Epidemiology of low back pain in the United Arab Emirates

Aims: Low back pain (LBP), a common presenting problem in general practice in the United Arab Emirates (UAE), has received increasing attention in recent decades. We seek to investigate the prevalence of LBP and associated risk factors among people living in the typically hot, humid desert environment of the UAE. Methods: A cross‐sectional questionnaire survey was conducted. The setting was the Primary Health Care (PHC) Clinics in Al‐Ain, UAE. The subjects were a multistage stratified sample of 1304 UAE nationals, 15–70 years of age, who attended PHC clinics for any reason. All subjects were invited to participate. The questionnaire used in the survey is a modified version of the Roland‐Morris scale for evaluating low back pain. The questionnaires were administered during face‐to‐face interviews conducted in Arabic by qualified nurses. Results: Of the total 1304 subject, 1103 (84.5%) living in both urban and rural areas agreed to participate and responded to the study; 586 (53.1%) were men and 517 (46.9%) women. The mean ages and SD of the subjects were 34.9 ± 13.4 years for the men and 33.5 ± 11.8 years for the women. The prevalence of LBP in the present study was 64.6% (95% CI = 60.7–68.5). The results revealed that there were statistically significant differences between men and women with respect to LBP and body mass index (BMI) (P < 0.001), marital status (P < 0.001), occupational status (P < 0.001), housing condition (P < 0.001), and smoking habits (P < 0.001). Back pain had a greater influence on the lifestyle habits of the women than men. Stepwise multiple regression analysis showed that only BMI (OR = 2.54, 95% CI = 2.30–281; P < 0.001), prolonged standing (OR = 6.22, 95% CI = 4.01–9.67; P < 0.0001), weakness in leg (OR = 2.11, 95% CI = 1.16–3.85; P = 0.0142), lifting heavy weights (OR = 6.34, 95% CI = 4.09–9.84; P = 0.019) regular exercise (OR = 12.47, 95% CI = 7.50–20.71; P < 0.001) and smoking habits (OR = 1.61, 95% CI = 1.08–2.38; P < 0.05) had a significant effect on the presence of LBP in these patients. Conclusions: The study showed that the prevalence of back‐related disability was higher among women than men in the UAE. Also, low socio‐economic status and adverse lifestyle habits may constitute risk factors and predictors of LBP.     

Insulin resistance is an independent correlate of increased urine albumin excretion: a cross‐sectional study in Iranian Type 2 diabetic patients

Aims To assess the association of insulin resistance with increased urinary albumin excretion (UAE) in a cohort of Iranian Type 2 diabetic patients. Methods Three hundred and sixty‐one men and 472 women with Type 2 diabetes were enrolled from three different outpatient clinics (Tehran, Iran) during the period 2005–2008. Patients with obstructive uropathy, severe heart failure, liver disease, cancer, autoimmune disease and macroalbuminuria were not included. Microalbuminuria (MA; defined as UAE ≥ 30 mg/day) was found in 242 (29.1%) patients; 591 (70.9%) subjects had normoalbuminuria (UAE < 30 mg/day). Insulin resistance was assessed using homeostasis model assessment of insulin resistance (HOMA‐IR). Results HOMA‐IR index values were higher in subjects with MA than those with normoalbuminuria (P < 0.00001). Adjusted values (for age, sex and duration of diabetes) of UAE and HOMA‐IR were 11.81 ± 7.51 (mg/day) and 3.30 ± 2.21 in normoalbuminuric and 75.36 ± 55.57 (mg/day) and 4.98 ± 3.22 in the MA group, respectively (P < 0.00001 for all). Multiple regression analysis showed that UAE was predicted by HOMA‐IR, independently of age, duration of diagnosed diabetes, triglycerides, waist circumference, metabolic control, blood pressure and related treatments (P < 0.00001). When patients were categorized into quartiles of HOMA‐IR, those of the fourth quartile (i.e. the most insulin resistant) were at a higher risk of increased UAE than other quartiles [odds ratio (OR) 3.7 (95% confidence intervals 2.7–6.2)]. Conclusions In Iranian Type 2 diabetic patients, albuminuria was strongly associated with insulin resistance. HOMA‐IR is an independent predictor of UAE.     

Symptoms of depression in people with impaired glucose metabolism or Type 2 diabetes mellitus: The Hoorn Study

Objective To study the prevalence and risk factors of depressive symptoms, comparing subjects with normal glucose metabolism (NGM), impaired glucose metabolism (IGM) or Type 2 diabetes mellitus (DM2). Research design and methods Cross‐sectional data from a population‐based cohort study conducted among 550 residents (276 men and 274 women) of the Hoorn region, the Netherlands. Levels of depressive symptoms were measured using the Centre for Epidemiologic Studies Depression Scale (CES‐D score ≥ 16). Glucose metabolism status was determined by means of fasting and post‐load glucose levels. Results The prevalence of depressive symptoms in men with NGM, IGM and DM2 was 7.7, 7.0 and 15.0% (P = 0.19) and for women 7.7, 23.1 and 19.7% (P < 0.01), respectively. Depression was significantly more common in women with IGM [odds ratio (OR) = 3.60, 95% confidence interval (CI) = 1.57 to 8.28] and women with DM2 (OR = 3.18, 95% CI = 1.31 to 7.74). In men, depression was not associated with IGM (OR = 0.90, 95% CI = 0.32 to 2.57) and non‐significantly more common in DM2 (OR = 2.04, 95% CI = 0.75 to 5.49). Adjustment for cardiovascular risk factors, cardiovascular disease and diabetes symptoms reduced the strength of these associations. Conclusions Depressive symptoms are more common in women with IGM, but not men. Adjustment for cardiovascular risk factors, cardiovascular disease and diabetes symptoms partially attenuated these associations, suggesting that these variables could be intermediate factors.     

High‐normal levels of albuminuria predict the development of micro‐ and macroalbuminuria and increased mortality in Brazilian Type 2 diabetic patients: an 8‐year follow‐up study

Aim To analyse the risk factors for the development of micro‐ and macroalbuminuria and mortality rates in a cohort of normoalbuminuric Type 2 diabetes mellitus (DM) patients. Methods In this prospective study, 193 Type 2 DM patients with urinary albumin excretion (UAE) < 20 µg/min, 96 men (50%), aged 56.5 ± 9 years, were followed for a mean period of 8 ± 3 years. UAE and estimated glomerular filtration rate (eGFR; Modification of Diet in Renal Disease) were measured. The outcomes were development of persistent micro‐ and macroalbuminuria and mortality. Results Twenty patients were lost to follow‐up. Of the 173 remaining patients, 33 (19%) died. The Cox analysis [hazard ratio (HR), 95% confidence interval] revealed that the baseline significant predictors of mortality were higher UAE [above median (5 µg/min); HR 2.7, 1.2–6.1; P = 0.02], male sex (HR  3.9, 1.7–9.2; P = 0.002), age (HR 1.6, 1.3–1.9; P = 0.0001), and fasting plasma glucose (HR 1.2, 1.1–1.3; P = 0.004). Smoking and eGFR were not significant in this model. Follow‐up renal data were available for 158 patients: 34 (22%) progressed to microalbuminuria and seven (4%) to macroalbuminuria, and the baseline predictors were a higher UAE (> 5 µg/min, HR 2.5, 1.2–5.1; P = 0.02), presence of diabetic retinopathy (HR 2.5, 1.3–5.0; P = 0.009), fasting glucose (HR 1.1, 1.0–1.2; P = 0.015), and male sex (HR 2.2, 1.1–4.7; P = 0.04), independently of smoking and hypertension. Lower GFR (HR 0.98, 0.97–1.00; P = 0.07) was of borderline significance. Conclusions In normoalbuminuric Type 2 DM patients, the development of micro‐ or macroalbuminuria and mortality rates was independently and positively associated with higher levels of albuminuria, although still in the traditionally established normal range.     

Moderating effect of mindfulness on the relationship between anxiety and somatization symptoms in middle-aged and elderly female patients with hypertension

To explore the moderating effect of mindfulness on the relationship between anxiety and somatization symptoms in middle-aged and elderly female patients with hypertension and provide a foundation for the development of more effective mindfulness intervention strategies. A total of 109 middle-aged and elderly female patients with hypertension participated in this cross-sectional study from April to July 2022 and provided valid responses to the Five Facet Mindfulness Questionnaire (FFMQ), the Hospital Anxiety and Depression Scale (HADS), and the Somatization Symptom Self-rating Scale (SSS). The moderating effect of mindfulness was determined using multiple linear regression. The participants’ average scores were as follows: mindfulness: 123.86 ± 10.49; anxiety: 7.41 ± 3.62; and somatization symptoms: 41.2 ± 9.44. The anxiety (P = .000) and somatization symptoms (P = .001) of participants with high mindfulness were significantly reduced. Anxiety was positively correlated with somatization symptoms (r = 0.606, P = .000), while mindfulness was negatively correlated with both anxiety (r = -0.468, P = .000) and somatization symptoms (r = -0.439, P = .000). Moreover, mindfulness had a significant moderating effect on the relationship between anxiety and somatization symptoms (n = 109) (B = -0.166, t = -2.125, P = .036). The effect of mindfulness on anxiety and somatization symptoms was more significant in participants with low mindfulness levels (n = 56) (B = 0.144, t = 2.805, P = .008) than in participants with high mindfulness levels (n = 53) (B = -0.037, t = -0.864, P = .393). The moderating effect analysis based on regression analysis showed that mindfulness had a significant moderating effect on anxiety and somatization symptoms, especially in participants with low mindfulness levels.     

Depression is not associated with peripheral insulin resistance in patients with chronic hepatitis C infection

Depression is common in individuals infected with hepatitis C virus (HCV), and both depression and HCV infection are independently associated with insulin resistance (IR). To evaluate the relationship between depression and IR, among other factors, in an HCV‐infected cohort. In this cross‐sectional analysis, seventy‐four non‐type 2 diabetic, noncirrhotic, HCV‐infected patients underwent comprehensive clinical, histologic and metabolic evaluation. IR was assessed directly with an insulin suppression test by measuring steady‐state plasma glucose (SSPG) levels during continuous infusions of octreotide, glucose and insulin. Logistic regression modelling was used to evaluate predictors associated with depression. Thirty‐nine (53%) patients were depressed, and 21 (54%) depressed patients were on at least one antidepressant. A higher estimated proportion of depressed patients were Caucasian (51% vs 20%, P = 0.005), unemployed (69% vs 49%, P = 0.07), heavier smokers (18 pack‐years vs 13 pack‐years, P = 0.07), on substance abuse therapy (16% vs 3%, P = 0.06) and had lower HDL levels (1.2 mmol/L vs 1.4 mmol/L, P = 0.01). The mean SSPG levels in depressed and nondepressed patients were 7.3 and 8.3 mmol/L (P = 0.45), respectively. In multipredictor adjusted analysis, only Caucasian race (OR 4.19, 95% CI 1.42–12.35, P = 0.009) and lower HDL (OR 0.95, 95% CI 0.89–0.99, P = 0.046) were associated with depression. In conclusion, although prevalent, depression was not associated with peripheral IR in this HCV‐infected cohort. Attention to other modifiable factors associated with depression in the HCV‐infected population is warranted.     

The frequency of smoking in fibromyalgia patients and its association with symptoms

The objective of the study was to determine the frequency of smoking in fibromyalgia (FM) and rheumatoid arthritis (RA) patients and investigate its association with the symptoms of FM. We included age-matched 302 FM (289 F, 13 M), and 115 (105 F, 10 M) RA patients. All patients were questioned about smoking and the severity of their chronic widespread pain (CWP) and symptoms of FM by using a visual analog scale (VAS, 0–10) and FM impact questionnaire. In addition, patients were asked questions about depression and anxiety. The frequency of smoking in FM patients (77 subjects, 25.5%) tended to be higher than in RA patients (19 subjects, 16.5%) (P = 0.05). When the features of smoker FM patients were compared to others, it was observed that the frequencies of subjects with an education duration >9 years (P < 0.001) and subjects with an history of psychiatric therapy (P = 0.01) and alcohol consumption (P = 0.013) were higher. The mean age of FM patients with smoking (P = 0.002) was lower; the duration of FM (P = 0.024) was shorter; and the scores of CWP severity (P = 0.05), unrestorative sleepiness (P = 0.017), paresthesia (P = 0.038) and anxiety-depression (P = 0.007) were higher. An important proportion of FM patients, nearly one-fourth, were re-smokers. Smoker FM patients had higher education level, and the severity of their FM-related symptoms like CWP and their anxiety-depression scores were higher.     

Predictors of disability among Filipinos with knee osteoarthritis

Aims: This study aims to describe the level of disability of Filipino patients with knee osteoarthritis (OA) in relation to common risk factors. Methodology: This is a cross‐sectional analytic study. Patients with knee osteoarthritis diagnosed using the American College of Rheumatology criteria for the classification of knee OA, seen at East Avenue Medical Center, using the Quezon City, Philippines, were entered by convenient sampling. The Western Ontario and McMaster Universities (WOMAC (va) 3.1 Tagalog Version) osteoarthritis index was used. Self‐reported disability was measured by the function subscale of the WOMAC OA index and used as the dependent variable. Independent variables assessed as possible risk factors affecting disability were age, sex, weight, height, body mass index (BMI), education (in years), number of comorbidities present, smoking status (pack years), duration of knee OA, pain and stiffness. Categories of disability were identified as high, moderate and low. Analyses of the data were performed using Statistical Package for the Social Sciences (SPSS) version 13. Results: Eighty‐five subjects were included in the study. The mean disability score was 674.1 ± 318.81 (moderate disability). Chi‐square tests showed that the categories or levels of disability are not significantly dependent on the categorical variables. Significant direct correlations were seen between mean disability and weight (r = 0.260, P = 0.016), pain (r = 0.574, P = 0.000), and stiffness (r = 0.616, P = 0.000). Conclusion: This is the first study analysing the relationship between disability and specific risk factors among Filipino patients with knee OA. Self‐reported disability of knee OA in the population studied was strongly related to pain scores, weight and joint stiffness scores.     

Patterns and predictors of nursing home placement over 14 years: Dubbo study of elderly Australians

Objective: To describe patterns and predictors of nursing home placement. Methods: This is a longitudinal study of an elderly cohort living in Dubbo, New South Wales, Australia. A total of 1233 men and 1572 women aged 60 years and older living in the community were examined in 1988 and followed for 14 years. The incidence of nursing home placement and underlying clinical diagnoses were assessed. Results were modelled for baseline predictors of placement using Cox proportional hazards regression. Results: From 2805 subjects in the study there were 244 (8.7%) nursing home placements, 95 in men (7.7%) and 149 in women (9.5%). A total of 44% placements were primarily due to dementia, but dementia was a secondary diagnosis in another 20% of cases. The other principal diagnoses were stroke (16%) and coronary heart disease (14%). Median time to death in a nursing home was 10.5 months in men and 9.0 months in women. In a Cox proportional hazards model using baseline characteristics, the hazard of nursing home placement increased significantly with age (hazard ratio = 1.13), urinary incontinence (1.66), impaired peak expiratory flow (3.19), physical disability (1.59) and depression (1.85). The hazard of placement was significantly reduced by alcohol intake (0.55) and female gender (0.55). Socioeconomic factors were not significant. Conclusions: Dementia and disability‐related care burdens rather than other health conditions are the dominant causes of nursing home placement in an unselected elderly community. Risk factors such as incontinence, impaired respiratory function and depression have been identified and these are potentially amenable to intervention.     

Watchful waiting: role of disease progression on uncertainty and depressive symptoms in patients with chronic Hepatitis C

Background and Aims: New therapies for HCV are rapidly emerging and providers are advising select patients to defer treatment and elect ‘watchful waiting’. During the watchful waiting period, patients have been shown to have high rates of illness uncertainty and depression. We sought to answer the question of whether reassuring histological data (showing minimal fibrosis or no fibrosis progression over time) is associated with less illness uncertainty and depressive symptoms. Methods: This was a single‐centre outpatient prospective cohort study to determine whether stage of fibrosis, fibrosis progression and reasons for treatment deferral were related to illness uncertainty and depressive symptoms in patients following watchful waiting. Results: Illness uncertainty was significantly related to depressive symptoms (r = 0.49, P < 0.01). More than half of the participants (54%) had moderate levels of uncertainty. About 40% of the participants were at risk for clinical depression (21.7% at mild to moderate risk and 18.5% at high risk). Treatment naïve subjects had lower mean scores on both the CES‐D (depressive symptoms measure) and the MUIS‐A (illness uncertainty measure) total score, MUIS‐A Ambiguity subscale and MUIS‐A Inconsistency subscale than subjects who failed treatment or were interferon intolerant or ineligible. Surprisingly, liver fibrosis stage and progression were not significantly associated with overall illness uncertainty or depressive symptoms. Conclusion: Patients with chronic hepatitis C on watchful waiting are at high risk for significant illness uncertainty and depressive symptoms. Reassuring histological data does not seem to correlate with less uncertainty or depressive symptoms.     

Effect of Depression on the Risk and Severity of Lower Urinary Tract Symptoms in Community‐Dwelling Elderly Korean Men

Objectives: To evaluate the association of the risk and severity of lower urinary tract symptoms (LUTS) and depression diagnosed by neuropsychiatrists according to the DSM‐IV diagnostic criteria using an objective questionnaire within community‐dwelling elderly Korean men. Methods: A total of 392 men who completed urological and psychiatric evaluations as a participant in the Korean Longitudinal Study on Health and Aging were included in this analysis. From each subject, an interview elicited demographic characteristics and medical history, International Prostate Symptom Score was ascertained, and a psychiatric questionnaire was completed. Subjects were analyzed with regard to depression and LUTS severity. Results: The mean age of the subjects was 75 years, 22% were current smokers and 45% were heavy drinkers. Two hundred and twenty‐nine subjects (59%) had moderate to severe LUTS and 6.4% of the subjects were diagnosed with major depressive disorders. Those with depression showed higher International Prostate Symptom Score and lower quality of life than the euthymic group (P = 0.03 and P = 0.02, respectively). Severe LUTS was more prevalent in the depression group compared with the euthymic group (P = 0.01). Moderate to severe LUTS was associated with higher age, lower prevalence of hypertension, and higher prevalence of depression than mild LUTS. Univariate and multivariate analyses identified age, hypertension, and depression as significant prognostic factors for moderate to severe LUTS. Depression was the most significant prognostic factor. Depression was associated with 5.81‐fold increased odds of having moderate to severe LUTS. Conclusion: In older Korean men, depressive symptoms are associated with moderate to severe LUTS.     

Prevalence of depression in adults with haemophilia

Multiple factors place adults with haemophilia at risk for depression. Health outcomes can be compromised in depressed patients secondary to increased risk taking behaviour and poor compliance with treatment recommendations. To assess the prevalence and risk factors associated with depression in adult patients with haemophilia treated at a haemophilia treatment centre. Adults with haemophilia were screened for depression during their annual clinic visit using the Patient Health Questionnaire 9 (PHQ‐9), a validated tool for depression screening in adults. Depression was defined as a PHQ‐9 score ≥ 5. Risk factors associated with depression were collected by chart review and correlated with depression scores. A total of 41 adult patients consented to the study and 37% met criteria for depression. Fifty‐three per cent of patients with depression reported moderate to severe symptoms of depression (PHQ‐9 score >10). Seventy‐six per cent of patients with depression reported suffering functional impairment due to their depressive symptoms. Lack of social support and unemployment were significantly associated with higher PHQ‐9 scores (P = 0.04 and P = 0.01 respectively). Adult patients with haemophilia have a high prevalence of depression. The addition of depression screening to the comprehensive care of adults with haemophilia may result in improved overall health outcomes and treatment adherence.     

Symptoms of anxiety and depression are independently associated with inflammatory bowel disease-related disability

BackgroundInflammatory bowel disease (IBD) frequently results in disability. The relevance of psychological effects in causing disability, and whether disability occurs similarly in non-Western cohorts is as yet unknown.AimWe assessed the relationship between symptoms of anxiety and depression, quality of life and disability in a Singaporean IBD cohort and their predictors.MethodsCross-sectional study. We assessed consecutive IBD subjects’ IBD-Disability Index (IBD-DI), Hospital Anxiety and Depression Scale (HADS), and IBD questionnaire (IBDQ). Clinical and demographic variables were collected. Non-parametric statistical analyses were performed. Independent predictors of disability were identified through multivariate logistic regression.Results200 consecutive subjects were recruited (males: 69%; median age: 43.8 (±15.4) years; 95 had Crohn’s disease (CD), 105 had ulcerative colitis (UC); median IBD duration: 10.8 (±9.0) years.) 27% of the cohort had anxiety and/or depression, which worsened disability (IBD-DI: −9 (±14) with anxiety vs 6 (±13) without anxiety, P < 0.001; −12 (±16) with depression vs 5 (±13) without depression, P < 0.001). Age at diagnosis, use of prednisolone, stricturing CD and active IBD were significant predictors of disability. IBDQ strongly correlated with IBD-DI(r_s = 0.82, P < 0.01).ConclusionSymptoms of anxiety and depression were common in this Asian cohort of IBD and were strongly associated with IBD-related disability. Recognizing psychological issues contributing to disability in IBD is important to ensure holistic care and appropriate treatment.     

Effect of cranberry extracts on lipid profiles in subjects with Type 2 diabetes

Aim To examine the effect of cranberry ingestion on lipid profiles in Type 2 diabetic patients taking oral glucose‐lowering drugs. Methods Thirty Type 2 diabetic subjects (16 males and 14 females; mean age 65 ± 1 years) who were taking oral glucose‐lowering medication regularly were enrolled in this randomized, placebo‐controlled, double‐blind study. Changes in lipid profiles, oxidized low‐density lipoprotein (ox‐LDL), glycaemic control, components of the metabolic syndrome, C‐reactive protein (CRP) and urinary albumin excretion (UAE) were assessed after cranberry or placebo treatment for 12 weeks. Results Low‐density lipoprotein (LDL) cholesterol decreased significantly in the cranberry group (from 3.3 ± 0.2 to 2.9 ± 0.2 mmol/l, P = 0.005) and the decrease was significantly greater than that in the placebo group (–0.4 ± 0.1 vs. 0.2 ± 0.1 mmol/l, P < 0.001). Total cholesterol and total : high‐density lipoprotein (HDL) cholesterol ratio also decreased significantly (P = 0.020 and 0.044, respectively) in the cranberry group and the reductions were significantly different from those in the placebo group (P < 0.001 and P = 0.032, respectively). However, ox‐LDL levels did not change significantly in response to cranberry consumption. Neither fasting glucose nor glycated haemoglobin improved in either group. Changes in components of the metabolic syndrome, UAE and CRP were not significantly different between groups. Conclusions Cranberry supplements are effective in reducing atherosclerotic cholesterol profiles, including LDL cholesterol and total cholesterol levels, as well as total : HDL cholesterol ratio, and have a neutral effect on glycaemic control in Type 2 diabetic subjects taking oral glucose‐lowering agents.     

Cognitive behavioural therapy (CBT) compared with blood glucose awareness training (BGAT) in poorly controlled Type 1 diabetic patients: long‐term effects on HbA1c moderated by depression. A randomized controlled trial

Objective To test the effectiveness at 6 and 12 months’ follow‐up of group cognitive behavioural therapy (CBT) compared with blood glucose awareness training (BGAT) in poorly controlled Type 1 diabetic patients and to explore the moderating effect of baseline depression. Research design and methods Adults with Type 1 diabetes (n = 86) with glycated haemoglobin (HbA_1c) ≥ 8% were randomized to CBT or BGAT. Primary outcome was HbA_1c control. Secondary outcomes were: self‐care, diabetes‐related distress (Problem Areas in Diabetes scale; PAID), diabetes self‐efficacy (Confidence in Diabetes Self‐care scale; CIDS) and depressive symptoms (Centre for Epidemiological Studies – Depression scale; CES‐D). Measurements were scheduled before CBT and BGAT, and at 3, 6 and 12 months after. Differential effects were analysed for the subgroup of patients reporting low vs. high baseline levels of depression. Results Neither CBT nor BGAT had a significant impact on HbA_1c at 6 and 12 months’ follow‐up. Both interventions resulted in lower depressive symptoms (CES‐D 15.7–13.3, P = 0.01) up to 12 months, but only CBT was effective in lowering HbA_1c in patients with high baseline depression scores (HbA_1c 9.5–8.8%) up to 1 year of follow‐up (P = 0.03). Conclusions Our findings suggest that group CBT can effectively help Type 1 diabetic patients with co‐morbid depression achieve and maintain better glycaemic outcomes.     

Profile of patients with lower back pain in Dr Saiful Anwar Hospital,Malang, Indonesia

Aim: To determine the profile of patients with lower back pain (LBP). Methods: A retrospective study was carried out on patients who presented to Dr Saiful Anwar Hospital (a referral hospital), Malang, Indonesia, from January to December 2000. Results: During the 1‐year period of the study, 456 patients with LBP presented at the Dr Saiful Anwar Hospital. There were 206 female patients (45.2%) with an average age of 46 ± 14.1 years (range: 17–86 years) and 250 male patients (54.8%) with an average age of 45 ± 13.9 years (range: 17–82 years). There were 219 patients affected under the age of 45 years (48%). The educational background of cases was 77 (16.4%) with an academic education, 142 (31.1%) with senior high school, 66 (14.5%) with junior high school, 82 (18%) with elementary school and 89 (19.5%) with an unknown educational background. Conclusions: Lower back pain was more frequent in men than in women. There were no differences statistically in the prevalence of LBP according to age group, sex and educational level.     

Gender differences in C‐reactive protein,interleukin‐1 receptor antagonist and adiponectin levels in the metabolic syndrome: a population‐based study

Aims We explored gender differences in the association of high‐sensitivity C‐reactive protein (hs‐CRP), interleukin‐1 receptor antagonist (IL‐1Ra) and adiponectin with the metabolic syndrome (MetS) defined by the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF) criteria. Methods A population‐based study of 923 middle‐aged subjects in Pieksämäki, East Finland. Results The prevalence of the MetS according to the IDF and NCEP definitions was 38% and 34% in men (N = 405) and 34% and 27% in women (N = 497), respectively. hs‐CRP and IL‐1Ra levels were higher in subjects with the MetS compared with those without the MetS in both sexes (P < 0.001). The levels of hs‐CRP (P < 0.001) and IL‐1Ra (P = 0.0016 for NCEP criteria, P = 0.0028 for IDF criteria) were significantly higher in women with MetS than in men with MetS. In contrast, in subjects without MetS, no gender differences in the levels of hs‐CRP or IL‐1Ra were found. Conclusion Women with MetS, defined by the IDF or NCEP criteria, had higher levels of hs‐CRP and IL‐1Ra than did men with MetS. Thus, low‐grade inflammation may contribute to the high risk of cardiovascular disease in women with MetS.     

Evaluation of the adverse effect of premature discontinuation of pegylated interferon α-2b and ribavirin treatment for chronic hepatitis C virus infection: results from Kyushu University Liver Disease Study

Background and Aims: Pegylated interferon (PEG‐IFN) α‐2b and ribavirin (RBV) treatment of chronic hepatitis C virus (HCV) infection is associated with a substantially elevated risk of discontinuation. The aim of this study is to evaluate the reason for premature discontinuation during PEG‐IFN α‐2b and RBV treatment due to adverse effects in patients with chronic HCV infection. Methods: A total of 2871 Japanese patients who had chronic HCV infection treated with PEG‐IFN α‐2b and RBV were screened. We prospectively investigated the reasons for premature discontinuation of treatment classified by sex and age, and analyzed the timing of discontinuation. Results: Of the 2871 patients, 250 (8.7%) discontinued treatment because of adverse effects. The main reasons for premature discontinuation were neurovegetative symptoms (n = 77, 30.8%), depression‐related syndrome (n = 46, 18.4%), hematologic effects (n = 41, 16.4%) and dermatologic effects (n = 27, 10.8%). The rate of discontinuation of treatment for patients aged ≥ 65 years was significantly higher than for patients aged < 65 years, for both men (P < 0.0001) and women (P = 0.0121). Moreover, the frequency of discontinuation due to neurovegetative symptoms, depression‐related syndrome, and hematologic effects for men aged ≥ 65 years was significantly higher than for those aged < 65 years (P = 0.0001, P = 0.0016, and P = 0.0170, respectively), but not for women. Conclusion: Premature discontinuation due to the adverse effects of PEG‐IFN α‐2b and RBV treatment by patients with chronic HCV infection is mainly due to neuropsychiatric symptoms and is more common for older than for younger patients.     

Depression and its correlation with in patients pain in the rheumatology service of a Mexican teaching hospital

The depressive symptoms are associated with chronic pain in this study. A cross-sectional study was performed. A visual analog scale was used to register pain intensity. Depressive symptoms were measured using the Center of Epidemiological Studies (CES-Dr) scale as modified by Eaton and reviewed for use in the Mexican population. The study included 245 patients, with a mean age of 46 years, 86.1% of whom were female. The prevalence of some degree of depression was 55.1%. Patients with fibromyalgia had the highest prevalence of symptoms of depression (78.38%) and major depression (29.73%). Stepwise multiple regressions indicated that the best model (r ² = 0.26) to predict the CES-Dr score included the global pain score (P < 0.0001) and education level (P < 0.004). The Cronbach’s alpha of the CES-Dr was high (α = 0.888). There was moderate correlation (r = 0.442), P < 0.0001 of the CES-Dr numeric score with the intensity of global pain.     

Recovery‐stress patterns and low back pain: Differences in pain intensity and disability

Background

Recovery describes a restoring process influencing the health conditions of individuals but a potential link to low back pain (LBP) has not been scrutinized so far. Psychological strategies to deal with LBP have been considered within the biopsychosocial approach but substantial evidence regarding specific psychological underpinnings remains elusive. The current study aimed to compare individuals with different recovery–stress patterns (i.e. specific combinations of recovery/stress) regarding their pain and disability in the lower back.

Methods

Cross‐sectional data from 265 physically active individuals with non‐specific LBP were collected via standardized questionnaires. The participants engaged in prescribed exercise therapy provided by a healthcare professional owing to their back burden. A k‐means cluster analysis identified three clusters.

Results

Cluster 1 entailed individuals with high recovery and low stress values, Cluster 2 represented participants with medium scores on both dimensions and Cluster 3 included participants with low recovery and high stress values. The statistical analyses for pain intensity using analyses of covariance indicated significantly higher values for Cluster 3 compared with Clusters 1 and 2 for worst pain intensity (p < 0.001 and p = 0.003, respectively) and mean pain intensity (p < 0.001 and p = 0.001, respectively). The disability comparisons using non‐parametric tests showed significantly higher LBP‐related disability in Cluster 3 than Cluster 1 on two disability measures.

Conclusions

The findings indicate an association between detrimental recovery–stress patterns and LBP. Examining the role of recovery has innovative practical relevance for LBP prevention and rehabilitation through the implementation of approaches to enhance recovery in relevant programmes.