Chronic Somatic Diseases Research Articles

Motor dysfunction in elderly patients with chronic musculoskeletal system diseases (locomotive syndrome)

Locomotive syndrome (LS) is defined as an unsatisfactory condition in patients after the age of 60 years, in which they require or may require physical assistance soon due to deterioration in the functional state of the musculoskeletal system, including pathology of bone tissue, joints, muscles, and the nervous system. The problem of LS treatment in elderly patients is relevant for all countries over the world. The presence of chronic somatic and neurological diseases in most older adults can complicate LS assessment and reduce treatment effectiveness. The patient's functional status and ability to continue activities of daily living should be assessed at the first visit to determine the degree of independence, the level of need for caregivers, and the overall quality of life. LS treatment should be permanent and include kinesiotherapy, professional psychological support, and complex drug therapy. The use of vital micronutrients, which include highly purified forms of chondroitin sulfate and glucosamine sulfate, which have a wide range of anti-inflammatory and regenerative effects, can provide the safety of long-term drug therapy.

Justification of the platform of Standards based on the risk's assessment to health employees disorders of the leading sector's enterprises of the economy

Introduction. In current conditions, the preservation of the health of the able-bodied population is of particular relevance and is an essential task of occupational health and ensuring social guarantees for employees. The study aims to scientifically substantiate the main requirements of the standards aimed at preserving employees' health. Materials and methods. The materials of harmful production factors, occupational morbidity at mining and coal industry enterprises, ferrous metallurgy, aluminum production plants are analyzed. We perform Cross-sectional epidemiological studies to assess the risk of developing chronic general somatic diseases. Results. We present the justification of the platform of standards based on the risk assessment of violation of worker's health in the extraction and processing of ore and coal minerals. The share of jobs with harmful working conditions at these enterprises ranges from 73 to 90%. We have the indicators of occupational morbidity and quantitative assessment of the occupational risk of developing chronic general somatic diseases. Conclusions. We give a comprehensive assessment of the current state of working conditions, the levels of occupational morbidity, the prevalence of production-related diseases in workers associated with the impact of production factors at enterprises of the leading sectors of the economy. It served as a justification for developing a platform of standards that include measures to reduce the risk of employee health disorders.

Intensity of development of somatic diseases of children's population in Kizlyar and Khasavyurt and cancer incidence

Aim. Study of the development of somatic and oncological diseases and the state of the dentoalveolar system as an indicator of somatic health on the example of the city of Kizlyar (a city of ecological trouble) and the city of Khasavyurt (ecological well-being).Materials and methods. To determine the health status of children and their mothers, a survey was conducted of 1015 children and (or) their parents (three age groups of the study), of which 528 were girls and 487 were boys, and for comparison, 542 children aged 2-17 years in the city of Khasavyurt (ecological well-being) northern zone of Dagestan. Patient selection criteria: 1) identical area of residence (Kizlyar, Khasavyurt); 2) children of preschool age from 2-6 years (1, 2, 3 health groups in the absence of somatic diseases in sub- and decompensated forms), 4 health groups with chronic somatic diseases and congenital malformations; 3) Children at the age of the period of changeable occlusion from 7 to 13 years old, 1-4 health groups; 4) Children aged 14 to 17 years of permanent occlusion, 1-4 health groups.Results. According to a study of schoolchildren aged 7 to 17 years in the city of Kizlyar, 47.1% of children with habitual mouth breathing or mixed breathing. Infantile type of swallowing in children was found in 23.8% of cases. Violation of posture in children was observed in 29% of cases, while in children from the city of Khasavyurt, this type of violation was observed only in 10.5% of cases. The main localizations of malignant neoplasms in the male population are the respiratory organs, stomach, skin, bladder, lip; in the structure of oncological morbidity in the female population, the largest number of patients with neoplasms of the mammary gland, skin, lymphatic and hematopoietic tissue, cervix, and stomach.In the population (period of permanent occlusion), there was a significant decrease in tumors from 0.8% to 0.4% out of 1000 examined, the endocrine system from 0.5% to 0.4%, blood diseases from 0.2% to 0.1%.Conclusions. The results obtained confirm the presence and development of somatic and oncological diseases from unfavorable factors in the region of residence. All indicators for the city of Khasavyurt (ecological well-being) 2 times lower than the data of the city of Kizlyar (city of ecological trouble).

Anxiety about illness of children with chronic somatic diseases

Anxiety about illness of children with chronic somatic diseases

Comorbid Major Depressive Disorder in Schizophrenia: A Systematic Review and Meta-Analysis.

Comorbid major depressive disorder (MDD) in schizophrenia (SZ; SZ-MDD) has been identified as a major prognostic factor. However, the prevalence and associated factors of SZ-MDD have never been explored in a meta-analysis. All studies assessing the prevalence of SZ-MDD in stabilized outpatients with a standardized scale or with structured interviews were included. The Medline, Web of Science, PsycINFO, and Google Scholar databases were searched. Using random effects models, we calculated the pooled estimate of the prevalence of SZ-MDD. We used meta-regression and subgroup analyses to evaluate the potential moderators of the prevalence estimates, and we used the leave-one-out method for sensitivity analyses. Of the 5633 potentially eligible studies identified, 18 studies (n = 6140 SZ stabilized outpatients) were retrieved in the systematic review and included in the meta-analysis. The pooled estimate of the prevalence of SZ-MDD was 32.6% (95% CI: 27.9-37.6); there was high heterogeneity (I2 = 92.6%), and Egger's test did not reveal publication bias (P = .122). The following factors were found to be sources of heterogeneity: publication in or after 2015, the inclusion of patients from larger studies, the assessment tools, the inclusion of patients with substance use disorder or somatic chronic diseases, age, education level, the lifetime number of hospitalizations, and antidepressant use. Two-thirds of the extracted variables could not be explored due to an insufficient amount of published data. The prevalence of MDD is high among SZ individuals. Healthcare providers and public health officials should have an increased awareness of the burden of SZ-MDD.

Relationship between job burnout and somatic diseases: a network analysis

Job burnout, characterized by feelings of exhaustion, cynicism and reduced personal efficacy, has been defined as a risk state for the development of diseases, but its association with somatic diseases is underexplored. Study participants were 5671 respondents (mean age 44.1 years, range 18–70; 38.6% men) to an online survey of job burnout, using a mobile health web application. Respondents provided data on sociodemographic characteristics, symptoms of burnout, measured with the Maslach Burnout Inventory-General Survey, depressive symptoms, measured with the Profile of Mood States, and 11 categories of somatic diseases. Adjusting for age, sex, educational level, depressive symptoms, and all disease categories included, network analysis showed a significant association of high exhaustion with “high blood pressure” and a category of “other chronic somatic diseases”. Low personal efficacy showed a significant association with “chronic lung diseases”. In network analysis, clinically relevant depressive symptoms were also significantly associated with “high blood pressure”, “other chronic somatic diseases” and “skin diseases”. Logistic regression analysis confirmed these associations. Burnout dimensions were significantly associated with an increased risk for somatic diseases, independently of sociodemographic factors and clinically relevant depressive symptoms. This relationship seems particularly evident for the exhaustion dimension of job burnout.

Условия труда и профессиональный риск нарушения здоровья рабочих рудных карьеров

The paper presents the results of hygienic assessment of the working environment and process factors in surface ore mining operations. It analyzes morbidity patterns and levels of occupational diseases among employees engaged in open-pit mining of ores. Occupational risks due to the impact of harmful industrial factors on employees' health are assessed based on the results of a cross-sectional epidemiological study. It has been established that the working conditions of personnel in openpit mines, who are subjected to continuous and intensive exposure to harmful occupational factors in the course of their labour activities, contribute to higher incidence rates and risks concerned with chronic somatic diseases as compared to the intermittent exposure to the same harmful occupational factors.

Severely increased generalized anxiety, but not COVID-19-related fear in individuals with mental illnesses: A population based cross-sectional study in Germany.

The COVID-19 pandemic affected individuals, governments, and health care centers all around the globe. Social isolation obligation, restricted working shifts, and curfews posed unprecedented challenges for the population. Social isolation, boredom, and financial problems have been shown to stress peoples' mental health in previous comparable pandemics and even in regular situations. Individuals with a mental illness may particularly be at risk due to an already instable mental health status. While research mainly focused on the pandemic's impact on somatic health care and risk group patients, psychological obstacles caused by legal restrictions and their impact on already mentally affected individuals have been discussed, but so far only scarcely been investigated in a large sample. For this study, 12,028 people completed an online-survey during that time in Germany, when the COVID-19 outbreak gained momentum with a surge in cases and death rates as well as a lockdown of the public life. Generalized anxiety (GAD-7), depression (PHQ-2), distress (distress thermometer) and COVID-19-specific items, especially COVID-19-related fear, were assessed in healthy individuals, patients suffering from mental illnesses, and in patients with chronic somatic diseases, known to be at risk for an unfavorable course of COVID-19. Results show that the COVID-19-pandemic significantly worsens psychometric scores throughout the population - individuals with already heightened levels, like people with mental illnesses now reach concerning levels. Surprisingly, even though generalized anxiety, depressive symptoms, and perceived distress are elevated in individuals with mental illness, these individuals seem to be less affected by explicit COVID-19-related fear, than the general population or individuals with chronic somatic diseases. This study thus objectively quantifies the psychological impact of COVID-19 in a large sample and provides evidence for not only the public, but also critically affected individuals with a mental illness.

PREMORBIDITY IN ACUTE INFLAMMATION OF THE MAXILLOFACIAL AREA IN CHILDREN

Current state-of-the-art technologies facilitate studying the role of internal and external factors at a higher organ-specific level, and the broad and systematic provision of treatment and prevention care for child population of all age groups differs favorably from the routine visit to a doctor, if necessary. Apparently, the above methodological approach enables establishing different responses of the body to damaging factors in each case.
 Methods and Material. 537 case histories of children with acute purulent odontogenic and neodontogenic inflammation of the maxillofacial area have been thoroughly studied. Only medical histories of in-patients have been selected.
 Results and Discussion. The analysis of premorbid state of 240 patients with acute purulent lymphadenitis has shown that the onset of the diseases was triggered by the experienced ARVI in 89 patients (37%) and in 37 cases (15%) inflammation of the lymph nodes coincided with manifestations of acute pathology of the ENT organs; in 34 (14%) cases it was combined with acute inflammation of the bronchopulmonary system, in 23 (10%) cases with disorder of the gastrointestinal tract (GIT), in 13 (6%) cases it was provoked by acute periodontitis and exacerbation of chronic periodontitis in temporary and permanent molars of the mandible.
 Concomitant chronic somatic diseases were detected in 122 patients (51%). They most often occurred in toddlers, preschoolers and school-aged children and related, in most cases, to the respiratory tract and ENT organs.
 Precursors of adenophlegmon in 150 patients were ARVI (45 children (30%)); acute inflammation and exacerbation of chronic ENT processes (21 children (14%)); pathological changes in the bronchopulmonary system (19 children (13%)); gastrointestinal disorders (15 children (10%)); acute periodontitis and exacerbation of chronic periodontitis in temporary molars (20 children (13%)), permanent molars (6 (4%)); acute inflammation of the oral mucosa (5 children (3%)); pyoderma (4 children (3%)). In 15 children (10%) the provoking factor for the development of adenophlegmon failed to be established.
 Concomitant chronic somatic pathology was diagnosed in 100 children out of 150 (66.7%), and combination of two chronic diseases was found in 6 children (6%). Most often, the chronic course of somatic pathology was established in preschoolers, less frequently in toddlers and school-aged children, and infrequently during breastfeeding.
 In acute odontogenic osteomyelitis, the source of infection was temporary molars in all toddlers and preschoolers, as well as in 12 school-aged children (18%). In total, the onset of osteomyelitis was triggered by temporary teeth in 67 cases (46%). Notably, 35 cases (52%) were related to the first molar and 32 (48%) cases to the second molar. Complicated dental caries in permanent second premolars caused osteomyelitis in 2 (14%) adult children only. Permanent molars caused the development of purulent process in 78 cases (53%).
 The analysis of the premorbid state has revealed that the onset of osteomyelitis was preceded by: ARVI (42 children (29%)); general hypothermia (37 (25%)), inflammation of the ENT organs (21 children (14%)) and bronchopulmonary system (15 (10 %)); exacerbation of chronic gastrointestinal diseases (8 children (5%)) and in 24 children (16%) a provoking factor failed to be established.
 Concomitant chronic diseases of organs and systems were found in 90 children (61.2%) out of 147 with acute odontogenic osteomyelitis of the mandible. The combination of their two nosological forms was noted in 3 children (3%).
 In conclusion, the establishment of certain adverse factors, or the presence of somatic diseases in children necessitates the formation of a risk group, especially when it comes to the existence of odontogenic foci of inflammation. Timely establishment of factors that can be influenced enables control over them through preventive measures, including routine dental check-ups.

Potencjalne niedodiagnozowanie współchorobowości somatycznej u pacjentów chorych na schizofrenię i zaburzenia afektywne dwubiegunowe

Introduction. Patients treated for schizophrenia and for bipolar affective disorder have a potentially higher risk of developing chronic somatic diseases compared to the general population. Aim. This is to compare the prevalence of somatic co-morbidity in patients with schizophrenia, patients with bipolar affective disorder (BD) and available data on the prevalence of somatic diseases in the general Polish population. Material and methods. Archival data of 527 (F = 249) patients with a diagnosis of schizophrenia, aged 42.56 ± 14.25 (M ± SD), and 155 (F = 82) patients with BD, aged 48.05 ± 14.45 (M ± SD), hospitalized in psychiatric hospital in Central Poland in 2019 were analyzed. Results. Majority of patients with schizophrenia and with BD had no registered somatic co-morbidity (80.6 and 67.7%, respectively); most common group of coexisting somatic diseases in both subgroups of patients were diseases of circulatory system (11.0 and 22.6%, respectively); and the most common disease was primary hypertension (10.4 and 20.6%, respectively). In men in the 7th decade of life, diseases of the circulatory system were significantly more common in patients with BD than in those with schizophrenia (p = 0.004). The prevalence of somatic diseases in both subgroups of patients turned out to be lower than their prevalence in the general population. Conclusions. Somatic co-morbidity in patients with BP and with schizophrenia is potentially underdiagnosed. Possible reasons of this finding were carefully discussed.

Risk and Protective Factors for PTSD in Caregivers of Adult Patients with Severe Medical Illnesses: A Systematic Review.

Caregivers of severely ill individuals often struggle to adjust to new responsibilities and roles while experiencing negative psychological outcomes that include depression, anxiety and Post-Traumatic Stress Disorder (PTSD). This systematic review aims to outline potential risk and protective factors for the development of PTSD in caregivers of adult subjects affected by severe somatic, potentially life-threatening illnesses. Twenty-nine studies on caregivers of adult patients affected by severe, acute, or chronic somatic diseases have been included. Eligibility criteria included: full-text publications reporting primary, empirical data; PTSD in caregivers of adult subjects affected by severe physical illnesses; risk and/or protective factors related to PTSD; and English language. Specific sociodemographic and socioeconomic characteristics, besides the illness-related distress, familiar relationships, exposure characteristics, coping style, and support, were identified as relevant risk/protective factors for PTSD. The review limitations are the small number of studies; studies on different types of diseases; studies with same samples. It is crucial to consider factors affecting caregivers of severely ill adult patients in order to plan effective intervention strategies aimed at reducing the risk of an adverse mental health outcome and at enhancing the psychological endurance of this population.

Клінічний протокол медичної допомоги дітям із коронавірусною інфекцією (COVID-19), яка перебігає на фоні хронічних соматичних захворювань

Клінічний протокол медичної допомоги дітям із коронавірусною інфекцією (COVID-19), яка перебігає на фоні хронічних соматичних захворювань

Affective Disorder and Functional Status as well as Selected Sociodemographic Characteristics in Patients with Multiple Sclerosis, Parkinson's Disease and History of Stroke.

The main arguments in support of researching anxiety and depression in patients with chronic somatic diseases are the prevalence of affective disorders in the population, somatic conditions as risk factors of affective disorders and the search for effective preventative and therapeutic strategies. The aim of the study was to determine the association between the functional status, selected sociodemographic characteristics and prevalence as well as severity of anxiety and depression in patients with multiple sclerosis (MS), Parkinson’s disease (PD) and history of stroke (S). Material and methods: Eighty participants (44 women and 36 men) with MS (n = 22), PD (n = 31) and history of stroke (n = 27) were enrolled. All participants completed a questionnaire consisting of metrics, the Katz Index of Independence in Activities of Daily Living and the Hospital Anxiety and Depression Scale (HADS). Results: Fifty-five per cent of all participants did not present with anxiety or depression, 20% scored above the diagnostic threshold on the anxiety scale and 26% scored above the diagnostic threshold on the depression scale. Subgroup analysis revealed that anxiety and depression sufferers were 13.64% and 13.64% of MS patients, respectively; 22.58% and 35.48% of PD patients, respectively; and 22.22% and 25.93% of stroke survivors, respectively. There was a significant correlation between depression and independence level in the entire group and between depression and marital status in stroke survivors. Conclusions: Although depression and anxiety are highly prevalent in patients with neurological conditions, the disorder has a very individual nature and is not associated with the patient’s age, duration of a condition or concomitant diseases. Screening for depression and anxiety as a part of comprehensive approach may increase treatment efficacy in neurological patients

THE ANALYSIS OF RISK FACTORS INFLUENCING THE FORMATION OF ADOLESCENTS’ VEGETATIVE DYSFUNCTIONS

The article analyzes the risk factors for adolescents’ vegetative dysfunction from the perspective of the modern realities in Ukraine. The atmosphere of general instability, an increased rhythm of life, a significant influence of gadgets and media lead to violations of the autonomic regulation of organs at the disease beginning and further appearance of organic pathologies, which affect adolescents’ personality, reduce their quality of life. Parents charge most strongly their children with negative emotions, as the family represents whole society in a miniature display. Children are socialized in their families. Given the fact that, in the recent decades, there is a tendency for more often occurrences of vegetative dysfunctions and their various manifestations at adolescents, the problem is very urgent. The risk factors for vegetative dysfunction occurrences are found on the mental, social, biological planes and they affect the measure of adolescents’ negative emotional expressions. Adolescents’ vegetative dysfunctions should be considered not only as a medical problem, but also as a socially important one, since it underlies all chronic somatic diseases, accompanying and complicating their course. At adolescence, vegetative dysfunctions are accompanied by violent emotional manifestations, personality disorders. This is due to the peculiarities of adolescence, which is accompanied by increased physical and psychological loads, the need for adaptation, changed life stereotypes. All this poses a certain danger to an adolescent’s health and psychological stability. By analyzing the works of national and foreign researchers, as well as the life histories of adolescents, composed based on the diagnostic talks, we identified both congenital and acquired risk factors for vegetative dysfunction formation. The diagnostic talks helped us collect psychosomatic anamneses in order to translate adolescents’ somatic symptoms misunderstood by them into meaningful connections with the external and internal histories of their lives.  The interest in this problem by scientists and doctors is related to the fact that the state of the autonomic vegetative nervous system determines the sanogenetic capabilities of the body.  In the context of our study, we draw attention to the most recent theoretical and practical studies on brain neuroplasty associated with negative thoughts, which are one of the risk factors for disease. The modern research in neuroscience, epigenetics gives an optimistic prognosis for psychological assistance and the ability to manage any negative life situations, which will prevent or stop the progression of adolescents’ vegetative dysfunction. &nbsp

Differences in medication beliefs between pregnant women using medication, or not, for chronic diseases: a cross-sectional, multinational, web-based study

ObjectivesTo assess whether medication beliefs differ between women who use or not use medication for their somatic chronic diseases during pregnancy and whether this association varies across diseases.DesignCross-sectional web-based survey.SettingMultinational...

Identifying subgroups of persons with multimorbidity based on their needs for care and support

BackgroundThere is broad consensus that countries need to develop and implement person-centred integrated care to better meet the needs of their growing populations with multimorbidity. To develop appropriate care, it is essential to know the needs for care and support among these populations. For this purpose, we examined whether subgroups of people with multimorbidity could be distinguished based on their needs, and profiled these subgroups according to medical complexity and the availability of personal resources.MethodsPersons diagnosed with two or more somatic chronic diseases (N = 613) were selected from 38 general practices throughout the Netherlands. We conducted a cluster analysis of their scores on the RAND-36 questionnaire of health-related quality of life (QoL), to gain insight in their needs for care and support. Differences in demographics, medical characteristics and personal resources between the identified clusters were tested using analysis of variance and chi-square tests.ResultsThe cluster analysis revealed three subgroups: 1. a group with a relatively good QoL (48% of the sample), 2. a group with a poor physical QoL (28%), and 3. a group with a poor QoL in all domains assessed by the RAND-36 (24%). The group with a relatively good QoL had more favourable medical characteristics than the other groups, i.e., less chronic diseases, shorter illness duration, more stable course of illness, better controllable conditions, less polypharmacy. The group with a poor QoL in all domains could rely on less personal resources (education, income, social support, health literacy, self-management capabilities) than the other groups.ConclusionsDifferent subgroups of people with multimorbidity can be distinguished based on their needs for care and support. These needs are not only determined by demographic and medical characteristics, but also by the personal resources people have available to manage their health and care. Patient profiles combining medical complexity and personal resources could guide the development of integrated care for specific target groups of persons with multimorbidity.

Trajectories and determinants of functional limitations in late-life depression: A 2-year prospective cohort study

BackgroundIn mental health research, functional recovery is increasingly valued as an important outcome in addition to symptomatic remission. MethodsCourse types of functional limitations among depressed older patients and its relation with symptomatic remission were explored in a naturalistic cohort study (Netherlands Study of Depression in Older persons). 378 depressed older patients (≥60 years) and 132 non-depressed persons were included. Depressive disorders were assessed with Composite International Diagnostic Interview at baseline and two-year follow-up. Functional limitations were assessed every 6 months with the World Health Organization Disability Assessment II. ResultsDepressed patients had more functional limitations compared to their non-depressed counterparts. Growth Mixture Modeling among depressed patients identified two trajectories of functional limitations, both starting at a high disability level. The largest subgroup (81.2%) was characterized by a course of high disability levels over time. The smaller subgroup (18.8%) had an improving course (functional recovery). After two years, the main predictor of functional recovery was the remission of depression. Among symptomatic remitted patients, female sex, higher level of education, higher gait speed, and less severe depression were associated with no functional recovery. Non-remitted patients without functional recovery were characterized by the presence of more chronic somatic diseases, a lower sense of mastery, and a higher level of anxiety. Conclusions1 in 5 depressed older patients have a course with functional recovery. Combining functional and symptomatic recovery points to a subgroup of older patients that might profit from more rigorous psychiatric treatment targeted at psychiatric comorbidity and a group of frail depressed older patients that might profit from integrated geriatric rehabilitation.

The development of an intersectoral intervention to patients with severe mental disease and selected somatic chronic diseases

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

CLINICAL CHARACTERISTICS OF POSTOPERATIVE ANALGESIA IN ELDERLY AND OLD PATIENTS

Nearly 13% of the elderly and old population experience psychosomatic pain that is not regarded as a response to irritants. Diagnosis and treatment of the postoperative pain in old and elderly patients may be complicated by chronic pain or somatic diseases. The aim of this work was to study clinical characteristics of the postoperative pain in old and elderly patients. Materials and methods. This study based on analysis of 99 cases of the perioperative period. Patients were divided into groups by age: the 1st group included individuals aged 18-59 years, the 2nd group included individuals over 60 years. The influence of age, type of anesthesia and postoperative analgesia on the character and severity of pain was determined by questioning and clinical comparison. The Visual Analogue Scale and the McGill questionnaire were used to assess the pain intensity. Results and their discussion: the elderly patients demonstrated higher scores of the affective component to surgical intervention; moreover, the direct relationship between the affective and evaluative components and the indirect correlation of the sensitive component of pain with age was found out. There have been established the significant direct links between postoperative pain and its components in elderly people with the level of pain before surgery, intrathecal anaesthesia, and vascular surgery. Conclusions: in the elderly, in contrast to the younger individuals, the level of postoperative pain is more pronounced. The initial level of pre-operative pain in these patients definitely influences the level of postoperative pain. Simultaneously, the postoperative pain in the elderly is due to the greater lability of all the components of pain, with the prevalence of affective and evaluative components. The persistence of pain in the postoperative period is typical for elderly people who underwent vascular interventions and intrathecal anaesthesia. In the context of the conventional tactics of postoperative pain relief in the elderly people, the strength and the characteristics of the pain are more significantly intense relatively to those in younger patients that require an improvement in the tactics of pain management.

The association between insomnia, c-reactive protein, and chronic low back pain: cross-sectional analysis of the HUNT study, Norway.

Chronic low back pain (chronic LBP) is the number one cause for years lived with disability among 301 diseases and injuries analyzed by The Global Burden of Disease study 2013. Insomnia is highly prevalent among people with chronic LBP. To explain the sleep-pain relationship, theoretical models propose that insomnia symptoms may be associated with increased basal inflammation, operationalized as c-reactive protein (CRP) and lead to further pain and disrupted sleep. We aimed to determine the associations between insomnia, chronic LBP, and inflammation (operationalized as CRP), whilst controlling for age, body mass index, smoking, physical activity, depression, anxiety and osteoarthritis. A cross-sectional analysis of the third Nord-Trøndelag Health Study (2006-2008), a rural population survey of 50,666 participants in Norway aged 20-96 years. Insomnia (dichotomous) was defined according to the Diagnostic and Statistical Manual of Mental Disorders 5th Edition, and chronic LBP (dichotomous) as low back pain or stiffness lasting at least 3 months. Data for CRP were obtained from non-fasting serum samples and assessed via latex immunoassay methodology. We excluded participants with the following self-reported chronic somatic diseases: chronic heart failure, chronic obstructive pulmonary disease, rheumatoid arthritis, fibromyalgia or ankylosing spondylosis. Possible associations between presence of insomnia and presence of chronic LBP (dependent), and the level of CRP and presence of chronic LBP (dependent), were assessed using logistic regression models. The possible association between insomnia and CRP (dependent) was assessed using linear regression. Multivariable analyses were conducted adjusting for confounders stated in our aim that achieved p ≤ 0.2 in univariate regressions. We performed stratified analyses for participants with "Normal" (<3 mg/L) "Elevated" (3-10 mg/L) and "Very High" (>10 mg/L) levels of CRP. In our total included sample (n = 30,669, median age 52.6, 54% female), 6.1% had insomnia (n = 1,871), 21.4% had chronic LBP (n = 6,559), and 2.4% had both (n = 719). Twenty four thousand two hundred eighty-eight (79%) participants had "Normal" CRP, 5,275 (17%) had "Elevated" CRP, and 1,136 (4%) had "Very High" CRP. For participants with "Normal" levels of CRP, insomnia was associated with higher levels of CRP (adjusted B = 0.04, 95%CI [0.00-0.08], p = 0.046), but not for people with "Elevated" or "Very High" levels of CRP. There was an association between CRP and presence of chronic LBP in the total sample (adjusted OR = 1.01, [1.00-1.01], p = 0.013) and for people with "Normal" CRP (1.05, [1.00-1.10, p = 0.034]. Insomnia was associated with the presence of chronic LBP in the total sample (adjusted OR = 1.99, 95%CI [1.79-2.21], <0.001) and for people with "Normal", "Elevated" and "Very High". Individuals with insomnia have twice the odds of reporting chronic LBP. Insomnia, CRP and chronic LBP appear to be linked but the role of CRP appears to be limited. Longitudinal studies may help further explore the causal inference between insomnia chronic LBP, and inflammation. Given the strong relationship between insomnia and chronic LBP, screening and management of comorbid insomnia and chronic LBP should be considered in clinical practice. Further longitudinal studies are required to explore whether the presence of insomnia and increased inflammation affects the development of chronic LBP.