Lower General Health Status Research Articles

Environmental exposures in early-life and general health in childhood

BackgroundEarly-life environmental exposures are suspected to be involved in the development of chronic diseases later in life. Most studies conducted so far considered single or few exposures and single-health parameter. Our study aimed to identify a childhood general health score and assess its association with a wide range of pre- and post-natal environmental exposures.MethodsThe analysis is based on 870 children (6–12 years) from six European birth cohorts participating in the Human Early-Life Exposome project. A total of 53 prenatal and 105 childhood environmental factors were considered, including lifestyle, social, urban and chemical exposures. We built a general health score by averaging three sub-scores (cardiometabolic, respiratory/allergy and mental) built from 15 health parameters. By construct, a child with a low score has a low general health status. Penalized multivariable regression through Least Absolute Shrinkage and Selection Operator (LASSO) was fitted in order to identify exposures associated with the general health score.FindingsThe results of LASSO show that a lower general health score was associated with maternal passive and active smoking during pregnancy and postnatal exposure to methylparaben, copper, indoor air pollutants, high intake of caffeinated drinks and few contacts with friends and family. Higher child’s general health score was associated with prenatal exposure to a bluespace near residency and postnatal exposures to pets, cobalt, high intakes of vegetables and more physical activity. Against our hypotheses, postnatal exposure to organochlorine compounds and perfluorooctanoate were associated with a higher child’s general health score.ConclusionBy using a general health score summarizing the child cardiometabolic, respiratory/allergy and mental health, this study reinforced previously suspected environmental factors associated with various child health parameters (e.g. tobacco, air pollutants) and identified new factors (e.g. pets, bluespace) warranting further investigations.

Infertility as a Proxy of Men's Health: Still a Long Way to Go.

Male infertility (MI) has been widely associated with the development of certain comorbidities and to a lower overall general health status. Higher risks of developing oncological, autoimmune, and chronic disorders among infertile individuals have led researchers to further investigate this issue. Recent clinical studies have been focusing more onto the concept of general health status and mortality. Overall, it has been postulated and subsequently demonstrated that the coexistence of specific diseases and semen alterations may lead to a decreased lifespan. As in Western countries, fatherhood is increasingly delayed in time, and aging might play an important role as a confounding factor for the after-mentioned statements. Although this holds true, even after adjusting for age, it emerges a worrisome picture regarding MI, lower general health status, and increased mortality. The aim of this nonsystematic narrative review is to provide an overview of the most relevant and recent findings on the topic.

The influence of socioeconomic status and general health on the fracture incidence

Background/Aim: There is an association between patient general health, socioeconomic status and fracture incidence. Aim of this study was to demonstrate the relation between the socioeconomic and health status and the occurrence of fractures in Al-Kindy Hospital residents. Methods: A prospective cross-sectional study was performed by using data collected from fractured patients in Al-Kindy Teaching Hospital / Baghdad Orthopaedics Outpatient Clinic, between 12 December 2021 and 8 March 2022. A hundred patients aged 20 to 75 years were included in this study. The data were collected using a researcher-administered questionnaire, which included items to assess patient's socioeconomic status (accommodations, occupation, income status, level of education, owing motor vehicle) and assessed patient's health status (height, weight, presence of chronic disease(s), smoking status, alcohol consumption, water source quality, sun exposure, nutrition status). Results: A 100 patients from Al-Kindy Teaching Hospital between the age 20-75 participated in the study. The incidence of fractures was higher in younger and more active males (68 %) than females (32 %). Highest percent appeared in lower group of socioeconomic status (58 %) and in lower group of health status (44 %). There was a significant relation between health status and body mass index (BMI). Obese and overweight patient were the more vulnerable to fractures. Conclusion: Fractures are more likely to happen to people with low socioeconomic status, low general health status and overweight people.

Determinants of Health Service Utilization Among Adults at High Risk of Developing Type 2 Diabetes in Kerala, India.

The purpose of this study was to examine the determinants of health service utilization in a population at high risk of developing type 2 diabetes mellitus in India. Using Andersen's behavioral model of healthcare utilization, multivariate logistic regression analysis was performed on baseline data of the Kerala Diabetes Prevention Program. We examined the association between predisposing, enabling, and need factors with outpatient health service use in the past four weeks and inpatient health service use in the past 12 months. More than a quarter (27.9%) and 12.9% of 1007 participants used outpatient services and inpatient services, respectively. Men were less likely to use outpatient services (odds ratio [OR] = 0.56). Outpatient service utilization was positively associated with low social support (OR = 1.69), low general health status (OR = 5.71), and time off from work due to illness (OR = 8.01). Higher educational status (OR = 0.63), low general health status (OR = 3.59), and time off from work due to illness (OR = 1.21) were associated with increased utilization of inpatient services. Although gender, educational status, and social support had important roles, health service utilization in this study population was largely dependent on general health status and presence of illness.

QOLP-33. EVIDENCE OF FINANCIAL TOXICITY IN PRIMARY CENTRAL NERVOUS SYSTEM TUMOR PATIENTS: CORRELATIONS BETWEEN EMPLOYMENT STATUS, SYMPTOM BURDEN AND HEALTH-RELATED QUALITY OF LIFE

Abstract SIGNIFICANCE AND AIMS Financial toxicity (FT) after a cancer diagnosis is the consequence of decreased earnings and increased spending. In patients with primary central nervous system (PCNS) tumors, the correlation between FT and factors such as symptom burden, psychological distress, and health-related quality of life has not been extensively studied. We assessed employment status and several patient illness factors in a PCNS tumor cohort. METHODS Patient and disease characteristics and patient-reported outcomes (PROs) were collected from adults diagnosed with PCNS tumors between 9/2016-12/2019. Descriptive statistics and regression analyses were used to describe PROs. RESULTS Of 277 patients, 77 (28%) reported being unemployed due to tumor diagnosis. They reported difficulty walking (64%) and performing usual activities (64%). This group had lower general health status (p< 0.001) and higher tumor-related symptom severity (p=0.004) than employed patients. Unemployed patients reported high symptom burden with an average of 6 moderate-severe symptoms for those with brain tumors and 10 for those with spine tumors. Both brain and spine tumor patients who were unemployed reported increased mood-related interference (p=0.020), as well as moderate-severe anxiety (30%) and depression (25%) compared to employed patients (15% vs 8%, respectively). Unemployed brain tumor patients reported worse scores in cognitive and neurologic symptom subscales (p< 0.001). CONCLUSIONS AND IMPLICATIONS These data provide indirect evidence that financial toxicity that correlates with high symptom burden across several domains and lower health-related quality of life. Future research work will include the COST questionnaire to further evaluate the implications of FT in the PCNS tumor patient population.

Personalization of Treatment for Patients with Childhood-Abuse-Related Posttraumatic Stress Disorder.

Background: Differences in effectiveness among treatments for posttraumatic stress disorder (PTSD) are typically small. Given the variation between patients in treatment response, personalization offers a new way to improve treatment outcomes. The aim of this study was to identify predictors of psychotherapy outcome in PTSD and to combine these into a personalized advantage index (PAI). Methods: We used data from a recent randomized controlled trial comparing prolonged exposure (PE; n = 48), intensified PE (iPE; n = 51), and skills training (STAIR), followed by PE (n = 50) in 149 patients with childhood-abuse-related PTSD (CA-PTSD). Outcome measures were clinician-assessed and self-reported PTSD symptoms. Predictors were identified in the exposure therapies (PE and iPE) and STAIR+PE separately using random forests and subsequent bootstrap procedures. Next, these predictors were used to calculate PAI and to retrospectively determine optimal and suboptimal treatment in a leave-one-out cross-validation approach. Results: More depressive symptoms, less social support, more axis-1 diagnoses, and higher severity of childhood sexual abuse were predictors of worse treatment outcomes in PE and iPE. More emotion regulation difficulties, lower general health status, and higher baseline PTSD symptoms were predictors of worse treatment outcomes in STAIR+PE. Randomization to optimal treatment based on these predictors resulted in more improvement than suboptimal treatment in clinician assessed (Cohens’ d = 0.55) and self-reported PTSD symptoms (Cohens’ d = 0.47). Conclusion: Personalization based on PAI is a promising tool to improve therapy outcomes in patients with CA-PTSD. Further studies are needed to replicate findings in prospective studies.

Molecular Epidemiology, Virulence Traits and Antimicrobial Resistance Signatures of Aeromonas spp. in the Critically Endangered Iberochondrostoma lusitanicum Follow Geographical and Seasonal Patterns.

Despite the fact that freshwater fish populations are experiencing severe declines worldwide, our knowledge on the interaction between endangered populations and pathogenic agents remains scarce. In this study, we investigated the prevalence and structure of Aeromonas communities isolated from the critically endangered Iberochondrostoma lusitanicum, a model species for threatened Iberian leuciscids, as well as health parameters in this species. Additionally, we evaluated the virulence profiles, antimicrobial resistance signatures and genomic relationships of the Aeromonas isolates. Lesion prevalence, extension and body condition were deeply affected by location and seasonality, with poorer performances in the dry season. Aeromonas composition shifted among seasons and was also different across river streams. The pathogenic potential of the isolates significantly increased during the dry season. Additionally, isolates displaying clinically relevant antimicrobial resistance phenotypes (carbapenem and fluroquinolone resistance) were detected. As it inhabits intermittent rivers, often reduced to disconnected pools during the summer, the dry season is a critical period for I. lusitanicum, with lower general health status and a higher potential of infection by Aeromonas spp. Habitat quality seems a determining factor on the sustainable development of this fish species. Also, these individuals act as reservoirs of important antimicrobial resistant bacteria with potential implications for public health.

Abstract P6-11-07: Impact of chemotherapy on the health related quality of life among elderly patients with localized breast cancer: Findings from the prospective CANTO cohort

Abstract Background: The incidence of breast cancer (BC) increases with age. However, there appears to be a trend that elderly patients with BC receive less than the standard treatment compared to younger ones and this leads to poorer outcomes. The aim of this work was to assess whether chemotherapy has a differential impact on the health related quality of life (HRQOL) of elderly patients with BC, compared to younger ones. Methods: CANTO (NCT 01993498) is a multicenter prospective observational study (26 centers in France) whose main objective is to study the chronic toxicities of anticancer treatments in 12,000 women with localized stages I to III BC. HRQOL was assessed at baseline and at the end of acute treatments (surgery +/- radiotherapy +/- chemotherapy) using the EORTC-QLQ-C30 questionnaire and its BC specific module, the EORTC-QLQ-BR23. HRQOL at the end of acute treatments of patients aged 70 and over treated by chemotherapy was compared to that of the youngest ones. Multivariable mixed linear model was used to assess the determinants of HRQOL for the dimensions with minimal clinically important differences; defined as a mean difference of at least 5 points in HRQOL scores; between younger and older patients. Results: 3079 patients were included in the CANTO cohort from March 2012 to December 2014 and treated by chemotherapy. The mean age at diagnosis was 53 years and 7.3% of this population was ≥70 years old. Older and younger patients treated by chemotherapy were similar for the disease stage at diagnosis (p=0.7869), the tumor histology (p=0.07), the SBR grade (p=0.2350) and the HER2 status (p=0.4268). However, elderly patients treated by chemotherapy were more likely to be overweight (p<0.0001), with lower general health status (p=0.0001), had more comorbidities (p=0.0001). Elderly had shorter duration of treatment by chemotherapy (p<0.004) and were less often treated with taxanes regimens (p<0.0001). At the end of the treatment, the proportion of patients with at least one toxicity (p=0.58), toxicities at the general (p=0.82), cutaneous (p=0.77) or gastro-intestinal levels (p=0.88), did not differ between younger and older patients. However elderly had more neurological (p=0.003) and arterio-veinous (p<0.0001) toxicities with more frequent dose reduction (p=0.01). At the end of acute treatments, HRQOL was similar for 18 of the 23 dimensions of EORTC-QlQ-C30 and EORTC-QlQ-BR23 questionnaires between older patients and younger ones. A more pronounced deterioration in the elderly, between end of treatment HRQOL scores and baseline HRQOL scores, was seen for the appetite loss (Mean Difference (MD) = +9.65) and upset by hair loss (MD= +16) symptoms scale. However, body image (MD=8.75), dyspnea (MD= -6.98) and financial difficulties (MD= -7.08) were less deteriorated in elderly. In multivariable analyses, after adjustment on comorbidities, the stage of the disease, the tumor histology, the type of chemotherapy, the occurrence of toxicities and dose reduction, age was not an independent predictive factor of HRQOL for body image, dyspnea, appetite loss, upset by hair loss and financial difficulties. Conclusions: results of this study did not show a differential impact of chemotherapy on the HRQOL of elderly BC patients compared to the younger ones. Citation Format: Sandrine Dabakuyo Yonli, Oumar Billa, Olivia Dialla, Florence Joly, Sarah Dauchy, Charles Cecile, Cedric Lemogne, Patrick Soulie, Marie-Ange Mouret-Reynier, Carole Tarpin, Mario Campone, Sophie Guillermet, Jean-Marc Ferrero, Sylvie Giacchetti, Florence Lerebours, Suzette Delaloge, Anne-Laure Martin, Sibille Everhard, Charles Coutant, Fabrice Andre, Patrick Arveux. Impact of chemotherapy on the health related quality of life among elderly patients with localized breast cancer: Findings from the prospective CANTO cohort [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-07.

Congenital platelet disorders and health status–related quality of life

BackgroundPatients with congenital blood platelet disorders (CPDs) demonstrate a predominantly mucocutaneous bleeding tendency. Repeated bleeds throughout life can have a significant impact on health status–related quality of life (HR‐QoL), but few studies have investigated HR‐QoL in patients with CPDs. ObjectivesTo determine HR‐QoL in patients with suspected or confirmed CPDs as compared with the general Dutch population and to assess the association between bleeding phenotype and HR‐QoL. MethodsData were derived from the Thrombocytopathy in the Netherlands (TiN) study, a cross‐sectional study of individuals suspected for a congenital platelet defect. TiN patients with an increased ISTH Bleeding Assessment Tool (ISTH‐BAT) score (>3 in men and > 5 in women) were included for analysis. HR‐QoL was assessed with the Short Form (SF)‐36 survey. Bleeding symptoms were evaluated with the ISTH‐BAT, resulting in a bleeding score. ResultsOne hundred fifty‐six patients were analyzed, of whom 126 (81%) were women. Sixty‐two patients (40%) had a confirmed CPD. Compared to the general Dutch population, patients with a suspected or confirmed CPD reported decreased physical functioning, limitations in daily activities due to physical health problems, limitations in social activities, decreased energy levels and fatigue, pain, and lower general health status. HR‐QoL was not correlated with the ISTH‐BAT score and was similar in patients with a confirmed CPD and those in whom a CPD could not be diagnosed. ConclusionA bleeding tendency in patients with a suspected or confirmed CPD significantly impacts HR‐QoL, independent of a confirmed explanatory diagnosis.

General health of students of medical sciences and its relation to sleep quality, cell phone overuse, social networks and internet addiction

BackgroundIn recent years, the phenomena of access to the cell phone and addiction to the Internet have been developed among students due to their many applications and attractiveness. Therefore, the present study was conducted with the aim of evaluating general health status and also determining the predictive role of variables such as cell phone usage, sleep quality, internet addiction and social networks addiction in students.MethodsThis cross-sectional study was conducted on 321 students of Kermanshah University of Medical Sciences in an analytical approach. Data collection tools were: Goldberg’s General Health Questionnaire, Pittburgh Sleep Quality Index, Young Internet Addiction Test, Social Network Addiction Questionnaire, and Cell Phone Overuse Scale. Data analysis was done using SPSS version 21 and general linear model.ResultsBased on the results, the mean (SD) score of the general health was 21.27 (9.49). Variables of gender, sleep quality, and levels of cell phone usage were independent predictors of student’s health. Male students (β (95% CI) = − 0.28 (− 0.49 to − 0.01) and students with favorable sleep quality (β (95% CI) = − 0.22 (− 0.44 to − 0.02) had lower total health score than the reference category (female students and students with unfavorable sleep quality, respectively). In addition, students with cell phone overuse (β (95% CI) = 0.39 (0.08 to 0.69) had a higher general health score than the reference category (students with cell phone little use).In general, this group of students had lower general health status (Low or high scores of general health indicate a higher and lower general health status for subjects, respectively).ConclusionVariables of gender, sleep quality and cell phone use were the most important variables associating the general health of medical students.

Does Current General Mental Health Status Relate to Current Smoking Status in Pregnant Women?

Purpose Research shows that smoking during pregnancy is related to mental health diagnoses. The purpose of this study was to assess whether current general mental health status is related to current smoking status in pregnant women after controlling for other factors related to both mental health and tobacco use during pregnancy. Methods This cross-sectional analysis used 2017 Behavioral Risk Factor Surveillance Survey (BRFSS) data for 621 pregnant women aged 18-38 from Florida (N=136), Kansas (N=116), Minnesota (N=105), Nebraska (N=90), New York (N=78), and Utah (N=96). Multiple logistic regression analysis was used to assess the relationship between current mental health status and current tobacco use, while controlling for state, depression diagnosis, routine checkup, healthcare plan, age, marital status, ethnicity/race, education level, income level, and employment status. Results Overall, very few participants reported current smoking (6%) and about one-third reported low or moderate mental health status in the past 30 days. Adjusted results indicated that those who reported high mental health status were about 3 times less likely (OR=0.29, 95% CI=0.09, 0.88) to report current smoking status compared to those who reported low mental health status. Conclusions Overall, current mental health status was highly related to current smoking status in pregnant women. Clinicians in obstetrics may expect a very low proportion of pregnant women to report smoking and up to one-third to report low or moderate current general mental health status. Given that current mental health issues and current tobacco use may harm both mother and child, be highly related in pregnant women, and change throughout the pregnancy, pregnant women should be screened automatically for both at each visit.

Clinical predictors and survival outcome of patients receiving suboptimal neoadjuvant chemotherapy and radical cystectomy for muscle-invasive bladder cancer: a single-center experience

To investigate the prevalence of and factors' association with receiving suboptimal neoadjuvant chemotherapy (NAC) and its impact on survival outcomes in patients with muscle-invasive bladder cancer (MIBC) treated with radical cystectomy (RC). We reviewed 1119 patients treated with NAC and/or RC for cT2-cT4N0M0 BC. Patients were segregated into three groups: (i) suboptimal NAC (received < 3 cycles of cisplatin-based NAC or non-cisplatin-based regimen), (ii) optimal NAC and (iii) no NAC. Clinical characteristics were compared among groups. Logistic regression analyses tested the association between clinical variables and the odds of receiving suboptimal NAC. To adjust for potential baseline confounders, propensity score matching was performed. Pathologic outcomes were compared between groups and Cox regression analyses tested the risk factors associated with recurrence, overall (OM) and cancer-specific mortality (CSM). Before matching, 84/315 (26.6%) patients received a suboptimal NAC regimen. Lower general health status and impaired renal functions were the most significant factors associated with the administration of a suboptimal NAC. After matching, the optimal NAC group achieved higher rates of complete pathological response as compared to the suboptimal group (p = 0.03). Suboptimal NAC (HR 1.77; p = 0.015) and no NAC (HR 1.52; p = 0.03) were both associated with higher risk of recurrence and OM (HR 1.71; p = 0.02 and HR 1.61; p = 0.02) as compared to optimal NAC. One out of four MIBC patients received a suboptimal NAC regimen before RC. Receiving a suboptimal NAC regimen was associated with worse disease recurrence and survival outcomes following surgery, as compared to an optimal NAC regimen.

Application of minimally invasive poking reduction technique in the treatment of thoracolumbar fractures

Objective To investigate the clinical effects of minimally invasive poking reduction technique in the treatment of single segment thoracolumbar fractures without neural impairment. Methods From February 2011 to June 2015, 83 cases of thoracolumbar fractures without neural impairment underwent minimally invasive pedicle screw fixation in Linyi Central Hospital were selected and randomly divided into two groups.Group A (40 cases) was treated with poking reduction technique by percutaneous polyaxial pedical screw fixation, 43 patients in group B were treated with only percutaneous polyaxial pedicle screw fixation.The perioperative index, pre-and postoperative radiography, relief of the low back pain and general health status of the two groups were recorded and compared. Results There were no statistically significant differences in the operation time, operative blood loss, hospitalization time.All patients were followed up for 20-27months (average 24 months), the scores of visual analogue scale(VAS) and Oswestry disablity index(ODI) had no statistically significant differences between the two groups in the same period(all P>0.05). Before operation, the Cobb angle, sagittal index and anterior height of the fracture vertebral body in group A were (66.3±14.2)%, (20.4±6.5) °, (21.9±6.6) °, respectively, which in group B were (64.8±13.5)%, (14.5±7.7) °, (15.6±5.9) °, respectively, the differences were not statistically significant (all P>0.05). After operation, the Cobb angle, sagittal index and anterior height of the fracture vertebral body in group A were (93.8±9.8)%, (5.3±3.3)°, (5.4±2.0)°, respectively, which in group B were (88.0±10.6)%, (4.1±2.8)°, (8.1±4.7)°, respectively , the differences were statistically significant (t=8.893, 2.345, 3.351, all P<0.01). Conclusion The effect of poking reduction technique by percutaneous polyaxial pedical screw fixation is better than simply polyaxial pedicle screw in the treatment of thoracolumbar fracture, which is a safe and effective operation method. Key words: Spinal fractures; Fracture fixation, internal; Bone wires; Comparative effectiveness research

Concordance with prescribing information dosage recommendations for dipeptidyl-peptidase-4 inhibitors among type 2 diabetes mellitus patients with moderate to severe chronic kidney disease

Objective: To estimate the proportion of patients with moderate to severe chronic kidney disease (CKD) whose initial dipeptidyl-peptidase-4 inhibitor (DPP4-i) dosage was concordant with prescribing information (label) recommendations in the United States.Methods: Adult patients with type 2 diabetes mellitus (T2DM) who initiated a DPP4-i (linagliptin, sitagliptin, saxagliptin) between 1 January 2011 and 30 June 2014 were identified using electronic medical records and administrative claims, with index date being the date of first observed DPP4-i treatment. Patients were required to have chronic kidney disease (CKD) stage 3b, 4 or 5 (estimated Glomerular Filtration Rate [eGFR] value <45 ml/min/1.73 m2) during the 12 month pre-index period. Patients were classified as concordant or not concordant based on whether the first prescribed dose was consistent with label recommendations. Demographics, clinical characteristics, resource use and costs during pre-index were evaluated by DPP4-i concordance status.Results: Of the 492 patients (323 sitagliptin, 57 saxagliptin, 112 linagliptin), 36.2% were prescribed doses that were not concordant with label recommendations (44.9% for sitagliptin, 57.9% for saxagliptin and 0% for linagliptin [which does not require dosage adjustment]). Concordant patients were slightly older (mean age 71 years vs. 68, p = .01) but had similar gender distribution (55% vs. 60% female, p = .31) compared to those who were not concordant. They had lower general health status (Charlson Comorbidity Score 2.6 vs. 2.2, p = .03), and had similar pre-index all-cause total costs ($25,245 vs. $21,972, p = .68) and lower pre-index T2DM-related costs ($1618 vs. $1922, p = .05).Conclusions: More than a third of DPP4-i patients with CKD stage 3b or higher were prescribed doses not concordant with DPP4-i label dosage recommendations.

One year results of a randomized controlled trial on radial Extracorporeal Shock Wave Treatment, with predictors of pain, disability and return to work in patients with subacromial pain syndrome.

Radial Extracorporeal Shock Wave Therapy (rESWT) is increasingly used to treat patients with subacromial pain syndrome despite conflicting evidence of its effectiveness. Better knowledge regarding prognostic factors may contribute to the improvement in treatment and prognosis for the patients. The first aim of this study was to evaluate the effect of rESWT in addition to supervised exercises in patients with subacromial pain syndrome after one year. The second aim was to identify predictors of pain and disability and work status after one year in this patient group. A randomized, double-blind, sham-controlled trial. An outpatient shoulder clinic of a University hospital. Patients aged 25 to 70 years, with subacromial pain syndrome lasting at least three months were included and randomly assigned to receive either rESWT and supervised exercises or sham rESWT and supervised exercises. The Shoulder Pain and Disability Index (SPADI) and work status were assessed after one year. We screened 265 patients and enrolled 143; 74 were allocated to receive sham rESWT and exercises, and 69 were allocated to receive rESWT and exercises. After one year, no differences were found for the SPADI Score (mean difference -1.6, 95% confidence interval (CI) -10.2 to 7.0, P=0.71). Subgroup analysis of patients with calcification in the rotator cuff demonstrated no significant additional effect of rESWT to supervised exercises (mean difference -6.3, 95% CI -22.4 to 9.8, P=0.44). Marital status (single), frequent use of pain medication, not working at baseline, negative outcome expectations, low self-reported general health status and few supervised exercise sessions predicted a poor outcome on SPADI after one year. Radial ESWT was not superior to sham rESWT in addition to supervised exercises in the long term for patients with subacromial pain syndrome. The identified predictors for pain, disability and work should be assessed in future studies and addressed by clinicians in order to improve the effectiveness of supervised exercises. Radial ESWT should not be recommended for patients with subacromial pain syndrome. Clinicians should assess patient`s outcome expectations, and if possible reduce the use of pain medication and sick leave in this patient group.

PROSE Treatment for Ocular Chronic Graft-Versus-Host Disease as a Clinical Network Expands.

Keratoconjunctivitis sicca occurs in 40% to 90% of patients with ocular chronic graft-versus-host disease (cGVHD). Ocular symptoms can have profound effects in both the visual function and quality of life of patients with GVHD. We report the impact of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment in patients with cGVHD as a clinical network expands. We queried the BostonSight PROSE manufacturing database from January 2002 to December 2011. Patients treated for ocular cGVHD were reported by age, gender, year, and network site where the treatment was undertaken. The baseline and six-month follow-up scores of visual function using a standardized validated instrument, the National Eye Institute Visual Function Questionnaire (NEI VFQ-25), were evaluated for a period in 2006 and again in 2010 after network expansion had occurred. A total of 407 patients with a male:female ratio of 226:181, mean age was 51 years with ocular cGVHD underwent PROSE treatment from January 2002 to December 2011. By 2011, 67% of all cases were treated at network clinics. Baseline characteristics of patients treated throughout the network in 2010 were similar to that of 2006 and 2010 cohorts from the main center. There was a significant improvement of 41 points (P<0.001) in composite NEI VFQ score among patients treated across the network in 2010, similar to the improvement of 30 points (P<0.001) seen among the patients treated at the main center in 2010. There was a trend toward lower baseline self-reported general health status (SRGHS) and VFQ scores among patients treated at network clinics, suggesting that expansion of the network allows treatment of sicker patients (lower general health status) or those more severely affected by ocular cGVHD. PROSE treatment of ocular cGVHD has increased in the last decade with the establishment of BostonSight network clinics across the United States. Patients treated at network clinics showed similar levels of baseline visual function and SRGHS, and achieved a similar high level of improvement in visual function as those treated at the main center. Patient-reported measures of functional status are useful in evaluating treatment options for patients with cGVHD. PROSE treatment has significant positive impact on the visual function of patients with ocular cGVHD regardless of whether the patient is treated at the main center or at a network site.

Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation.

Back-related leg pain (BRLP) is often disabling and costly, and there is a paucity of research to guide its management. To determine whether spinal manipulative therapy (SMT) plus home exercise and advice (HEA) compared with HEA alone reduces leg pain in the short and long term in adults with BRLP. Controlled pragmatic trial with allocation by minimization conducted from 2007 to 2011. (ClinicalTrials.gov: NCT00494065). 2 research centers (Minnesota and Iowa). Persons aged 21 years or older with BRLP for least 4 weeks. 12 weeks of SMT plus HEA or HEA alone. The primary outcome was patient-rated BRLP at 12 and 52 weeks. Secondary outcomes were self-reported low back pain, disability, global improvement, satisfaction, medication use, and general health status at 12 and 52 weeks. Blinded objective tests were done at 12 weeks. Of the 192 enrolled patients, 191 (99%) provided follow-up data at 12 weeks and 179 (93%) at 52 weeks. For leg pain, SMT plus HEA had a clinically important advantage over HEA (difference, 10 percentage points [95% CI, 2 to 19]; P=0.008) at 12 weeks but not at 52 weeks (difference, 7 percentage points [CI, -2 to 15]; P=0.146). Nearly all secondary outcomes improved more with SMT plus HEA at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks. No serious treatment-related adverse events or deaths occurred. Patients and providers could not be blinded. For patients with BRLP, SMT plus HEA was more effective than HEA alone after 12 weeks, but the benefit was sustained only for some secondary outcomes at 52 weeks. U.S. Department of Health and Human Services.

Quality of life along the diabetes continuum: a cross-sectional view of health-related quality of life and general health status in middle-aged and older Finns

To examine the general health status and health-related quality of life (HRQOL) along the diabetes continuum of middle-aged and older Finns, and to determine the glucose metabolism stage by which the HRQOL has decreased noticeably. The cross-sectional sample consisted of 920 persons aged 51-75 from the general population in a single municipality in a rural area of Eastern Finland. Data were adjusted for age, sex, smoking history, current alcohol consumption, employment and marital status. The HRQOL and health status were evaluated using two preference-based HRQOL instruments, 15D and SF-6D, and one health profile instrument, 36-Item Short Form Health Survey (SF-36). Individuals with impaired glucose tolerance (IGT) and type 2 diabetes had noticeably low mean SF-6D, 15D and general health status. The decrease in overall HRQOL was mainly due to a decline in the physical dimensions of HRQOL. The adjusted odds ratios (95% CI) for having noticeably low HRQOL on SF-6D, 15D and general health dimension of SF-36 associated with IGT were 1.95 (1.18-3.25), 1.35 (0.84-2.18) and 2.00 (1.21-3.29), respectively. The progression along the diabetes continuum was significantly associated with a decrease in HRQOL and health status. Furthermore, the data indicate that when a person is detected to have IGT, the HRQOL and general health status have already diminished noticeably. The prevailing evidence suggests that detection and intervention before a patient develops IGT is essential in order to minimize the loss of quality of life and quality-adjusted life years.

Personal predictors of educational attainment after compulsory school: Influence of measures of vulnerability, health, and school performance

Getting a secondary education is essential in preventing future inequalities in health and socioeconomic status. We investigated to what degree personal predictors like low school performance, high vulnerability, and poor health status are associated with not completing a secondary education in a Danish youth cohort. This prospective study used data from a questionnaire in 2004 and register data in 2010. The study population consisted of 3053 adolescents born in 1989. Information on educational attainment from Statistics Denmark was divided into four categories: completed, still studying, dropped out, or never attained a secondary education. Data was analysed using multinomial logistic regression. Low grades when completing compulsory school predicted not having completed a secondary education by age 20/21 (odds ratios (OR) between 1.7 and 2.5). Low sense of coherence in childhood was associated with dropping out from a vocational education (OR 2.0). Low general health status was associated with dropping out (OR 2.2) or never attaining a secondary education (OR 2.7) and overweight was associated with never attaining a secondary education (OR 3.5). The study confirms the social gradient in educational attainment. Furthermore, the results indicate that factors related to the individual in terms of low school performance, low health status, and high vulnerability predict future success in the educational system. It is recommended that these high-risk groups are recognised and targeted when designing guidance and supervision programmes for youth at secondary education.

Retrospective study of factors related to preterm labor in Yasuj, Iran

IntroductionPremature labor is a serious worldwide problem that can cause neonatal death and other serious disorders. This study aimed to determine the most important factors related to preterm labor in Yasuj, Iran.MethodThis case-control study was conducted in the maternity ward of Imam Sajjad Hospital, the obstetrics and gynecology center of Yasuj, in 2010. Among eligible samples, mothers with preterm labor were selected as the case group, and for each sample in the case group, one mother with full-term labor was selected by using clipper-matched sampling to make up the control group. Data were collected by a researcher-made questionnaire and the 28-item General Health Questionnaire. Finally, after deleting imperfect questionnaires, collected data of 52 subjects of case group and the same amount in control group were analyzed.ResultsAmong the 5400 live birth infants in Yasuj in 2010, 130 infants were premature (2.4%). The preterm labor risk in women with two or more pregnancies was 5.5 times more than women with less than two pregnancies, its risk in women with low general health status was 2.9 times more than in women with normal general health status, and the preterm labor risk in women with a history of diabetes mellitus/thyroid dysfunction/cardiac disease was 2.3 times more than healthy mothers (P < 0.01).ConclusionWith respect to the above and due to the role and importance of mother–infant health in community health, it is necessary that the health-care system improve health education with regard to the appropriate number of pregnancies, diagnose and cure disease during pregnancy, especially diabetes and cardiovascular disease (hypertension and/or eclampsia), and recognize pregnant mothers with mental pressure or lack of sufficient support and help them.