Chronic low back pain among tobacco farmers in southern Brazil

Background:

Despite tobacco farming involving intensive manual labor, chronic low back pain (CLBP) prevalence and associated factors are unknown among this occupational group.

Methods:

This was a cross-sectional study conducted in southern Brazil. A random sample of tobacco farmers was interviewed. Socioeconomic and individual characteristics, occupational tasks, workloads, and comorbidities were investigated. Chronic low back pain prevalence was described in relation to independent variables, and associations were examined with Poisson regression.

Results:

Chronic low back pain prevalence was 8·4%. Increasing age, rearing two or more species of livestock (PR 1·65), exposure to tasks that require heavy physical exertion (PR 2·00), working in awkward postures (PR 1·36), green tobacco sickness (GTS) (PR 1·63), pesticide poisoning (PR 2·37), and minor psychiatric disorders (PR 2·55) were associated with CLBP.

Conclusions:

This study found that CLBP is a relevant health problem among tobacco farmers and highlights understudied risk factors such as pesticide poisoning and GTS. Policies to minimize exposure to physiological and chemical workloads in tobacco planting to prevent CLBP are needed. Health professionals should be trained to diagnose and prevent acute low back pain episodes and thus prevent/minimize limitations and disabilities due to CLBP.     

Relationship Between Physical Activity and Chronic Musculoskeletal Pain Among Community-Dwelling Japanese Adults

Background

Both little and excessive physical activity (PA) may relate to chronic musculoskeletal pain. The primary objective of this study was to characterize the relationship of PA levels with chronic low back pain (CLBP) and chronic knee pain (CKP).

Methods

We evaluated 4559 adults aged 40–79 years in a community-based cross-sectional survey conducted in 2009 in Shimane, Japan. We used self-administered questionnaires to assess sociodemographics and health status: PA was assessed by the International Physical Activity Questionnaire, and CLBP and CKP were assessed by a modified version of the Knee Pain Screening Tool. We examined relationships of PA with prevalence of CLBP and CKP using Poisson regression, controlling for potential confounders.

Results

CLBP and CKP were both prevalent (14.1% and 10.7%, respectively) and associated with history of injury, medication use, and consultation with physicians. PA was not significantly related to CLBP or CKP (P > 0.05) before or after adjustment for potential confounders. For example, compared with adults reporting moderate PA (8.25–23.0 MET-hours/week), prevalence ratios for CKP adjusted for sex, age, education years, self-rated health, depressive symptom, smoking, chronic disease history, and body-mass index were 1.12 (95% confidential interval [CI] 0.84–1.50) among those with the lowest PA and 1.26 (95% CI 0.93–1.70) among those with the highest PA (P quadratic = 0.08). The prevalence ratios were further attenuated toward the null after additional adjustment for history of injury, medication use, and consultation (P quadratic = 0.17).

Conclusions

This cross-sectional study showed that there were no significant linear or quadratic relationships of self-reported PA with CLBP and CKP. Future longitudinal study with objective measurements is needed.Key words: exercise, musculoskeletal pain, arthritis, epidemiology, public health     

Prevalence of low back pain among handloom weavers in West Bengal,India

Background:

Handloom is one of the oldest industries in India, particularly in West Bengal, where a considerable number of rural people are engaged in weaving.

Objectives:

The purpose of this study was to evaluate the prevalence of low back pain among the handloom weavers in India.

Methods:

A modified Nordic Musculoskeletal Disorder Questionnaire and Oswestry Low Back Pain Disability Questionnaire along with a body part discomfort scale were administered to handloom weavers (n = 175). Working posture of the participants was assessed using the Ovako Working Posture Analysis System (OWAS).

Results:

Sixty eight per cent of the participants reported suffering from low back pain, making it the most prevalent disorder in our sample. Analysis of the Oswestry Low Back Pain Disability Questionnaire data revealed that among those with low back pain (n = 119), 2% had severe disabilities, 46% had moderate disabilities, and 52% had minimal disabilities. Statistical analyses revealed a positive significant association between the intensity of pain in the lower back and an increased number of years of work experience (P<0.05).

Conclusions:

The study underlines the need for further research regarding the postural strain of weavers and also suggests the implementation of ergonomic design into weaver workstations to minimize the adverse effect of their current working postures. Improving upon the weaver’s work-posture could improve their quality of life.     

Peer Reviewed: Adult Tobacco Use Among Racial and Ethnic Groups Living in the United States, 2002–2005

Introduction

U.S. data on adult tobacco use and the relationship between such use and tobacco-related health disparities are primarily limited to broad racial or ethnic populations. To monitor progress in tobacco control among adults living in the United States, we present information on tobacco use for both aggregated and disaggregated racial and ethnic subgroups.

Methods

We used data from the nationally representative sample of adults aged 18 years or older who participated in the National Survey on Drug Use and Health conducted 4 times during 2002–2005. We calculated 2 outcome measures: 1) use of any tobacco product (cigarettes, chewing or snuff tobacco, cigars, or pipes) during the 30 days before each survey and 2) cigarette smoking during the 30 days before each survey.

Results

The prevalence of tobacco use among adults aged 18 years or older varied widely across racial or ethnic groups or subgroups. Overall, about 3 of 10 adults living in the United States were tobacco users during the 30 days before being surveyed. The population groups or subgroups with a tobacco-use prevalence of 30% or higher were African Americans, American Indians or Alaska Natives, Native Hawaiians or other Pacific Islanders, Puerto Ricans, and whites.

Conclusion

These results indicate that the prevalence of adult tobacco use is still high among several U.S. population groups or subgroups. Our results also support the need to design and evaluate interventions to prevent or control tobacco use that would reach distinct U.S. adult population groups or subgroups.     

Knee pain and future self-reliance in older adults: evidence from a community-based 3-year cohort study in Japan

Background

Although knee pain is common in older persons and can cause ambulatory limitation, its impact on self-reliance has rarely been examined in Japan, particularly in a community setting. The aim of this 3-year cohort study was to investigate the association of knee pain with dependence in activities of daily living (ADL) and mortality in community-dwelling older Japanese adults.

Methods

In 2005, presence of knee pain was assessed by a home visit survey of 1391 older adults aged 65 years or older (participation proportion = 97.3%). A total of 1265 participants who were ADL-independent at baseline were followed for 3 years, and information on outcomes, namely death and dependence in ADL, was collected.

Results

Participants who always had knee pain were more likely to become dependent in ADL than those who reported no knee pain (multivariate-adjusted OR, 1.98; 95% CI, 1.03–3.83); however, always having knee pain was not associated with mortality or a composite outcome of ADL dependence and death. Further analyses of each component of ADL dependence revealed that knee pain was associated with a need for assistance at home (long-term care eligibility, bathing, dressing, and transferring), but not with institutionalization.

Conclusions

The participants were highly representative of the target population and the rate of follow-up was almost perfect (99.4%). The results suggest that knee pain is associated with future dependence in ADL, particularly a need for assistance at home.Key words: joint diseases, activities of daily living, mortality, cohort studies, aged     

Prevalence of Physical Activity Among Adults in a Metropolitan Nigerian City: A Cross-Sectional Study

Background

Baseline information on physical activity is relevant to controlling the epidemic of chronic noncommunicable diseases occurring in many African countries. However, standardized data on physical activity are lacking in Nigeria. We assessed the prevalence of physical activity and its relationships with sociodemographic characteristics in a subnational sample of Nigerian adults.

Methods

A cross-sectional survey was conducted among a representative sample of 934 adults (age, 20–82 years) living in metropolitan Maiduguri, Nigeria. Physical activity was measured using the validated Nigerian version of the International Physical Activity Questionnaire (Hausa IPAQ-SF). Using the World Health Organization (WHO) guideline, participants were classified as sufficiently active or insufficiently active. Sociodemographic correlates of sufficient physical activity were identified using multinomial logistic regression.

Results

Overall, 68.6% of Nigerian adults were sufficiently active. There was no significant difference (P > 0.05) in prevalence of physical activity between men (68.0%) and women (69.3%), but physical activity tended to decrease with increasing age category, especially among men. Physical activity prevalence was positively associated with being married (OR = 1.52, CI = 1.04–4.37) and blue collar work (OR = 2.19, CI = 1.16–4.12) and negatively associated with car ownership (OR = 0.38, CI = 0.17–0.86) and higher income (OR = 0.54, CI = 0.10–0.95).

Conclusions

The prevalence of physical activity varied between sociodemographic subgroups of Nigerian adults; thus, public health policies and interventions based on ecologic models of health behaviors may be warranted in promoting physical activity in Nigeria.Key words: physical activity, sociodemographic characteristics, IPAQ, Nigerian adults     

Prevalence of diabetes and prediabetes and their risk factors among Bangladeshi adults: a nationwide survey

Objective

To estimate the prevalence of diabetes and prediabetes in Bangladesh using national survey data and to identify risk factors.

Methods

Sociodemographic and anthropometric data and data on blood pressure and blood glucose levels were obtained for 7541 adults aged 35 years or more from the biomarker sample of the 2011 Bangladesh Demographic and Health Survey (DHS), which was a nationally representative survey with a stratified, multistage, cluster sampling design. Risk factors for diabetes and prediabetes were identified using multilevel logistic regression models, with adjustment for clustering within households and communities.

Findings

The overall age-adjusted prevalence of diabetes and prediabetes was 9.7% and 22.4%, respectively. Among urban residents, the age-adjusted prevalence of diabetes was 15.2% compared with 8.3% among rural residents. In total, 56.0% of diabetics were not aware they had the condition and only 39.5% were receiving treatment regularly. The likelihood of diabetes in individuals aged 55 to 59 years was almost double that in those aged 35 to 39 years. Study participants from the richest households were more likely to have diabetes than those from the poorest. In addition, the likelihood of diabetes was also significantly associated with educational level, body weight and the presence of hypertension. The prevalence of diabetes varied significantly with region of residence.

Conclusion

Almost one in ten adults in Bangladesh was found to have diabetes, which has recently become a major public health issue. Urgent action is needed to counter the rise in diabetes through better detection, awareness, prevention and treatment.     

Tobacco smoking and tuberculosis treatment outcomes: a prospective cohort study in Georgia

Objective

To assess the effect of tobacco smoking on the outcome of tuberculosis treatment in Tbilisi, Georgia.

Methods

We conducted a prospective cohort study of adults with laboratory-confirmed tuberculosis from May 2011 to November 2013. History of tobacco smoking was collected using a standardized questionnaire adapted from the global adult tobacco survey. We considered tuberculosis therapy to have a poor outcome if participants defaulted, failed treatment or died. We used multivariable regressions to estimate the risk of a poor treatment outcome.

Findings

Of the 591 tuberculosis patients enrolled, 188 (31.8%) were past smokers and 271 (45.9%) were current smokers. Ninety (33.2%) of the current smokers and 24 (18.2%) of the participants who had never smoked had previously been treated for tuberculosis (P < 0.01). Treatment outcome data were available for 524 of the participants, of whom 128 (24.4%) – including 80 (32.9%) of the 243 current smokers and 21 (17.2%) of the 122 individuals who had never smoked – had a poor treatment outcome. Compared with those who had never smoked, current smokers had an increased risk of poor treatment outcome (adjusted relative risk, aRR: 1.70; 95% confidence interval, CI: 1.00–2.90). Those who had ceased smoking more than two months before enrolment did not have such an increased risk (aRR: 1.01; 95% CI: 0.51–1.99).

Conclusion

There is a high prevalence of smoking among patients with tuberculosis in Georgia and smoking increases the risk of a poor treatment outcome.     

Descriptive Epidemiology of Diabetes Prevalence and HbA1c Distributions Based on a Self-Reported Questionnaire and a Health Checkup in the JPHC Diabetes Study

Background

The present study examined the prevalence of diabetes in Japan during the late 1990s and early 2000s using the Japan Public Health Center-based Prospective Diabetes cohort. We also investigated the distributions of HbA1c values in noncompliant diabetic participants in the cohort.

Methods

A total of 28 183 registered inhabitants aged 46–75 years from 10 public health center areas were included in the initial survey. The 5-year follow-up survey included 20 129 participants. The prevalence of diabetes was estimated using both a self-reported questionnaire and laboratory measurements. Among the participants who reported the presence of diabetes on the questionnaire (self-reported diabetes), the distributions of HbA1c values were described according to their treatment status.

Results

The age-standardized prevalence of diabetes in 55- to 74-year-old adults was 8.2% at the initial survey and 10.6% at the 5-year follow-up. At the initial survey, among participants with self-reported diabetes, the mean HbA1c values in the participants who had never and who had previously received diabetes treatment were 7.01% (standard deviation [SD] 1.56%) and 6.56% (SD 1.46%), respectively. Approximately 15% of the participants who had self-reported diabetes but had never received diabetes treatment had an HbA1c ≥ 8.4%.

Conclusions

The prevalence of diabetes increased in the JPHC cohort between the late 1990s and early 2000s. A certain proportion of participants who were aware of their diabetes but were not currently receiving treatment had poor diabetic control. Efforts to promote continuous medical attendance for diabetes care may be necessary.Key words: diabetes mellitus, prevalence, self-report, HbA1c     

Lower limb amputation in England: prevalence,regional variation and relationship with revascularisation,deprivation and risk factors. A retrospective review of hospital data

Objective

We describe the prevalence of major lower limb amputation across England and its relationship with revascularisation, patient demography and disease risk factors.

Design

Retrospective cohort study.

Setting

England 1 April 2003 to 31 March 2009.

Participants

Patients aged 50–84 years.

Main outcome measures

Age standardised prevalence rates were calculated using Hospital Episode Statistics as the numerator with census data as the denominator. The outcome measure ‘amputation with revascularisation’ was created if an amputation could be linked with a revascularisation. Logistic regression determined the odds of having an amputation with a revascularisation across England. Regression was performed unadjusted and repeated after controlling for demographic (age, sex, social deprivation) and disease risk factors (diabetes, hypertension, coronary heart disease, cerebrovascular disease, smoking).

Results

There were 25,312 amputations and 136,215 revascularisations, and 7543 cases were linked. The prevalence rate per 100,000 (95% confidence intervals) for amputation was 26.3 (26.0–26.6) with rates significantly higher in Northern England (North: 31.7; 31.0–32.3, Midlands: 26.0; 25.3–26.7, South: 23.1; 22.6–23.5). The revascularisation rate was 141.6 (140.8–142.3) with significantly higher rates again in Northern England (North: 182.1; 180.5–183.7, Midlands: 121.3; 119.8–122.9, South 124.9; 123.9–125.8). The odds of having an amputation with a revascularisation remained significantly higher in the North (OR 1.22; 1.13–1.33) even after controlling demographic and disease risk factors.

Conclusions

There is a North–South divide in England for both major lower limb amputation and revascularisation. The higher odds of having an amputation with a revascularisation in the North were not fully explained by greater levels of deprivation or disease risk factors.     

Peer Reviewed: Differences in Health and Health Behaviors Between State Employees and Other Employed Adults in Oregon, 2007

Introduction

Worksite health promotion and interventions have gained popularity among state agencies. We studied the health behaviors and health characteristics of adults employed in state agencies in Oregon and compared those state employees with the statewide population of employed, insured adults.

Methods

We used data from the Oregon Behavioral Risk Factor Surveillance System (BRFSS) and a modified BRFSS survey administered to state employees. State employees were compared with employed, insured BRFSS respondents in total and then separately for men and women.

Results

The prevalence of healthy weight was lower among state employees compared with the statewide population of employed, insured adults (29% vs 35%), and the prevalence of obesity was higher (35% vs 26%). State employees were also less likely to meet physical activity recommendations (44% vs 56%). Diabetes prevalence was higher among state employees (7% vs 5%), and self-reported excellent or very good health status was lower (54% vs 64%).

Conclusions

State employees differ from the statewide population of employed, insured adults on a number of health behaviors and conditions. These differences suggest obesity prevention and diabetes control as priority areas for state agency worksite interventions.     

The effectiveness of graded activity for low back pain in occupational healthcare

Background

Low back pain is a common medical and social problem associated with disability and absence from work. Knowledge on effective return to work (RTW) interventions is scarce.

Objective

To determine the effectiveness of graded activity as part of a multistage RTW programme.

Design

Randomised controlled trial.

Setting

Occupational healthcare.

Subjects

112 workers absent from work for more than eight weeks due to low back pain were randomised to either graded activity (n = 55) or usual care (n = 57).

Intervention

Graded activity, a physical exercise programme aimed at RTW based on operant‐conditioning behavioural principles.

Main outcome measures

The number of days off work until first RTW for more then 28 days, total number of days on sick leave during follow up, functional status, and severity of pain. Follow up was 26 weeks.

Results

Graded activity prolonged RTW. Median time until RTW was equal to the total number of days on sick leave and was 139 (IQR = 69) days in the graded activity group and 111 (IQR = 76) days in the usual care group (hazard ratio = 0.52, 95% CI 0.32 to 0.86). An interaction between a prior workplace intervention and graded activity, together with a delay in the start of the graded activity intervention, explained most of the delay in RTW (hazard ratio = 0.86, 95% CI 0.40 to 1.84 without prior intervention and 0.39, 95% CI 0.19 to 0.81 with prior intervention). Graded activity did not improve pain or functional status clinically significantly.

Conclusions

Graded activity was not effective for any of the outcome measures. Different interventions combined can lead to a delay in RTW. Delay in referral to graded activity delays RTW. In implementing graded activity special attention should be paid to the structure and process of care.     

Prevalence of Brick Tea-Type Fluorosis in the Tibet Autonomous Region

Background

The prevalence of brick tea-type fluorosis is high in Tibet because of the habit of drinking brick tea in this region. Brick tea-type fluorosis has become an urgent public health problem in China.

Methods

A cross-sectional survey was conducted to investigate prevalence of brick tea-type fluorosis in all districts of Tibet using a stratified cluster sampling method. Dental fluorosis in children aged 8–12 years and clinical skeletal fluorosis in adults were diagnosed according to the national criteria. A total of 423 children and 1320 adults participated in the study. Samples of drinking water, brick tea, brick tea infusion (or buttered tea), and urine were collected and measured for fluoride concentrations by the fluoride ion selective electrode method.

Results

The fluoride level in all but one of the brick tea samples was above the national standard. The average daily fluoride intake from drinking brick tea in all seven districts in Tibet was much higher than the national standard. The prevalence of dental fluorosis was 33.57%, and the prevalence of clinical skeletal fluorosis was 46.06%. The average daily fluoride intake from drinking brick tea (r = 0.292, P < 0.05), urine fluoride concentrations in children (r = 0.134, P < 0.05), urine fluoride concentrations in adults (r = 0.162, P < 0.05), and altitude (r = 0.276, P < 0.05) were positively correlated with the prevalence of brick tea-type fluorosis. Herdsmen had the highest fluoride exposure and the most severe skeletal fluorosis.

Conclusions

Brick tea-type fluorosis in Tibet is more serious than in other parts of China. The altitude and occupational factors are important risk factors for brick tea-type fluorosis.Key words: brick tea-type fluorosis, skeletal fluorosis, dental fluorosis, altitude, Tibet     

A Differential Equation Model for the Dynamics of Youth Gambling

Objectives

We examine the dynamics of gambling among young people aged 16–24 years, how prevalence rates of at-risk gambling and problem gambling change as adolescents enter young adulthood, and prevention and control strategies.

Methods

A simple epidemiological model is created using ordinary nonlinear differential equations, and a threshold condition that spreads gambling is identified through stability analysis. We estimate all the model parameters using a longitudinal prevalence study by Winters, Stinchfield, and Botzet to run numerical simulations. Parameters to which the system is most sensitive are isolated using sensitivity analysis.

Results

Problem gambling is endemic among young people, with a steady prevalence of approximately 4–5%. The prevalence of problem gambling is lower in young adults aged 18–24 years than in adolescents aged 16–18 years. At-risk gambling among young adults has increased. The parameters to which the system is most sensitive correspond to primary prevention.

Conclusion

Prevention and control strategies for gambling should involve school education. A mathematical model that includes the effect of early exposure to gambling would be helpful if a longitudinal study can provide data in the future.     

Effect of Preexisting Musculoskeletal Diseases on the 1-Year Incidence of Fall-related Injuries

Objectives

People who have chronic diseases, as well as gait imbalance or psychiatric drug use, may be susceptible to injuries from falls and slips. The purpose of this study was to evaluate the effect of musculoskeletal diseases on incidental fall-related injuries among adults in Korea.

Methods

We analyzed data from the 4th Korea National Health and Nutrition Examination Survey (2007-2009), which are national data obtained by a rolling survey sampling method. The 1-year incidence of fall-related injuries was defined by health service utilization within the last year due to injury occurring after a slip and fall, and musculoskeletal diseases included osteoarthritis, rheumatoid arthritis, osteoporosis, and back pain. To evaluate the effects of preexisting musculoskeletal diseases, adults diagnosed before the last year were considered the exposed group, and adults who had never been diagnosed were the unexposed group.

Results

The weighted lifetime prevalence of musculoskeletal disease was 32 540 per 100 000 persons. Musculoskeletal diseases were associated with a higher risk of fall-related injury after adjustment for sex, age, residence, household income, education, occupation, visual disturbance, paralysis due to stroke, and medication for depression (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.03 to 1.93). As the number of comorbid musculoskeletal diseases increased, the risk of fall-induced injuries increased (p-value for trend <0.001). In particular, patients who had any musculoskeletal condition were at much higher risk of recurrent fall-related injuries (OR, 6.20; 95% CI, 1.06 to 36.08).

Conclusions

One must take into account the risk of fall-related injuries and provide prevention strategies among adults who have musculoskeletal diseases.     

Obesity and diabetes in New York City, 2002 and 2004

Introduction

Obesity and diabetes have increased rapidly nationwide, yet reliable information on these disease trends in local urban settings is unavailable. We undertook this study to characterize trends in obesity and diagnosed diabetes from 2002 to 2004 among white, black, and Hispanic adult residents of New York City.

Methods

We used data from the Community Health Survey, an annual random-digit–dial telephone survey of approximately 10,000 New York City adults aged 18 years or older, and from the Behavioral Risk Factor Surveillance System, a similar nationwide survey. Main outcome measures were body mass index (BMI), calculated from self-reported height and weight, and self-reported diabetes.

Results

In 2 years, the prevalence of obesity increased 17% in New York City, from 19.5% in 2002 to 22.8% in 2004 (P < .0001). The prevalence of diagnosed diabetes also increased 17%, from 8.1% in 2002 to 9.5% in 2004 (P < .01). Nationally, the prevalence of obesity increased by 6% during this same time period (P < .05), and diabetes prevalence did not increase significantly. The median BMI among white adults in New York City was 25.1 kg/m², significantly lower than among Hispanics (26.4 kg/m²) and blacks (26.6 kg/m², P < .05). The prevalence of diabetes increased across all BMI categories.

Discussion

The rapid increase in obesity and diabetes in New York City suggests the severity of these twin epidemics and the importance of collecting and analyzing local data for local programming and policy making.     

Peer Reviewed: Prevalence of Self-Reported Prediabetes Among Adults Participating in a Community-Based Health Awareness Program,New York State

Introduction

The purpose of this study was to assess crude, age-adjusted, and risk-factor–specific prevalences of self-reported prediabetes and to identify factors associated with self-reported prediabetes in an adult population.

Methods

Data were collected through questionnaires completed by a racially diverse sample of diabetes-free adult participants in the statewide community-based wellness and diabetes awareness program in New York State during 2006 (N = 2,572). Prediabetes was determined by the affirmative answer to the question, "Have you ever been told by a doctor that you have prediabetes?"

Results

The overall crude prevalence of self-reported prediabetes was 9.1%, and the age-adjusted prevalence was 7.6%. The age-adjusted prevalence of prediabetes was significantly lower among non-Hispanic blacks (4.2%) and significantly higher among American Indians (22.4%), compared with the prevalence among non-Hispanic whites (7.3%). The prevalence of self-reported prediabetes was uniformly higher among older (aged ≥45 years) adults than younger (aged <45 years) adults, overall and in each racial/ethnic group. In all age and racial/ethnic groups, the prevalence significantly increased with the number of additional risk factors. The best fit multivariate logistic regression model identified that self-reported prediabetes was associated with family history of diabetes (odds ratio [OR], 3.65), body mass index 25.0 kg/m² or higher (OR, 2.79), age 45 years or older (OR, 2.77), and having health insurance (OR, 2.38).

Conclusion

This study found that adults who were at high risk for diabetes and had health insurance were more likely to report having prediabetes. Community-based diabetes prevention needs to consider strategies to increase detection of prediabetes in high-risk uninsured people and to raise general awareness of prediabetes.