Neck, shoulder, and hand and wrist pain among administrative employees: relation to work-time organization and psychosocial factors at work

OBJECTIVE: We sought to analyze the associations between work-time organization, psychosocial factors at work, and musculoskeletal pain of the neck, shoulders, and wrists and hands among administrative employees. METHODS: We analyzed the pain felt in a population of 762 employees during the 7 days before the survey at any of the three sites studied (multiple logistic regression). RESULTS: We found no associations between work-time organization and neck or shoulder pain. Wrist and hand pain increased with irregular schedule (odds ratio "OR" = 2.01; 95% confidence interval "95% CI" = 1.19-3.41) and lack of advance (at least 8 days) notice of schedule (OR = 1.90; 95% CI = 1.03-3.50). Of the psychosocial factors, only high psychological demand was associated with a significant increase in the prevalence of pain, in the neck and the shoulders (respectively: OR = 1.86, 95% CI = 1.23-2.82; OR = 1.88, 95% CI = 1.17-3.03). CONCLUSION: Prevention by improved psychosocial constraints at work must continue.     

The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors?

BACKGROUND: Syndromes for which no physical or pathological changes can be found tend to be researched and managed in isolation although hypotheses suggest that they may be one entity. The objectives of our study were to investigate the co-occurrence, in the general population, of syndromes that are frequently unexplained and to evaluate whether they have common associated factors. METHODS: We conducted a population-based cross-sectional survey that included 2,299 subjects who were registered with a General Medical Practice in North-west England and who completed full postal questionnaires (response rate 72%). The study investigated four chronic syndromes that are frequently unexplained: chronic widespread pain, chronic oro-facial pain, irritable bowel syndrome, and chronic fatigue. Validated instruments were used to measure the occurrence of syndromes and to collect information on a variety of associated factors: demographic (age, gender), psychosocial (anxiety, depression, illness behaviour), life stressors, and reporting of somatic symptoms. RESULTS: We found that 587 subjects (27%) reported one or more syndromes: 404 (18%) reported one, 134 (6%) reported two, 34 (2%) reported three, and 15 (1%) reported all four syndromes. The occurrence of multiple syndromes was greater than would be expected by chance (P < 0.001). There were factors that were common across syndromes: female gender [odds ratio (OR) = 1.8; 95% confidence interval (95% CI) 1.5-2.2], high levels of aspects of health anxiety like health worry preoccupation (OR = 3.5; 95% CI 2.8-4.4) and reassurance seeking behaviour (OR = 1.4; 95% CI 1.1-1.7), reporting of other somatic symptoms (OR = 3.6; 95% CI 2.9-4.4), and reporting of recent adverse life events (OR = 2.3; 95% CI 1.9-2.8). CONCLUSION: This study has shown that chronic syndromes that are frequently unexplained co-occur in the general population and share common associated factors. Primary care practitioners need to be aware of these characteristics so that management is appropriate at the outset.     

Cross-sectional and longitudinal associations of low-back pain and related disability with psychological distress among patients enrolled in the UCLA Low-Back Pain Study

The objectives of the study are to test the hypotheses that psychological distress affects subsequent low-back pain, and pain affects subsequent distress. Six hundred eighty-one participants in a randomized clinical trial of low-back pain treatments were followed for 18 months with assessments for pain, disability, and psychological distress at 6 weeks and 6, 12, and 18 months. Multivariable logistic regression modeling with generalized estimating equations was used to estimate effects. Current pain and disability increased the odds of subsequent psychological distress [pain: adjusted odds ratio (OR)=1.36, 95% confidence interval (CI)=1.07, 1.72; disability: adjusted OR=1.23, 95% CI=0.98, 1.55], and current distress increased the odds of subsequent pain and disability (pain: adjusted OR=1.51, 95% CI=1.24, 1.86; disability: adjusted OR=1.49; 95% CI=1.20, 1.85). Cross-sectional associations were much stronger than the longitudinal associations, suggesting bias in the former due to selection factors and/or temporal ambiguity. The longitudinal findings suggest that pain/disability and psychological distress may be causes and consequences of each other, although the associations are small.     

Psychological distress as a risk factor for coronary heart disease in the Whitehall II Study

BACKGROUND: Psychiatric disorder and psychological distress are increasingly recognized as risk factors for coronary heart disease (CHD). Elucidation of the mechanisms of these associations has implications for prevention. This study aims to confirm the association between psychological distress and CHD and examine if it could be explained by other factors such as health behaviours, social isolation and low control at work. METHODS: A prospective occupational cohort study of London-based civil service employees (Whitehall II Study) with baseline data collected from 1985-1988 with a 5-year follow-up. The participants were male and female middle-aged civil servants working in 20 Government Departments; 73% of eligible employees attended baseline screening. Psychological distress measured by the General Health Questionnaire (GHQ) at baseline was used to predict incidence of self-reported CHD and possible and probable electrocardiographic (ECG) abnormalities during follow-up. RESULTS: In men, baseline psychological distress was associated with an increased incidence of overall self-reported CHD (odds ratios [OR] = 1.83, 95% CI : 1.5-2.3) and ECG abnormalities (OR = 1.51, 95% CI : 1.1-2.1), after adjustment for age, employment grade and length of follow-up. In women, baseline psychological distress was also associated with an increased incidence of CHD (OR = 1.60, 95% CI : 1.2-2.1), but not with ECG abnormalities. Adjustment for health behaviours, marital status, social networks and work characteristics reduced the risks for incident CHD by 12% in men and by 10% in women; for ECG abnormalities these adjustments increased the risk in men by 16% and had little effect in women. CONCLUSIONS: The experience of psychological distress confers increased risk of CHD in men that is not explained by health behaviours, social isolation or work characteristics. The increased risk of CHD associated with psychological distress is not consistently demonstrated in women.     

Self-rated health among industrial workers in Southern Brazil

OBJECTIVE: To analyze the prevalence of negative self-rated health and its factors associates among industrial workers. METHODS: Cross-sectional study with a probabilistic sample of 482 metal mechanic industrial workers of a city in Southern Brazil. Data was collected by means of self-administered questionnaire and anthropometric measures. The magnitude of the association between self-rated health and the study variables was estimated by odds ratio with 95% confidence intervals (95% CI). Multivariate logistic regression models were obtained using a theoretical hierarchical model. RESULTS: Response rate was 98.6%. Negative self-rated health was seen in 16.6% of the employees and most (84.8%) were males engaged in predominantly production activities (79.4%). The most common complaint was back pain (30.9%). After statistical modeling the following variables remained associated with negative self-rated health: females (OR=3.0 95% CI 1.5;6.2), physical inactivity (OR=1.8 95% CI 1.0;3.4), psychological stress (OR=3.0 95% CI 1.6;5.6), lack of control over life (OR=3.0 95% CI 1.5;6.1), reporting of one (OR=3.2 95% CI 1.4;7.2) or two or more chronic conditions (OR=7.7 95% CI 3.4;17.8), short-term medical leave (OR=2.9 95% CI 1.5;5.5), and incapacitating illness (OR=2.8 95% CI 1.2;6.6). CONCLUSIONS: The prevalence of negative self-rated health was associated with socioeconomic/demographic, lifestyle, psychosocial and health-related dimensions. The variable causing the greatest impact on the outcome was reporting of more than two chronic conditions.     

Gender and mental health aspects of living with HIV disease and its longer-term outcomes for UK heterosexual patients

Gender is important in the experience of illness generally and HIV specifically. In this study the authors compare 183 HIV positive women with 76 HIV positive heterosexual men attending United Kingdom HIV clinics on clinical, treatment, and mental health factors. Participants completed a questionnaire on mental health and HIV-related factors. Laboratory measures of HIV viral load and CD4 cell count were obtained at baseline and 6-18 months later. After adjusting for age, employment, and treatment status, men were significantly less likely than women to suffer from high psychological [adjusted odds ratio (OR) = 0.38, 95% confidence interval (CI): 0.17, 0.86] and global symptom distress (adjusted OR = 0.42, 95% CI: 0.19, 0.92). However, men were more likely than women to report having suicidal thoughts (adjusted OR = 1.85, 95% CI: 0.95, 3.58). Relational, sexual behavior, and quality of life factors were similar for men and women. Adherence levels did not differ by gender but were sub-optimal in 56% of patients. Men had significantly lower CD4 counts than women at baseline, but not at follow-up. No differences were observed in the proportions with viral suppression. The groups had generally similar HIV experiences with high psychological distress. Adherence monitoring and gender appropriate psychological support are needed for these groups.     

Physical and psychological effects of injury. Data from the 1958 British birth cohort study

BACKGROUND: There is only scant evidence for the long-term health effects of road traffic injuries. We therefore assessed the extent to which motor vehicle driver injuries influence limiting long-standing illness and psychological distress using data from a nationwide study (the 1958 British birth cohort) in early adulthood. METHODS: Information was obtained on driver injuries occurring between ages 23 and 33 years and limiting illnesses and psychological distress at age 33 years. The risks of injury-related adverse consequences were derived using logistic regression and expressed as odds ratios (ORs) and 95% confidence intervals. RESULTS: A single injury was associated with limiting illness (OR = 2.01 and 95% CI: 1.38-2.94). The association between a single injury and psychological distress was strong for a recent injury occurring between ages 30 and 33 years (OR = 1.86 and 95% CI: 1.24-2.81), but not for injuries occurring earlier on. The population attributable fraction for limiting illness with one injury was 3.8% (range 1.7-5.3%) and with two or more injuries was 1.0% (range 0.5-1.3%). After controlling for potential confounding factors the corresponding figures were 4.2% (range 2.2-5.6%) and 1.1% (range 0.5-1.3%) respectively. CONCLUSIONS: Driver injuries are associated with a substantial increase in disability and, also in the short term, with increases in psychological distress. These results highlight the need for identifying effective strategies for the prevention of road traffic injuries as well as more effective approaches for rehabilitation of the injured.     

Predictors of low back pain onset in a prospective British study

OBJECTIVES: This study examined predictors of low back pain onset in a British birth cohort. METHODS: Univariate and multivariate analyses focused on individuals who experienced onset of low back pain at 32 to 33 years of age (n= 571) and individuals who were pain free (n = 5210). Participants were members of the 1958 British birth cohort. RESULTS: Incident pain was elevated among those with psychological distress at 23 years of age (adjusted odds ratio [OR] = 2.52, 95% confidence interval [CI] = 1.65, 3.86) and among persistent moderate or heavy smokers (adjusted OR = 1.63, 95% CI = 1.23, 2.17). Significant univariate associations involving other factors (e.g., social class, childhood emotional status, body mass index, job satisfaction) did not persist in multivariate analyses. CONCLUSIONS: This prospectively studied cohort provides evidence that psychological distress more than doubles later risk of low back pain, with smoking having a modest independent effect. Other prospective studies are needed to confirm these findings before implications for low back pain prevention can be assessed.     

Occupational activity and prevalence of osteomuscular pain among dentists in Belo Horizonte, Minas Gerais State, Brazil: a contribution to the debate on work-related musculoskeletal disorders

The objective was to determine the prevalence of upper-limb and back pain among dentists (n = 358) and factors associated with these symptoms. Dentists were interviewed using a self-administered questionnaire containing data on sociodemographic, occupational, lifestyle, and psychosocial factors and presence, site, and characteristics of pain. Participation rate was 92.3%. 58% reported upper limb pain, with 22, 21, 20, and 17% for the arm, back, neck, and shoulder, respectively. 26% reported daily frequency and 40% classified pain as moderate or severe. In the multivariate analysis (multiple logistic regression), the factors associated with pain were: neck: anxiety/depression (OR = 2.3; CI95%: 1.2-4.5), compressor in the office (OR = 2.1; CI95%: 1.2-3.7), job satisfaction (OR = 0.3; CI95%: 0.1-0.9), and use of indirect vision (OR = 0.5; CI95%: 0.3-0.9); shoulder: income > 20 minimum wage (OR = 2.9; CI95%: 1.2-6.7), greater productivity (OR = 3.3; CI95%: 1.3-8.4), height > or = 160cm (OR = 0.3; CI95%: 0.2-0.7), and age 30-49 years (OR = 0.3; CI95%: 0.1-0.8); back: anxiety/depression (OR = 2.3; CI95%: 1.2-4.5), manual activity (OR = 0.4; CI95%: 0.2-0.9), and being married (OR = 0.5; CI95%: 0.3-0.9); arms: manual activity (OR = 1.8; CI95%: 1.0-3.2).     

Unexplained Gastrointestinal Symptoms After Abuse in a Prospective Study of Children at Risk for Abuse and Neglect

PURPOSE Unexplained gastrointestinal symptoms are more common in adults who recall abuse as a child; however, data available on children are limited. The aim of this study was to investigate the association of childhood maltreatment and early development of gastrointestinal symptoms and whether this relation was mediated by psychological distress.METHODS Data were obtained from the Longitudinal Studies of Child Abuse and Neglect, a consortium of 5 prospective studies of child maltreatment. The 845 children who were observed from the age of 4 through 12 years were the subjects of this study. Every 2 years information on gastrointestinal symptoms was obtained from parents, and maltreatment allegations were obtained from Child Protective Services (CPS). At the age of 12 years children reported gastrointestinal symptoms, life-time maltreatment, and psychological distress. Data were analyzed by logistic regression.RESULTS Lifetime CPS allegations of sexual abuse were associated with abdominal pain at age 12 years (odds ratio [OR] = 1.75; 95% confidence interval [CI] = 1.1–2.47). Sexual abuse preceded or coincided with abdominal pain in 91% of cases. Youth recall of ever having been psychologically, physically, or sexually abused was significantly associated with both abdominal pain and nausea/vomiting (range, OR = 1.5 [95% CI, 1.1–2.0] to 2.1 [95% CI, 1.5–2.9]). When adjusting for psychological distress, most effects became insignificant except for the relation between physical abuse and nausea/vomiting (OR = 1.5; 95% CI, 1.1–2.2).CONCLUSION Youth who have been maltreated are at increased risk for unexplained gastrointestinal symptoms, and this relation is partially mediated by psychological distress. These findings are relevant to the clinical care for children who complain of unexplained gastrointestinal symptoms.     

Childhood and early adult predictors of risk of incident back pain: Ontario Child Health Study 2001 follow-up

Musculoskeletal disorders of the back and spine are a leading cause of disability in working-age populations. There is limited information on the potential consequences of childhood socioeconomic and health status on the risk of incident back pain in early adulthood. The authors describe factors associated with having had a first episode of back pain during the past year in the Ontario Child Health Study, a prospective cohort study of children who were aged 4-16 years at the time of enrollment in 1983 and were resurveyed in 2001. Respondents reporting a first episode of back pain (n=143) were compared with respondents who had never experienced back pain (n=896). The annual incidence of a first episode of back pain in this sample of young adults was 74.7/1,000. Following adjustment for age, sex, childhood conditions, childhood health status, and measures of early adult health, behavior, socioeconomic status, and work environment, the risk of incident back pain was associated with both low (odds ratio (OR)=1.86, 95% confidence interval (CI): 1.14, 3.03) and moderate/high (OR=1.85, 95% CI: 1.07, 3.02) levels of psychological distress, current heavy smoking (OR=1.85, 95% CI: 1.10, 3.10), lower levels of parental education in childhood (OR=1.72, 95% CI: 1.06, 2.80), and emotional or behavioral disorders in childhood (OR=1.87, 95% CI: 1.02, 3.41). The associations of low childhood socioeconomic status and childhood emotional and behavioral disorders with risk of incident back pain in early adulthood are important findings with implications for better understanding the etiology of soft-tissue disorders.     

Is Chronic Musculoskeletal Pain in Adulthood Related to Factors at Birth? A Population-Based Case-Control Study of Young Adults

Chronic musculoskeletal pain affects one-third of the general population, yet apart from occupational and psychosocial risk factors, relatively little is known about its aetiology. Exposures in very early life may influence the development of chronic pain as a young adult. However, unlike the study of early life influences on some other common chronic diseases, little research has been conducted in this area. Using a nested case-control analysis of a population-based cross-sectional survey, this pilot study investigated associations of selected birth-related factors with chronic pain in young adults living in North Staffordshire. 858 participants responded to the survey (adjusted response 37%). 580 were included in the case-control analysis. No association was found between prematurity (OR: 0.14 95% CI: 0.0, 1.1), foetal distress (OR: 0.80 95% CI: 0.4, 1.8), artificial commencement of labour (OR: 1.04 95% CI: 0.6, 1.8), or non-vaginal delivery (OR: 1.03 95% CI: 0.5, 2.0) and chronic pain at age 18–25 years. Associations were observed between pain status and low birth weight (OR: 2.17 95% CI: 0.6, 7.0) and neonatal ITU admission (OR: 1.63 95% CI: 0.4, 7.4). Although these estimates were not statistically significant in this exploratory study they may be worthy of further investigation.     

Gender and Mental Health Aspects of Living with HIV Disease and Its Longer-Term Outcomes for UK Heterosexual Patients

Gender is important in the experience of illness generally and HIV specifically. In this study the authors compare 183 HIV positive women with 76 HIV positive heterosexual men attending United Kingdom HIV clinics on clinical, treatment, and mental health factors. Participants completed a questionnaire on mental health and HIV-related factors. Laboratory measures of HIV viral load and CD4 cell count were obtained at baseline and 6–18 months later. After adjusting for age, employment, and treatment status, men were significantly less likely than women to suffer from high psychological [adjusted odds ratio (OR) = 0.38, 95% confidence interval (CI): 0.17, 0.86] and global symptom distress (adjusted OR = 0.42, 95% CI: 0.19, 0.92). However, men were more likely than women to report having suicidal thoughts (adjusted OR = 1.85, 95% CI: 0.95, 3.58). Relational, sexual behavior, and quality of life factors were similar for men and women. Adherence levels did not differ by gender but were sub-optimal in 56% of patients. Men had significantly lower CD4 counts than women at baseline, but not at follow-up. No differences were observed in the proportions with viral suppression. The groups had generally similar HIV experiences with high psychological distress. Adherence monitoring and gender appropriate psychological support are needed for these groups.     

Belgian coca-cola-related outbreak: intoxication, mass sociogenic illness, or both?

An epidemic of health complaints occurred in five Belgian schools in June 1999. A qualitative investigation described the scenario. The role of soft drinks was assessed by using a case-control study. Cases were students complaining of headache, dizziness, nausea, vomiting, abdominal pain, diarrhea, or trembling. Controls were students present at school on the day of the outbreak but not taken ill. An analysis was performed separately for school A, where the outbreak started, and was pooled for schools B-E. In school A, the attack rate (13.2%) was higher than in schools B-E (3.6%, relative risk = 3.6, 95% confidence interval (CI): 2.5, 5.3). Exclusive consumption of regular Coca-Cola (school A: odds ratio (OR) = 29.7, 95% CI: 1.32, 663.6; schools B-E: OR = 7.3, 95% CI: 2.9, 18.0) and low mental health score (school A: OR = 16.1, 95% CI: 1.3, 201.9; schools B-E: OR = 3.1, 95% CI: 1.5, 6.6) were independently associated with the illness. In schools B-E, consumption of Fanta, consumption of Coca-Cola light, and female gender were also associated with the illness. It seems reasonable to attribute the first cases of illness in school A to regular Coca-Cola consumption. However, mass sociogenic illness could explain the majority of the other cases.     

Psychological distress after employment transitions: the role of subjective financial position as a mediator

OBJECTIVE: To explore the extent to which the mental health effects of transitions into unemployment, or other forms of non-employment, and vice versa, are mediated by financial changes. METHODS: Longitudinal analysis of the British Household Panel Survey from 1991 to 2000. There were 89,264 person-years of observation from 14,686 individuals aged > or =16 years. Main outcome measure was psychological distress measured by the 12-item General Health Questionnaire. RESULTS: Transitions to unemployment were associated with increased risk of psychological distress for men (adjusted odds ratio (OR) 3.15 (95% confidence interval (CI) 2.50 to 3.98)) and for women (OR 2.60 (95% CI 1.97 to 3.43)). Women who left work to look after the family were also more likely to experience psychological distress (OR 1.72 (95% CI 1.45 to 2.05)). A reduced risk of psychological distress was seen for transitions from unemployment to paid employment for men (OR 0.52 (95% CI 0.41 to 0.68)) and for women (OR 0.68 (95% CI 0.69 to 1.40)). Financial difficulty partially mediated these relationships: men who became unemployed and were worse off financially were more likely to experience psychological distress (OR 4.19 (95% CI 3.20 to 5.50)) than men who were not (OR 1.48 (95% CI 0.95 to 2.33)). Conversely, the beneficial health effect for people who left unemployment and became employed was confined to those who were better off financially (OR 0.34 (0.25 to 0.48) for men). CONCLUSIONS: Changes in employment status have both direct and indirect effects, through changes in financial circumstances, on subsequent psychological distress. The results support the view that the direction of causation runs from employment transitions to financial difficulties and psychological distress.     

Pain catastrophizing and kinesiophobia: predictors of chronic low back pain

By using a population-based cohort of the general Dutch population, the authors studied whether an excessively negative orientation toward pain (pain catastrophizing) and fear of movement/(re)injury (kinesiophobia) are important in the etiology of chronic low back pain and associated disability, as clinical studies have suggested. A total of 1,845 of the 2,338 inhabitants (without severe disease) aged 25-64 years who participated in a 1998 population-based questionnaire survey on musculoskeletal pain were sent a second questionnaire after 6 months; 1,571 (85 percent) participated. For subjects with low back pain at baseline, a high level of pain catastrophizing predicted low back pain at follow-up (odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.0, 2.8) and chronic low back pain (OR = 1.7, 95% CI: 1.0, 2.3), in particular severe low back pain (OR = 3.0, 95% CI: 1.7, 5.2) and low back pain with disability (OR = 3.0, 95% CI: 1.7, 5.4). A high level of kinesiophobia showed similar associations. The significant associations remained after adjustment for pain duration, pain severity, or disability at baseline. For those without low back pain at baseline, a high level of pain catastrophizing or kinesiophobia predicted low back pain with disability during follow-up. These cognitive and emotional factors should be considered when prevention programs are developed for chronic low back pain and related disability.     

Psychological Distress in Hospitalized Patients with Chronic Obstructive Pulmonary Disease

OBJECTIVES: To investigate the prevalence of psychological distress in hospitalized patients with chronic obstructive pulmonary disease (COPD), and to examine possible associations between psychological distress and several sociodemographic variables. METHODS: The Hopkins Symptom Checklist was used to gather data from 92 hospitalized COPD patients. These data were compared with 3,319 respondents aged 45 or over drawn from the 1998 Norwegian Statistics Health Survey. The latter were divided into four groups: respondents with COPD, respondents with other respiratory diseases, respondents with mixed chronic diseases, and a healthy group. RESULTS: The prevalence of psychological distress was found to be 58.7% in the hospitalized COPD patients and 42.9% in the community-based COPD sample. After controlling for sociodemographic variables and current smoking, the results showed a higher risk of psychological distress among hospitalized COPD patients (OR = 23.69; 95% CI: 13.37-41.98) and the community-based COPD sample (OR = 18.16; 95% CI: 8.31-39.68), and with sub-samples with other respiratory diseases (OR = 5.87; 95% CI: 3.82-9.02), and mixed chronic diseases (OR = 3.51; 95% CI: 2.39-5.18). CONCLUSIONS: COPD is associated with a high prevalence of psychological distress in both hospital and community settings. Furthermore, it appears that age, gender, education, marital status, and current smoking status do not substantially mediate the association between the severity of psychological distress and COPD status. The results provide additional evidence of the importance of screening for psychological distress symptoms in both hospitalized and community-based patients with COPD.     

围手术期糖尿病视网膜病变患者的心理状态及其影响因素分析

目的 了解围手术期糖尿病视网膜病变（diabetic retinopathy,DR）患者的心理状况并分析其影响因素。方法 取2016年6月~2018年2月在安徽医科大学第一附属医院眼科住院的86名DR患者（49例行玻璃体切除术,37例行玻璃体切除+硅油填充术）行横断面研究,采用一般资料调查表、中文版糖尿病心理痛苦量表（diabetes distress scale,DDS）和焦虑自评量表（self-rating anxiety scale,SAS）评估。用t检验比较计量资料组间差异,秩和检验比较等级资料组间差异,Logistic回归分析痛苦和焦虑的影响因素。结果 86例DR患者中,有56人痛苦,31人焦虑。DDS和SAS在两组不同手术方式之间的差异具有统计学意义（均有P<0.05）。多因素分析表明,治疗方案（OR=3.116,95%CI:1.036~9.372,P=0.043）是痛苦发生的独立危险因素;女性（OR=4.376,95%CI:1.052~18.201,P=0.042）、糖尿病遗传史（OR=7.596,95%CI:1.788~32.272,P=0.006）与治疗方案（OR=12.742,95%CI:3.609~44.983,P<0.001）是焦虑发生的危险因素。结论 DR患者有较高的痛苦及焦虑发生率（行玻璃体切除+硅油填充术>单纯行玻璃体切除术）。重视DR患者的心理对提高患者的依从性及预防、控制并发症具有重要意义。     

The shape of health to come: prospective study of the determinants of 30-year health trajectories in the Alameda County Study

BACKGROUND: Considerable evidence now exists indicating that incidence and progression of disease and disability are associated with socio-economic, behavioural, demographic and psychosocial factors. The emerging life course perspective suggests that these factors might be associated with not just the incidence of disease and death, but also trajectories of health over decades. METHODS: Prospective study of a representative, population-based cohort studied on four occasions over 30 years. Trajectories of health over this period, combining self-rated health and date of death, were related to behavioural, psychosocial and socio-economic risk factors. RESULTS: Trajectories of health were associated with behavioural, socioeconomic, and psychosocial risk factors, the strongest predictors being household income and physical activity. Those with an income 1 SD above the mean were approximately 25% more likely to die having previously consistently reported excellent health (Men: relative risk (RR) = 1.27, 95% CI = 1.10-1.46; Women: RR = 1.25, 95% CI = 1.06-1.47), were more likely to remain 'Alive in Excellent Health' (Men: RR = 1.35, 95% CI = 1.21-1.51; Women: RR = 1.30, 95% CI = 1.19-1.43) and were less likely to have shown an 'Unremitting Decline' (Men: RR = 0.72, 95% CI = 0.49-1.05; Women: RR = 0.71, 95% CI = 0.48-1.04). Those with low physical activity were approximately 50% less likely to die having consistently reported excellent health (Men: RR = 0.54, 95% CI = 0.39-0.76; Women: RR = 0.48, 95% CI = 0.33-0.71), and were five-times more likely to show an 'Unremitting Decline' (Men: RR = 5.05, 95% CI = 1.75-14.56; Women: RR = 5.00, 95% CI = 1.48-16.92). They were also less likely to be 'Alive in Excellent Health' (Men: RR = 0.41, 95% CI = 0.29-0.57; Women: RR = 0.44, 95% CI = 0.33-0.57). CONCLUSIONS: The burden of illness associated with behavioural, socio-economic and psychosocial risk factors extends beyond shortening of life to poorer trajectories of health over decades.     

Psychological distress and depressed mood in employees with asthma, chronic bronchitis or emphysema: A population-based observational study on prevalence and the relationship with smoking cigarettes

OBJECTIVES: To evaluate if employees with asthma, chronic bronchitis or emphysema can be characterized as a population of patients with a high prevalence of psychological distress and/or depressed mood. Above all, we wanted to examine the influence of smoking status on the relationship between chronic disease and psychological distress/depressed mood. METHODS: A postal survey was conducted among 12,103 employees participating in the Maastricht Cohort Study. RESULTS: Smoking employees, who reported having asthma, chronic bronchitis or emphysema were more likely to report suffering from depressed mood compared to smokers with no long-lasting disease (prevalence rate, PR: 29.3 and 9.0%, respectively; OR for depressed mood = 4.04; 95% CI: 2.56-6.39) and when compared to smoking employees with a history of heart disease, hypertension or myocardial infarction (PR: 18.1%; OR: 1.99; 95% CI: 1.07-3.68), or rheumatoid arthritis (PR: 20.1%; OR: 1.73; 95% CI: 0.96-3.11). CONCLUSION: These findings provide health care professionals with additional evidence regarding the importance for including the assessment of psychological distress and depressed mood in the routine evaluation of the patient with asthma, chronic bronchitis or emphysema, especially with regard to smoking cessation.