Patients Of Working Age Research Articles

Случай острого инфаркта миокарда у пациента трудоспособного возраста с язвенным колитом на фоне позднего начала патогенетической терапии

The article describes a case of acute myocardial infarction with multiple atherosclerotic lesions of the coronary arteries in a working-age patient with ulcerative colitis, against of late initiation of pathogenetic therapy.

Factors affecting treatment adherence in working-age patients with myocardial infarction

Aim of the study was to analyze the factors affecting treatment adherence in working-age patients with myocardial infarction (MI). Material and methods. During hospitalization, data of 150 patients with MI were collected using medical records and questionnaires. Social treatment readiness was assessed using the S.V. Davydov method with the calculation of treatment adherence (TA) score. After 6 months, the vital status, frequency and causes of hospitalizations, intake of the main groups of drugs, achievement of cardiovascular health target, frequency of regular medical check-up and the type of specialist conducting it were analyzed. In conclusion, the factors affecting the TA score were identified, as well as factors related to the achievement of cardiovascular health targets. Results. 6 months after MI, 4 (2.7 %) patients died due to cardiovascular diseases, 24 (16 %) were hospitalized. The inpatient TA score was 5 (4; 8) (median (lower quartile; upper quartile)), in 79 (52.6 %) patients it was low. The adherence of the surviving patients to treatment after six months was high: 142 (97.3 %) were taking disaggregants, 138 (94.5 %) were taking beta-blockers and reninangiotensin-aldosterone system inhibitors, 139 (95.2 %) were taking statins. However, only 56 (69.1 %) patients achieved target levels of low-density lipoproteins (LDL); 118 (80.8 %) patients achieved target levels of blood pressure, 95 (65.1 %) patients achieved target levels of heart rate (HR) at rest. Only about half (56.8 %) of patients with MI had regular medical check-ups, and only 38.5 % visited cardiologist. Patients who did not achieve target levels of LDL and HR had lower baseline TA score (p = 0.038 and p = 0.029, respectively), they showed up to fewer regular medical checkups after MI (p < 0.001). In patients who did not achieve target HR, the indicator of willingness to pay for treatment was low (p = 0.041), and regular medical check-ups were 4.2 more likely to be performed by a paramedic (p = 0.021). High-score TA was associated with the patient`s lack of propensity for social isolation, high social awareness, trust in the therapeutic treatment, willingness to pay for treatment, high sociability, dyslipidemia in history, the absence of passive smoking during the year, undergoing stage 2 of stroke recovery, working at the time of MI or the late age at onset of alcohol consumption. Low TA score was associated with the patient being the resident in the city, Q-wave MI, and a long-term smoking. Conclusions. Among the factors affecting treatment adherence in working-age patients with MI, certain indicators such as medical and social treatment readiness throughout hospitalization, and social, economic and clinical anamnestic characteristics are highlighted. The identification these factors should be implemented in real clinical practice to improve secondary prevention and outpatient follow-up.

Effectiveness of rehabilitation for working-age patients after a total hip arthroplasty: a comparison of usual care between the Netherlands and Germany

BackgroundPostoperative rehabilitation after primary total hip arthroplasty (p-THA) differs between the Netherlands and Germany. Aim is to compare clinical effectiveness and to get a first impression of cost effectiveness of Dutch versus German usual care after p-THA.MethodsA transnational prospective controlled observational trial. Clinical effectiveness was assessed with self-reported questionnaires and functional tests. Measurements were taken preoperatively and 4 weeks, 12 weeks, and 6 months postoperatively. For cost effectiveness, long-term economic aspects were assessed from a societal perspective.Results124 working-age patients finished the measurements. German usual care leads to a significantly larger proportion (65.6% versus 47.5%) of satisfied patients 12 weeks postoperatively and significantly better self-reported function and Five Times Sit-to-Stand Test (FTSST) results. German usual care is generally 45% more expensive than Dutch usual care, and 20% more expensive for working-age patients. A scenario analysis assumed that German patients work the same number of hours as the Dutch, and that productivity costs are the same. This analysis revealed German care is still more expensive but the difference decreased to 8%.ConclusionsGerman rehabilitation is clinically advantageous yet more expensive, although comparisons are less straightforward as the socioeconomic context differs between the two countries.Trial registrationThe study is registered in the German Registry of Clinical Trials (DRKS00011345, 18/11/2016).

Sickness Absence and Disability Pension Among Patients With Chronic Pain in Interdisciplinary Treatment or Unspecified Interventions

Interdisciplinary treatment is a widely implemented strategy for the rehabilitation of patients with chronic pain. A primary treatment objective is to decrease the load on the social insurance system; however, it is questionable whether interdisciplinary treatment reduces sickness absence and disability pension (SA/DP). This register-based observational study compared SA and DP between patients in interdisciplinary treatment and unspecified interventions. With data from 7,752 Swedish specialist health care patients in their prime working age, we analyzed total net SA/DP days over 3 years from the first visit to a pain rehabilitation center. A zero-one-inflated beta model, adjusted for theoretically substantiated confounders, was used to estimate the mean differences in total days and the proportions of patients with both zero and maximum days. Compared with unspecified interventions, interdisciplinary treatment resulted in a mean (95% confidence interval) absolute increase of 50 (37, 62) total days, a 13.0% (11.3%, 14.6%) decrease in patients with zero days, and a 1.5% (.2%, 2.8%) decrease in patients with the maximum days. These findings support that interdisciplinary treatment increases SA/DP compared to less intensive interventions but reduces the risk of maximum days, implying that it is advantageous for patients with the highest absence. This highlights the need for improved patient selection procedures and the adaptation of interdisciplinary treatment programs to more adequately target SA/DP reduction. PerspectivesThis study provides an accessible overview of SA/DP among working-age patients with chronic pain in Swedish specialist health care. It also shows that interdisciplinary treatment does not decrease SA/DP more than alternative treatments in most patients but is advantageous for the patients with the longest absence.

#5743 ALTERNATIVES TO DAYTIME IN-CENTER HEMODIALYSIS AND EMPLOYMENT AMONG PATIENTS WITH KIDNEY FAILURE

Abstract Background and Aims Maintaining employment is a priority for many patients with kidney failure. In addition to its economic benefits, employment is associated with physical and psychological wellbeing. Yet, only 30-35% of working aged patients with advanced chronic kidney disease in the United States (US) report employment prior to starting dialysis and many patients stop working at the onset of kidney failure. While access to a dialysis treatment schedule outside of working hours may help patients to remain employed, the effects of alternative dialysis options on employment after starting dialysis are not well understood. Method We analyzed data from the US National Dialysis Registry to determine whether access to nearby facilities offering evening dialysis shifts and home dialysis increases the likelihood that patients are able to continue working after they start dialysis. Our cross-sectional analysis included working-aged patients (ages 18-54) receiving dialysis in US facilities in 2016. We combined information reported at the levels of individual patients and dialysis facilities. In a negative binomial regression model, we examined the associations among exposures of interest (the presence of facilities offering home dialysis and/or evening dialysis shifts in a patient's locality) and the number of employed working-aged adults at each dialysis facility. The multivariable regression model adjusted for observed patient, dialysis facility, and geographic characteristics, including patient health and demographic characteristics, information about individual patient employment at the onset of dialysis, local unemployment rates, and the number of working-aged patients at a given dialysis facility. Results We identified 4,860 US dialysis facilities with information about patient employment in 2016. Median employment among working-aged adults at these facilities was 17.9% (interquartile range 8.8% to 28.6%). In multivariable, fully adjusted, regression models, the presence of at least one facility offering an evening dialysis shift in a county was associated with a 5% increase in the relative rate of maintaining employment among all working-aged patients receiving dialysis in the county (risk ratio (rr) 1.05; 95% Confidence Interval (CI) 1.01 to 1.09; p = 0.02). The presence of at least one facility offering home dialysis in a county was associated with a 26% increase in the relative rate of maintaining employment (RR 1.26; 95% CI 1.18 to 1.34; p<0.001). The likelihood of employment did not increase with additional facilities in a county offering home dialysis. Conclusion Access to dialysis schedules outside of regular working hours – evening dialysis shifts and home dialysis – is associated with increased employment among patients with kidney failure. Efforts to increase access to these alternative dialysis treatments could help patients to continue working.

Predicted clinical and economic burden associated with reduction in access to acute coronary interventional care during the COVID-19 lockdown in two European countries.

As a consequence of untimely or missed revascularization of ST-elevation myocardial infarction (STEMI) patients during the COVID-19 pandemic, many patients died at home or survived with serious sequelae, resulting in potential long-term worse prognosis and related health-economic implications.This analysis sought to predict long-term health outcomes [survival and quality-adjusted life-years (QALYs)] and cost of reduced treatment of STEMIs occurring during the first COVID-19 lockdown. Using a Markov decision-analytic model, we incorporated probability of hospitalization, timeliness of PCI, and projected long-term survival and cost (including societal costs) of mortality and morbidity, for STEMI occurring during the first UK and Spanish lockdowns, comparing them with expected pre-lockdown outcomes for an equivalent patient group.STEMI patients during the first UK lockdown were predicted to lose an average of 1.55 life-years and 1.17 QALYs compared with patients presenting with a STEMI pre-pandemic. Based on an annual STEMI incidence of 49 332 cases, the total additional lifetime costs calculated at the population level were £36.6 million (€41.3 million), mainly driven by costs of work absenteeism. Similarly in Spain, STEMI patients during the lockdown were expected to survive 2.03 years less than pre-pandemic patients, with a corresponding reduction in projected QALYs (-1.63). At the population level, reduced PCI access would lead to additional costs of €88.6 million. The effect of a 1-month lockdown on STEMI treatment led to a reduction in survival and QALYs compared to the pre-pandemic era. Moreover, in working-age patients, untimely revascularization led to adverse prognosis, affecting societal productivity and therefore considerably increasing societal costs.

Аспекты качества жизни лиц трудоспособного возраста с хроническими неинфекционными заболеваниями органов дыхания

Chronic noncommunicable diseases (NCD) are widespread and affect people of different age groups in all countries. The fight against this group of diseases is one of the priorities of the modern health care. Non-infectious diseases of the respiratory system as well as other diseases, affect social, physical and mental components of well-being. The qualitative assessment of their influence helps to assess the study of the quality of life. P u r p o s e : to assess the quality of life of the working-age population of the Nizhny Novgorod region and to develop measures to reduce the risk factors for chronic non-infectious diseases of the respiratory system in these cohorts. M a t e r i a l s a n d m e t h o d s . A one-stage comparative study was carried out using the method of standardized interviewing using the SF‑36 questionnaire. The quality of life of people of various age-gender groups with chronic non-infectious diseases of the respiratory system was assessed. All respondents were stratified into groups by pathology and age. R e s u l t s . The scientific article reflects the results of the study of assessing the quality of life of working-age patients with the chronic respiratory system pathology. The analysis of the data revealed statistically significant differences in age, gender and groups of pathologies among the respondents. Differences in indicators reflecting emotional states were revealed among men and women of the working age. Age-related changes in indicators of physical and psychological components of health and on all scales of the quality of life were presented. The obtained values of patient indicators show the need to develop specific measures to reduce behavioral risk factors for chronic non-infectious respiratory diseases of the population of the Nizhny Novgorod region. Findings. The comparative analysis of the results of the scales of the quality of life and health components reflects the age-related changes in indicators. The people of the older age group of the working age demonstrate significantly low results. The indicators of physical functioning are statistically significantly different in different pathologies of the respiratory system. Chronic obstructive pulmonary disease (COPD) restricts the physical activity of patients more strongly than other pathologies. Low values of the quality of life reflect the need to develop the measures to reduce the risk factors for chronic non-infectious diseases for the population of the Nizhny Novgorod region.

Physical activity after revision knee arthroplasty including return to sport and work: a systematic review and meta-analysis including GRADE

BackgroundThe number of primary knee arthroplasties (KAs) performed annually is rising, especially among active, working age patients. Consequently, revision KA is also increasingly performed. Our aim was to systematically review the extent to which patients were physically active following revision KA, and the rate and timing of return to sport and work.MethodsA search was conducted in the databases Medline and Embase until February 24th, 2023. Studies describing patients with revision total knee arthroplasty (rTKA) or revision unicondylar knee arthroplasty (rUKA), with outcomes regarding physical activity or return to sport (RTS) or work (RTW) were included. Quality of studies was assessed using the Newcastle–Ottawa scale, meta-analyses were performed using RevMan 5.4 and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).ResultsOf the 4,314 articles screened, 22 studies were included describing 2,462 rTKA patients (no rUKA), 42% were male with a mean age of 67 years (range 24 – 95). No studies reported objective physical activity measurements. Twenty-two studies reported patient reported outcome measures (PROMs). The PROMs that were pooled on a scale from zero to ten were the UCLA Activity Score, the Tegner Activity Level Scale, the Lower-Extremity Activity Scale, Devane Activity Score, and physical activity related subscales of the Knee injury and Osteoarthritis Outcome Score. The retrospective studies of moderate quality showed a statistically significant postoperative improvement of 1.7 points (MD = 1.71, 95% CI 1.48 – 1.94 (p < 0.0001); 14 studies, n = 1,211). For the prospective moderate-quality studies, a statistically significant postoperative increase of 0.9 points was found (MD = 0.89, 95% CI 0.48 – 1.30 (p < 0.0001); 6 studies, n = 1,027). Regarding RTS, 12% of patients participated in so-called ‘non-recommended’ activities (i.e., hockey, soccer, football, gymnastics, jogging, singles tennis, and basketball) after rTKA (1 study, n = 206). The pooled RTW was 86% (2 studies, range 18–95%, n = 234).ConclusionsThe majority of patients self-reported an improved postoperative activity level after rTKA. Patients could maintain an active lifestyle in daily life, including sports and work. For reliable physical activity, RTS and RTW estimations, more studies are required. In terms of GRADE, the quality of evidence for the five prospective studies was rated as low.Level of evidenceLevel 3.

AWARENESS OF THE POPULATION ABOUT CARDIOVASCULAR FACTORS OF THE DEVELOPMENT OF DISEASES AS A RESULT OF THE APPLICATION OF A POPULATION STRATEGY

At the state level, measures have been carried out in different years to form a sustainable understanding of the importance of health as a personal value by the population. This is due to the global strategic interests of the Russian Federation in preserving and strengthening the health of the population.&#x0D; In our study, the awareness of working-age patients of primary health care about the risk factors for the development of cardiovascular diseases and their frequency of occurrence was analyzed, taking into account the standardization of statistical indicators for 5 years (2014-2018) in the office of prevention of hypertension.&#x0D; Materials and methods. The study was conducted on the basis of urban clinics of the Krasnoselsky district of St. Petersburg in two stages. At the first stage, a sociological survey was conducted using a specially designed questionnaire. At the second stage, an analysis of 807 cases of patients aged 18 to 65 years in the office of prevention of arterial hypertension was carried out.&#x0D; As a result of the sociological survey, respondents among both men and women are well informed about the influence of a number of behavioral risk factors on the occurrence and development of cardiovascular diseases.&#x0D; Conclusion. There is a high awareness of risk factors for the development of non-communicable diseases, including cardiovascular diseases, in patients of working age, which is a positive result of the implementation of a population and high-risk strategy.&#x0D; But there are significant reserves for improving behavior for those who are ready to change it in favor of choosing a healthy lifestyle.&#x0D; Within the framework of primary health care, medical examinations and preventive medical examinations are aimed at increasing the awareness of the population about risk factors for the development of non-communicable, including cardiovascular diseases through medical consultations. The work of Health Centers, prevention offices, Health Schools should be aimed at low-informed patients, examine and determine the functional reserves of their body with the possibility of subsequent correction of the identified disorders.&#x0D; In our work, low awareness was noted in 13% of respondents. Low awareness of patients creates a high risk of unfavorable outcomes of diseases. If the patient understands the essence of his illness and the importance of following the doctor’s recommendations, then the situation may change for the better.

Patients’ expectations of physiotherapists before and after an intensive chronic low back pain rehabilitation programme: a qualitative study based on semi-structured interviews and observations

Purpose To investigate the expectations regarding physiotherapists of patients attending an interdisciplinary CLBP rehabilitation programme and the response to these expectations. Materials and methods A thematic analysis was conducted, based on interviews of working-age patients with CLBP and without significant comorbidities. Results Twenty patients participated (9 male, 11 female, aged 21–58 years; symptoms duration 4.3 ± 3.0 years; pain VAS 53 ± 21 mm). Patients expected to learn pain and activity management. Expected outcomes were a reduction of pain, increased well-being and a return to normality. A collaborative approach involving therapeutic and relational adaptation was expected. Despite divergences concerning emotional aspects, patients expected a large range of applied psychosocial skills. The programme met the expectations of most patients, especially when its goals matched those reported by the individuals. For most participants, the pain relief was below expectations. Active therapies were valued. After the programme, patients felt more ready to take responsibility for their back. Conclusion The expectation of developing self-management skills was prevalent. Expected treatments were mostly compatible with recommendations. Expectations to resume activities and decrease pain were in line with the rehabilitation goals, although the expected reduction in pain was overestimated. Relational expectations converged towards patient-centred care.

Burden of idiopathic inflammatory rheumatic diseases in occupational healthcare: increased absenteeism and healthcare resource utilization.

Patients with idiopathic inflammatory rheumatic diseases (IIRD) often have decreased working capacity resulting in indirect costs. However, data on patients' short-term sick leave has been limited. This retrospective cohort study evaluated the number and length of sick leave, including short-term leave, and occupational healthcare resource utilization (HCRU) of the working-aged patients with IIRD compared to controls. The data on sick leave and occupational HCRU were gathered from the electronic medical records of the largest occupational healthcare provider in Finland from January 2012 to December 2019. Employed patients with an IIRD (including rheumatoid arthritis, spondyloarthritis, psoriatic and enteropathic arthritis, juvenile arthritis, and reactive arthritis) with at least a 12-months follow-up were identified and compared to age-, sex-, and follow-up matched controls without IIRD. Altogether 5405 patients with IIRD were identified and compared with an equal number of controls. The patients incurred approximately 2.5 times more sick leave than controls: 21.7 versus 8.5 days per patient year, respectively. Short-term sick leave was common: 83% of sickness absence periods of the patients lasted 1-9 days and represented 30% of the total absenteeism. Loss of productivity due to lost workdays was on average €4572 (95% confidence interval €4352-4804) per patient year. Occupational HCRU was approximately 1.8 times higher among IIRD patients than controls. Workers with an IIRD incur considerably more sick leave and use more occupational healthcare services than controls. Short sick leave not registered in national insurance registers constitute a significant portion of days off work among patients with IIRD.

Age-related differences in employment, insurance, and financial hardship among colorectal cancer patients: a report from the ColoCare Study.

Employment and financial hardships are common issues for working-age colorectal cancer patients. We surveyed colorectal cancer survivors to investigate employment, insurance, and financial outcomes by age at diagnosis. Cross-sectional survey of six ColoCare Study sites regarding employment, insurance, and financial hardship outcomes. Eligible participants were 1 to 5years from colorectal cancer diagnosis. Diagnosis age (18-49, 50-64, 65+ years) with outcomes of interest were compared using chi-square and t-tests. Multivariable logistic and Poisson regressions were fit to examine association of demographic factors with any material/psychological hardship (yes/no) and the count of hardships. N = 202 participants completed the survey (age: 18-49 (n = 42, 20.8%), 50-64 (n = 79, 39.1%), 65+ (n = 81, 40.1%)). Most diagnosed age < 65 worked at diagnosis (18-49: 83%; 50-64: 64%; 65+ : 14%, p < 0.001) and continued working after diagnosis (18-49: 76%; 50-64: 59%; 65+ : 13%; p < 0.001). Participants age 18-49 reported cancer-related difficulties with mental (81.3%) and physical (89%) tasks at work more than those working in the older age groups (45%-61%). In regression models, among those reporting any hardship, the rates of material and psychological hardships were higher among those age 18-64 (Incidence Rate Ratios (IRR) range 1.5-2.3 vs. age 65+) and for those with < college (IRR range 1.3-1.6 vs. college +). Younger colorectal cancer patients are more likely to work after a cancer diagnosis and during cancer treatment, but report higher levels of financial hardship than older patients. Younger colorectal cancer patients may encounter financial hardship, thus may feel a need to work during and after treatment.

Possibilities of lipid clinics in identifying patients with familial hypercholesterolemia

Aim. To assess the detection rate of familial hypercholesterolemia among outpa­tients visiting a lipidologist.Material and methods. We analyzed the causes and nature of lipid metabolism disorders in patients of the Adult Lipidology Center as follows: 1233 people aged 18-84, including 777 women (63,02%) and 456 men (36,98%). Biomaterial samples from 421 patients with the phenotype of definite, possible or probable familial hypercholesterolemia were studied by massive parallel sequencing using a panel of 5 genes associated with familial hypercholesterolemia (LDLR, LDLRAP1, APOB, APOE, PCSK9). For statistical processing, descriptive statistics methods were used.Results. Working-age patients apply 1,56 times more often than patients of the older age group (60,91% vs 39,09%), and the vast majority of them were referred by a primary care physician based on data from periodic health examinations. The mean level of total cholesterol and low-density lipoprotein cholesterol in the lipidology center was 7,58 and 4,8, respectively. Out of 421 samples, 127 patients (10,3% of the total number of patients and 30,16% of the number of biosamples) had previously described variants of the LDLR, APOB and/or PCSK9 genes associated with familial hypercholesterolemia.Conclusion. The detection rate of definite familial hypercholesterolemia ranges from 5,51 to 8,43% of outpatients visiting a lipidologist, while the proportion of verified carriers of gene mutations related to familial hypercholesterolemia is 10,3%. The diagnosis should not be rejected with a formally low probability according to the S. Broom and DLCN criteria, as well as when identifying data suggestive of secondary lipid metabolism disorders.

Modern principles of diagnostics of acute destructive pancreatitis

The incidence of acute destructive pancreatitis is steadily increasing worldwide and, according to the recent literature, is 300-900 patients/mil per year. The increased lethality rate of acute destructive pancreatitis in recent decades, which according to global statistics, ranges from 5% to 20% depending on the severity of the disease, is a cause for concern. It should be noted that most patients with acute destructive pancreatitis are working-age patients, which significantly increases the socio-economic aspect of the problem and urgently requires an active search for ways to solve it. It has been established that the leading pathogenetic mechanism of acute destructive pancreatitis development is enzymatic autolysis of pancreatic parenchyma by its enzymes with their subsequent release into the bloodstream and damage of other organs.

Factors associated with referral to physiotherapists for adult patients consulting for musculoskeletal disorders in primary care; an ancillary study to ECOGEN

BackgroundMusculoskeletal disorders (MSD) are multifactorial requiring multidisciplinary treatment including physiotherapy. General practitioners (GP) have a central role in managing MSDs and mostly solicit physiotherapists accounting for 76.1% of physiotherapy referrals in France. Patient, physician, and contextual factors, including healthcare accessibility, can influence physiotherapy referral rates.ObjectiveTo identify patient, physician, and contextual factors associated with physiotherapy referral in adult patients with MSDs in general practice.MethodsThis study is based on the 2011/2012 French cross-sectional ECOGEN study. Analyses included working-age patients consulting their GP for any MSD. Physiotherapy referral was assessed initially, then adjusted multilevel logistic model analysis of patient, physician, geographical area-related factors associated with these referrals was performed.ResultsAmong the 2305 patients included, 456 (19.8%) were referred to a physiotherapist. Following multilevel multivariate analyses, physiotherapist referral was more frequent for female patients (OR 1.28; 95% CI [1.03, 1.59]) with spinal (OR 1.47; 95% CI [1.18, 1.83]) and upper limb disorders (OR 1.66; 95% CI [1.20, 2.29]), and less frequent for patients ≥ 50 years (OR 0.69; 95% CI [0.52, 0.91]), living in deprived geographical areas (OR 0.60; 95% CI [0.40, 0.90]). GPs referred to a physiotherapist less frequently if they were ≥ 50 years (OR 0.50; 95% CI [0.39, 0.63]), had a high number of annual consultations, or were practicing in semi-urban area in a multidisciplinary team.ConclusionThis multilevel analysis identifies factors associated with physiotherapy referral for patients with MSDs, including living in deprived geographical areas. This constitutes an original contribution towards addressing healthcare disparities.

Community Integration and Associated Factors 10 Years after Moderate-to-Severe Traumatic Brain Injury.

This study evaluated the impact of baseline injury characteristics and one-year functional level on the 10-year community integration outcomes for working-age patients with moderate-to-severe traumatic brain injury (TBI). Patients aged 16-55 and diagnosed with moderate-to-severe TBI within 24 h of injury were eligible for the study. Multivariable hierarchical linear regression was utilized to assess the impact of baseline characteristics and one-year functional measures on the mean Community Integration Questionnaire (CIQ) scores 10 years after injury. Of 133 original study participants, 97 survived 10 years, and 75 were available for this study. The mean total CIQ score changed positively from one to 10 years post-injury, from 18.7 (±5.5) to 19.8 (±4.8) (p = 0.04). The results suggested that age (β = -0.260, p = 0.013), FIM-Cognitive subscale (β = 0.608, p = 0.002), and the bodily pain subscale (BP) (β = 0.277, p = 0.017) of the SF-36 were significantly associated with the mean CIQ scores. In conclusion, this study demonstrated improved community integration from one to 10 years in a sample of working-age patients with moderate-to-severe TBI. The findings also showed that age, cognitive function, and bodily pain were significant predictors of long-term community integration, suggesting post-acute rehabilitation should focus on factors related to long-term risk and protective factors to improve long-term outcomes.

Cost-effectiveness of specialised manual therapy versus orthopaedic care for musculoskeletal disorders: long-term follow-up and health economic model.

Physiotherapy is usually the first line of treatment for musculoskeletal disorders. If pain persists, an appointment with an orthopaedic surgeon is indicated, but many disorders for which patients are placed on orthopaedic waiting lists cannot be treated in an orthopaedic clinic. Specialised manual therapy, although not mainstream, can be an effective alternative to orthopaedic care, although its cost-effectiveness beyond 12 months is unknown. To perform an 8-year follow-up of the quality of life and costs of specialised manual therapy versus standard orthopaedic care for working-age patients with common nonsurgical musculoskeletal disorders referred to orthopaedic surgeons and to develop a health economic model. Cost-effectiveness study using Markov modelling. The index group of a previously published pragmatic randomised controlled trial received a maximum of five treatment sessions of specialised manual therapy, while the control group received orthopaedic 'care as usual'. At 3, 6, 12 and 96 months, Health-Related Quality of Life and costs were measured with Short Form Health Survey 36, Short Form Health Survey 6D and Diagnostic Related Groups. An incremental cost-effectiveness ratio was calculated, a Markov model was developed and a sensitivity analysis was performed. Overall, 95% (n = 75) of the participants completed the 8-year follow-up. Recovery rates during the first 3 months ('per protocol') in the index and control group were 69% and 58%, respectively. The index group had 0.159 more gains in quality-adjusted life years and cost 40,270 SEK (€4027) less per patient over 8 years. The sensitivity analysis results were consistent with the main results. Specialised manual therapy dominated standard care after 8 years. The results of this small but very first study are promising; therefore, further exploration within other health care professions, clinics and/or countries is required. Our study raises questions about the triaging of orthopaedic outpatients, cost-effectiveness and resource allocation. Not applicable per the information provided by ClinicalTrials.gov. Specialised manual therapy is more cost-effective than 'care as usual' for working-age patients referred to an orthopaedist. This study provides an 8-year follow-up of the cost effects and quality of life of a previously published trial. Why was this study conducted? The standard care for musculoskeletal pain consists of exercises with a physiotherapist in primary care. If the pain persists, a referral to an orthopaedic clinic is often made. Many of these referrals are inappropriate because they concern pain from muscles and joints that do not benefit from surgery or the resources available in an orthopaedic clinic. There is a gap in competence and treatment between primary and specialised care that is costly, time- and resource-consuming and causes prolonged patient suffering. Although specialised manual therapy (MT) is effective, its use is not mainstream. Costs and effects after more than 12 months of treatment that may shorten waiting lists have never been evaluated. What did the researchers do? Quality of life and costs were compared in 75 patients with nonsurgical disorders referred to orthopaedic surgeons at 8 years after treatment with specialised MT or standard orthopaedic care. A health economics model for the probability of recovery was also developed and tested. What did the researchers find? Compared with the control group, the study participants treated with specialised MT had a better quality of life, required fewer health care interventions, underwent less surgery, incurred significantly lower costs and demonstrated an increased probability of recovery. What do these findings mean? It seems probable that using specialised MT for an old, well-known structural problem may yield better treatment effects at a significantly lower cost. Our study findings suggest that policy recommendations should focus on costs and effects rather than resource utilisation alone. The study is small and requires expansion using its economic health model.

D-hypovitaminosis in working age patients with diseases of the respiratory organs: the risks and prevention

D-hypovitaminosis in the working-age population is quite common in industrialized countries, especially when it comes to patients with chronic diseases, including respiratory ones. The role of vitamin D in calcium and bone homeostasis is well known. In recent years, vitamin D has been recognized to modulate many processes and regulatory systems involved in the immune response and reparative processes, in addition to the classic function of this vitamin. Aim. A review of the prevalence of D-hypovitaminosis in the working-age population with respiratory diseases was conducted using the PubMed, Web of Science, Scopus, clinicaltrials.gov databases for 2014 - 2019. Results. Epidemiological and experimental studies have shown that low serum vitamin D is associated with impaired lung function, an increase in the incidence of inflammatory, infectious, or neoplastic diseases, which include asthma, COPD, and cancer. Conclusion. Knowledge of direct pathogenetic relationships between vitamin D levels and lung diseases is currently limited, although there is a number of studies that highlight the relevance of this relationship. A number of studies are contradictory in their results, which requires further study of the role of vitamin D levels in the pathogenesis of respiratory diseases and the need for its inclusion in the essential therapy to improve the effectiveness of treatment and accuracy of the prognosis. However, large-scale screening studies of vitamin D level for the purpose of its correction are costly, even with a single measurement.

Predictors of self-management in patients with chronic low back pain: a longitudinal study

BackgroundSelf-management (SM) is a key recommended strategy for managing chronic low back pain (CLBP). However, SM programmes generate small to moderate benefits for reducing pain and disability in patients with CLBP. The benefits of the SM programme can potentially be optimised by identifying specific subgroups of patients who are the best responders. To date, no longitudinal study has examined the predictive relationships between SM and biopsychosocial factors in patients with CLBP. The aim was to determine whether biopsychosocial factors predict SM and its change over time in patients with CLBP.MethodsIn this multi-centre longitudinal cohort study, we recruited 270 working-age patients with CLBP (mean age 43.74, 61% female) who consulted outpatient physiotherapy for their CLBP. Participants completed self-reported validated measures of pain intensity, disability, physical activity, kinesiophobia, catastrophising, depression and SM at baseline and six months. SM constructs were measured using eight subscales of the Health Education Impact Questionnaire (heiQ), including Health Directed Activity (HDA), Positive and Active Engagement in Life (PAEL), Emotional Distress (ED), Self-Monitoring and Insight (SMI), Constructive Attitudes and Approaches (CAA), Skill and Technique Acquisition (STA), Social Integration and Support (SIS) and Health Service Navigation (HSN). Data were analysed using General Linear Model (GLM) regression.ResultsPhysical activity and healthcare use (positively) and disability, depression, kinesiophobia, catastrophising (negatively) predicted (p < 0.05, R2 0.07–0.55) SM constructs at baseline in patients with CLBP. Baseline depression (constructs: PAEL, ED, SMI, CAA and STA), kinesiophobia (constructs: CAA and HSN), catastrophising (construct: ED), and physical disability (constructs: PAEL, CAA and SIS) negatively predicted a range of SM constructs. Changes over six months in SM constructs were predicted by changes in depression, kinesiophobia, catastrophising, and physical activity (p < 0.05, R2 0.13–0.32).ConclusionsSelf-reported disability, physical activity, depression, catastrophising and kinesiophobia predicted multiple constructs of SM measured using the heiQ subscales in working-age patients with CLBP. Knowledge of biopsychosocial predictors of SM may help triage patients with CLBP into targeted pain management programmes.Trial registrationThe study protocol was registered at ClinicalTrials.gov on 22 December 2015 (ID: NCT02636777).

Patterns of sleep disorders after a new coronavirus infection COVID-19

Background. Sleep disorders have a negative impact on many aspects of life. COVID-19 exacerbates this problem in the context of the post-COVID syndrome where sleep disorder is one of the common complaints.Objective. We aimed to assess the frequency of sleep disorders after COVID-19 and the presence of associations between post-COVID sleep disorders and the severity of COVID-19.Material and methods. A cross-sectional study was carried out in Novosibirsk. It included 115 people aged 26 to 74 years (an average age of 54.22 ± 12.48 years) after recovery from COVID-19, which occurred two to eleven months before. Patients underwent questionnaire survey (Spiegel sleep score questionnaire, HADS Anxiety and Depression Scale, International Restless Legs Syndrome (RLS) Severity Scale), examination by a somnologist, and screening night computer pulse oximetry. If an index of desaturations was more than five per hour, we performed overnight somnography by WAtch PAT 200 or polysomnography. Patients were divided into groups depending on the presence of sleep disorders, COVID-19 severity, and their age. Statistical analysis included a descriptive analysis. Odds ratio was assessed by determining the risk measure for dichotomous variables in the contingency table.Results. RLS was the most common post-COVID sleep disorder (n = 63, 75%). However, primary insomnia was diagnosed only in patients with moderate-to-severe course of COVID-19 (n = 3, 9%). There were 40 patients with post-COVID sleep disorder; they had significantly lower sleep time on workdays (7.00 [6.00; 7.50] vs. 7.50 [6.50; 8.00] hours, p = 0.021) and significantly higher mean HADS depression score (5.00 [3.00; 7.00] vs. 3.00 [1.00; 6.00] points, p = 0.006) compared with the corresponding parameters in patients without deterioration of sleep quality. The chance of reduced sleep quality was 11.6 times higher after moderate-to-severe COVID-19 infection than that after mild infection only in patients aged 26-59 years (95% confidence interval 1.42–94.32, p = 0.007).Conclusion. The chance of worsening sleep quality was significantly higher after a moderate-to-severe COVID-19 infection than after mild infection in 26-59-year-old old patients. At the same time, RLS was the most common post-COVID sleep disorder according to our study. Given the importance of sleep disorders, working-age patients after moderate-to-severe COVID-19 infection require active monitoring by doctors in order to timely correct emerging complaints.