactive middle-aged Finnish women. In addition, we examined the association of physical activity with female reproductive factors at midlife. The study population consisted of 647 women aged 48 to 55 years who participated in our Estrogenic Regulation of Muscle Apoptosis (ERMA) study during the period from 2015 to 2016. Physical activity was measured objectively using hip-worn accelerometers for seven consecutive days. The outcome measures included the amounts of light intensity physical activity and moderate to vigorous intensity physical activity accumulated in bouts of at least 10 minutes (MVPA10). MVPA10 was used to determine whether women were placed in the active (≥150 min/week) or inactive (<150 min/week) group. Multiple linear regression models were performed with physical activity measures as dependent variables and cumulative reproductive history index, menopausal symptoms, and pelvic floor dysfunction as independent variables. We found that a large portion (61%) of Finnish middle-aged women did not meet the physical activity recommendations of 150 minutes of MVPA10 per week. In the studied cohort, 78% of women experienced menopausal symptoms, and 54% exhibited pelvic floor dysfunction. Perceived menopausal symptoms were associated with greater light physical activity. Perceived pelvic floor dysfunction was associated with lower MVPA10. According to the fully adjusted multiple linear regression models, reproductive factors explained 6.0% of the variation of MVPA10 and 7.5% of the variation of light physical activity. The results increase our knowledge of the factors related to physical activity participation among middle-aged women and indicate that menopausal symptoms and pelvic floor dysfunction should be identified and considered when promoting physical activity for women during midlife. The results emphasize that awareness of female reproductive factors, especially menopausal symptoms and pelvic floor dysfunction, is important for physical activity counseling to effectively help women in performing and sustaining health-enhancing amounts of physical activity. Specifically, the condition of the pelvic floor should be taken into account when identifying the proper activity type and intensity level so that health benefits of physical activity can still be attained without worsening symptoms. PMID:28225786

Activity characteristics and movement patterns in people with and people without low back pain who participate in rotation-related sports

PubMed Central

Chimenti, Ruth L.; Scholtes, Sara A.

2013-01-01

Many risk factors have been identified as contributing to the development or persistence of low back pain (LBP). However, the juxtaposition of both high and low levels of physical activity being associated with LBP reflects the complexity of the relationship between a risk factor and LBP. Moreover, not everyone with an identified risk factor, such as a movement pattern of increased lumbopelvic rotation, has LBP. Objective The purpose of this study was to examine differences in activity level and movement patterns between people with and people without chronic or recurrent LBP who participate in rotation-related sports. Design Case Case-control study. Setting University laboratory environment. Participants 52 people with chronic or recurrent LBP and 25 people without LBP who all play a rotation-related sport. Main Outcome Measures Participants completed self-report measures including the Baecke Habitual Activity Questionnaire and a questionnaire on rotation-related sports. A 3-dimensional motion-capture system was used to collect movement-pattern variables during 2 lower-limb-movement tests. Results Compared with people without LBP, people with LBP reported a greater difference between the sport subscore and an average work and leisure composite subscore on the Baecke Habitual Activity Questionnaire (F = 6.55, P = .01). There were no differences between groups in either rotation-related-sport participation or movement-pattern variables demonstrated during 2 lower-limb movement tests (P > .05 for all comparisons). Conclusions People with and people without LBP who regularly play a rotation-related sport differed in the amount and nature of activity participation but not in movement pattern variables. An imbalance between level of activity during sport and daily functions may contribute to the development or persistence of LBP in people who play a rotation-related sport. PMID:23295458

Variables associated with sleep quality in chronic tension-type headache: A cross-sectional and longitudinal design.

PubMed

Benito-González, Elena; Palacios-Ceña, Maria; Fernández-Muñoz, Juan J; Castaldo, Matteo; Wang, Kelun; Catena, Antonella; Arendt-Nielsen, Lars; Fernández-de-Las-Peñas, César

2018-01-01

To investigate variables associated at baseline (cross-sectional design) and at one year (longitudinal design) with the quality of sleep in chronic tension-type headache (CTTH). One hundred and eighty (n = 180) and 135 individuals with CTTH participated in the cross-sectional and longitudinal design respectively. Clinical features were collected with a 4-weeks headache diary at baseline and one-year follow-up. Sleep quality was assessed at baseline and 1-year follow-up with the Pittsburgh Sleep Quality Index. Anxiety and depression (Hospital Anxiety and Depression Scale-HADS), burden of headache (Headache Disability Inventory-HDI), quality of life (SF-36 questionnaire), and pressure pain thresholds (PPTs) at trigeminal, extra-trigeminal and widespread area were assessed at baseline. Hierarchical regression analyses were conducted to determine the associations between variables at baseline and 1-year follow-up with sleep quality. At baseline positive correlations between sleep quality and headache intensity, headache frequency, headache duration, emotional and physical burden of headache and depression were observed. The regression analyses found that depression and emotional burden of headache explained 27.5% of the variance in sleep quality at baseline (r2 = .262; F = 23.72 P < .001). At one-year, sleep quality was significantly associated with baseline burden of headache, depression, widespread PPTs, vitality and mental health domains. Regression analyses revealed that vitality, PPT over the second metacarpal and PPT over the neck explained 30.0% of the variance of sleep quality at one-year (r2 = .269, F = 9.71, P < .001). It seems that sleep quality exhibits a complex interaction in individuals with CTTH since depression and the emotional burden were associated with sleep quality at baseline, but vitality and PPTs over extra-trigeminal areas were associated with the quality of sleep at one-year.

Educational Functioning of Children of Parents with Chronic Physical Illness: A Systematic Review

ERIC Educational Resources Information Center

Chen, Cliff Yung-Chi

2016-01-01

A systematic review of the literature was performed to answer the question: What are the effects of parental chronic physical illness on children's educational functioning? Thirteen studies that met the inclusion criteria for the purpose of this review were identified, indicating the paucity of research on the topic. The results found that…

Solving Developmental Tasks in Adolescents with a Chronic Physical Illness or Physical/Sensory Disability: A Meta-Analysis

ERIC Educational Resources Information Center

Pinquart, Martin; Pfeiffer, Jens P.

2015-01-01

Chronic illnesses and disabilities may impair the attainment of age-typical developmental tasks, such as forming relationships with peers and gaining autonomy. Based on a systematic search in electronic databases and cross-referencing, 447 quantitative empirical studies were included which compared the attainment of developmental tasks of…

Pain Expectancies, Pain, and Functional Self-Efficacy Expectancies as Determinants of Disability in Patients with Chronic Low Back Disorders.

ERIC Educational Resources Information Center

Lackner, Jeffrey M.; And Others

1996-01-01

Tested the predictive power of self-efficacy expectations of physical capabilities, expectations of pain, and expectations of reinjury on physical function in chronic back pain patients. Before assessment of function, patients rated their abilities to perform essential job tasks--functional self-efficacy (FSE)--and the likelihood working would…

Barriers and facilitators to being physically active on a rural, Northern Plains American Indian Reservation

USDA-ARS?s Scientific Manuscript database

American Indians have among the highest prevalence of obesity and chronic disease in the US. Physical activity (PA) is associated with maintenance of a healthy body weight and prevention of some chronic diseases, yet a large proportion of American Indians do not engage in any PA. The objectives of t...

The effectiveness of balneotherapy in chronic low back pain.

PubMed

Onat, Şule Şahin; Taşoğlu, Özlem; Güneri, Fulya Demircioğlu; Özişler, Zuhal; Safer, Vildan Binay; Özgirgin, Neşe

2014-01-01

The aim of this study is to determine the effectiveness of balneotherapy plus physical therapy versus only physical therapy in patients with chronic low back pain. In this trial, 81 patients with low back pain were followed up in two groups. Patients in group I (n = 44) were treated with physical therapy alone. Patients in group II (n = 37) were treated with balneotherapy in addition to the same physical therapy protocol in group I. Patients in both groups were given a home-based standardized exercise program. The following parameters were measured: visual analog scale (0-10 cm), fingertip-to-floor distance (cm), Oswestry Disability Index, and Short Form 36 quality of life scale. First evaluations were done at the time of enrollment, and second evaluations were done after accomplishment of a 3-week treatment program. There were no significant differences between the two groups for the sociodemographic features. All of the measured parameters improved in both groups. However, improvements in pain, functionality, and quality of life scores were found to be superior in the balneotherapy plus physical therapy group. For the patients with chronic low back pain, balneotherapy plus physical therapy is more effective, compared to physical therapy alone.

Physical Therapy for an Adult with Chronic Stroke after Botulinum Toxin Injection for Spasticity: A Case Report

PubMed Central

Phadke, Chetan P.; Ismail, Farooq; Boulias, Chris

2015-01-01

ABSTRACT Purpose: In this case report, we describe the type and duration of a physical therapy and botulinum toxin type A (BoNTA) intervention directed at lower limb spasticity and the gait and balance improvement in a patient post-stroke. Treatment of focal spasticity with BoNTA intramuscular injections combined with physical therapy is recommended by rehabilitation experts. However, the optimal type and duration of physical therapy intervention to optimize any functional gains that follow chemodenervation induced by BoNTA has not been established. Method: One individual with chronic stroke who received BoNTA injections for upper and lower extremity spasticity was included. Physical therapy intervention consisted of 45- to 60-min sessions twice weekly for 12 weeks, based on the Bobath–neurodevelopmental therapy approach, and an activity-based home program. Results: After BoNTA injections and physical therapy, the patient made clinically significant improvements in balance and gait speed and became more independent with his ambulation. Conclusions: This case report demonstrates that physical therapy after BoNTA injections can result in significant functional improvements for individuals with spasticity after chronic stroke that may not be possible with BoNTA injections alone. PMID:25931655

Sedentary Lifestyle and High-Carbohydrate Intake are Associated with Low-Grade Chronic Inflammation in Post-Menopause: A Cross-sectional Study.

PubMed

Alves, Bruna Cherubini; Silva, Thaís Rasia da; Spritzer, Poli Mara

2016-07-01

Introduction Cardiovascular disease (CVD) is the leading cause of death in post menopausal women, and inflammation is involved in the atherosclerosis process. Purpose to assess whether dietary pattern, metabolic profile, body composition and physical activity are associated with low-grade chronic inflammation according to high-sensitivity C-reactive protein (hs-CRP) levels in postmenopausal women. Methods ninety-five postmenopausal participants, with no evidence of clinical disease, underwent anthropometric, metabolic and hormonal assessments. Usual dietary intake was assessed with a validated food frequency questionnaire, habitual physical activity was measured with a digital pedometer, and body composition was estimated by bioelectrical impedance analysis. Patients with hs-CRP ≥10 mg/L or using hormone therapy in the last three months before the study were excluded from the analysis. Participants were stratified according to hs-CRP lower or ≥3 mg/L. Sedentary lifestyle was defined as walking fewer than 6 thousand steps a day. Two-tailed Student's t-test, Wilcoxon-Mann-Whitney U or Chi-square (χ(2)) test were used to compare differences between groups. A logistic regression model was used to estimate the odds ratio of variables for high hs-CRP. Results participants with hs-CRP ≥3 mg/L had higher body mass index (BMI), body fat percentage, waist circumference (WC), triglycerides, glucose, and homeostasis model assessment of insulin resistance (HOMA-IR) (p = 0.01 for all variables) than women with hs-CRP <3 mg/L. Also, women with hs-CRP ≥3 mg/L had a higher glycemic load diet and lower protein intake. Prevalence of sedentary lifestyle (p < 0.01) and metabolic syndrome (p < 0.01) was higher in women with hs-CRP ≥3 mg/L. After adjustment for age and time since menopause, the odds ratio for hs-CRP ≥3 mg/L was higher for sedentary lifestyle (4.7, 95% confidence interval [95%CI] 1.4-15.5) and carbohydrate intake (2.9, 95%CI 1.1-7.7). Conclusions sedentary lifestyle and high-carbohydrate intake were associated with low-grade chronic inflammation and cardiovascular risk in postmenopause. Thieme Publicações Ltda Rio de Janeiro, Brazil.

Predictors of working beyond retirement in older workers with and without a chronic disease - results from data linkage of Dutch questionnaire and registry data.

PubMed

de Wind, Astrid; Scharn, Micky; Geuskens, Goedele A; van der Beek, Allard J; Boot, Cécile R L

2018-02-17

An increasing number of retirees continue to work beyond retirement despite being eligible to retire. As the prevalence of chronic disease increases with age, working beyond retirement may go along with having a chronic disease. Working beyond retirement may be different for retirees with and without chronic disease. We aim to investigate whether demographic, socioeconomic and work characteristics, health and social factors predict working beyond retirement, in workers with and without a chronic disease. Employees aged 56-64 years were selected from the Study on Transitions in Employment, Ability and Motivation (N = 1125). Questionnaire data on demographic and work characteristics, health, social factors, and working beyond retirement were linked to registry data from Statistics Netherlands on socioeconomic characteristics. Separate prediction models were built for retirees with and without chronic disease using multivariate logistic regression analyses. Workers without chronic disease were more likely to work beyond retirement compared to workers with chronic disease (27% vs 23%). In retirees with chronic disease, work and health factors predicted working beyond retirement, while in retirees without a chronic disease, work, health and social factors predicted working beyond retirement. In the final model for workers with chronic disease, healthcare work, better physical health, higher body height, lower physical load and no permanent contract were positively predictive of working beyond retirement. In the final model for workers without chronic disease, feeling full of life and being intensively physically active for > = 2 days per week were positively predictive of working beyond retirement; while manual labor, better recovery, and a partner who did not support working until the statutory retirement age, were negatively predictive of working beyond retirement. Work and health factors independently predicted working beyond retirement in workers with and without chronic disease, whereas social factors only did so among workers without chronic disease. Demographic and socioeconomic characteristics did not independently contribute to prediction of working beyond retirement in any group. As prediction of working beyond retirement was more difficult among workers with a chronic disease, future research is needed in this group.

Neighbourhood socioeconomic deprivation and health-related quality of life: A multilevel analysis

PubMed Central

Ribeiro, Ana Isabel; Severo, Milton; Barros, Henrique; Fraga, Sílvia

2017-01-01

Objective To assess the relationship between socioeconomic deprivation and health-related quality of life in urban neighbourhoods, using a multilevel approach. Methods Of the population-based cohort EPIPorto, 1154 georeferenced participants completed the 36-Item Short-Form Health Survey. Neighbourhood socioeconomic deprivation classes were estimated using latent-class analysis. Multilevel models measured clustering and contextual effects of neighbourhood deprivation on physical and mental HRQoL. Results Residents from the least deprived neighbourhoods had higher physical HRQoL. Neighbourhood socioeconomic deprivation together with individual-level variables (age, gender and education) and health-related factors (smoking, alcohol consumption, sedentariness and chronic diseases) explained 98% of the total between-neighbourhood variance. Neighbourhood socioeconomic deprivation was significantly associated with physical health when comparing least and most deprived neighbourhoods (class 2—beta coefficient: -0.60; 95% confidence interval:-1.76;-0.56; class 3 –beta coefficient: -2.28; 95% confidence interval:-3.96;-0.60), and as neighbourhood deprivation increases, a decrease in all values of physical health dimensions (physical functioning, role physical, bodily pain and general health) was also observed. Regarding the mental health dimension, no neighbourhood clustering or contextual effects were found. However, as neighbourhood deprivation increases, the values of vitality and role emotional dimensions significantly decreased. Conclusion Neighbourhood socioeconomic deprivation is associated with HRQoL, affecting particularly physical health. This study suggests that to improve HRQoL, people and places should be targeted simultaneously. PMID:29236719

Psychological Manifestations of Early Childhood Adversity in the Context of Chronic Hematologic Malignancy.

PubMed

McFarland, Daniel C; Shen, Megan Johnson; Polizzi, Heather; Mascarenhas, John; Kremyanskaya, Marina; Holland, Jimmie; Hoffman, Ronald

Myeloproliferative neoplasms (MPNs), a group of chronic hematologic malignancies, carry significant physical and psychological symptom burdens that significantly affect patients' quality of life. We sought to identify the relationship between early childhood adversity (ECA) and psychological distress in patients with MPNs, as ECA may compound symptom burden. Patients with MPNs were assessed for ECA (i.e., the Risky Families Questionnaire-subscales include abuse/neglect/chaotic home environment), distress (i.e., Distress Thermometer and Problem List), anxiety (i.e., Hospital Anxiety and Depression Scale-Anxiety [HADS-A]), depression (i.e., Hospital Anxiety and Depression Scale-Depression [HADS-D]), meeting standardized cutoff thresholds for distress (i.e., Distress Thermometer and Problem List≥ 4 or ≥ 7)/anxiety (HADS-A ≥8)/depression (HADS-D ≥ 8), and demographic factors. A total of 117 participants completed the study (78% response rate). ECA was associated with depression (p < 0.000), anxiety (p < 0.000), and distress (p < 0.000) and problem list variables emotional (p < 0.000), physical (p = 0.004), family (p = 0.01), and spiritual (p = 0.01) by bivariate analysis and only with distress (HADS) (p = 0.038) on multivariate analysis. ECA was associated with meeting cutoff threshold criteria for distress (p = 0.007), anxiety (p = 0.001), and depression (p = 0.02). ECA subscale variables abuse and chaotic home environment were associated with psychological outcomes. ECA was higher based on disease subtypes with greater symptom burden (other > polycythemia vera > myelofibrosis > essential thrombocythemia) (p = 0.047) and taking an antidepressant (p = 0.011). ECA is associated with psychological distress and meets screening criteria for anxiety and depression in patients with MPNs. ECA may help to explain individual patient trajectories, and further understanding may enhance patient-centered care among patients with MPNs. Copyright © 2017 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Web-Based Mindfulness Interventions for People With Physical Health Conditions: Systematic Review.

PubMed

Toivonen, Kirsti I; Zernicke, Kristin; Carlson, Linda E

2017-08-31

Mindfulness-based interventions (MBIs) are becoming increasingly popular for helping people with physical health conditions. Expanding from traditional face-to-face program delivery, there is growing interest in Web-based application of MBIs, though Web-based MBIs for people with physical health conditions specifically have not been thoroughly reviewed to date. The objective of this paper was to review Web-based MBIs for people with physical health conditions and to examine all outcomes reported (eg, efficacy or effectiveness for physical changes or psychological changes; feasibility). Databases PubMed, PsycINFO, Science Direct, CINAHL Plus, and Web of Science were searched. Full-text English papers that described any Web-based MBI, examining any outcome, for people with chronic physical health conditions were included. Randomized, nonrandomized, controlled, and uncontrolled trials were all included. Extracted data included intervention characteristics, population characteristics, outcomes, and quality indicators. Intervention characteristics (eg, synchronicity and guidance) were examined as potential factors related to study outcomes. Of 435 publications screened, 19 published papers describing 16 studies were included. They examined Web-based MBIs for people with cancer, chronic pain or fibromyalgia, irritable bowel syndrome (IBS), epilepsy, heart disease, tinnitus, and acquired brain injury. Overall, most studies reported positive effects of Web-based MBIs compared with usual care on a variety of outcomes including pain acceptance, coping measures, and depressive symptoms. There were mixed results regarding the effectiveness of Web-based MBIs compared with active control treatment conditions such as cognitive behavioral therapy. Condition-specific symptoms (eg, cancer-related fatigue and IBS symptoms) targeted by treatment had the largest effect size improvements following MBIs. Results are inconclusive regarding physical variables. Preliminary evidence suggests that Web-based MBIs may be helpful in alleviating symptom burden that those with physical health conditions can experience, particularly when interventions are tailored for specific symptoms. There was no evidence of differences between synchronous versus asynchronous or facilitated versus self-directed Web-based MBIs. Future investigations of Web-based MBIs should evaluate the effects of program adherence, effects on mindfulness levels, and whether synchronous or asynchronous, or facilitated or self-directed interventions elicit greater improvements. ©Kirsti I Toivonen, Kristin Zernicke, Linda E Carlson. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 31.08.2017.

Familial Risk of Chronic Musculoskeletal Pain and the Importance of Physical Activity and Body Mass Index: Prospective Data from the HUNT Study, Norway.

PubMed

Lier, Ragnhild; Mork, Paul Jarle; Holtermann, Andreas; Nilsen, Tom Ivar Lund

2016-01-01

The main objectives of the current study was i) to prospectively examine if chronic musculoskeletal pain in parents is associated with risk of chronic musculoskeletal pain in their adult offspring, and ii) to assess if these parent-offspring associations are modified by offspring body mass index and leisure time physical activity. We used data on 4,742 adult offspring linked with their parents who participated in the population-based HUNT Study in Norway in 1995-97 and in 2006-08. Family relations were established through the national Family Registry. A Poisson regression model was used to estimate relative risk (RR) with 95% confidence interval (CI). In total, 1,674 offspring (35.3%) developed chronic musculoskeletal pain during the follow-up period of approximately 11 years. Both maternal (RR: 1.26, 95% CI: 1.03, 1.55) and paternal chronic musculoskeletal pain (RR: 1.29, 95% CI: 1.06, 1.57) was associated with increased risk of offspring chronic musculoskeletal pain. Compared to offspring of parents without chronic musculoskeletal pain, the adverse effect of parental pain was somewhat stronger among offspring who reported a low (RR: 1.82, 95% CI: 1.32, 2.52) versus high (RR: 1.32, 95% CI: 0.95, 1.84) level of leisure time physical activity. Offspring of parents with chronic musculoskeletal pain and who were classified as obese had more than twofold increased risk (RR: 2.33, 95% CI: 1.68, 3.24) of chronic musculoskeletal pain compared to normal weight offspring of parents without pain. In conclusion, parental chronic musculoskeletal pain is positively associated with risk of chronic musculoskeletal pain in their adult offspring. Maintenance of normal body weight may reduce the risk of chronic musculoskeletal pain in offspring of pain-afflicted parents.

Familial Risk of Chronic Musculoskeletal Pain and the Importance of Physical Activity and Body Mass Index: Prospective Data from the HUNT Study, Norway

PubMed Central

Lier, Ragnhild; Mork, Paul Jarle; Holtermann, Andreas; Nilsen, Tom Ivar Lund

2016-01-01

The main objectives of the current study was i) to prospectively examine if chronic musculoskeletal pain in parents is associated with risk of chronic musculoskeletal pain in their adult offspring, and ii) to assess if these parent-offspring associations are modified by offspring body mass index and leisure time physical activity. We used data on 4,742 adult offspring linked with their parents who participated in the population-based HUNT Study in Norway in 1995–97 and in 2006–08. Family relations were established through the national Family Registry. A Poisson regression model was used to estimate relative risk (RR) with 95% confidence interval (CI). In total, 1,674 offspring (35.3%) developed chronic musculoskeletal pain during the follow-up period of approximately 11 years. Both maternal (RR: 1.26, 95% CI: 1.03, 1.55) and paternal chronic musculoskeletal pain (RR: 1.29, 95% CI: 1.06, 1.57) was associated with increased risk of offspring chronic musculoskeletal pain. Compared to offspring of parents without chronic musculoskeletal pain, the adverse effect of parental pain was somewhat stronger among offspring who reported a low (RR: 1.82, 95% CI: 1.32, 2.52) versus high (RR: 1.32, 95% CI: 0.95, 1.84) level of leisure time physical activity. Offspring of parents with chronic musculoskeletal pain and who were classified as obese had more than twofold increased risk (RR: 2.33, 95% CI: 1.68, 3.24) of chronic musculoskeletal pain compared to normal weight offspring of parents without pain. In conclusion, parental chronic musculoskeletal pain is positively associated with risk of chronic musculoskeletal pain in their adult offspring. Maintenance of normal body weight may reduce the risk of chronic musculoskeletal pain in offspring of pain-afflicted parents. PMID:27082110

Changes in autonomy, job demands and working hours after diagnosis of chronic disease: a comparison of employed and self-employed older persons using the English Longitudinal Study of Ageing (ELSA).

PubMed

Fleischmann, Maria; Carr, Ewan; Xue, Baowen; Zaninotto, Paola; Stansfeld, Stephen A; Stafford, Mai; Head, Jenny

2018-06-23

Modifications in working conditions can accommodate changing needs of chronically ill persons. The self-employed may have more possibilities than employees to modify their working conditions. We investigate how working conditions change following diagnosis of chronic disease for employed and self-employed older persons. We used waves 2-7 from the English Longitudinal Study of Ageing (ELSA). We included 1389 participants aged 50-60 years who reported no chronic disease at baseline. Using fixed-effects linear regression analysis, we investigated how autonomy, physical and psychosocial job demands and working hours changed following diagnosis of chronic disease. For employees, on diagnosis of chronic disease autonomy marginally decreased (-0.10, 95% CI -0.20 to 0.00) and physical job demands significantly increased (0.13, 95% CI 0.01 to 0.25), whereas for the self-employed autonomy did not significantly change and physical job demands decreased on diagnosis of chronic disease (-0.36, 95% CI -0.64 to -0.07), compared with prediagnosis levels. Psychosocial job demands did not change on diagnosis of chronic disease for employees or the self-employed. Working hours did not change for employees, but dropped for self-employed (although non-significantly) by about 2.8 hours on diagnosis of chronic disease (-2.78, 95% CI -6.03 to 0.48). Improvements in working conditions after diagnosis of chronic disease were restricted to the self-employed. This could suggest that workplace adjustments are necessary after diagnosis of chronic disease, but that the self-employed are more likely to realise these. Policy seeking to extend working life should consider work(place) adjustments for chronically ill workers as a means to prevent early exit from work. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Food environment and fruit and vegetable intake in a urban population: a multilevel analysis.

PubMed

Pessoa, Milene Cristine; Mendes, Larissa Loures; Gomes, Crizian Saar; Martins, Paula Andréa; Velasquez-Melendez, Gustavo

2015-10-05

Environmental, social and individual factors influence eating patterns, which in turn affect the risk of many chronic diseases. This study aimed to estimate associations between environmental factors and the consumption of fruit and vegetables among adults in a Brazilian urban context. Data from the surveillance system for risk factors for chronic diseases (VIGITEL) of Brazilian Ministry of Health were used. A cross-sectional telephone survey (VIGITEL - 2008-2010) was carried out with 5826 adults in the urban area of Belo Horizonte. Individual variables were collected. The frequency of fruit and vegetables consumption was assessed from number of servings, weekly frequency and an intake score was calculated. Georeferenced variables were used to characterize the food environment. The density of healthy food outlets (stores specialized in selling fruit and vegetables), unhealthy food outlets (bars, snack bars and food trucks/trailers) and the neighborhood family income were investigated and associated with fruit and vegetables intake score. Weighted multilevel linear regression was used to evaluate the associations between the environment variables and the fruit and vegetables intake score. Higher fruit and vegetables intake scores were observed in neighborhoods with higher density of healthy food outlets and higher income. Lower scores were observed in neighborhood with higher density of unhealthy food outlets. These associations were adjusted by individual variables such as gender, age, physical activity, sugar sweetened beverages consumption, education level and smoking. The food environment might explain some of the socioeconomic disparities with respect to healthy food intake and health outcomes. Healthy food stores are less common in socially disadvantaged neighborhoods, and therefore, healthy foods such as fruits and vegetables are less available or are of a lower quality in lower income areas. Food environment characteristics and neighborhood socioeconomic level had significant associations with fruit and vegetable intake score. These are initial findings that require further investigation within the middle income world populations and the role of the environment with respect to both healthy and unhealthy food acquisition and intake.

Contribution of Modis Satellite Image to Estimate the Daily Air Temperature in the Casablanca City, Morocco

NASA Astrophysics Data System (ADS)

Bahi, Hicham; Rhinane, Hassan; Bensalmia, Ahmed

2016-10-01

Air temperature is considered to be an essential variable for the study and analysis of meteorological regimes and chronics. However, the implementation of a daily monitoring of this variable is very difficult to achieve. It requires sufficient of measurements stations density, meteorological parks and favourable logistics. The present work aims to establish relationship between day and night land surface temperatures from MODIS data and the daily measurements of air temperature acquired between [2011-20112] and provided by the Department of National Meteorology [DMN] of Casablanca, Morocco. The results of the statistical analysis show significant interdependence during night observations with correlation coefficient of R2=0.921 and Root Mean Square Error RMSE=1.503 for Tmin while the physical magnitude estimated from daytime MODIS observation shows a relatively coarse error with R2=0.775 and RMSE=2.037 for Tmax. A method based on Gaussian process regression was applied to compute the spatial distribution of air temperature from MODIS throughout the city of Casablanca.

A brief review and clinical application of heart rate variability biofeedback in sports, exercise, and rehabilitation medicine.

PubMed

Prinsloo, Gabriell E; Rauch, H G Laurie; Derman, Wayne E

2014-05-01

An important component of the effective management of chronic noncommunicable disease is the assessment and management of psychosocial stress. The measurement and modulation of heart rate variability (HRV) may be valuable in this regard. To describe the measurement and physiological control of HRV; to describe the impact of psychosocial stress on cardiovascular disease, metabolic syndrome, and chronic respiratory disease, and the relationship between these diseases and changes in HRV; and to describe the influence of biofeedback and exercise on HRV and the use of HRV biofeedback in the management of chronic disease. The PubMed, Medline, and Embase databases were searched (up to August 2013). Additional articles were obtained from the reference lists of relevant articles and reviews. Articles were individually selected for further review based on the quality and focus of the study, and the population studied. Heart rate variability is reduced in stress and in many chronic diseases, and may even predict the development and prognosis of some diseases. Heart rate variability can be increased with both exercise and biofeedback. Although the research on the effect of exercise is conflicting, there is evidence that aerobic training may increase HRV and cardiac vagal tone both in healthy individuals and in patients with disease. Heart rate variability biofeedback is also an effective method of increasing HRV and cardiac vagal tone, and has been shown to decrease stress and reduce the morbidity and mortality of disease. The assessment and management of psychosocial stress is a challenging but important component of effective comprehensive lifestyle interventions for the management of noncommunicable disease. It is, therefore, important for the sports and exercise physician to have an understanding of the therapeutic use of HRV modulation, both in the reduction of stress and in the management of chronic disease.

Neighborhood, Socioeconomic, and Racial Influence on Chronic Pain.

PubMed

Maly, Angelika; Vallerand, April Hazard

2018-02-01

The purpose of this review is to highlight the neighborhood, socioeconomic, and racial influences on chronic pain. Negative influences on the experience of chronic pain are explored and defined as any adverse stressor common in low socioeconomic, urban neighborhoods that potentially contributes to health disparity in African Americans experiencing chronic pain. The multifactorial influences on chronic pain disparity in African Americans are explored and expounded upon in this review of existing evidence. Databases used for the search included CINAHL, PubMed, and PsycArticles. The experience of chronic pain is multifaceted, existing with multiple comorbidities and lasting consequences. To improve the burden of chronic pain requires a multifactorial assessment that considers neighborhood risk factors, emphasis on environmental stressors, limitations to support networks, barriers to physical activity, and access to primary care providers with whom communication is open and without bias. A comprehensive assessment of barriers will aid in the development of interventions that reach beyond the physical factors of chronic pain, also considering the psychosocial barriers to improving the burden of chronic pain in African Americans living in impoverished urban neighborhoods. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Association of Mental Disorders With Subsequent Chronic Physical Conditions

PubMed Central

Scott, Kate M.; Lim, Carmen; Al-Hamzawi, Ali; Alonso, Jordi; Bruffaerts, Ronny; Caldas-de-Almeida, José Miguel; Florescu, Silvia; de Girolamo, Giovanni; Hu, Chiyi; de Jonge, Peter; Kawakami, Norito; Medina-Mora, Maria Elena; Moskalewicz, Jacek; Navarro-Mateu, Fernando; O’Neill, Siobhan; Piazza, Marina; Posada-Villa, José; Torres, Yolanda; Kessler, Ronald C.

2017-01-01

IMPORTANCE It is clear that mental disorders in treatment settings are associated with a higher incidence of chronic physical conditions, but whether this is true of mental disorders in the community, and how generalized (across a range of physical health outcomes) these associations are, is less clear. This information has important implications for mental health care and the primary prevention of chronic physical disease. OBJECTIVE To investigate associations of 16 temporally prior DSM-IV mental disorders with the subsequent onset or diagnosis of 10 chronic physical conditions. DESIGN, SETTING, AND PARTICIPANTS Eighteen face-to-face, cross-sectional household surveys of community-dwelling adults were conducted in 17 countries (47 609 individuals; 2 032 942 person-years) from January 1, 2001, to December 31, 2011. The Composite International Diagnostic Interview was used to retrospectively assess the lifetime prevalence and age at onset of DSM-IV–identified mental disorders. Data analysis was performed from January 3, 2012, to September 30, 2015. MAIN OUTCOMES AND MEASURES Lifetime history of physical conditions was ascertained via self-report of physician’s diagnosis and year of onset or diagnosis. Survival analyses estimated the associations of temporally prior first onset of mental disorders with subsequent onset or diagnosis of physical conditions. RESULTS Most associations between 16 mental disorders and subsequent onset or diagnosis of 10 physical conditions were statistically significant, with odds ratios (ORs) (95% CIs) ranging from 1.2 (1.0–1.5) to 3.6 (2.0–6.6). The associations were attenuated after adjustment for mental disorder comorbidity, but mood, anxiety, substance use, and impulse control disorders remained significantly associated with onset of between 7 and all 10 of the physical conditions (ORs [95% CIs] from 1.2 [1.1–1.3] to 2.0 [1.4–2.8]). An increasing number of mental disorders experienced over the life course was significantly associated with increasing odds of onset or diagnosis of all 10 types of physical conditions, with ORs (95% CIs) for 1 mental disorder ranging from 1.3 (1.1–1.6) to 1.8 (1.4–2.2) and ORs (95% CIs) for 5 or more mental disorders ranging from 1.9 (1.4–2.7) to 4.0 (2.5–6.5). In population-attributable risk estimates, specific mental disorders were associated with 1.5% to 13.3% of physical condition onsets. CONCLUSIONS AND RELEVANCE These findings suggest that mental disorders of all kinds are associated with an increased risk of onset of a wide range of chronic physical conditions. Current efforts to improve the physical health of individuals with mental disorders may be too narrowly focused on the small group with the most severe mental disorders. Interventions aimed at the primary prevention of chronic physical diseases should optimally be integrated into treatment of all mental disorders in primary and secondary care from early in the disorder course. PMID:26719969

Physical exercise and executive functions in preadolescent children, adolescents and young adults: a meta-analysis.

PubMed

Verburgh, Lot; Königs, Marsh; Scherder, Erik J A; Oosterlaan, Jaap

2014-06-01

The goal of this meta-analysis was to aggregate available empirical studies on the effects of physical exercise on executive functions in preadolescent children (6-12 years of age), adolescents (13-17 years of age) and young adults (18-35 years of age). The electronic databases PubMed, EMBASE and SPORTDiscus were searched for relevant studies reporting on the effects of physical exercise on executive functions. Nineteen studies were selected. There was a significant overall effect of acute physical exercise on executive functions (d=0.52, 95% CI 0.29 to 0.76, p<0.001). There were no significant differences between the three age groups (Q (2)=0.13, p=0.94). Furthermore, no significant overall effect of chronic physical exercise (d=0.14, 95%CI -0.04 to 0.32, p=0.19) on executive functions (Q (1)=5.08, p<0.05) was found. Meta-analytic effect sizes were calculated for the effects of acute physical exercise on the domain's inhibition/interference control (d=0.46, 95% CI 0.33 to 0.60, p<0.001) and working memory (d=0.05, 95% CI  -0.51 to 0.61, p=0.86) as well as for the effects of chronic physical exercise on planning (d=0.16, 95% CI 0.18 to 0.89, p=0.18). Results suggest that acute physical exercise enhances executive functioning. The number of studies on chronic physical exercise is limited and it should be investigated whether chronic physical exercise shows effects on executive functions comparable to acute physical exercise. This is highly relevant in preadolescent children and adolescents, given the importance of well-developed executive functions for daily life functioning and the current increase in sedentary behaviour in these age groups. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The Different Roles of Perceived Stress in the Association Between Older Adults’ Physical Activity and Physical Health

PubMed Central

Rueggeberg, Rebecca; Wrosch, Carsten; Miller, Gregory E.

2011-01-01

This 4-yr longitudinal study examined the different roles of perceived stress in the association between older adults’ physical activities and physical health. We hypothesized that physical activities would exert beneficial effects on physical health by preventing chronically high levels of perceived stress. Design and Measures We assessed baseline levels of physical activities and repeated measures of perceived stress and physical symptoms in three waves of data from a sample of 157 older adults. Results Among participants with high (but not low) baseline levels of perceived stress, physical activity predicted a 2-yr reduction of perceived stress and a 4-yr prevention of physical health symptoms. Moreover, the interaction effect on 4-yr changes in physical symptoms was mediated by 2-yr changes in perceived stress. Conclusions Physical health benefits of physical activity are particularly pronounced among older adults who perceive high levels of stress, and this effect is mediated by a prevention of chronically high perceptions of stress. PMID:21875206

Risk Factors for Low Back Pain and Spine Surgery: A Retrospective Cohort Study in Soldiers.

PubMed

Kardouni, Joseph R; Shing, Tracie L; Rhon, Daniel I

2016-11-01

Musculoskeletal low back pain (LBP) is commonly treated symptomatically, with practice guidelines advocating reserving surgery for cases that fail conservative care. This study examined medical comorbidities and demographic variables as risk factors for chronic/recurrent LBP, spinal surgery, and time to surgery. A 2015 retrospective cohort study was conducted in U.S. Army soldiers (N=1,092,420) from 2002 to 2011. Soldiers with medical encounters for LBP were identified using ICD-9 codes. Surgical treatment for LBP was identified according to Current Procedural Terminology codes. Comorbid medical conditions (psychological disorders, sleep disorders, tobacco use, alcohol use, obesity) and demographic variables were examined as risk factors for chronic/recurrent LBP within 1 year of the incident encounter, surgery for LBP, and time to surgery. Of 383,586 patients with incident LBP, 104,169 (27%) were treated for chronic/recurrent LBP and 7,446 (1.9%) had surgery. Comorbid variables showed increased risk of chronic/recurrent LBP ranging from 26% to 52%. Tobacco use increased risk for surgery by 33% (risk ratio, 1.33; 95% CI=1.24, 1.44). Comorbid variables showed 10%-42% shorter time to surgery (psychological disorders, time ratio [TR]=0.90, 95% CI=0.83, 0.98; sleep disorders, TR=0.68, 95% CI=0.60, 0.78; obesity, TR=0.88, 95% CI=0.79, 0.98; tobacco use, TR=0.58, 95% CI=0.54, 0.63; alcohol use, TR=0.85, 95% CI=0.70, 1.05). Women showed 20% increased risk of chronic/recurrent LBP than men but 42% less risk of surgery. In the presence of comorbidities associated with mental health, sleep, obesity, tobacco use, and alcohol use, LBP shows increased risk of becoming chronic/recurrent and faster time to surgery. Published by Elsevier Inc.

[Self-perception of disease in patients with chronic diseases].

PubMed

Adrián-Arrieta, L; Casas-Fernández de Tejerina, J M

2017-11-18

The aim of this study is to assess the self-perception of disease by patients with chronic diseases and determine factors related to their perception of disease. Cross-sectional descriptive study performed between September 2014 and April 2015 in nine (6 urban and 3 rural) Health Centres of Navarra, Spain. The participants were recruited by convenience sampling of 196 patients aged over 65 years with at least one chronic disease. The outcome variable was: Perception of disease evaluated through The Brief Illness Perception Questionnaire (9 items. Assessment of the cognitive and emotional representation of the disease. A higher total score indicates a greater threat of disease to the patient). Explanatory variables: Evaluation of the care received through the Patient Assessment of Chronic Illness Care, Katz index, Gijon's socio-family evaluation scale and quality of life using the EQ5D questionnaire. Other variables studied were: gender, age, education, Charlson index, and number of chronic diseases. The association between the total The Brief Illness Perception Questionnaire value and the rest of the variables was calculated. The self-perception of disease is more negative for a larger number of diseases (rho: 0.242; p=.001), greater patient dependence (rho: -0.193; P=.007), and a poorer self-perceived quality of life (EQ VAS rho: -0.484; P<.001. EQ5D5L Index value rho: -0.507; P<.001). The perception that chronic patients have about their disease worsens as their diseases and their dependence increase, and also worsens their quality of life. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Bimanual Force Variability and Chronic Stroke: Asymmetrical Hand Control

PubMed Central

Kang, Nyeonju; Cauraugh, James H.

2014-01-01

The purpose of this study was to investigate force variability generated by both the paretic and non-paretic hands during bimanual force control. Nine chronic stroke individuals and nine age-matched individuals with no stroke history performed a force control task with both hands simultaneously. The task involved extending the wrist and fingers at 5%, 25%, and 50% of maximum voluntary contraction. Bimanual and unimanual force variability during bimanual force control was determined by calculating the coefficient of variation. Analyses revealed two main findings: (a) greater bimanual force variability in the stroke group than the control group and (b) increased force variability by the paretic hands during bimanual force control in comparison to the non-paretic hands at the 5% and 25% force production conditions. A primary conclusion is that post stroke bimanual force variability is asymmetrical between hands. PMID:25000185

Chronic variable stress improves glucose tolerance in rats with sucrose-induced prediabetes

PubMed Central

Packard, Amy E. B.; Ghosal, Sriparna; Herman, James P.; Woods, Stephen C.; Ulrich-Lai, Yvonne M.

2014-01-01

The incidence of type-2 diabetes (T2D) and the burden it places on individuals, as well as society as a whole, compels research into the causes, factors and progression of this disease. Epidemiological studies suggest that chronic stress exposure may contribute to the development and progression of T2D in human patients. To address the interaction between chronic stress and the progression of T2D, we developed a dietary model of the prediabetic state in rats utilizing unlimited access to 30% sucrose solution (in addition to unlimited access to normal chow and water), which led to impaired glucose tolerance despite elevated insulin levels. We then investigated the effects of a chronic variable stress paradigm (CVS; twice daily exposure to an unpredictable stressor for 2 weeks) on metabolic outcomes in this prediabetic model. Chronic stress improved glucose tolerance in prediabetic rats following a glucose challenge. Importantly, pair-fed control groups revealed that the beneficial effect of chronic stress did not result from the decreased food intake or body weight gain that occurred during chronic stress. The present work suggests that chronic stress in rodents can ameliorate the progression of diet-induced prediabetic disease independent of chronic stress-induced decreases in food intake and body weight. PMID:25001967

Impaired quality of life in patients with systemic sclerosis compared to the general population and chronic dermatoses.

PubMed

Bretterklieber, Agnes; Painsi, Clemens; Avian, Alexander; Wutte, Nora; Aberer, Elisabeth

2014-09-02

Systemic sclerosis (SSc) is a rare and potentially life threatening autoimmune disorder. The burden of disease compared to other dermatoses is unknown. The purpose of this study was to assess both the quality of life in patients with SSc and the variables that are associated with poor quality of life. Forty-one patients with systemic sclerosis (29 limited, 2 diffuse, 10 undifferentiated forms) were assessed with respect to their health status and compared to published data for the normal population, SSc patients from other studies, and patients with chronic skin diseases. For the most part, our SSc patients had better outcomes in all 8 dimensions of the SF-36 than SSc patients from other studies, and poorer scores than the healthy population and those with occupational contact dermatitis, ichthyosis, non-melanoma skin cancer, contact dermatitis, atopic eczema, chronic nail disease, vitiligo, health care workers with work-related disease, and those with other chronic skin diseases, but significantly better scores for mental health than those with nail disease, vitiligo, and health-care workers. Patients with atopic dermatitis, psoriasis and pemphigus had significantly poorer mean scores in social function and mental health than SSc patients. Patients with pemphigus were also significantly impaired in their physical and emotional roles. Patients with systemic lupus erythematosus (SLE) had the significantly poorest mean scores for QoL in all 8 domains except bodily pain and emotional role. Besides SLE, SSc is one of the most severe chronic dermatologic diseases in terms of reduced QoL. Since SSc cannot be cured, treatment strategies should include therapeutic interventions such as psychotherapy, social support, physiotherapy, and spiritual care. Their beneficial effects could be studied in future.

Cyber-Victimization of People With Chronic Conditions and Disabilities: A Systematic Review of Scope and Impact.

PubMed

Alhaboby, Zhraa A; Barnes, James; Evans, Hala; Short, Emma

2017-01-01

The victimization of individuals with chronic conditions or disabilities is prevalent with severe impact at psychological and physiological levels. With the increasing use of technology these experiences were further reshaped. This systematic review aimed at scoping the experiences of cyber-victimization of people living with chronic conditions or disabilities and examine the documented impact on them. Following a four-stage search strategy in several databases including MEDLINE, Embase, PsychINFO, CINAHL, Cochrane and snowballing of references, a total of 2,922 studies were scanned and 10 studies were eventually included. Quality assessment was done in two phases using tools specific to observational studies and cyber-victimization research. A narrative synthesis of reported results covered a total of 3,070 people. Sample size ranged between 42 and 823 participants, and the age range was 6-71 years with a majority of White ethnic backgrounds. Most studies (n=9) were cross sectional. The prevalence range of cyber-victimization was 2%-41.7% based on variable definitions, duration and methods. Targeted conditions included physical impairments, intellectual disabilities and specific chronic diseases. The most common documented impact was psychological/psychiatric, mainly depression followed by anxiety and distress. Somatic health complaints and self-harm were also reported. We concluded that people with chronic conditions and disabilities were consistently at higher risk of victimization with devastating health complications. Research gaps were identified such as the need to address more conditions and acknowledge differences between heterogeneous health conditions. Other recommendations include allowing flexibility and accountability to patients/victims in research design, education on victimization and health consequences, and improving primary care.

The Role of Negative Affect on Headache-Related Disability Following Traumatic Physical Injury.

PubMed

Pacella, Maria L; Hruska, Bryce; George, Richard L; Delahanty, Douglas L

2018-03-01

Acute postinjury negative affect (NA) may contribute to headache pain following physical injury. Early psychiatric-headache comorbidity conveys increased vulnerability to chronic headache-related disability and impairment. Yet, it is unknown whether NA is involved in the transition to chronic headache related-disability after injury. This prospective observational study examined the role of acute postinjury NA on subacute and chronic headache-related disability above and beyond nonpsychiatric factors. Eighty adult survivors of single-incident traumatic physical injury were assessed for negative affect (NA): a composite of depression and anxiety symptoms, and symptoms of posttraumatic stress disorder (PTSS) during the acute 2-week postinjury phase. NA was examined as the primary predictor of subacute (6-week) and chronic (3-month) headache-related disability; secondary analyses examined whether the individual NA components differentially impacted the outcomes. Hierarchical linear regression confirmed NA as a unique predictor of subacute (Cohen's f  2  = 0.130; P = .005) and chronic headache related-disability (Cohen's f  2  = 0.160; P = .004) beyond demographic and injury-related factors (sex, prior headaches, and closed head injury). Upon further analysis, PTSS uniquely predicted greater subacute (Cohen's f  2  = 0.105; P = .012) and chronic headache-related disability (Cohen's f  2  = 0.103; P = .022) above and beyond demographic and injury-related factors, depression, and anxiety. Avoidance was a robust predictor of subacute headache impairment (explaining 15% of the variance) and hyperarousal was a robust predictor of chronic headache impairment (10% of the variance). Although NA consistently predicted headache-related disability, PTSS alone was a unique predictor above and beyond nonpsychiatric factors, depression, and anxiety. These results are suggestive that early treatment of acute postinjury PTSS may correlate with reductions in disability and negative physical health sequelae associated with PTSS and chronic headache. © 2017 American Headache Society.

A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain patients more than exercise: an RCT.

PubMed

Tekur, P; Nagarathna, R; Chametcha, S; Hankey, Alex; Nagendra, H R

2012-06-01

Previously, outpatient Yoga programs for patients with chronic low back pain (CLBP) lasting several months have been found to reduce pain, analgesic requirement and disability, and improve spinal mobility. This study evaluated changes in pain, anxiety, depression and spinal mobility for CLBP patients on short-term, residential Yoga and physical exercise programs, including comprehensive yoga lifestyle modifications. A seven day randomized control single blind active study in an residential Holistic Health Centre in Bangalore, India, assigned 80 patients (37 female, 43 male) with CLBP to yoga and physical exercise groups. The Yoga program consisted of specific asanas and pranayamas for back pain, meditation, yogic counselling, and lectures on yoga philosophy. The control group program included physical therapy exercises for back pain, and matching counselling and education sessions. Group×time interactions (p<0.05) and between group differences (p<0.05) were significant in all variables. Both groups' scores on the numerical rating scale for pain reduced significantly, 49% in Yoga (p<0.001, ES=1.62), 17.5% in controls (p=0.005, ES=0.67). State anxiety (STAI) reduced 20.4% (p<0.001, ES=0.72) and trait anxiety 16% (p<0.001, ES=1.09) in the yoga group. Depression (BDI) decreased in both groups, 47% in yoga (p<0.001, ES=0.96,) and 19.9% in controls (p<0.001, ES=0.59). Spinal mobility ('Sit and Reach' instrument) improved in both groups, 50%, in yoga (p<0.001, ES=2.99) and 34.6% in controls (p<0.001, ES=0.81). Seven days intensive residential Yoga program reduces pain, anxiety, and depression, and improves spinal mobility in patients with CLBP more effectively than physiotherapy exercises. Copyright © 2012 Elsevier Ltd. All rights reserved.

Balneotherapy for chronic low back pain: a randomized, controlled study.

PubMed

Kesiktas, Nur; Karakas, Sinem; Gun, Kerem; Gun, Nuran; Murat, Sadiye; Uludag, Murat

2012-10-01

A large number of treatments were used for patients with chronic low back pain. Frequent episodes have been reported very high. Although balneotherapy was found effective in this disease, there are not well-designed studies. We aimed to determine the effectiveness of balneotherapy versus physical therapy in patients with chronic low back pain. Exercise was added to both treatment programs. Sixty patients with chronic low back pain were randomly divided into two groups. Physical modalities plus exercise were applied to group 1, and group 2 was received balneotherapy plus exercise for ten sessions. The following parameters were measured: visual analogue scale at rest and movement for pain, paracetamol dose, manual muscle test for lumber muscles, modified Schoeber' test, Oswestry disability index, and Short-Form 36 at the beginning and end of the therapies and at the 3 months follow-up. The statistical analyses were performed using the SPSS 10.0 program. Both groups achieved significant improvements within themselves. But balneotherapy groups were improved at back extensor muscle test (P < 0.05), modified Schoeber's test (P < 0.03), Oswestry disability index, and the some scores of SF 36 (energy vitality, social function, role limitations related to physical problems, and general health P < 0.05). Balneotherapy combined with exercise therapy had advantages than therapy with physical modalities plus exercise in improving quality of life and flexibility of patients with chronic low back pain.

Success in everyday physics: The role of personality and academic variables

NASA Astrophysics Data System (ADS)

Norvilitis, Jill M.; Reid, Howard M.; Norvilitis, Bret M.

2002-05-01

Two studies examined students' intuitive physics ability and characteristics associated with physics competence. In Study 1, although many students did well on a physics quiz, more than 25% of students performed below levels predicted by chance. Better performance on the physics quiz was related to physics grades, highest level of math taken, and students' perceived scholastic competence, but was not related to a number of other hypothesized personality variables. Study 2 further explored personality and academic variables and also examined students' awareness of their own physics ability. Results indicate that the personality variables were again unrelated to ability, but narcissism may be related to subjects' estimates of knowledge. Also, academic variables and how important students think it is to understand the physical world are related to both measured and estimated physics proficiency.

The Burden of Cardiovascular Disease in Low- and Middle-Income Countries: Epidemiology and Management.

PubMed

Bowry, Ashna D K; Lewey, Jennifer; Dugani, Sagar B; Choudhry, Niteesh K

2015-09-01

Cardiovascular disease (CVD) is the second leading cause of mortality worldwide, accounting for 17 million deaths in 2013. More than 80% of these cases were in low- and middle-income countries (LMICs). Although the risk factors for the development of CVD are similar throughout the world, the evolving change in lifestyle and health behaviours in LMICs-including tobacco use, decreased physical activity, and obesity-are contributing to the escalating presence of CVD and mortality. Although CVD mortality is falling in high-income settings because of more effective preventive and management programs, access to evidence-based interventions for combating CVD in resource-limited settings is variable. The existing pressures on both human and financial resources impact the efforts of controlling CVD. The implementation of emerging innovative interventions to improve medication adherence, introducing m-health programs, and decentralizing the management of chronic diseases are promising methods to reduce the burden of chronic disease management on such fragile health care systems. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

The Relevance of Interoception in Chronic Tinnitus: Analyzing Interoceptive Sensibility and Accuracy

PubMed Central

Lau, Pia; Miesen, Miriam; Wunderlich, Robert; Stein, Alwina; Engell, Alva; Gerlach, Alexander L.; Junghöfer, Markus; Ehring, Thomas

2015-01-01

In order to better understand tinnitus and distress associated with tinnitus, psychological variables such as emotional and cognitive processing are a central element in theoretical models of this debilitating condition. Interoception, that is, the perception of internal processes, may be such a psychological factor relevant to tinnitus. Against this background, 20 participants suffering from chronic tinnitus and 20 matched healthy controls were tested with questionnaires, assessing interoceptive sensibility, and participated in two tasks, assessing interoceptive accuracy: the Schandry task, a heartbeat estimation assignment, and a skin conductance fluctuations perception task assessing the participants' ability to perceive phasic increases in sympathetic activation were used. To test stress reactivity, a construct tightly connected to tinnitus onset, we also included a stress induction. No differences between the groups were found for interoceptive accuracy and sensibility. However, the tinnitus group tended to overestimate the occurrence of phasic activation. Loudness of the tinnitus was associated with reduced interoceptive performance under stress. Our results indicate that interoceptive sensibility and accuracy do not play a significant role in tinnitus. However, tinnitus might be associated with a tendency to overestimate physical changes. PMID:26583114

Fear-avoidance beliefs and parental responses to pain in adolescents with chronic pain.

PubMed

Wilson, Anna C; Lewandowski, Amy S; Palermo, Tonya M

2011-01-01

The fear-avoidance model of chronic pain posits that fear of pain is associated with fear and avoidance of activity, which can lead to deconditioning and persistence of pain and disability. Despite being well supported in adults, little is known about the role of fear-avoidance beliefs regarding physical activity in children. Research has shown that parental protectiveness contributes to activity limitations in children; however, no studies have examined relationships between protectiveness, and fear and avoidance. To conduct a cross-sectional study to provide additional information regarding the reliability and validity of the Fear-Avoidance Beliefs Questionnaire physical activity subscale among adolescents with chronic pain; examine fear-avoidance beliefs and depressive symptoms as concurrent predictors of physical activity limitations; and test competing models using fear-avoidance beliefs as mediators and moderators of the association between parental protectiveness and activity limitations. Adolescents (n=42) 11 to 17 years of age with chronic pain completed questionnaires assessing pain intensity, fear-avoidance beliefs, depressive symptoms and physical activity limitations. Their parents completed questionnaires regarding protectiveness and adolescent activity limitations. The Fear-Avoidance Beliefs Questionnaire physical activity subscale was useful for assessing fear-avoidance beliefs in the present population. In support of hypotheses, greater fear-avoidance beliefs were associated with greater activity limitations, above pain intensity and depressive symptoms. Support was found for fear-avoidance beliefs as mediators of the association between parental protectiveness and activity limitations. Tests of moderation were not significant. Fear-avoidance beliefs may be an important target for interventions focused on decreasing activity limitations in youth with chronic pain. Future research should investigate these associations longitudinally.

Age and gender differences among Australian suicide ideators: prevalence and correlates.

PubMed

Fairweather, A Kate; Anstey, Kaarin J; Rodgers, Bryan; Jorm, Anthony F; Christensen, Helen

2007-02-01

We investigated the prevalence and correlates of suicidal ideation in an Australian population sample at three stages of adulthood. Random sampling of a community acquired 7485 participants. Cohorts were 20 to 24, 40 to 44, or 60 to 64 years old. Twelve-month prevalence of suicidal ideation was 8.2%. Suicidal ideation was highest among the youngest cohort. Males with chronic physical illness were more prone to suicidal ideation, as were those aged 20 to 24 and 60 to 64. Furthermore, under-employed subjects 60 to 64 years old were seven times more likely to experience suicidal ideation than their counterparts working full-time. Childhood adversity and rumination had positive associations with suicidality; however, considering oneself more masterful was linked with lower levels of suicidal ideation. Contrary to clinical and popular views, our results highlight that proximal non-mental health variables such as employment, physical health, social factors, and personality are equally important to experiencing suicidal ideation as symptoms of psychological distress.

Cardiac Cachexia: Perspectives for Prevention and Treatment.

PubMed

Okoshi, Marina Politi; Capalbo, Rafael Verardino; Romeiro, Fernando G; Okoshi, Katashi

2017-01-01

Cachexia is a prevalent pathological condition associated with chronic heart failure. Its occurrence predicts increased morbidity and mortality independent of important clinical variables such as age, ventricular function, or heart failure functional class. The clinical consequences of cachexia are dependent on both weight loss and systemic inflammation, which accompany cachexia development. Skeletal muscle wasting is an important component of cachexia; it often precedes cachexia development and predicts poor outcome in heart failure. Cachexia clinically affects several organs and systems. It is a multifactorial condition where underlying pathophysiological mechanisms are not completely understood making it difficult to develop specific prevention and treatment therapies. Preventive strategies have largely focused on muscle mass preservation. Different treatment options have been described, mostly in small clinical studies or experimental settings. These include nutritional support, neurohormonal blockade, reducing intestinal bacterial translocation, anemia and iron deficiency treatment, appetite stimulants, immunomodulatory agents, anabolic hormones, and physical exercise regimens. Currently, nonpharmacological therapy such as nutritional support and physical exercise are considered central to cachexia prevention and treatment.

"There's nothing I can't do – I just put my mind to anything and I can do it": a qualitative analysis of how children with chronic disease and their parents account for and manage physical activity

PubMed Central

Fereday, Jennifer; MacDougall, Colin; Spizzo, Marianne; Darbyshire, Philip; Schiller, Wendy

2009-01-01

Background This paper reports the findings of a South Australian qualitative, exploratory study of children and young people living with a chronic disease, and their perceptions and experiences of physical activity. The perceptions and experiences of their parents were also explored. The chronic diseases were type 1 diabetes, asthma and cystic fibrosis. Methods Multiple qualitative data collection techniques were used to elicit the children and young people's perspectives and experiences of physical activity, including focus groups, maps, photos and 'traffic light posters'. The children's parents were interviewed separately to ascertain their views of their child's participation in physical activities. Results Children and young people described their active participation in a wide variety of physical activities including organised sports and play, but made very little mention of any negative influence or impact due to their disease. Their parents' stories described the diligent background planning and management undertaken to enable their child to participate in a wide range of physical activities. Conclusion The results of this study suggest that for these children and young people, having a chronic disease was not perceived as a barrier to participation in organised sport and recreational activities. They were physically active and perceived themselves to be no different from their peers. Their positive beliefs were shared by their parents and the level of participation described was enabled by the high level of parental support and background planning involved in managing their child's health care needs. PMID:19117528

[Using connected objects to favour patients' adherence to physical activity].

PubMed

Arefyev, Alexander; Lechauve, Jean-Baptiste; Gay, Chloé; Gerbaud, Laurent; Chérillat, Marie-Sophie; Tavares Figueiredo, Isabelle; Plan-Paquet, Anne; Coudeyre, Emmanuel

2018-01-01

A study explored the factors which can have an impact on the use of connected objects to improve patients' adherence to physical activity, when they suffer from chronic low back pain. The results can be used to adjust the development of an application aimed at patients with chronic low back pain. Copyright © 2017. Publié par Elsevier Masson SAS.

Physical Activity on Medical Prescription: A Qualitative Study of Factors Influencing Take-Up and Adherence in Chronically Ill Patients

ERIC Educational Resources Information Center

Gasparini, William; Knobé, Sandrine; Didierjean, Romaine

2015-01-01

Objective: This study sought to determine the effects of an innovative public health programme offering physical and sports activities on medical prescription to chronically ill patients. Method: Semi-structured interviews were conducted with programme participants at two time points: at the start of their activity (n?=?33) and 3?months after the…

Guidance, Counseling, and Support Services for High School Students with Physical Disabilities: Visual, Hearing, Orthopedic, Neuromuscular, Epilepsy, Chronic Health Conditions. Includes State Resource Directory.

ERIC Educational Resources Information Center

Foster, June C.; And Others

Intended for use by high school guidance personnel, the two volumes provide general information and a resource guide on physical disabilities including visual impairment, hearing impairment, orthopedic handicap, neuromuscular handicap, epilepsy, diabetes, and other chronic health conditions. The first section provides an overview of each of the…

Adherence to a Depression Self-Care Intervention among Primary Care Patients with Chronic Physical Conditions: A Randomised Controlled Trial

ERIC Educational Resources Information Center

McCusker, Jane; Cole, Martin G.; Yaffe, Mark; Strumpf, Erin; Sewitch, Maida; Sussman, Tamara; Ciampi, Antonio; Lavoie, Kim; Belzile, Eric

2016-01-01

Objective: Among primary care patients with chronic physical conditions and comorbid depressive symptoms, to assess (1) the effect of lay telephone coaching on adherence to a psycho-educational intervention for depression, (2) demographic characteristics that predict adherence and (3) the association between adherence and 6-month outcomes. Design:…

Illness Identity in Adults with a Chronic Illness.

PubMed

Oris, Leen; Luyckx, Koen; Rassart, Jessica; Goubert, Liesbet; Goossens, Eva; Apers, Silke; Arat, Seher; Vandenberghe, Joris; Westhovens, René; Moons, Philip

2018-02-21

The present study examines the concept of illness identity, the degree to which a chronic illness is integrated into one's identity, in adults with a chronic illness by validating a new self-report questionnaire, the Illness Identity Questionnaire (IIQ). Self-report questionnaires on illness identity, psychological, and physical functioning were assessed in two samples: adults with congenital heart disease (22-78 year old; n = 276) and with multisystem connective tissue disorders (systemic lupus erythematosus or systemic sclerosis; 17-81 year old; n = 241). The IIQ could differentiate four illness identity states (i.e., engulfment, rejection, acceptance, and enrichment) in both samples, based on exploratory and confirmatory factor analysis. All four subscales proved to be reliable. Rejection and engulfment were related to maladaptive psychological and physical functioning, whereas acceptance and enrichment were related to adaptive psychological and physical functioning. The present findings underscore the importance of the concept of illness identity. The IIQ, a self-report questionnaire, is introduced to measure four different illness identity states in adults with a chronic illness.

The independent roles of cardiorespiratory fitness and sedentary time on chronic conditions and Body Mass Index in older adults.

PubMed

Stathokostas, L; Dogra, S; Paterson, D H

2015-10-01

The aim of this paper was to examine the independent influence of cardiorespiratory fitness and sedentary behavior on chronic disease incidence and body composition in older adults. A sample of 292 community dwelling men and women (mean 69.3±8.1 years) underwent maximal treadmill testing and completed questionnaires relating to their leisure-time physical activity, sedentary time, and health. The average V O2 of the sample was approximately 21 ml.kg(-1).min(-1) with the average sedentary time being over 3 hours per day. Cardiorespiratory fitness was found to be a stronger predictor of number of chronic conditions and BMI than total physical activity and sedentary. Those with a higher cardiorespiratory fitness had fewer chronic conditions and a lower BMI. No such associations were seen for either total physical activity levels or sedentary time. Cardiorespiratory fitness is a stronger predictor of health among older adults and further highlights the importance of promoting public health guidelines for cardiorespiratory fitness.

The relationship between perceived promotion of autonomy/dependence and pain-related disability in older adults with chronic pain: the mediating role of self-reported physical functioning.

PubMed

Matos, Marta; Bernardes, Sónia F; Goubert, Liesbet

2016-08-01

Chronic pain is prevalent among older adults and is usually associated with high levels of functional disability. Social support for the promotion of functional autonomy and dependence has been associated with pain-related disability and self-reported physical functioning. Nevertheless, these relationships need further inquiry. Our aims were to investigate: (1) the relationship between perceived promotion of autonomy/dependence and pain-related disability and (2) the extent to which self-reported physical functioning mediated these relationships. 118 older adults (Mage = 81.0) with musculoskeletal chronic pain completed the Portuguese versions of the revised formal social support for Autonomy and Dependence in Pain Inventory, the pain severity and interference scales of the Brief Pain Inventory, and the physical functioning scale of the Medical Outcomes Study-Short-Form 36 v2. Higher levels of perceived promotion of autonomy were associated with lower pain-related disability; this relationship was partially mediated by self-reported physical functioning (B = -.767, p < .001 decreasing to B' = -.485, p < .01). Higher perceived promotion of dependence was associated with higher pain-related disability; this effect was also partially accounted for by self-reported physical functioning (B = .889, p < .01 decreasing to B' = .597, p < .05). These results highlight the importance of perceived promotion of autonomy and dependence for managing older adults' experience of chronic pain.

Physical activity buffers fatigue only under low chronic stress.

PubMed

Strahler, Jana; Doerr, Johanna M; Ditzen, Beate; Linnemann, Alexandra; Skoluda, Nadine; Nater, Urs M

2016-09-01

Fatigue is one of the most commonly reported complaints in the general population. As physical activity (PA) has been shown to have beneficial effects, we hypothesized that everyday life PA improves fatigue. Thirty-three healthy students (21 women, 22.8 ± 3.3 years, 21.7 ± 2.3 kg/m(2)) completed two ambulatory assessment periods. During five days at the beginning of the semester (control condition) and five days during final examination preparation (examination condition), participants repeatedly reported on general fatigue (awakening, 10 am, 2 pm, 6 pm and 9 pm) by means of an electronic diary, collected saliva samples for the assessment of cortisol and α-amylase immediately after providing information on fatigue and wore a triaxial accelerometer to continuously record PA. Self-perceived chronic stress was assessed as a moderator. Using hierarchical linear modeling, including PA, condition (control vs. examination), sex and chronic stress as predictors, PA level during the 15 min prior to data entry did not predict momentary fatigue level. Furthermore, there was no effect of condition. However, a significant cross-level interaction of perceived chronic stress with PA was observed. In fact, the (negative) relationship between PA and fatigue was stronger in those participants with less chronic stress. Neither cortisol nor α-amylase was significantly related to physical activity or fatigue. Our study showed an immediate short-term buffering effect of everyday life PA on general fatigue, but only when experiencing lower chronic stress. There seems to be no short-term benefit of PA in the face of higher chronic stress. These findings highlight the importance of considering chronic stress when evaluating the effectiveness of PA interventions in different target populations, in particular among chronically stressed and fatigued subjects.

[Evaluation of a chronic fatigue in patients with moderate-to-severe chronic heart failure].

PubMed

Jasiukeviciene, Lina; Vasiliauskas, Donatas; Kavoliūniene, Ausra; Marcinkeviciene, Jolanta; Grybauskiene, Regina; Grizas, Vytautas; Tumyniene, Vida

2008-01-01

To evaluate the chronic fatigue and its relation to the function of hypothalamus-pituitary-adrenal axis in patients with New York Heart Association (NYHA) functional class III-IV chronic heart failure. A total of 170 patients with NYHA functional class III-IV chronic heart failure completed MFI-20L, DUFS, and DEFS questionnaires assessing chronic fatigue and underwent echocardiography. Blood cortisol concentration was assessed at 8:00 am and 3:00 pm, and plasma N-terminal brain natriuretic pro-peptide (NT-proBNP) concentration was measured at 8:00 am. Neurohumoral investigations were repeated before cardiopulmonary exercise test and after it. The results of all questionnaires showed that 100% of patients with NYHA functional class III-IV heart failure complained of chronic fatigue. The level of overall fatigue was 54.5+/-31.5 points; physical fatigue - 56.8+/-24.6 points. Blood cortisol concentration at 8:00 am was normal (410.1+/-175.1 mmol/L) in majority of patients. Decreased concentration was only in four patients (122.4+/-15.5 mmol/L); one of these patients underwent heart transplantation. In the afternoon, blood cortisol concentration was insufficiently decreased (355.6+/-160.3 mmol/L); reaction to a physical stress was attenuated (Delta 92.9 mmol/L). Plasma NT-proBNP concentration was 2188.9+/-1852.2 pg/L; reaction to a physical stress was diminished (Delta 490.3 pg/L). All patients with NYHA class III-IV heart failure complained of daily chronic fatigue. Insufficiently decreased blood cortisol concentration in the afternoon showed that in the presence of chronic fatigue in long-term cardiovascular organic disease, disorder of a hypothalamus-pituitary-adrenal axis is involved.

Impact of a disease management program upon caregivers of chronically critically ill patients.

PubMed

Douglas, Sara L; Daly, Barbara J; Kelley, Carol Genet; O'Toole, Elizabeth; Montenegro, Hugo

2005-12-01

Few studies have examined the effects of caregiving on the caregivers of chronically critically ill (CCI) patients, and no one has examined the impact of a disease management program (DMP) on physical and psychological outcomes for the caregivers of CCI patients. The purposes of this study of caregivers of CCI patients were as follows: (1) to describe the characteristics of CCI patients and caregivers and to examine the frequency of depression, subjective burden, and physical health; (2) to examine factors related to depression after hospital discharge; and (3) to examine the effects of a DMP on the physical health, depression, and burden of caregivers 2 months post-hospital discharge. Prospective experimental design. Caregivers of 290 patients who had received > 3 days of mechanical ventilation while in the ICU of a university medical center. Sociodemographics, caregiver burden, physical health status, and depression were measured using established tools. Interviews of caregivers were conducted at hospital discharge and 2 months later. Seventy-three percent of patients survived, completed the study period, and required caregiving 2 months later. Caregivers of patients residing in an institution reported higher depression (p = 0.0001), higher burden (ie, disrupted schedule, p = 0.0001; lack of family support, p = 0.036), and greater health problem scores (p = 0.0001) than did caregivers of patients residing at home. The DMP did not have a statistically significant impact on any of the outcome variables. However, by 2 months, 54% of caregivers in the experimental group had no depression or mild depression compared with 34.5% of the control group. Two months after hospital discharge, approximately 25% of caregivers were classified as depressed with 16.7% of the depressed group classified as moderately or severely depressed. The caregivers of CCI patients are at risk for post-hospital discharge depression, and the caregivers of institutionalized CCI patients are at highest risk of long-term negative effects from caregiving.

Evaluation of malnutrition detected with the Nutritional Risk Screening 2002 (NRS-2002) and the quality of life in hospitalized patients with chronic obstructive pulmonary disease.

PubMed

Arslan, M; Soylu, M; Kaner, G; İnanç, N; Başmısırlı, E

2016-01-01

Patients with severe chronic obstructive pulmonary disease (COPD) have impaired quality of life, but the relationship between their nutritional status and quality of life has not been established. The aim of this study was to determine the relationship between quality of life and nutritional status in hospitalized COPD patients. Demographic data, quality of life and nutritional status of 90 inpatients with a mean age of 68.76 ± 10.85 years were enrolled in the study. The Nutritional Risk Screening 2002 (NRS-2002) tool was used to evaluate their nutritional status. The quality of life was assessed using the Short Form-36 (SF-36) questionnaire. The correlation analysis was used for the relationship between SF-36 subscales and nutritional status variables. Of the 90 COPD patients included in the study, 54.4 % were men, and 45.6 % were women. Moderate, severe, and very severe COPD were detected in 37.8 %, 38.9 %, and 23.3 % of the patients, respectively. At risk of malnutrition were 55.6 % of the 90 COPD patients, whereas 44.4 % were not. The scores for physical function, physical role functioning, pain, general health, emotional role functioning, vitality, social function, and mental function subscales were lower in the patients at risk of malnutrition (p <0.001). There was a statistically significant negative correlation between malnutrition score and the subscores of SF-36 related to physical function, physical role functioning, pain, general health, emotional role functioning, vitality, social function, and mental function (p <0.001). COPD patients were found to have a high risk of malnutrition that adversely affects their quality of life. Therefore, the evaluation of the nutritional status of COPD patients should be an integral part of their clinical treatment plans aiming towards improving their quality of life. Hippokratia 2016, 20(2):147-152.

Self-efficacy: a useful construct to promote physical activity in people with stable chronic heart failure.

PubMed

Du, HuiYun; Everett, Bronwyn; Newton, Phillip J; Salamonson, Yenna; Davidson, Patricia M

2012-02-01

To explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and propose a model of intervention. The benefits of physical activity in reducing cardiovascular risk have led to evidence-based recommendations for patients with heart disease, including those with chronic heart failure. However, adherence to best practice recommendations is often suboptimal, particularly in those individuals who experience high symptom burden and feel less confident to undertake physical activity. Self-efficacy is the degree of confidence an individual has in his/her ability to perform behaviour under several specific circumstances. Four factors influence an individual's level of self-efficacy: (1) past performance, (2) vicarious experience, (3) verbal persuasion and (4) physiological arousal. Discursive. Using the method of a discursive paper, this article seeks to explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and proposes a model of intervention, the Home-Heart-Walk, to promote physical activity and monitor functional status. Implementing effective interventions to promote physical activities require appreciation of factors impacting on behaviour change. Addressing concepts relating to self-efficacy in physical activity interventions may promote participation and adherence in the longer term. The increasing burden of chronic disease and the emphasis on self-management strategies underscore the importance of promoting adherence to recommendations, such as physical activity. © 2011 Blackwell Publishing Ltd.

The effect of Tai Chi on four chronic conditions-cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease: a systematic review and meta-analyses.

PubMed

Chen, Yi-Wen; Hunt, Michael A; Campbell, Kristin L; Peill, Kortni; Reid, W Darlene

2016-04-01

Many middle-aged and older persons have more than one chronic condition. Thus, it is important to synthesise the effectiveness of interventions across several comorbidities. The aim of this systematic review was to summarise current evidence regarding the effectiveness of Tai Chi in individuals with four common chronic conditions-cancer, osteoarthritis (OA), heart failure (HF) and chronic obstructive pulmonary disease (COPD). 4 databases (MEDLINE, EMBASE, CINAHL and SPORTDiscus) were searched for original articles. Two reviewers independently screened the titles and abstracts and then conducted full-text reviews, quality assessment and finally data abstraction. 33 studies met the inclusion criteria. Meta-analyses were performed on disease-specific symptoms, physiological outcomes and physical performance of each chronic condition. Subgroup analyses on disease-specific symptoms were conducted by categorising studies into subsets based on the type of comparison groups. Meta-analyses showed that Tai Chi improved or showed a tendency to improve physical performance outcomes, including 6-min walking distance (6MWD) and knee extensor strength, in most or all four chronic conditions. Tai Chi also improved disease-specific symptoms of pain and stiffness in OA. The results demonstrated a favourable effect or tendency of Tai Chi to improve physical performance and showed that this type of exercise could be performed by individuals with different chronic conditions, including COPD, HF and OA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Youth with chronic health problems: how do they fare in main-stream mentoring programs?

PubMed

Lipman, Ellen L; DeWit, David; DuBois, David L; Larose, Simon; Erdem, Gizem

2018-01-05

Youth with chronic physical health problems often experience social and emotional problems. We investigate the relationship between participation in the Big Brothers Big Sisters of Canada community-based mentoring programs (BBBS) and youth social and mood outcomes by youth health status. Youth newly enrolled in BBBS were classified by health status (one or more chronic physical health problems without activity limitation, n = 191; one or more chronic physical health problems with activity limitation, n = 94; no chronic health problem or activity limitation, n = 536) and mentoring status (yes/no) at 18 month follow-up. Youth outcomes measured at follow-up were social anxiety, depressed mood, and peer self-esteem. Youth with chronic health problems and activity limitation were more likely to live with two biological parents, use mental health or social services, and have parents who reported difficulties with depressed mood, social anxiety, family functioning and neighbourhood problems. At 18 month follow-up, mentored youth in this health status group experienced fewer symptoms of social anxiety and higher peer self-esteem compared to non-mentored youth. Mentored youth with chronic health problems without activity limitation and mentored youth with no health problems or limitations did not show significant improvements in social anxiety and peer self-esteem. Regardless of their health status, mentored youth reported fewer symptoms of depressed mood than non-mentored youth. Youth with chronic health problems, particularly those with activity limitation as well, demonstrate a capacity to experience social and mood benefits associated with mentoring.

Fourth revolution in psychiatry - Addressing comorbidity with chronic physical disorders.

PubMed

Gautam, Shiv

2010-07-01

The moral treatment of mental patients, Electro Convulsive therapy (ECT), and Psychotropic medications constitute the first, second, and third revolution in psychiatry, respectively. Addressing comorbidities of mental illnesses with chronic physical illnesses will be the fourth revolution in psychiatry. Mind and body are inseparable; there is a bidirectional relationship between psyche and soma, each influencing the other. Plausible biochemical explanations are appearing at an astonishing rate. Psychiatric comorbidity with many chronic physical disorders has remained neglected. Such comorbidity with cardiac, respiratory, Gastrointestinal, endocrinal, and neurological disorders, trauma, and other conditions like HIV and so on, needs to be addressed too. Evidence base of prevalence and causal relationship of psychiatric comorbidities in these disorders has been highlighted and strategies to meet the challenge of comorbidity have been indicated.

Fourth revolution in psychiatry – Addressing comorbidity with chronic physical disorders

PubMed Central

Gautam, Shiv

2010-01-01

The moral treatment of mental patients, Electro Convulsive therapy (ECT), and Psychotropic medications constitute the first, second, and third revolution in psychiatry, respectively. Addressing comorbidities of mental illnesses with chronic physical illnesses will be the fourth revolution in psychiatry. Mind and body are inseparable; there is a bidirectional relationship between psyche and soma, each influencing the other. Plausible biochemical explanations are appearing at an astonishing rate. Psychiatric comorbidity with many chronic physical disorders has remained neglected. Such comorbidity with cardiac, respiratory, Gastrointestinal, endocrinal, and neurological disorders, trauma, and other conditions like HIV and so on, needs to be addressed too. Evidence base of prevalence and causal relationship of psychiatric comorbidities in these disorders has been highlighted and strategies to meet the challenge of comorbidity have been indicated. PMID:21180405

Management of chronic (post-viral) fatigue syndrome.

PubMed Central

Wessely, S; David, A; Butler, S; Chalder, T

1989-01-01

Simple rehabilitative strategies are proposed to help patients with the chronic fatigue syndrome. A model is outlined of an acute illness giving way to a chronic fatigue state in which symptoms are perpetuated by a cycle of inactivity, deterioration in exercise tolerance and further symptoms. This is compounded by the depressive illness that is often part of the syndrome. The result is a self-perpetuating cycle of exercise avoidance. Effective treatment depends upon an understanding of the interaction between physical and psychological factors. Cognitive behavioural therapy is suggested. Cognitive therapy helps the patient understand how genuine symptoms arise from the frequent combination of physical inactivity and depression, rather than continuing infection, while a behavioural approach enables the treatment of avoidance behaviour and a gradual return to normal physical activity. PMID:2553945

Health related quality of life among elderly living in region of high vulnerability for health in Belo Horizonte, Minas Gerais, Brazil.

PubMed

Camelo, Lidyane do Valle; Giatti, Luana; Barreto, Sandhi Maria

2016-01-01

To investigate whether social relations, sociodemographic characteristics, lifestyle, and health conditions are associated with health-related quality of life (HRQOL) among elderly persons living in regions classified as high vulnerable in terms of health. A cross-sectional study conducted with a population-based random sample of 366 elderly (≥ 60 years of age) persons registered at a primary health-care unit in Belo Horizonte, Minas Gerais, Brazil. HRQOL was measured using the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) and the scores obtained in the physical component score (PCS) and mental component score (MCS) were our response variables. Social relations, sociodemographic characteristics, lifestyle, and health conditions were considered our groups of explanatory variables. Multiple linear regression models were used for the analysis. In the final multivariate models, we found that elevated number of diagnosis of chronic diseases, and being bedridden for the last 15 days were variables associated with worse PCS and MCS. However, lack of education, dissatisfaction with personal relationships, lack of support and help when bedridden or to go to the doctor, and to prepare meals were associated with worse HRQOL only in MCS. Participants who reported black race/color, absence of work activity, lack of physical activity, no alcohol consumption, and hospitalization in the last 12 months had worse HRQOL only in PCS. In addition to the aspects related to social adversity, lifestyle, and health conditions, some functional aspects of social relations were important for understanding the HRQOL in elderly persons living in social vulnerability.

Exercise as a Polypill for Chronic Diseases.

PubMed

Pareja-Galeano, Helios; Garatachea, Nuria; Lucia, Alejandro

2015-01-01

Exercise may be described as a polypill to prevent and/or treat almost every chronic disease, with obvious benefits such as its low cost and practical lack of adverse effects. Implementing physical activity interventions in public health is therefore a goal at the medical, social, and economic levels. This chapter describes the importance of health promotion through physical activity and discusses the impacts of exercise on the most prevalent chronic diseases, namely metabolic syndrome-related disorders, cardiovascular diseases, cancer, and Alzheimer's disease. For each of these chronic conditions, we discuss the epidemiological evidence supporting a beneficial role of exercise, provide guidelines for exercise prescription, and describe the biological mechanisms whereby exercise exerts its modulatory effects. © 2015 Elsevier Inc. All rights reserved.

The importance of lactic acid in migraines and fibromyalgia.

PubMed

de Sá Ribeiro, Guido Assis Cachuba; Scola, Rosana Hermínia; Piovesan, Elcio Juliato; Wollmann Junior, Darley Rugeri; Paiva, Eduardo Dos Santos; da Cunha, Claudio Leinig Pereira; Werneck, Lineu Cesar

2015-01-01

Lactic acid is a byproduct of both muscle metabolism and the central nervous system. Changes in metabolism are related to various physiological and pathological conditions. The aim of this study was to determine the relationship between migraine and fibromyalgia with the levels of lactic acid in the blood. We study of 93 patients was divided into five groups: 1) patients with fibromyalgia (n=20); 2) episodic migraine (n=20); 3) chronic migraine (n=20); 4) fibromyalgia and episodic migraine (n= 13); and 5) fibromyalgia and chronic migraine (n=20), and 20 healthy subjects (control group). Blood levels of lactic acid were measured at four different time points: at rest, during aerobic exercise, during anaerobic physical activity and while resting after anaerobic exercise. Lactic acid increased in all groups during anaerobic physical activity without predominance for either group. During aerobic physical activity, all groups increased lactic acid levels, but the increase was more expressive in the chronic migraine group and the chronic migraine with fibromyalgia group without statistical significance. We did not found abnormalities involving the metabolism of lactic acid in episodic and chronic migraine with or without fibromyalgia. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

Anterior vaginal wall tenderness (AVWT) as a physical symptom in chronic pelvic pain.

PubMed

Paulson, John D; Paulson, Joseph N

2011-01-01

Chronic pelvic pain is often difficult to diagnose and treat properly. Physicians called on to treat this problem may not be able to give a specific diagnosis. The aim of this study was to see whether the physical presence of anterior vaginal wall tenderness could help narrow down and elucidate diagnoses in a practice focusing on diagnosis and treatment of chronic pelvic pain. The study cohort comprised 284 patients with chronic pelvic pain limited to gynecologic and lower urinary problems. Histories, physical examinations, and endoscopic procedures were performed on each patient. An analysis of this information was conducted. Of the chronic pelvic pain patients, 78% had endometriosis, 81% had interstitial cystitis, and 61% had both concurrently. The sensitivity of anterior vaginal wall tenderness (AVWT) in patients with interstitial cystitis was 95%, and in those with only endometriosis and no interstitial cystitis, the sensitivity was 17%. The positive predictive value for interstitial cystitis was 85%, and for endometriosis it was 67%. Examination of the anterior vaginal wall with an empty bladder at the initial examination can lead one to suspect interstitial cystitis and possibly either concomitant or singular endometriosis and allow the physician to approach the workup accordingly.

Responding to Students' Chronic Illnesses

ERIC Educational Resources Information Center

Shaw, Steven R.; Glaser, Sarah E.; Stern, Melissa; Sferdenschi, Corina; McCabe, Paul C.

2010-01-01

Chronic illnesses are long-term or permanent medical conditions that have recurring effects on everyday life. Large and growing number of students have chronic illnesses that affect their emotional development, physical development, academic performance, and family interactions. The primary error in educating those students is assuming that the…

Living With Chronic Pain.

PubMed

Ingle, Barby

2015-01-01

A health educator who has reflex sympathetic dystrophy, an autoimmune condition involving chronic pain, shares her knowledge about living life to the fullest while dealing with a chronic health condition. Her advice encompasses dealing with the health care system, managing information, and obtaining physical and emotional self-care.

Switching between pitch surfaces: practical applications and future perspectives for soccer training.

PubMed

Rago, Vincenzo; Silva, João R; Brito, João; Barreira, Daniel; Mohr, Magni; Krustrup, Peter; Rebelo, António N

2018-04-04

Soccer training and completion is conventionally practiced on natural grass (NG) or artificial turf (AT). Recently, AT pitches for training / competition, and of unstable surfaces for injury prevention training has increased. Therefore, soccer players are frequently exposed to variations in pitch surface during either training or competition. These ground changes may impact physical and physiological responses, adaptations as well as the injury. The aim of this review was to summarize the acute physical and physiological responses, chronic adaptations, and injury risk associated with exercising on different pitch surfaces in soccer. Eligible studies were published in English, had pitch surface as an independent variable, and had physical, physiological or epidemiological information as outcome variables. Specific data extracted from the articles included the training response, training adaptations or injury outcomes according to different pitch surfaces. A total of 224 studies were retrieved from a literature search. Twenty articles met the inclusion criteria: 9 for acute physical and physiological responses, 2 for training adaptations and 9 for injury assessment. The literature lacks consistent evidence regarding the effects of pitch surface on performance and health outcomes in soccer players. However, it seems that occasionally switching training surfaces seems a valuable strategy for focusing on specific musculoskeletal queries and enhancing players' fitness. For instance, sand training may be occasionally proposed as complementary training strategy, given the recruitment of additional musculature probably not involved on firmer surfaces, but the possible training-induced adaptations of non-conventional soccer surfaces (e.g., sand) might potentially result into a negative transfer on AT or NG. Since the specific physical demands of soccer can differ between surfaces, coaches should resort to the use of non-traditional surfaces with parsimony, emphasizing the specific surface-related motor tasks, normally observed on natural grass or artificial turf. Further studies are required to better understand the physiological effects induced by systematic surface-specific training, or switching between pitch surfaces.

The Effect of 2 Forms of Talocrural Joint Traction on Dorsiflexion Range of Motion and Postural Control in Those With Chronic Ankle Instability.

PubMed

Powden, Cameron J; Hogan, Kathleen K; Wikstrom, Erik A; Hoch, Matthew C

2017-05-01

Talocrural joint mobilizations are commonly used to address deficits associated with chronic ankle instability (CAI). Examine the immediate effects of talocrural joint traction in those with CAI. Blinded, crossover. Laboratory. Twenty adults (14 females; age = 23.80 ± 4.02 y; height = 169.55 ± 12.38 cm; weight = 78.34 ± 16.32 kg) with self-reported CAI participated. Inclusion criteria consisted of a history of ≥1 ankle sprain, ≥2 episodes of giving way in the previous 3 mo, answering "yes" to ≥4 questions on the Ankle Instability Instrument, and ≤24 on the Cumberland Ankle Instability Tool. Subjects participated in 3 sessions in which they received a single treatment session of sustained traction (ST), oscillatory traction (OT), or a sham condition in a randomized order. Interventions consisted of four 30-s sets of traction with 1 min of rest between sets. During ST and OT, the talus was distracted distally from the ankle mortise to the end-range of accessory motion. ST consisted of continuous distraction and OT involved 1-s oscillations between the mid and end-range of accessory motion. The sham condition consisted of physical contact without force application. Preintervention and postintervention measurements of weight-bearing dorsiflexion, dynamic balance, and static single-limb balance were collected. The independent variable was treatment (ST, OT, sham). The dependent variables included pre-to-posttreatment change scores for the WBLT (cm), normalized SEBTAR (%), and time-to-boundary (TTB) variables(s). Separate 1-way ANOVAs examined differences between treatments for each dependent variable. Alpha was set a priori at P < .05. No significant treatment effects were identified for any variables. A single intervention of ST or OT did not produce significant changes in weight-bearing dorsiflexion range of motion or postural control in individuals with CAI. Future research should investigate the effects of repeated talocrural traction treatments and the effects of this technique when combined with other manual therapies.

Developing consensus measures for global programs: lessons from the Global Alliance for Chronic Diseases Hypertension research program.

PubMed

Riddell, Michaela A; Edwards, Nancy; Thompson, Simon R; Bernabe-Ortiz, Antonio; Praveen, Devarsetty; Johnson, Claire; Kengne, Andre P; Liu, Peter; McCready, Tara; Ng, Eleanor; Nieuwlaat, Robby; Ovbiagele, Bruce; Owolabi, Mayowa; Peiris, David; Thrift, Amanda G; Tobe, Sheldon; Yusoff, Khalid

2017-03-15

The imperative to improve global health has prompted transnational research partnerships to investigate common health issues on a larger scale. The Global Alliance for Chronic Diseases (GACD) is an alliance of national research funding agencies. To enhance research funded by GACD members, this study aimed to standardise data collection methods across the 15 GACD hypertension research teams and evaluate the uptake of these standardised measurements. Furthermore we describe concerns and difficulties associated with the data harmonisation process highlighted and debated during annual meetings of the GACD funded investigators. With these concerns and issues in mind, a working group comprising representatives from the 15 studies iteratively identified and proposed a set of common measures for inclusion in each of the teams' data collection plans. One year later all teams were asked which consensus measures had been implemented. Important issues were identified during the data harmonisation process relating to data ownership, sharing methodologies and ethical concerns. Measures were assessed across eight domains; demographic; dietary; clinical and anthropometric; medical history; hypertension knowledge; physical activity; behavioural (smoking and alcohol); and biochemical domains. Identifying validated measures relevant across a variety of settings presented some difficulties. The resulting GACD hypertension data dictionary comprises 67 consensus measures. Of the 14 responding teams, only two teams were including more than 50 consensus variables, five teams were including between 25 and 50 consensus variables and four teams were including between 6 and 24 consensus variables, one team did not provide details of the variables collected and two teams did not include any of the consensus variables as the project had already commenced or the measures were not relevant to their study. Deriving consensus measures across diverse research projects and contexts was challenging. The major barrier to their implementation was related to the time taken to develop and present these measures. Inclusion of consensus measures into future funding announcements would facilitate researchers integrating these measures within application protocols. We suggest that adoption of consensus measures developed here, across the field of hypertension, would help advance the science in this area, allowing for more comparable data sets and generalizable inferences.