Community Oriented Research Articles

Key themes of community-oriented primary care projects from a longitudinal, rural interprofessional health professions curriculum (1997–2023)

BackgroundThe Community Oriented Primary Care Project Model (COPC) has been well studied globally as well as in the United States as a way to provide both community-centered primary care and to engage in community based research. Rural trainees through the University of Illinois College of Medicine’s Rural Medical Education Program (RMED) and Rural Pharmacy Education Program (RPHARM) students through the University of Illinois Chicago College of Pharmacy have participated in a COPC project as a capstone to a four month longitudinal, immersive community-based experience in a rural primary care setting. The purpose of this study was to assess the type of projects implemented through a rural health professions curriculum over a 30 year project period. .MethodsA research team reviewed projects on 30 elements; including topic and demographics. Patterns in COPC topics and rurality of the location in which the COPC project were also examined by using 2021 U.S. Census Bureau population data and Rural Urban Commuting Area (RUCA) Code.ResultsCOPC projects were categorized into 31 main topic areas with mental health being the most prevalent topic area covered by projects (n = 67, 15.7%) followed by 43 (10.1%) projects that focused on nutrition/exercise, and 41 (9.6%) focused on substance use (presented as a separate category from mental health in this analysis).ConclusionsFor three decades, COPC themes reflect priority health issues in rural communities while providing a scholarly activity for health profession student trainees Past projects have also been implemented in highly rural areas where research is not often conducted. The COPC research process can be easily replicated in other trainee models such as to fulfill ACGME requirements of scholarly activity and can provide a template for trainees of this model to implement community-engaged research in the future.

The Epidemiology of Rheumatic Diseases in India

Epidemiological studies, referred to as the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) studies, have been conducted under the aegis of the International League against Rheumatism and the World Health Organization to evaluate the epidemiology of rheumatic and musculoskeletal (RMSK) diseases in India. These COPCORD studies conducted in rural Bhigwan and urban Pune in Maharashtra, rural Calicut and rural Trivandrum in Kerala and rural and urban Lucknow in Uttar Pradesh, along with data from the Global Burden of Diseases study have helped to understand the burden of rheumatic diseases in the community. Based on these studies, RMSK diseases, which are amongst the top 25 causes of disability in the Indian population, are prevalent in nearly 25%–30% of the Indian population. The common rheumatic diseases in the community are soft tissue rheumatism, neck and back pain, fibromyalgia and unspecified pains and osteoarthritis (most commonly affecting the knee). These diseases most commonly affect young persons between the third to the fifth decade of life, more often affect females, are prevalent in both rural and urban populations, and account for considerable disability in up to one-fifth of individuals leading to loss of livelihood and dependence on others for self-care. Community-based national healthcare programs to manage RMSK diseases at the community level are urgently needed. There also remains an unmet need to train more doctors to diagnose and manage rheumatic diseases at the primary, secondary and tertiary levels of care.

Understanding how self-management education and support programmes for type 2 diabetes are expected to change behaviour: A document analysis of two programmes.

Attendance at diabetes self-management education and support (DSMES) programmes for type 2 diabetes is associated with positive outcomes, but the impact on some outcomes is inconsistent and tends to decline over time. Understanding the active ingredients of effective programmes is essential to optimise their effectiveness. This study aimed to (1) retrospectively identify behaviour change techniques (BCTs), mechanisms of action (MoAs) and intervention functions in two DSMES programmes, the Community-Oriented Diabetes Education and the Diabetes Education and Self-Management for Ongoing and Newly Diagnosed and (2) examine variation in content between programmes. A multiple case study approach, including a documentary analysis of the programme materials, was conducted. Materials were coded using the BCT Taxonomy v1, the Mode of Delivery Ontology v1 and the Intervention Source Ontology v1. The Behaviour Change Wheel guidance and the Theory and Techniques tool were used to identify intervention functions and MoAs. Programme stakeholders provided feedback on the findings. Thirty-four BCTs were identified across the programmes, with 22 common to both. The identified BCTs were frequently related to 'goals and planning', 'feedback and monitoring' and 'natural consequences'. BCTs were linked with 15 MoAs, predominantly related to reflective motivation ('beliefs about capabilities' and 'beliefs about consequences') and psychological capability ('knowledge'). BCTs served six intervention functions, most frequently 'education', 'enablement' and 'persuasion'. Although both programmes included several BCTs, some BCTs were rarely or never used. Additional BCTs could be considered to potentially enhance effectiveness by addressing a wider range of barriers.

Community Oriented Substance Use Programme in the City of Tshwane: A Cross-sectional Survey of Stakeholder Perceptions

The City of Tshwane and University of Pretoria’s Community Oriented Substance Use Programme (COSUP) is an applied research intervention to address drug use-related harms in the city by using a harm reduction community-oriented primary care approach. This is a study of stakeholder perceptions of South Africa’s first publicly funded community-based harm reduction programme. In late 2021, purposively sampled respondents were surveyed using a cross-sectional survey. Electronically captured data were collected on respondent demographic characteristics, familiarity with COSUP and perceptions of COSUP’s effect on service users’ well-being, access to drug use services, family relationships, community integration, and on effective approaches to managing drug use. Frequencies and proportions were analysed as a total and by the degree of familiarity with COSUP, using descriptive statistics. Overall, 338 (93.1%) of the 363 stakeholders who consented to participate in the study had some familiarity with COSUP. Socio-demographically, 68.1% were female and over half (52.4%) were aged between 25–39 years. Most (70–80%) thought COSUP improved client well-being, family relationships and community re-integration. Most (80–84%) perceived COSUP to have increased service provider willingness to support people who use drugs, improved stakeholder networking and raised awareness of drug-related services. Most (76%) considered harm reduction to be the best approach to manage harmful drug use in the city. Stakeholders exposed to the work of COSUP perceive the intervention to be beneficial for individuals, families and service-providing organisations. Most favour a harm reduction approach to drug use and believe COSUP should be sustained and expanded.

Methadone use for acute opioid withdrawal in Tshwane shelters during the COVID-19 lockdown.

Temporary shelters were established for street-based people during the national level 5 coronavirus disease 2019 (COVID-19) lockdown. However, street-based substance users' need to access substances was not addressed, resulting in large numbers of people experiencing withdrawal. The Community Oriented Substance Use Programme (COSUP) in Tshwane provided methadone to manage opioid withdrawal. A cross-sectional, descriptive study was conducted using the daily methadone dosing records from shelters in Tshwane between March 2020 and September 2020. The final analysis included 495 participants, of which 64 (12.9%) were initiated on 20 mg - 30 mg of methadone, 397 (80.2%) on 40 mg - 50 mg, and 34 (6.9%) on 60 mg - 70 mg. A total of 194 (39.2%) participants continued their initiation dose for 1-2 months, after which 126 (64.9%) had their doses increased, and 68 (35.1%) had their doses decreased. Approximately 12 (2.4%) participants were weaned off methadone after 1-3 months and 46 (9.3%) after 4-6 months. In all, 100 (20.2%) participants left the shelter prematurely and did not continue with methadone. A total of 126 (25.5%) participants continued to stay in the shelters and received methadone for 6 months, with 125 (25.3%) participants leaving the shelter with continued follow-up at a COSUP site. This study demonstrates variability in methadone dosing regimens among shelter residents. As the lockdown measures eased, many chose to leave the shelters, while others remained to receive methadone and other services. The COSUP appears to be effective during periods of increased vulnerability, since a large number of participants were successfully followed up.Contribution:Opioid dependence is a persistent, lifelong disease. It is multifaceted with complex environmental and individual determinants. This study highlighted the use of opioid substitution therapy during a period of increased vulnerability.

Challenges Introducing a Novel Health Assessment System in Disaster-prone Japan: Community-Oriented Approach for Comprehensive Healthcare in Emergency Situations (COACHES)

Introduction:Collecting real-time individual health data of all disaster-affected populations is usually considered impossible. The University of Kochi's team and its partners conceived a novel health assessment system named "Community Oriented Approach for Comprehensive Healthcare in Emergency Situations (COACHES)." It collects individual health data anonymously and records such data in a cloud-based database. The system runs on any personal mobile device by scanning a personal identification code (QR code). It is expected that anyone on site with qualifications in healthcare will run this system as a volunteer to ensure data reliability. The COACHES app development is in process, and its prototype is currently available. This study aimed to assess how people react to the novel system and see the feasibility of installation in Japan.Method:Two focus group interviews (FGI) were conducted in a small coastal village in western Japan. The village anticipates severe damages with days of isolation once a large-scale earthquake followed by a tsunami hits the area. The first FGI was held with nine purposively recruited participants. The second FGI was held one month after and included seven of the first FGI participants with one of the absent participants providing a written response. FGI was for one-hour each, with discussion following the system demonstration. The voice data during the FGI were recorded and analyzed. The research was approved by the University of Kochi IRB.Results:Some showed intense interest in the system, whereas concerns such as the privacy violation for using personal devices, the availability of healthcare personnel, or a fear that anonymous data collection may delay identifying a person in need of assistance.Conclusion:Further studies are proposed, particularly in recruiting volunteers, data storage in case of technical damage, and how to make people with limited IT literacy comfortable using the new system.

Research for Community Oriented Approach for Comprehensive Healthcare in Emergency Situations (COACHES)

Japan has a high prevalence of natural disasters and it is essential that local and national governments and other organisations develop effective means of handling the impacts of disasters and the resulting emergencies. A research team led by Professor Mari Kinoshita based within the Faculty of Nursing at the University of Kochi in Japan has helped propose a system called the Community Oriented Approach for Comprehensive Healthcare in Emergency Situations (COACHES) that has the potential to be implemented across Japan and lead to more effective and efficient responses to the impacts of disasters and emergencies. Kinoshita has identified shortfalls with current methods of accumulating information about a disaster affected population and, through COACHES, wants to detect hidden or missed data and provide a whole picture of the situation to be able to provide more optimised relief. COACHES provides information to relief personnel that is vital in an emergency situation, including data on where the affected people are located and how they are doing at the present time, which enables rescue and relief teams to prioritise according to the most urgent need. Data is recorded so that it can be reviewed and analysed later, enabling continuous improvements.

CHARACTERISTICS OF MATERNAL PREGNANCY AND CHILDBIRTH IN PAYANGAN SUB-SUB-DISTRICT, BALI

Health and nutrition during pregnancy has a clSanjiwani Regional General Hospital, Gianyar ose relationship with child development. Poor nutritional status during pregnancy can have an impact on fetal growth restriction (FGR), low birth weight (LBW) and stunting. Efforts to reduce the prevalence of stunting in Indonesia are carried out through the 1000 days of life program. The Faculty of Medicine and Health Sciences (FKIK) of Warmadewa University integrates the first 1000 days program in the field of education through the implementation of community-oriented medical education. This study aims to provide an overview of the characteristics of pregnancy and childbirth obtained by the first 1000 days program in the Payangan Sub-District, Bali Province. This research was a descriptive study using secondary data sourced from the survey of the Community Oriented Medical Education 1000 Days Early Life education program conducted by FKIK Warmadewa University. The research subjects were pregnant women who lived in the Payangan sub-Sub-District, Gianyar Regency, Bali in 2019-2020. The total number of subjects in this study were 110 people. The data collected consisted of data on demographic characteristics, pregnancy, childbirth, and diet. Of 110 Pregnant women in Payangan Sub-District in 2019-2020, 48% showed an average normal body mass index, most (76%) pregnant women in this region had no history of disease and high and very high-risk pregnancy was found in 61% of the subjects. The diet, environment and family APGAR mostly were considered good, namely in 86%, 72%, and 100% respectively. Most deliveries were by cesarean section, i.e., 59% and most did not have delivery complications (85%).

Prevalence of musculoskeletal complaints and health-related quality of life in a Maroon and Kalinya Indigenous rural village in Suriname.

Musculoskeletal complaints (MSCs), a leading contributor to disability worldwide, have a major impact on health-related quality of life (HRQoL). Poor general health related to lifestyle factors such as smoking, alcohol consumption and physical inactivity can lead to a higher risk to suffer MSCs. For minority groups in Suriname such as the Maroons and the Indigenous peoples no research has been conducted regarding prevalence of MSCs, HRQoL and various lifestyle factors. The aims were to determine the prevalence of MSCs and HRQoL in two rural tribal villages in the forested interior of Suriname and to identify various lifestyle factors associated with HRQoL in these communities. This was a cross-sectional community-based study using the Community Oriented Program for the Control of Rheumatic Diseases stage 1, phase 1 & 2 methodology in Goejaba, a Maroon village and Galibi, an Indigenous rural village. Sociodemographic data, self-reported comorbidities, past MSCs (for longer than seven days), lifestyle factors including smoking, alcohol use, body mass index (BMI) and physical activity (PA), and HRQoL (using the 36-item Short Form Survey (SF-36)) data were gathered among 153 Indigenous individuals in Galibi, and 516 Maroons in Goejaba. Regression models were constructed to explore associations between presence of MSCs, lifestyle factors and HRQoL. High prevalence rates for past MSCs were reported in Galibi (72.4%) and Goejaba (58.3%). In both communities, respondents with MSCs reported significantly worse HRQoL than persons without MSCs. MSCs and the presence of comorbidities had a strong negative association with HRQoL, whereas PA positively influenced the physical and mental health domains of the SF-36. Smoking, alcohol use and BMI showed no association with HRQoL. In this first study, a high prevalence for MSCs was reported in an Indigenous and Maroon rural community in Suriname. MSCs and comorbidities had a significant negative impact on HRQoL. PA was associated with higher self-reported HRQoL.

Epidemiology of rheumatic and musculoskeletal diseases in a Nigerian peri-urban community: results of a cross-sectional survey using the COPCORD stage 1 model.

There is relative neglect of rheumatic and musculoskeletal diseases (RMDs) in sub-Saharan Africa (SSA). While hospital-based reports on RMDs abound, there is a paucity of population-based reports on these conditions which are otherwise recognized to cause functional disability and reduced quality of life in the affected individuals. Thus, the objective of this study is to determine the prevalence, diagnostic types, and predictors of musculoskeletal (MSK) pain in Agbowa, a peri-urban community in Lagos, South-West Nigeria. This community-based survey utilized the World Health Organisation/International League of Association of Rheumatology Community Oriented Programme for the Control of Rheumatic Diseases (WHO/ILAR COPCORD) stage 1 model. All respondents had their profiles documented via modified COPCORD questionnaires. Pain intensity and functional disability were assessed by the Numerical Rating Scale (NRS) and Health Assessment Questionnaires Disability Index (HAQ-DI) respectively. The rheumatic and musculoskeletal diseases were classified using relevant validated criteria. Data obtained were analysed using SPSS Version 21. There were 3056 respondents who were predominantly female (59.2%). The period prevalence of MSK pain among the 3056 respondents was 58% (n = 1,773). There were significantly more females with MSK pain than males (62.8% vs. 37.2%, p = 0.001). Overall, 380 (12.4%) subjects had clinically diagnosed RMDs. The common RMDs in decreasing order were osteoarthritis (n = 185, 6.1%), chronic low back pain (n = 95, 3.1%) and soft tissue rheumatism (n = 52, 1.7%). The bivariate analysis showed that female sex, family history of MSK conditions, history of previous trauma, and some comorbidities were significantly associated with MSK pain. The median HAQ-DI was 0.6 (IQR 0.1-1.8) with significant disability (HAQ-DI ≥ 1) in 39.5% of the subjects. The burden and impacts of these conditions are considerable. Thus, the government needs to devise programmes and policies to limit the effects of RMDs in such communities.

Physical activity, fear avoidance beliefs and level of disability in a multi-ethnic female population with chronic low back pain in Suriname: A population-based study.

Chronic low back pain (CLBP) is an important cause for reduced daily physical activity (PA) and loss of quality of life, especially in women. In Suriname, a middle-income country in South America, the relationship between PA and CLBP is still unknown. To assess the level of PA in women with CLBP of different ethnicity, and to identify whether fear avoidance beliefs (FAB), disability, co-occurring musculoskeletal pain sites and various sociodemographic and lifestyle factors were associated with self-reported PA. A cross-sectional community-based house-to-house survey was conducted between April 2016 and July 2017. The survey followed the Community Oriented Program for Control of Rheumatic Diseases methodology. Selection criteria were being female of Asian-Surinamese, African-Surinamese or of Mixed ethnicity and aged 18 or older, living in an urban area, and reporting CLBP. Data was collected on PA, FAB, disability, co-occurring musculoskeletal pain sites, CLBP intensity and sociodemographic and lifestyle factors. Urban adult women with current CLBP (N = 210) were selected. Nearly 57% of the population met the WHO recommendation on PA, with work-related PA as the largest contributor to total self-reported PA. Most women showed low FAB scores (FABQ-Work ≤34 (96.2%) and FABQ-PA ≤14 (57.6%)) and low disability levels (Oswestry Disability Index ≤20 (62.4%)). An inverse association between total PA and FABQ-Work (OR = 0.132, CI: 0.023; 0.750) was found. In contrast, total PA had a significant, positive association with disability (OR = 2.154, CI: 1.044; 4.447) and workload (OR = 2.224, CI: 1.561; 3.167). All other variables showed no association with total PA. This was the first study in Suriname reporting that 43.3% of urban adult women with CLBP were physically inactive. Total self-reported PA is influenced by FABQ-Work, average to heavy workload and moderate to severe disability. In this study, PA-Work was the major contributor to total PA. Therefore, future longitudinal studies should evaluate different types and aspects of PA in relation to CLBP management.

Prevalence and pattern of soft‐tissue rheumatism in a rural community in South‐South Nigeria: A cross‐sectional survey

AbstractBackgroundSoft tissue rheumatism arises from the pathology of periarticular structures. They are marked by pain and disability. Epidemiological studies in sub‐Saharan Africa are sparse. This study aimed to determine the epidemiology of soft‐tissue rheumatism in a rural community in South‐South Nigeria.MethodsThis was a community‐based, cross‐sectional study conducted from February to July 2017 in South‐South Nigeria among 319 participants using the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) methodology. Participants aged 18 years and older were included in the study. Subjects reporting positive musculoskeletal pain were examined for specific soft tissue rheumatism. The diagnosis was based on established criteria.ResultsThe mean age of the study population was 48.87 ± 19.58 years. The prevalence of soft‐tissue rheumatism was 11.0% (35/319). Soft tissue rheumatism was more prevalent in females (24, 68.6%) than in males (11, 31.4%). The most common form of soft‐tissue rheumatism diagnosed was adhesive capsulitis (20.0%), closely followed by rotator cuff tendinitis (14.3%), carpal tunnel syndrome (14.3%), and plantar fasciitis (14.3%). Age (p = 0.06), body mass index (p = 0.034), and dyslipidemia (p = 0.028) were significantly associated with the prevalence of soft‐tissue rheumatism. A significant disability index (HAQ‐DI ≥ 1) was recorded in 40.0% of participants with soft tissue rheumatism. Twelve (34.3%) participants with soft‐tissue rheumatism attributed the disorder to their work, and 74.3% used hospital‐prescribed medications for treatment.ConclusionSoft‐tissue rheumatism is associated with a significant disability affecting activities of daily living. Factors associated with its prevalence include increasing age and obesity.

Managing acute opioid withdrawal with tramadol during COVID-19 lockdown in a peri-urban setting.

BackgroundThe coronavirus disease 2019 (COVID-19) has highlighted the scope of heroin dependence and need for evidence-based treatment amongst marginalised people in South Africa. Acute opioid withdrawal management without maintenance therapy carries risks of increased morbidity and mortality. Due to the high costs of methadone, Tshwane’s Community Oriented Substance Use Programme (COSUP) used tramadol for opioid withdrawal management during the initial COVID-19 response.AimTo describe demographics, route of heroin administration and medication-related experiences amongst people accessing tramadol for treatment of opioid withdrawal.SettingThree community-based COSUP sites in Mamelodi (Tshwane, South Africa).MethodsA retrospective cross-sectional study was conducted. Data were collected using an interviewer-administered paper-based tool between April and August 2020. Descriptive statistics were used to analyse data.ResultsOf the 220 service users initiated onto tramadol, almost half (n = 104, 47%) were not contactable. Fifty-eight (26%) people participated, amongst whom most were male (n = 55, 95%). Participants’ median age was 32 years. Most participants injected heroin (n = 36, 62.1%). Most participants experienced at least one side effect (n = 47, 81%) with 37 (64%) experiencing two or more side effects from tramadol. Insomnia occurred most frequently (n = 26, 45%). One person without a history of seizures experienced a seizure. Opioid withdrawal symptoms were experienced by 54 participants (93%) whilst taking tramadol. Over half (n = 38, 66%) reported using less heroin whilst on tramadol.ConclusionTramadol reduced heroin use but was associated with withdrawal symptoms and unfavourable side effects. Findings point to the limitations of tramadol as opioid withdrawal management to retain people in care and the importance of access to first-line opioid agonists.ContributionThis research contributes to the limited data around short-acting tramadol for opioid withdrawal management in the African context, with specific focus on the need for increased access to opioid agonists for those who need them, in primary care settings.

A case‐study approach to mapping Corporate Citizenship

AbstractThis explores what responsible business practice within the context of Malaysia, an Eastern collective society, diverging from the Western individualistic society where most Corporate Social Responsibility (CSR) research originates. A bottom‐up approach was adopted, incorporating different stakeholder perspectives of a case‐study firm, widely acknowledged for its CSR programs. Concept mapping method was selected because it is a structural conceptualization method designed to organize and represent ideas from an identified group adding structure to disorganized and subjective ideas. By using concept mapping all the various perspectives and ideas were brought together to create a single conceptualization. The findings from the concept mapping present 101 statements which produced seven clusters; Products & Services, Community Oriented, Stakeholder & Business Value, Employee Oriented, Legal & Ethical Responsibilities, Environmental & Social Oriented, and Philanthropic Oriented. These clusters covered the whole conceptual domain of Corporate Citizenship and demonstrated multiple CSR theories, including corporate sustainability, stakeholder concept, and shared value, were apparent, while also uncovering some unique aspects from the normative stakeholder perspective. The implications of this study suggest that while some aspects of globally institutionalized CSR are generically accepted, there are contextually specific aspects which need to be considered as these may contradict or conflict with the “global” standards.

Acute Exacerbation of COPD in the Elderly with Chronic Hypertension, Suspected Meniere's Disease and History of Active Smoking

Background: Chronic Obstructive Pulmonary Disease (COPD) is a clinical symptom consisting of a group of chronic, progressive, and ongoing respiratory conditions. Meniere's Disease (MD) is a disorder of the inner ear characterized by hearing loss, tinnitus, and vertigo. Objective: Cases of COPD and MD in the elderly. Case: A 72-year-old man came to the primary clinic with the main symptoms of acute shortness of breath and vertigo. On physical examination there was an increase in the respiratory rate and wheezing in both lung fields and on the chest X-ray there was empphysematous lung. Neurological examination revealed hearing and balance problems. The patient was diagnosed with COPD and MD, with a history of active smoking for 30 years, and did not regularly visit the hospital. In this case, comprehensive interventions were carried out including Patient Centered, Family Focused, and Community Oriented. Conclusion: COPD and MD are chronic diseases that can cause acute symptoms and can recur, so that if they occur in the elderly it can reduce quality of life and mortality. Comprehensive intervention is needed to prevent the recurrence of dyspnea, vertigo, and complications.

Factors associated with smoking and transitioning to nyaope injection amongst women in the City of Tshwane Municipality: A self-report by women.

BackgroundSubstance use disorder has emerged as a key health and social challenge in South Africa (SA). It is projected that about 15% of South African youth, especially young women are prone to engage in drug use and the prospects of coming into contact with nyaope, a highly addictive drug, are higher. Nyaope is mainly smoked, but the prevalence of injecting it is increasing in most regions.AimThis study aimed to explore and describe the perception of women, who use nyaope, about the factors contributing to nyaope smoking and transitioning to injecting nyaope amongst women in the City of Tshwane Municipality (CoT), Gauteng.SettingThe research was conducted within Community Oriented Substance Use Programme sites across the CoT Municipality.MethodsQualitative research methods were utilised to explore and describe the perceptions of the participants on factors contributing to the use of nyaope amongst women residing in the CoT. Data were collected through face-to-face interviews and thematically analysed.ResultsIntimate partner influence (IPI), peer pressure, being misled by friends, weight loss, lack of effective coping mechanisms and counteracting other drugs contributed to women smoking nyaope. Additionally, a need for an intense high, IPI, influence by the social network, curiosity and cost-effectiveness contributed to women transitioning from smoking to injecting nyaope.ConclusionThe study has established factors contributing to smoking and transition to injecting nyaope as viewed by women residing in the CoT.ContributionThis research affirms that women are influenced by different factors to use and transition to injecting Nyaope.

Risk factors of knee osteoarthritis in Bangladeshi adults: a national survey

BackgroundKnee osteoarthritis was reported as the second most prevalent condition in the national musculoskeletal survey. The purpose of this extended study was to identify risk factors for knee osteoarthritis in Bangladeshi adults.MethodsThis cross-sectional study was conducted in rural and urban areas of Bangladesh using stratified multistage cluster sample of 2000 adults aged 18 years or older recruited at their households. The Modified Community Oriented Program for Control of Rheumatic Disorders (COPCORD) questionnaire was used to collect data. The diagnosis of knee osteoarthritis was made using the decision tree clinical categorization criteria of the American College of Rheumatology. Univariate and multivariate logistic regression analyses were done to identify the risk factors for knee osteoarthritis.ResultsA total of 1843 individuals (892 men and 951 women) participated, and 134 had knee osteoarthritis yielding a prevalence of 7.3% (95% confidence interval (CI) 4.9 to 9.6%). The mean (standard deviation) age of the knee osteoarthritis patients was 51.7 (11.2) years. Multivariate logistic regression analysis found a significant association with increasing age (≥38 years OR 8.9, 95% CI 4.8–16.5; ≥58 years OR 13.9, 95% CI 6.9–28.0), low educational level (OR 1.7, 95% CI 1.0–2.7) and overweight (OR 1.9, 95% CI 1.2–2.9) with knee osteoarthritis. Knee osteoarthritis patients had a high likelihood of having work loss preceding 12 months (age and sex-adjusted OR 2.3; 95% CI 1.4–3.8; P < 0.01).ConclusionsKnee osteoarthritis is a commonly prevalent musculoskeletal problem among Bangladeshi adults having link to work loss. Increasing age, low education and overweight are significant risk factors of knee osteoarthritis.

A Legacy of Excellence in Research and Service

In 1961, Dr. Lourdes Manahan, a young internist at the Philippine General Hospital, presented her paper entitled “Rheumatic disease in the Philippines” at the Australian Rheumatism Congress in Sydney.1 This was the first time an article on the Philippine rheumatology experience was presented at an international convention. It was, however, not Dr. Manahan’s first foray into research. In 1948, she was published in this very journal – a report on familial non-hemolytic jaundice, a syndrome which would later bear her name, the Rotor-Manahan-Florentin syndrome.2 Her interest soon shifted towards a new field of study centered on diseases referred to then as “rheumatism.” After training in the United States for a year, she established an arthritis clinic to serve Filipino rheumatic patients in the PGH dispensary. For over a decade, she cared for patients alone, painstakingly documenting her findings in pages of handwritten notes and tables. These pages turned into scientific publications, and Dr. Manahan became a pioneer in research in rheumatology in the region. She was the first to describe gout in the Philippines.3, 4 She authored the COPCORD (Community Oriented Program for Control of Rheumatic Diseases) studies, a joint effort by the World Health Organization and International League Against Rheumatism to measure the burden of arthritis and disability in the community.5,6&#x0D; The Division of Rheumatology continues this legacy. Research in rheumatic diseases has been one of the core disciplines of the division over its now 50 years of existence. In celebration of our founder’s 100th birth anniversary, this special issue of ACTA MEDICA PHILIPPINA republishes three of Dr. Manahan’s earlier works. The first is a report of a family with Rotor-Manahan-Florentin syndrome. 7 While not a rheumatic disease, her encounter with this condition sparked her interest in scientific inquiry. Dr. Manahan also co-authored the first clinical and laboratory description of Chikungunya in the Philippines.8 She also was one of the first to investigate HLA antigens in Ankylosing Spondylitis in Filipinos.9&#x0D; This special issue in rheumatology also presents interesting cases in rheumatic diseases and original studies by the faculty of the division and its graduates. The gout registry feasibility study emphasizes the importance of databases in collecting data over time to describe the clinical profiles and outcomes of Filipino patients with gout. Penserga and Penserga’s paper shines a spotlight on the unmet need to manage rheumatoid arthritis in the Philippines, where most patients do not have access to biological treatments. Finally, Villanueva-Misa et al. demonstrate the Knee Injury and Osteoarthritis Outcome Score (KOOS) to be a valuable tool for measuring disability in Filipino patients with osteoarthritis in clinical practice and research.&#x0D; As we honor the legacy of the first among us, we are reminded that the central focus of our work, both in research and clinical practice, is always in the service of the Filipino patient&#x0D; &#x0D; Anna Kristina Gutierrez-Rubio, MD Division of Rheumatology Department of Medicine Philippine General Hospital University of the Philippines Manila&#x0D; &#x0D; REFERENCES &#x0D; &#x0D; Manahan L. Rheumatic Disease in the Philippines. in Australian Rheumatism Congress. 1964. Sydney.&#x0D; Rotor AB, Manahan L, Florentin A. Familial Non-hemolytic Jaundice with Direct Van Den Bergh Reaction. Acta Med Phil. 1948; 5:37.&#x0D; Manahan L. Is Gout Found in the Philippines? Acta Med Philipp. 1954; 10: 477-82&#x0D; Manahan L. Uric Acid in Diabetic Filipinos. Acta Med Philipp. 1964; 1:11-4.&#x0D; Manahan L, Caragay R, Muirden KD, Allander E, Valkenburg HA, Wigley RD. Rheumatic Pain in a Philippine Village. A WHO[1] ILAR COPCORD Study. Rheumatol Int. 1985; 5:149-53.&#x0D; Wigley RD, Manahan L, Muirden KD, Caragay R, Pinfold B, Couchman KG, et al. Rheumatic Disease in a Philippine Village. II: A WHO-ILAR-APLAR COPCORD Study, Phases II and III. Rheumatol Int. 1991; 11: 157-61.&#x0D; Poblete PF, Reyes M, Manahan L, Dalmacio-Cruz A. Rotor's Syndrome: A Family Study. Acta Med Phil. 1967; 4: 64-71.&#x0D; Reyes, MP, Caviles AP, Manahan L, Espiritu-Campos L, Campos P. Clinical and Laboratory Study of a Newly Observed Viral Infection in the Philippines: A Preliminary Report. Phil J Intern Med. 1968; 5: 74-9.&#x0D; Manahan L, Chavez C, Pascasio FM. HLA Antigens in Filipinos with Ankylosing Spondylitis. Phil J Intern Med. 1986; 24:187-90.&#x0D;

The burden of the most common rheumatic disease in Colombia

BackgroundEstimating the burden of rheumatic diseases (RDs) requires proper evaluation of its lethal and nonlethal consequences. In Colombia, it is possible to find local data and Global Burden of Disease (GBD) reports that collect information from varied contexts and apply complex statistical models, but no on-site estimations are available.MethodsThis was a descriptive study on the burden of RD based on occurrence and mortality data in the general population during 2015, including information and prevalence estimations from the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) study. Disability-adjusted life years (DALYs) were estimated by combining measures of years of life lost (YLL) and years lived with disability (YLDs). For disability weight estimations among cases, different COPCORD responses were mapped using flowcharts to show the severity distribution according to GBD. All model parameters and results were validated through an expert consensus panel.ResultsLow back pain (LBP) was the RD with the greatest burden of disease, costing 606.05 (95% CI 502.76–716.58) DALYs per 100,000 inhabitants, followed by osteoarthritis (292.11; 95% CI 205.76–386.85) and rheumatoid arthritis (192.46, 95% CI 109.7–239.69).ConclusionsThe burden of RD is as high in Colombia as in other countries of the region. The results offer an interesting tool for optimizing healthcare system design as well as for planning the distribution of human and economic resources to achieve early diagnosis and adequate care of these diseases.

Musculoskeletal disorders among the population in Northwest Ethiopia.

Objective:This study aimed to assess the magnitude and patterns of chronic musculoskeletal disorders among the population in East Gojjam zone, Northwest Ethiopia.Methods:A community-based cross-sectional study with 846 recruited study participants was done using a multistage sampling technique in conjunction with a simple and systematic random sampling technique. Face-to-face interviews, physical examinations, a semi-structured questionnaire adapted from the Community Oriented Program for Control of Rheumatic Diseases, and other literature were used to collect data. EpiData 3.1 was used to enter the data, which were then exported to STATA 14.0 for analysis.Result:The study had a response rate of 98.8%, with about 836 people out of a total of 846 expected to take part. The magnitude of musculoskeletal disorders was found to be 40.1%. Back pain was the most common musculoskeletal condition (16%) of the population, followed by osteoarthritis (10%) and other forms of arthritis (rheumatoid arthritis (8%), gout arthritis (6%)). The most common comorbidity (multimorbidity) patterns were hypertension (9.8%), diabetes (5.6%), obesity (3.9%), and others (2.2%).Conclusion:Almost one in four participants have at least one musculoskeletal disorder in Northwest Ethiopia. Rheumatoid arthritis, osteoarthritis, low back pain, and gout arthritis were the most common musculoskeletal disorders. The most common comorbidity patterns were hypertension, diabetes, obesity, and others. An in-depth investigation of the musculoskeletal burden at the national level will be critical for implementing evidence-based strategies, as well as early detection and screening, linking to health institutions, and direct interventions.