Prevalence of musculoskeletal pain and associated factors in the Quebec working population

Background: While the determinants of musculoskeletal pain are numerous, few studies conducted among workers have taken into account, altogether, physical factors, psychosocial factors (personal and work-related) and individual characteristics. Objectives: To estimate the 1-year prevalence of musculoskeletal pain in the Quebec working population by gender and anatomical site, and to determine which factors are associated with these prevalence figures. Methods: Data came from the 1998 Quebec Health Survey and included 9,496 individuals. One-year period prevalences for neck pain, back pain and pain in the upper and lower extremities were calculated for men and women. Logistic regression analyses were conducted to estimate the associations between individual, physical and psychosocial work factors, on one hand, and musculoskeletal pain in the four body regions, on the other hand. Results: For both genders back pain was the most frequent musculoskeletal symptom that had disturbed their activities during the past year. The largest difference between genders was observed for neck pain (women: 18%; men: 11%). Multivariate analyses indicated that physical and psychosocial work factors, as well as psychological variables, were associated with musculoskeletal pain in different body regions. Body mass index was associated only with pain in lower extremities for both genders. Conclusions: The results of this study suggest that interventions aimed at reducing musculoskeletal pain should take into account personal and work-related psychosocial variables, in addition to physical workload.     

Medication and treatment use in primary care patients with chronic pain of predominantly neuropathic origin

BACKGROUND: Neuropathic pain is widely recognized as one of the most difficult pain syndromes to treat and presents a significant challenge for pain clinicians and GPs. METHODS: The Self-complete Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire, recently validated for identifying pain of predominantly neuropathic origin (POPNO), was sent to 6000 adults identified from general practices in the UK. The questionnaire also contained items about chronic pain identification, medications and treatments received for pain and the pain relief these provided. RESULTS: In total, 1420/3002 (48%) of respondents indicated that they suffered with any chronic pain. These were further categorized as those with chronic pain who were S-LANSS negative ['chronic pain (non-POPNO)' group, n = 1179] and those with chronic pain who were S-LANSS positive, indicating the presence of POPNO ('chronic POPNO' group, n = 241). Questions relating to treatments and medications were completed by 88% of the respondents (1244/1420). The chronic POPNO group was more likely to receive multiple pain medications (37% versus 21% took two or more pain medications, P < 0.001) and stronger painkillers [e.g. opioids odds ratio 1.94; 95% confidence interval 1.10, 3.42]. Despite this, they reported less effective pain relief than the non-POPNO chronic pain group. CONCLUSION: Patients in primary care reporting chronic pain were found generally to obtain incomplete relief from their medication with chronic POPNO patients reporting less relief. It is important that patients with any chronic pain are identified and managed appropriately according to their distinct treatment needs.     

Transitions in self-reported musculoskeletal pain and interference with activities among newspaper workers

Active surveillance of symptoms and disability due to musculoskeletal disorders (MSD) in working populations can map individual transitions in symptom intensity or disability level. Using repeat surveys, this study examined if aetiological risk factors for new symptoms or disability, measured by interference with activities, were similar to prognostic risk factors for subsequent outcomes of symptoms and disability. This paper reports on 379 Toronto newspaper workers who completed questionnaires in 1996 and 1997. Questions on pain/discomfort during the last year, episode frequency and duration formed the basis for constructing three mutually exclusive symptom levels: noncases (Level 1); mild cases (Level 2); and more severe or frequent pain cases (Level 3). A similar construction of overall interference levels was based on the frequency with which musculoskeletal pain/discomfort interfered with daily, recreational, social and family activities, or ability to do one's job during the previous 12 months. The last was also examined as work interference alone. Levels of symptoms were cross-tabulated by overall and work interference at the two time points and Markov models of transitions between states were formulated. Results indicate that period prevalence of symptoms and overall interference increased between phases, though only significantly for symptoms (Levels 2 and 3, 65.7–70.7%, p = 0.04), while work interference was unchanged (17.9–17.0%). Equivalent proportions of workers improved as worsened in symptoms (21.1 and 22.4%, respectively), overall interference (16.7 and 17.8%), and work interference (7.4 and 6.6%). The only significant predictor for those without work interference at time one was job tenure, which was protective against work interference (Odds Ratio (OR) 1.06, 95% Confidence Interval (CI) 1.01–1.12). Among those who had more severe/frequent symptoms at time one, lack of improvement over time was predicted by longer job tenure (OR = 0.92 per year, CI: 0.87–0.97), greater psychological demands of work (OR = 0.65 per point, CI: 0.51–0.84) and marginally by greater upper extremity disability score. At time one, women with work interference were more likely to have persistent interference at time two (OR = 7.22, CI: 1.57–33.20). Suggestive findings included opposite effects of social support at work: reduced risk of development of new symptoms but increased risk of persistence at the highest symptom level.     

Psychosocial care experiences of patients with COVID-19 at home in Iran: A qualitative study

Due to the onset peak of COVID-19, as well as a shortage of human resources, physical environment, protective and medical equipment in hospitals, many patients with mild to moderate symptoms of COVID-19 are pushed to home care. This condition not only raises public health concerns but also causes a number of psychosocial problems. Therefore, this study intends to examine the psychosocial experiences of patients with COVID-19 after passing the crisis stage. A qualitative study with a conventional content analysis method was used. Thirty participants were selected using purposeful sampling from Khoy Educational and Medical Centers from 20 March to 20 June 2020. In-depth semi-structured interviews were used to collect data. Data were analysed by continuous comparative analysis using MAXQDA 10 software. The concepts extracted from data analysis identified eight subthemes and three main themes. Social rejection theme includes three subthemes: ‘Insularity of the patient’, ‘Concealment’ and ‘patient as the life-threatening center’. Lack of support theme consists of three subthemes including: ‘financial concerns’, ‘non-response of the treatment team after discharge’ and ‘concerns about the persistent condition of the disease’. Efforts to gain mental peace theme has two subthemes: ‘recourse to spirituality’ and ‘strengthening hope’. According to the results of the present study, it is necessary to examine the psychological and social needs of patients. Also, by identifying high-risk groups, supportive psychological networks such as telephone, internet and on-site medical services to help patients, medical worker and others affected in overcoming psychological problems should be increased. Providing free service packages such as the Internet, free financial aid to damaged jobs and creating the necessary platforms for online shopping and payment services, as well as training on how to plan and practice rehabilitation at home for patients and family caregivers can be helpful.     

Patterns of pain and consulting behaviour in patients with musculoskeletal disorders in rural Crete, Greece

BACKGROUND: Musculoskeletal disorders (MSDs) account as a reason for frequent consultations in primary care. However, the magnitude of the problem at the GP's clinic, the patterns of pain and the consulting behaviour has not been sufficiently explored. OBJECTIVES: The aim of this study was to report on patterns of pain relevant to MSDs and explore the co-morbidities and consulting behaviour in rural primary care settings in Crete. METHODS: Three primary care centres (PCCs) of Crete were selected for a study period of 2 weeks. Every visitor, aged 20-75 years, regardless of the reason for visiting the facility was invited to participate. The Greek version of the general Nordic questionnaire for the analysis of musculoskeletal disorders (NMQ) was used for data collection. RESULTS: A total of 455 subjects answered the NMQ. Three hundred and seventy-six (82.6%) of the study population reported having one or more symptoms during the previous year. Low back (56.9%), neck (34.1%), shoulder (29.9%) and knee (27.9%) were the commonest sites of pain. In almost half cases (48.6%), the complaints about pain were accompanied by activity restrictions. Multivariate statistical analysis showed significant correlations with increasing age and female gender (P < 0.05). Common chronic conditions were associated with co-morbidities from the musculoskeletal system. Only one-third of those who reported MSDs had consulted their GPs for the same problems within the previous year. CONCLUSIONS: MSDs are highly prevalent among rural population in Crete but fewer patients seek care than those who report symptoms.     

Determinants of job satisfaction in foreign domestic helpers caring for people with dementia in Hong Kong

The job satisfaction of live‐in foreign domestic helpers (FDHs) may influence their caring motivation and the quality of care they provide, which may in turn affect the health status of care recipients. This study identifies the factors affecting job satisfaction of FDHs caring for people with dementia in Hong Kong, focusing especially on the role of FDHs' adaptation status, job self‐efficacy and care recipients' situation. A total of 152 FDHs taking care of people with dementia were recruited from 6 day care centres for elderly people in Hong Kong when they attended with their care recipients. Data were collected from February to August 2011 and the response rate was 95%. Participants completed questionnaires which included measures of care recipients' dementia severity and disruptive behaviours, FDHs' demographic factors, personal adaptation status, caregiving self‐efficacy and job satisfaction. Hierarchical regression analysis was conducted to analyse the data. The results showed that longer stay in Hong Kong, better fluency in Cantonese (local dialect), greater satisfaction in living conditions, higher caregiving self‐efficacy and less disruptive behaviour of care recipients were independently associated with stronger job satisfaction in FDHs looking after people with dementia. On the basis of these findings, we would suggest that employers should consider helpers who have been in Hong Kong for a longer period of time and speak fluent Cantonese, and have previous experience of taking care of people with dementia. In addition, FDHs caring for people with dementia may benefit from carer training which improves their self‐efficacy in dementia care.     

Continuity of care and health care cost among community‐dwelling older adult veterans living with dementia

ObjectivesTo estimate the causal impact of continuity of care (COC) on total, institutional, and noninstitutional cost among community‐dwelling older veterans with dementia.Data SourcesCombined Veterans Health Administration (VHA) and Medicare data in Fiscal Years (FYs) 2014‐2015.Study DesignFY 2014 COC was measured by the Bice‐Boxerman Continuity of Care (BBC) index on a 0‐1 scale. FY 2015 total combined VHA and Medicare cost, institutional cost of acute inpatient, emergency department [ED], long‐/short‐stay nursing home, and noninstitutional long‐term care (LTC) cost for medical (like skilled‐) and social (like unskilled‐) services were assessed controlling for covariates. An instrumental variable for COC (change of residence by more than 10 miles) was used to account for unobserved health confounders.Data CollectionCommunity‐dwelling veterans with dementia aged 66 and older, enrolled in Traditional Medicare (N = 102 073).Principal FindingsMean BBC in FY 2014 was 0.32; mean total cost in FY 2015 was $35 425. A 0.1 higher BBC resulted in (a) $4045 lower total cost; (b) $1597 lower acute inpatient cost, $119 lower ED cost, $4368 lower long‐stay nursing home cost; (c) $402 higher noninstitutional medical LTC and $764 higher noninstitutional social LTC cost. BBC had no impact on short‐stay nursing home cost.ConclusionsCOC is an effective approach to reducing total health care cost by supporting noninstitutional care and reducing institutional care.     

Racial/ethnic differences in healthcare use among patients with uncontrolled and controlled diabetes

Objectives: To examine racial/ethnic differences in healthcare use among patients classified as having controlled and uncontrolled diabetes.

Design: Data from the Carolinas HealthCare System electronic data warehouse were used. Glycemic control was defined as glycosylated hemoglobin (HbA1c)?<?8% (64?mmol/mol) in 2012 (n?=?9996). Patients with HbA1c?≥?8% (64?mmol/mol) in 2012 were classified as uncontrolled (n?=?2576). Race and ethnicity were jointly classified as non-Hispanic Black, non-Hispanic White or Other. Separate mixed effects negative binomial models estimated the independent effect of race/ethnicity on the number of emergency department (ED) visits, hospitalizations and physician office visits in 2013, in each patient group, adjusting for significant confounding variables.

Results: Rates of diabetes-related ED visits were two to three times higher for non-Hispanic Blacks compared to non-Hispanic Whites (uncontrolled rate ratio [RR]: 3.41 95% CI: 1.41–8.22; controlled RR: 2.95; 95% CI: 1.78–4.91). Similar differences were observed for all-cause ED visits (uncontrolled RR: 1.83, 95% CI: 1.50–2.24; controlled RR: 2.45, 95% CI: 2.17–2.77). Non-Hispanic Blacks with controlled and uncontrolled diabetes also had lower rates of all-cause physician office visits when compared to non-Hispanic Whites (uncontrolled RR: 0.84, 95% CI: 0.77–0.91; controlled RR: 0.81, 95% CI: 0.78–0.84).

Conclusion: Notable racial/ethnic disparities exist in the use of emergency services and physician offices for diabetes care. Strategies such as patient education and care delivery changes that address healthcare access issues in racial/ethnic minorities should be considered to offer better diabetes management and address diabetes disparities.     

Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain

To assess quality of life (QoL), costs, and cost-effectiveness of acupuncture treatment plus routine care versus routine care alone in osteoarthritis patients, a randomised, controlled trial was conducted in 255 general practices in Germany. Four hundred and eighty-nine patients with chronic pain due to osteoarthritis of the knee or hip were included to evaluated QoL and costs at baseline and after 3 months using health insurance funds data and standardized questionnaires. Patients receiving acupuncture had an improved QoL associated with significantly higher costs over the 3 months treatment period compared to routine care alone (mean cost-difference: 469.50 [95%CI 135.80-803.19]). This increase in costs was primarily due to the costs of acupuncture. The overall ICER was 17,845 per QALY gained. The degree of cost-effectiveness was influenced by gender, with female patients achieving a better cost-effectiveness ratio than men. In conclusion, acupuncture was a cost-effective treatment strategy in patients with chronic osteoarthritis pain.     

Psychosocial Problems and Coping Patterns of HIV Seropositive Wives of Men with HIV/AIDS

Abstract

The sociocultural milieu provides HIV positive women with fewer resources and more role responsibilities. The present research aimed at studying the psychosocial problems encountered in living, post HIV infection, and the coping patterns adopted by HIV seropositive wives of men with HIV/AIDS. In the background of an exploratory research design, thirty (n = 30) HIV positive women, attending Counseling Clinics in Bangalore (South India), selected through purposive sampling, were assessed using an interview schedule and a standardized coping scale. Majority of the respondents were the primary caregivers for their infected spouse and/or children. Content analysis of the problems revealed increased financial difficulties; problems in child care and support; compromised help-seeking due to stigma; problems in sexual interactions and communication in their marital relationship; role strain in caregiving; gender discriminatory and inadequate care; and increased concerns about parenting efficacy, post HIV infection. Escape avoidance was the most preferred coping strategy adopted by them. Situating the illness in a socio-familial context is indicated, and implications for social work and mental health practice follow from the findings.     

术前疼痛教育对慢性硬膜下血肿手术患者疼痛控制的影响

目的评价术前疼痛教育对慢性硬膜下血肿患者行颅内血肿钻孔引流术后的镇痛疗效和护理满意度。方法采用非同期队列对照设计,将2011年1月—12月神经外科收治的慢性硬膜下血肿患者65例设为对照组,采取常规术前教育;将2012年1月—12月收治的慢性硬膜下血肿患者65例设为干预组,在常规术前教育基础上给予疼痛教育。采用VAS疼痛评分和护理满意度量表分别对两组患者进行评价。结果术后24 h、48 h、72 h,干预组VAS得分比对照组显著下降（P〈0.01）;术后72 h干预组患者的总体护理满意度得分显著高于对照组（P〈0.05）。结论疼痛教育可显著减轻慢性硬膜下血肿患者行颅内血肿钻孔引流术后疼痛的程度,提高患者的护理满意度。     

Internal migrants' experiences with and perceptions of frontline health workers: A nationwide study in 13 Indian cities

The role of frontline health workers is crucial in strengthening primary health care in India. This paper reports on the extent of services provided by frontline health workers in migrants' experiences and perceptions of these services in 13 Indian cities. Cluster random sampling was used to sample 51 055 households for a quantitative survey through interviewer‐administered questionnaires. Information was sought on the receipt of health workers' services for general health care overall (from the head/other adult member of the household) and maternal and immunization services in particular (from mothers of children <2 years old). Purposively, 240 key informants and 290 recently delivered mothers were selected for qualitative interviews. Only 31% of the total respondents were aware of the visits of frontline health workers, and 20% of households reported visits to their locality during past month. In 4 cities, approximately 90% of households never saw health workers in their locality. Only 20% of women and 22% of children received antenatal care and vaccination cards from frontline health workers. Qualitative data confirm that the frontline health workers' visits were not regular and that health workers limited their services to antenatal care and childhood immunization. It was further noted that health workers saw the migrants as“outsiders.” These findings warrant developing migrant‐specific health‐care services that consider their vulnerability and living conditions. The present study has implications for India's National Urban Health Mission, which envisions addressing the health care needs of the urban population with a focus on the urban poor.     

Physical and psychosocial correlates of test-retest isometric torque variability in patients with chronic low back pain

Variability in trunk torque production has been suggested as a means of detecting submaximal effort in the assessment of chronic low back pain. Several investigations question the validity of using torque variability to detect submaximal efforts in patients with back injuries. However, few investigations have studied the correlates of text-retest torque variability in clinical populations. The present study investigated psychological distress, disability/flexibility/pain, and symptom magnification correlates of test-retest torque variability in chronic low back pain patients. Contrary to previous studies, psychological distress, tendency to report symptoms, and pain were negatively correlated with measures of torque variability. The findings indicate the potential for psychological variables to influence torque production, but on the whole provide little strong support for the use of test-retest torque variability as a means of detecting submaximal performance.     

Assessing the symptoms,anxiety and practical needs of HIV/AIDS patients receiving palliative care

We report the work of two community teams who care for people with AIDS/HIV related illness, the characteristics of patients referred, and the impact of the teams on four aspects of quality of life. Data was collected on 140 patients (85 St. Mary's Home Support Team, 55 Bloomsbury Community Care Team) who were referred to and remained in the care of these teams until death. All patients were male, mean age 37.9 years, 116 were homosexual. Most referrals were from genito-urinary medicine clinics (48%) or AIDS wards (41%). There was a wide range of reasons for referral. At referral 62% were in hospital and 35% at home. Mean time in care was 31 weeks 5 days. Fifty-seven per cent died in hospital, 22% at home and 21% in a hospice. The Support Team Assessment Schedule (STAS), consisting of 17 items of care, was used by the teams to measure aspects of quality of life. Throughout care until death four STAS items: pain control, symptom control, patient anxiety and practical aid are reported in detail. Symptom control was a commonly severe problem at referral and although the teams had some success in improving this item it remained a serious problem throughout care. Patient anxiety, also a commonly severe problem at referral, improved significantly throughout care. Pain control was less commonly severe at referral and improved significantly throughout care. Practical aid, in contrast, was rarely a severe problem at any stage of care.     

芬太尼透皮贴剂治疗中重度癌痛的疗效观察及安全评估

目的观察芬太尼透皮贴剂治疗中重度癌痛的近期疗效和不良反应。方法内脏痛、骨转移痛、侵犯和压迫神经痛、皮肤黏膜痛等慢性癌性疼痛42例,应用芬太尼透皮贴剂治疗,记录疗效及治疗期间便秘、恶心呕吐、嗜睡、头晕、呼吸抑制等不良反应出现的情况。结果总有效率为90．4％（38／42）,不良反应有便秘4例（9．5％）,恶心呕吐4例（9．5％）,其他有嗜睡、头晕、胃部不适、呼吸抑制,但发生率均〈5％。结论使用芬太尼透皮贴剂治疗中重度癌痛安全有效,可作为癌痛治疗的首选药物可作为癌痛治疗的首选药物。     

Which GP deals better with depressed patients in primary care in Kastamonu, Turkey: the impacts of 'interest in psychiatry' and 'continuous medical education'

BACKGROUND: Little is known about the reasons behind Turkish GPs' limited ability to diagnose and treat major depression. OBJECTIVE: The aim of this preliminary study is to evaluate the impact of a GP's level of interest in psychiatry and participation in previous continuous medical education (CME) on their ability to recognize and treat major depression. METHODS: Thirty-eight GPs from an underdeveloped city in Turkey participated in the study. A survey consisting of questions about their demographic characteristics, self-reported capacity for recognition and antidepressant management of depression, presence of previous CMEs and self-ratings of their interest in psychiatry was given to all GPs. Comparisons were made using hierarchical multiple regression analyses and SPSS software. RESULTS: Almost half of the GPs had participated previously in at least one CME course on depression, and these were significantly more involved with the treatment of depressed patients (P = 0.02). Hierarchical multiple regression analysis indicated that 'interest in psychiatry' was an important factor in predicting the GPs' confidence in recognizing and treating depression even after controlling for other variables such as age, gender (P = 0.01) and participation in previous CME (P = 0.05). CONCLUSION: Our findings suggest that personal characteristics, including a GP's interest in psychiatry, should be considered when planning education and other interventions to improve the detection and treatment of depression in primary care.     

腰腿痛患者中腰椎间盘磁共振成像局限性高信号区的分布特点及相关因素分析

目的 探讨腰腿痛患者中腰椎间盘磁共振成像(MRI)局限性高信号区(HIZ)的分布特点,并分析发生HIZ的相关因素.方法 选取2009年6月至2010年8月因腰腿痛行腰椎MRI检查的患者628例.分析HIZ在年龄、椎间盘节段和椎间盘退变中的分布特点及其相关因素.结果 628例患者3140个椎间盘中,172例(27.39％,172/628 )206个椎间盘(6.56％,206/3140)存在HIZ.其中男性患者和女性患者HIZ的发生率分别为26.38％(86/326)和28.48％( 86/302),差异无统计学意义(P=0.556).40～49岁是HIZ发生率最高的年龄段[40.22％(72/179)].椎间盘节段存在HIZ的发生率:L1～2 0.80％(5/628)、L2～3 2.07％ (13/628)、L3～42.07％(13/628)、L4～5 14.01％(88/628)、L5～S113.85％(87/628).有和无HIZ时椎间盘退变程度≥Ⅳ级者的发生率分别为49.03％( 101/206)及23.76％(697/2934),差异有统计学意义(P＜0.01).年龄、椎间盘退变程度、椎间盘节段与HIZ均具有相关性(r=-0.040,P=0.025;r=0.217,P＜0.01;r=0.179,P＜0.01).结论 腰腿痛患者中腰椎间盘MRI发生HIZ与年龄、椎间盘节段、椎间盘退变程度之间存在相关性,椎间盘退变程度是最重要的影响因素.HIZ最常发生于L4～5和L5～S1节段,40～ 49岁是高发年龄段.