Anne Russell

Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity.

Although obesity and physical activity have been argued to predict back pain, these factors are also related to incontinence and breathing difficulties. Breathing and continence mechanisms may interfere with the physiology of spinal control, and may provide a link to back pain. The aim of this study was to establish the association between back pain and disorders of continence and respiration in women. We conducted a cross-sectional analysis of self-report, postal survey data from the Australian Longitudinal Study on Womens Health. We used multinomial logistic regression to model four levels of back pain in relation to both the traditional risk factors of body mass index and activity level, and the potential risk factors of incontinence, breathing difficulties, and allergy. A total of 38,050 women were included from three age-cohorts. When incontinence and breathing difficulties were considered, obesity and physical activity were not consistently associated with back pain. In contrast, odds ratios (OR) for often having back pain were higher for women often having incontinence compared to women without incontinence (OR were 2.5, 2.3 and 2.3 for young, mid-age and older women, respectively). Similarly, mid-aged and older women had higher odds of having back pain often when they experienced breathing difficulties often compared to women with no breathing problems (OR of 2.0 and 1.9, respectively). Unlike obesity and physical activity, disorders of continence and respiration were strongly related to frequent back pain. This relationship may be explained by physiological limitations of co-ordination of postural, respiratory and continence functions of trunk muscles.

Effects of physical activity on emotional well-being among older Australian women Cross-sectional and longitudinal analyses

OBJECTIVE To explore relationships between physical activity and mental health cross-sectionally and longitudinally in a large cohort of older Australian women. METHOD Women in their 70s participating in the Australian Longitudinal Study on Womens Health responded in 1996 (aged 70-75) and in 1999 (aged 73-78). Cross-sectional data were analyzed for 10,063 women and longitudinal data for 6472. Self-reports were used to categorize women into four categories of physical activity at each time point as well as to define four physical activity transition categories across the 3-year period. Outcome variables for the cross-sectional analyses were the mental health component score (MCS) and mental health subscales of the Medical Outcomes Study Short Form (SF-36). The longitudinal analyses focused on changes in these variables. Confounders included the physical health component scale (PCS) of the SF-36, marital status, body mass index (BMI) and life events. Adjustment for baseline scores was included for the longitudinal analyses. RESULTS Cross-sectionally, higher levels of physical activity were associated with higher scores on all dependent variables, both with and without adjustment for confounders. Longitudinally, the effects were weaker, but women who had made a transition from some physical activity to none generally showed more negative changes in emotional well-being than those who had always been sedentary, while those who maintained or adopted physical activity had better outcomes. CONCLUSION Physical activity is associated with emotional well-being among a population cohort of older women both cross-sectionally and longitudinally, supporting the need for the promotion of appropriate physical activity in this age group.

Do incontinence, breathing difficulties, and gastrointestinal symptoms increase the risk of future back pain?

UNLABELLED Cross-sectional studies have suggested a relationship between respiratory disorders, incontinence, gastrointestinal symptoms, and back pain. However, longitudinal data are lacking. This study aimed to evaluate whether these disorders increase risk for the development of back pain. A total of 2943 younger, 2298 mid-age, and 2258 older women from the Australian Longitudinal Study on Womens Health who reported no back pain during the preceding 12 months were followed for 4, 2, and 3 years, respectively. Crude and adjusted associations between the development of back pain and changes in the presence of incontinence, breathing difficulty, and gastrointestinal symptoms were assessed with logistic regression. Women with preexisting incontinence (prevalence ratios [PR]: 1.26 to 1.46) and gastrointestinal symptoms (PR: 1.24 to 1.44) and women who developed breathing problems (PR: 1.63 to 2.11) were more likely to develop back pain than women without such problems. Menstrual pain and allergy were also associated with back pain development. Consistent with predictions from physiological data, this study provides novel evidence that the presence and/or development of incontinence, respiratory problems, and gastrointestinal symptoms are associated with the development of back pain. This highlights the importance of comorbidities and suggests opportunities for future preventative interventions. PERSPECTIVE This study demonstrates that women with incontinence, respiratory disorders, and gastrointestinal symptoms have increased risk for the development of back pain. Evidence of compromised control of the spine in people with incontinence and respiratory disorders and the potential for viscerosomatic hyperalgesia in people with gastrointestinal symptoms may provide physiological explanations for these findings.

Changes in smoking behaviour among young women over life stage transitions

Objective:To examine changes in smoking behaviour among young women over four life stages: leaving home; employment or attending college or university; marriage; and parenthood.

Is there a relationship between parity, pregnancy, back pain and incontinence?

The aims of this study were to compare prevalence of back pain in parous, nulliparous, pregnant and non-pregnant women and to determine whether there is an association between incontinence and back pain in pregnant women. Associations between back pain, pregnancy, parity and incontinence were assessed in 14,779 younger and 14,099 mid-age women using chi-squared analysis. The odds of back pain were modelled with multinomial logistic regression. Back pain was more frequent in parous than nulliparous (p < 0.001) and pregnant than non-pregnant (p < 0.001) younger women. However, no associations were seen for mid-aged women. Pregnant women who had incontinence had increased odds ratios for ‘often’ and ‘rarely or sometimes’ having back pain (8.5 and 3.8, respectively). This study suggests that pregnancy may lead to earlier development of back pain, without affecting long-term prevalence. Incontinence and back pain may be related because of contribution of the trunk muscles to continence and lumbopelvic control.

The relationship between incontinence, breathing disorders, gastrointestinal symptoms, and back pain in women: a longitudinal cohort study.

Objectives:Recent studies suggest a relationship between incontinence, respiratory disorders, gastrointestinal (GI) symptoms, and back pain (BP). However, causality is difficult to infer. This longitudinal study aimed to determine whether the presence or development of one disorder increases risk for the development of another. Methods:Women from the Australian Longitudinal Study on Women’s Health were divided into subgroups; those with no BP (n=7259), no incontinence (n=18,480), no breathing problems (including allergy) (n=15,096), and no GI symptoms (n=17,623). Each subgroup was analyzed to determine the relationship between the development of the absent condition and the presence or development of the other conditions. Factors with a previously identified relationship with BP were included in analysis. Results:Women with pre-existing and/or newly developed incontinence (prevalence ratios [PR]: 1.26 to 2.12) and breathing problems (PR: 1.38 to 2.11) had an increased risk for the development of BP, and women with pre-existing and newly developed BP were more likely to develop incontinence and breathing problems (PR: 1.18 to 2.44 and 1.53 to 2.62, respectively). The presence of GI symptoms was also identified as a risk factor for the development of these conditions. Discussion:This study provides evidence of a relationship between BP, incontinence, respiratory problems, and GI symptoms in which the presence of one symptom is associated with the development of another. This suggests that common factors may contribute to the development of symptoms across this range of conditions.

How Common Is Back Pain in Women With Gastrointestinal Problems

ObjectiveThis study examined the relationship between back pain and gastrointestinal (GI) symptoms in a large scale population study with consideration of possible confounding factors. MethodsCross-sectional analysis of survey data from the Australian Longitudinal Study on Womens Health was conducted using multinomial logistic regression to model 4 frequencies of back pain in relation to number of GI symptoms (including constipation, hemorrhoids, and other bowel problems). A total of 38,050 women from 3 age cohorts were included in analysis. ResultsAfter adjustment for confounding factors, the number of GI symptoms was significantly associated with back pain among all age cohorts. Odds ratios for experiencing back pain “rarely,” “sometimes,” and “often” increased with the number of GI symptoms. Young, mid-age, and older women who experience 2 or 3 GI symptoms had adjusted odds ratios of 3.3 (2.5 to 4.4), 3.0 (2.5 to 3.7) and 2.8 (2.3 to 3.4), respectively, for “often” having back pain. DiscussionThis study has identified a strong association between back pain and GI symptoms in women. Possible factors that may account for this relationship include referred pain through viscerosomatic convergence, altered pain perception, increased spinal loading when straining during defecation, or reduced support of the abdominal contents and spine secondary to changes in function of the abdominal muscles.

Implications of non-response of older women to a short form of the center for epidemiologic studies depression scale

The Center for Epidemiologic Studies Depression Scale (CES-D) is frequently used in epidemiological surveys to screen for depression, especially among older adults. This article addresses the problem of non-completion of a short form of the CES-D (CESD-10) in a mailed survey of 73- to 78-year-old women enrolled in the Australian Longitudinal Study on Womens Health. Completers of the CESD-10 had more education, found it easier to manage on available income and reported better physical and mental health. The Medical Outcomes Study Short Form Health Survey (SF-36) scores for non-completers were intermediate between those for women classified as depressed and not depressed using the CESD-10. Indicators of depression had an inverted U-shaped relationship with the number of missing CESD-10 items and were most frequent for women with two to seven items missing. Future research should pay particular attention to the level of missing data in depression scales and report its potential impact on estimates of depression.

Contemporary challenges for specialist nursing in interstitial lung disease

The role of clinical nurse specialists (CNSs) in interstitial lung disease (ILD) is evolving in response to clinical guidelines and the growth of clinical research. The role is well established in the UK, although more ILD posts are needed to ensure supply meets clinical demand. This phenomenon is also happening across Europe. An appreciation of the similarities and differences between CNS and advanced nurse practitioners is important given the challenges in defining, developing and supporting this nursing specialisation. Globally, different models exist. In some countries charitable organisations take a leading role in supporting patients. Many European centres look to the National Institute for Health and Care Excellence guidelines and quality standards as a template to develop and evaluate the role of the ILD CNS. We present a UK perspective in the context of a government subsidised healthcare system to promote professional discussion and debate regarding the future of nursing practice in the ILD specialty. Key points ILDs are often complex and associated with significant mortality, morbidity and co-morbid conditions that require a technical healthcare skill set There is worldwide shortage of nurses, low retention rates and retirement of many skilled nurses Collaboration across the ILD interdisciplinary community is needed to safeguard the future of our professions and high-quality patient care The ILD interdisciplinary and nurse network has identified key priorities to help secure the future of the ILD clinical and academic nurse specialism Educational aims To explain the similarities and differences between clinical nurse specialists (CNSs) and advanced nurse practitioners (ANPs) in the context of ILD specialism To review contemporary nursing specialism in the UK’s government subsidised healthcare system To stimulate discussion and debate across the European/international respiratory community regarding the clinical and academic development of the ILD CNS To identify key priorities that will support collaboration across the ILD interdisciplinary workforce in clinical practice and research Specialist nurses and interdisciplinary healthcare professionals are fundamental to the care of patients diagnosed with ILD. ILD specific clinical and academic standards are needed to sustain and develop a dedicated ILD workforce http://ow.ly/toee30h1UkW

S57 Predictors of uptake of ambulatory oxygen on completion of the ambox trial, a study to assess effects of ambulatory oxygen on quality of life in patients with fibrotic interstitial lung disease

Background There are no ILD specific guidelines on the use of ambulatory oxygen. The AmbOx trial is a multicenter, randomised, cross-over controlled trial (NCT02286063), to assess quality of life during two weeks on ambulatory oxygen compared to two weeks off oxygen, in patients with fibrotic ILD. Methods Individuals with fibrotic ILD whose oxygen saturation was normal at rest, but dropped to ≤88% on a 6MWT, with stable symptoms during a two week run-in period, were recruited and randomised. Primary outcome: health status assessed by King’s Brief ILD questionnaire (KBILD). A simple question on whether breathlessness had changed (better, same, worse) over the previous two weeks was a key secondary outcome. Patients‘ experiences with portable oxygen were explored through interviews in a subgroup. At the end of the four week trial period, patients were asked if they wished to continue with the ambulatory oxygen. Results Out of 84 randomised patients, 76 completed the trial. Mean age 64.5±1.1 years, 58 males, 53 ever smokers, FVC 73.3%±19.1%, DLCO 38.7%±12.8%. 43 patients had possible/definite IPF. Ambulatory oxygen, compared to no oxygen, was associated with improvements in total KBILD score (p<0.0001). At the end of the two weeks on oxygen, the majority of patients reported improved breathlessness (better:52/76 – same:23/76 – worse:1/76), compared to the two weeks on no oxygen (better 1/76 – same:57/76 – worse:18/76). On trial completion, 51/76 (67%) of patients chose to continue on ambulatory oxygen. On multivariate analysis, factors independently predictive of the patient’s decision to continue, included younger age (64.8 vs 72.8 years, p=0.002), more severe disease (CPI 55.5 vs 49.1, p=0.003) and patient’s global assessment of improvement in breathlessness (OR 3.2, p=0.018). Despite symptomatic improvements in the majority, ambulatory oxygen was also associated with a number of patient-reported challenges, explored in the patient interviews.