Erik J. Timmermans

Self-perceived weather sensitivity and joint pain in older people with osteoarthritis in six European countries: Results from the European Project on OSteoArthritis (EPOSA)

BackgroundPeople with osteoarthritis (OA) frequently report that their joint pain is influenced by weather conditions. This study aimed to examine whether there are differences in perceived joint pain between older people with OA who reported to be weather-sensitive versus those who did not in six European countries with different climates and to identify characteristics of older persons with OA that are most predictive of perceived weather sensitivity.MethodsBaseline data from the European Project on OSteoArthritis (EPOSA) were used. ACR classification criteria were used to determine OA. Participants with OA were asked about their perception of weather as influencing their pain. Using a two-week follow-up pain calendar, average self-reported joint pain was assessed (range: 0 (no pain)-10 (greatest pain intensity)). Linear regression analyses, logistic regression analyses and an independent t-test were used. Analyses were adjusted for several confounders.ResultsThe majority of participants with OA (67.2%) perceived the weather as affecting their pain. Weather-sensitive participants reported more pain than non-weather-sensitive participants (M = 4.1, SD = 2.4 versus M = 3.1, SD = 2.4; p < 0.001). After adjusting for several confounding factors, the association between self-perceived weather sensitivity and joint pain remained present (B = 0.37, p = 0.03). Logistic regression analyses revealed that women and more anxious people were more likely to report weather sensitivity. Older people with OA from Southern Europe were more likely to indicate themselves as weather-sensitive persons than those from Northern Europe.ConclusionsWeather (in)stability may have a greater impact on joint structures and pain perception in people from Southern Europe. The results emphasize the importance of considering weather sensitivity in daily life of older people with OA and may help to identify weather-sensitive older people with OA.

Physical Activity Patterns Among Older Adults With and Without Knee Osteoarthritis in Six European Countries.

To investigate patterns of physical activity in older adults with knee osteoarthritis (OA) compared to older adults without knee OA across 6 European countries. We expect country‐specific differences in the physical activity levels between persons with knee OA compared to persons without knee OA. A varying degree of physical activity levels across countries would express a facilitating or impeding influence of the social, environmental, and other contextual factors on a physically active lifestyle.

Not urbanization level but socioeconomic, physical and social neighbourhood characteristics are associated with presence and severity of depressive and anxiety disorders

Background Which neighbourhood factors most consistently impact on depression and anxiety remains unclear. This study examines whether objectively obtained socioeconomic, physical and social aspects of the neighbourhood in which persons live are associated with the presence and severity of depressive and anxiety disorders. Methods Cross-sectional data are from the Netherlands Study of Depression and Anxiety including participants (n = 2980) with and without depressive and anxiety disorders in the past year (based on DSM-based psychiatric interviews). We also determined symptom severity of depression (Inventory of Depression Symptomatology), anxiety (Beck Anxiety Inventory) and fear (Fear Questionnaire). Neighbourhood characteristics comprised socioeconomic factors (socioeconomic status, home value, number of social security beneficiaries and percentage of immigrants), physical factors (air pollution, traffic noise and availability of green space and water) and social factors (social cohesion and safety). Multilevel regression analyses were performed with the municipality as the second level while adjusting for individual sociodemographic variables and household income. Results Not urbanization grade, but rather neighbourhood socioecononomic factors (low socioeconomic status, more social security beneficiaries and more immigrants), physical factors (high levels of traffic noise) and social factors (lower social cohesion and less safety) were associated with the presence of depressive and anxiety disorders. Most of these neighbourhood characteristics were also associated with increased depressive and anxiety symptoms severity. Conclusion These findings suggest that it is not population density in the neighbourhood, but rather the quality of socioeconomic, physical and social neighbourhood characteristics that is associated with the presence and severity of affective disorders.

How Hand Osteoarthritis, Comorbidity, and Pain Interact to Determine Functional Limitation in Older People: Observations From the European Project on OSteoArthritis Study

To examine the role of comorbidity and pain in the associations of hand osteoarthritis (OA) with self‐reported and performance‐based physical function in a general population of elderly persons.

How hand osteoarthritis, comorbidity and pain interact to determine functional limitation in older people: observations from the EPOSA study

To examine the role of comorbidity and pain in the associations of hand osteoarthritis (OA) with self‐reported and performance‐based physical function in a general population of elderly persons.

Neighbourhood safety and smoking in population subgroups: The HELIUS study

This study examines the associations between neighbourhood safety and three types of smoking behaviour, and whether these associations differ by sex, age, ethnicity and individual-level socio-economic position. Baseline data (2011-2015) from the The HEalthy LIfe in an Urban Setting (HELIUS) study (Amsterdam, the Netherlands) were used. Smoking behaviour was based on self-report. Heavy smoking was defined as smoking ≥10 cigarettes per day. Nicotine dependence was assessed using the Fagerström questionnaire. Geographic Information System techniques were used to construct local residential areas and to examine neighbourhood safety for these areas using micro-scale environmental data. Multilevel logistic regression analyses with 6-digit zip code area as a second level were used to assess the association between neighbourhood safety and smoking. In our study sample of 22,728 participants (18-70 years), 24.0% were current smokers, 13.7% were heavy smokers and 8.1% were nicotine dependent individuals. Higher levels of neighbourhood safety were significantly associated with less heavy smoking (OR = 0.88, 95% CI = 0.78-0.99) and less nicotine dependence (OR = 0.81, 95% CI = 0.69-0.95), but not with less current smoking (OR = 1.01, 95% CI = 0.91-1.11). The associations between neighbourhood safety and the three types of smoking behaviour varied by ethnicity. For instance, higher levels of neighbourhood safety were associated with less current smoking in participants of African Surinamese origin (OR = 0.71, 95% CI = 0.57-0.89), but not in those of Dutch (OR = 1.13, 95% CI = 0.91-1.39), South-Asian Surinamese (OR = 1.22, 95% CI = 0.95-1.55), Turkish (OR = 1.08, 95% CI = 0.84-1.38), Moroccan (OR = 1.53, 95% CI = 1.12-2.10) or Ghanaian (OR = 1.18, 95% CI = 0.47-2.94) origin. Policies that improve neighbourhood safety potentially contribute to less heavy smoking and nicotine dependence.

The Influence of Weather Conditions on Outdoor Physical Activity Among Older People With and Without Osteoarthritis in 6 European Countries.

BACKGROUND Older adults with osteoarthritis (OA) often report that their disease symptoms are exacerbated by weather conditions. This study examines the association between outdoor physical activity (PA) and weather conditions in older adults from 6 European countries and assesses whether outdoor PA and weather conditions are more strongly associated in older persons with OA than in those without the condition. METHODS The American College of Rheumatology classification criteria were used to diagnose OA. Outdoor PA was assessed using the LASA Physical Activity Questionnaire. Data on weather parameters were obtained from weather stations. RESULTS Of the 2439 participants (65-85 years), 29.6% had OA in knee, hand and/or hip. Participants with OA spent fewer minutes in PA than participants without OA (Median = 42.9, IQR = 20.0 to 83.1 versus Median = 51.4, IQR = 23.6 to 98.6; P < .01). In the full sample, temperature (B = 1.52; P < .001) and relative humidity (B = -0.77; P < .001) were associated with PA. Temperature was more strongly associated with PA in participants without OA (B = 1.98; P < .001) than in those with the condition (B = 0.48; P = .47). CONCLUSIONS Weather conditions are associated with outdoor PA in older adults in the general population. Outdoor PA and weather conditions were more strongly associated in older adults without OA than in their counterparts with OA.

Within-Person Pain Variability and Mental Health in Older Adults With Osteoarthritis: An Analysis Across 6 European Cohorts

Pain is a key symptom of osteoarthritis (OA) and has been linked to poor mental health. Pain fluctuates over time within individuals, but a paucity of studies have considered day-to-day fluctuations of joint pain in relation to affective symptoms in older persons with OA. This study investigated the relationship of pain severity as well as within-person pain variability with anxiety and depression symptoms in 832 older adults with OA who participated in the European Project on OSteoArthritis (EPOSA): a 6-country cohort study. Affective symptoms were examined with the Hospital Anxiety and Depression Scale, pain severity was assessed with the Western Ontario and McMaster Universities OA Index and the Australian/Canadian Hand Osteoarthritis Index, and intraindividual pain variability was measured using pain calendars assessed at baseline, 6, and 12 to 18 months. Age-stratified multiple linear regression analyses adjusted for relevant confounders showed that more pain was associated with more affective symptoms in older-old participants (74.1-85 years). Moreover, older-old participants experienced fewer symptoms of anxiety (ratio = .85, 95% confidence interval [CI], .77-.94), depression (ratio = .90, 95% CI, .82-.98), and total affective symptoms (ratio = .87, 95% CI, .79-.94) if their pain fluctuated more. No such association was evident in younger-old participants (65-74.0 years). These findings imply that stable pain levels are more detrimental to mental health than fluctuating pain levels in older persons. PERSPECTIVE This study showed that more severe and stable joint pain levels were associated with anxiety and depressive symptoms in older persons with OA. These findings emphasize the importance of measuring pain in OA at multiple time points, because joint pain fluctuations may be an indicator for the presence of affective symptoms.

Smoking Cessation and 16-year Trajectories of Functional Limitations Among Dutch Older Adults: Results from the Longitudinal Aging Study Amsterdam

Background This study examined whether smoking cessation in middle age and old age is associated with following a successful trajectory of functional limitations over time in Dutch older adults. Methods We used 16-year longitudinal data from 645 participants of the Longitudinal Aging Study Amsterdam. Three types of trajectories regarding functional limitations over time were defined: successful (high initial level of functioning and limited decline), late decline (high initial level of functioning and late onset of decline), and early decline (lower initial level of functioning and early onset of decline). Smoking cessation status was self-reported and categorized into: early quitters (stopped in middle age [35-40 years]), late quitters (already smoked in middle age and stopped in old age [≥55 years]), and continued smokers (smoked in middle age and still smoking in old age). Multinomial Logistic Regression Analyses were used to assess the association between smoking cessation and trajectory membership. Results The sample (55-85 years at baseline) consisted of 20.3% early quitters, 22.9% late quitters, and 56.8% continued smokers. After adjustment for confounders, the model showed that late quitters were less likely to follow an early decline trajectory instead of a successful trajectory compared to continued smokers (odds ratio [OR] = 0.48, 95% confidence interval [CI] = 0.24-0.97). After adjustment for clinically relevant level of depressive symptoms, this association remained substantial but was no longer statistically significant (OR = 0.50, 95% CI = 0.24-1.02). Conclusions Although not statistically significant in the full model, the observed associations suggest that smoking cessation in old age may have an important impact on daily functioning in old age.

The association between road traffic noise and depressed mood among different ethnic and socioeconomic groups. The HELIUS study

BACKGROUND Although there is growing evidence that depressed mood is affected by road traffic noise, previous results are not fully consistent. Furthermore, to our knowledge, no previous research has assessed ethnic and socioeconomic inequalities in the association of noise exposure with depressed mood. OBJECTIVE To investigate the association between road traffic noise with depressed mood and to determine to what extent this association varies between ethnic and socioeconomic groups. METHOD We investigated cross-sectional data collected between 2011 and 2015 from 23,293 HELIUS participants (18-70 years) living in Amsterdam. Our study included five different ethnic groups (Dutch, Moroccan, Turkish, South-Asian Surinamese and African Surinamese origin). All respondents were linked by their residential postal code to geographic data on road traffic noise levels (24 h noise average in A-weighted decibels [dB(A)]). Noise was categorized into five categories (45-54 dB(A), 55-59 dB(A), 60-64 dB(A), 65-69 dB(A), ≥70 dB(A)) and high noise exposure was defined as noise levels ≥65 dB(A). Depressed mood was defined as a sum-score of ≥10 on the 9-item Patient Health Questionnaire (PHQ-9). Logistic regression was performed to assess the relationship between road traffic noise and depressed mood. Multilevel analyses were used to take into account the clustering of observations within neighbourhoods. Lastly, logistic regression analyses were applied to estimate relative risks for depressed mood per different ethnic and socioeconomic groups exposed to high noise exposure ≥65 dB(A) compared to <65 dB(A). Analyses were adjusted for individual- and neighbourhood-level confounders. RESULTS Exposure to ≥70 dB(A) compared to the reference group of 45-54 dB(A) showed a significant positive association with depressed mood (OR: 1.65, 95% CI 1.10, 2.48). Participants exposed to 60-64 dB(A) showed a significantly lower odds ratio of 0.82 (95% CI 0.70, 0.97) compared to the reference group. We observed no differences between ethnic groups in the association of high noise exposure ≥65 dB(A) with depressed mood. Regarding socioeconomic groups, results were different for the medium-low educated group and unemployed group only. CONCLUSION This study adds new evidence regarding a positive association between high road traffic noise exposure and depressed mood in residential settings. We found no evidence for systematic ethnic or socioeconomic inequalities regarding this association.