Lower General Health Status Research Articles

P-502 - Studying depression out off the hospital hallways - an epidemiological study in the prevalence of depressive symptomatology in a portuguese adults community sample

The aim of this study is to describe the prevalence of depressive symptomatology among a Portuguese non-clinical representative community sample, with ages between 18 and 65. The CES-D as well as a Questionnaire including questions concerning sociodemographic variables, general health variables and interpersonal stress factors were mailed to a sample of 1480 subjects. A phone line was available and local papers asked for collaboration. A high level of depressive symptomatology was found in the general population (17.91 ± 12.14). Considering a cut off score of 20, the prevalence of high depressive symptomatology in the general population was 32%. A gender difference in the prevalence of depressive symptomatology was also founded: it was 43.6% for women and 15.9% for men. The intensity of depressive symptomatology was higher in women(20, 53 ± 13.2) in comparison with men (13, 79 ± 8.9) (t = −5, 16; p = 0.000). Unemployment and housewife status, low family income levels, low educational level and living in rural areas, low self-perceived general health status, evidence of previous depression episodes and menopause were significantly related with higher CES-D score. Logistic regression has shown women had a double risk of being depressed in comparison with men and housewives and recent unemployeds had a triple risk of being depressed in comparison to employed subjects. Having children and high family income adequacy levels were found to be protective factors of depressive disorders.

Will This Patient Develop Persistent Disabling Low Back Pain?

Low back pain is extremely common. Early identification of patients more likely to develop persistent disabling symptoms could help guide decisions regarding follow-up and management. To systematically review the usefulness of individual risk factors or risk prediction instruments for identifying patients more likely to develop persistent disabling low back pain. Electronic searches of MEDLINE (1966-January 2010) and EMBASE (1974-February 2010) and review of the bibliographies of retrieved articles. Prospective studies of patients with fewer than 8 weeks of low back pain from which likelihood ratios (LRs) were calculated for prediction of persistent disabling low back pain for findings attainable during the clinical evaluation. Two authors independently assessed studies and extracted data to estimate LRs. A total of 20 studies evaluating 10,842 patients were identified. Presence of nonorganic signs (median [range] LR, 3.0 [1.7-4.6]), high levels of maladaptive pain coping behaviors (median [range] LR, 2.5 [2.2-2.8]), high baseline functional impairment (median [range] LR, 2.1 [1.2-2.7]), presence of psychiatric comorbidities (median [range] LR, 2.2 [1.9-2.3]), and low general health status (median [range] LR, 1.8 [1.1-2.0]) were the most useful predictors of worse outcomes at 1 year. Low levels of fear avoidance (median [range] LR, 0.39 [0.38-0.40]) and low baseline functional impairment (median [range] LR, 0.40 [0.10-0.52]) were the most useful items for predicting recovery at 1 year. Results were similar for outcomes at 3 to 6 months. Variables related to the work environment, baseline pain, and presence of radiculopathy were less useful for predicting worse outcomes (median LRs approximately 1.5), and a history of prior low back pain episodes and demographic variables were not useful (median LRs approximately 1.0). Several risk prediction instruments were useful for predicting outcomes, but none were extensively validated, and some validation studies showed LRs similar to estimates for individual risk factors. The most helpful components for predicting persistent disabling low back pain were maladaptive pain coping behaviors, nonorganic signs, functional impairment, general health status, and presence of psychiatric comorbidities.

Gender Differences in Asthma Experience and Disease Care in a Managed Care Organization

The purpose of this study was to describe gender differences in asthma in a managed care organization. We collected data from a patient survey, electronic administrative data, and hard-copy chart reviews. Women reported significantly lower general health status, more symptoms and greater severity of asthma, more activity limitations, more use of asthma-relieving medications, and more acute visits for asthma than men. Conversely, women tended to report better asthma care measures. These gender disparities warrant further study to support appropriate adjustment of clinical care and health-care-related services for women.

Initial validation of an instrument to identify barriers to self-management for persons with co-morbidities

To develop and initially validate a questionnaire designed to assess barriers to self-management perceived by persons with multiple chronic medical conditions. We hypothesized that persons who reported increased barriers to self-management would also report lower general health status and a greater disease burden. A cross-sectional survey was done of Health Maintenance Organization members aged 65 years or older with varying numbers of chronic medical conditions. On the basis of a previous qualitative investigation, we have identified 13 domains representing potential barriers to self-management. We developed questions to assess each of these domains and, for each, calculated coefficients alpha and assessed correlation of that domain with self-reported general health status and disease burden. Respondents reported an average of 5.9 chronic conditions. Eight domains demonstrated acceptable internal consistency in this population. Nine of 13 domains correlated significantly in the expected direction with health status and/or disease burden. These results provide an encouraging first step in developing a tool that will be clinically useful in assessing and addressing barriers to medical self-management for persons with co-morbidities. Use of assessments such as this in clinical settings may facilitate appropriate and efficient care management and improved health outcomes for this growing and vulnerable patient population.

Clinical Year in Review II: Pulmonary Infections, Diagnostic Imaging, Pleural Diseases, and Neuromuscular Disease

Occupational asthma (OA) remains a significant problem for patients and employers alike. In a comprehensive review of the existing literature, Beach and colleagues (1) tackle the best diagnostic approach to this problem. They conclude that, in patients with high pretest probability of OA by history, either nonspecific (e.g., methacholine) challenge or skin-prick testing improves sensitivity and specificity in the diagnosis, although neither can be relied on to fully confirm or exclude OA. When compared to the research “gold standard” of specific inhalational challenge, methacholine challenge improved sensitivity to 84% and, therefore, should be used in the diagnostic approach to the patient with suspected OA. Nicholson and colleagues (2) also addressed the issue of OA identification and prevention in their 2005 evidence-based guidelines. They point out that 1 in 10 cases of new or recurrent asthma is occupational, and that, interestingly, allergic rhinitis occurring with exposure to a known cause of asthma predicts subsequent asthma development. Early diagnosis and exposure avoidance does improve prognosis and should be advised to these individuals and their employers. Another important area of interest in the field of occupational medicine is that of home environmental factors that my effect adult asthma severity. Blanc and colleagues (3) examined 226 California adults with asthma and rhinitis and made home measures of total dust, dust mite, cat dander, dog dander, endotoxin, and glucan levels. They also measured nitrogen dioxide, volatile organic compounds, carbon monoxide, carbon dioxide, temperature, and humidity levels in each of these homes. Levels were compared to FEV1% predicted, as well as to severity of asthma scores and responses to questionnaires of health status and quality-of-life. The authors conclude that total milligrams of dust in the bed and dog ownership correlated with lower FEV1, whereas visible damp patches, mold, and elevated glucan levels all were associated with lower general health status in these adults. Thorne and colleagues (4) likewise attempted to sort out which of many factors may be causal in asthma propagation in a nationwide survey of dust samples from 831 housing units. They found a clear association between endotoxin levels and the prevalence of diagnosed asthma, asthma symptoms within the preceding year, current use of asthma medications, and self-reported wheezing. This study included both children and adults, but it is worth noting that the association with endotoxin was demonstrable only in the adult population. Another controversial area in occupational lung disease is the purported association of diesel exhaust with the development

Association of low general health status, measured prospectively by Euroqol EQ5D, with osteoporosis, independent of a history of prior fracture

There have been no studies of generic health-related quality of life (HR-QOL) measured prospectively, in patients referred for bone mass measurement. The aim of this study was to examine the relationship between HR-QOL, measured before DXA scanning was undertaken, and bone mineral density (BMD). Comparison of HR-QOL with the age- and sex-matched general population was also made. HR-QOL questionnaires were completed by patients who were being entered into a randomized, prospective, parallel group trial to assess the impact of direct access DXA scanning (DADS) versus referral to a hospital consultant, upon clinical decision making by general practitioners (GPs) (Dhillon et al., Osteoporos Int 14:326-333, 2003). HR-QOL questionnaires were completed prior to both randomization and DXA scanning. 325 patients from 18 representative general practices of a total of 77 in the city of Edinburgh. Patients had been referred by their GPs who had access to national guidelines on the identification of patients at high risk of osteoporosis. Generic HR-QOL was measured using Euroqol (EQ5D). This provides a profile of self-reported problems in five dimensions (EQ5D(profile)), health utility (EQ5D(utility)), and a visual analogue global self-rated health assessment (EQ5D(vas)). Odds ratios (ORs) for any self-reported problems on EQ5D(profile) were higher in patients with osteoporosis than those without, and compared with the general population. Age-adjusted mean (SD) EQ5D(utility )was significantly lower in patients with osteoporosis than in those without (0.65 [0.28] vs 0.76 [0.27]; p< 0.01), but the difference lessened with advancing age. Age-adjusted mean (SD) EQ5D(vas) was significantly reduced in patients with compared with no osteoporosis (68 [20] vs 76 [16]; p<0.01). There were no such differences in patients with a history of prior fracture compared with those without a history of prior fracture. Female patients with osteoporosis have reduced generic HR-QOL compared with the age-matched female general population, irrespective of a history of prior fracture. The causal relationship between osteoporosis and HR-QOL, if any, is unclear. Further studies are needed to define this relationship and to determine whether treatment of osteoporosis has a beneficial effect on HR-QOL independent of fracture risk.