María Dueñas

Gender differences and determinants of health related quality of life in coronary patients: a follow-up study

BackgroundThe role of gender differences in Health Related Quality Life (HRQL) in coronary patients is controversial, so understanding the specific determinants of HRQL in men and women might be of clinical importance. The aim of this study was to know the gender differences in the evolution of HRQL at 3 and 6 months after a coronary event, and to identify the key clinical, demographic and psychological characteristics of each gender associated with these changes.MethodsA follow-up study was carried out, and 175 patients (112 men and 63 women) with acute myocardial infarction (AMI) or unstable angina were studied. The SF-36v1 health questionnaire was used to assess HRQL, and the GHQ-28 (General Health Questionnaire) to measure mental health during follow-up. To study the variables related to changes in HRQL, generalized estimating equation (GEE) models were performed.ResultsFollow-up data were available for 55 men and 25 women at 3 months, and for 35 men and 12 women at 6 months. Observations included: a) Revascularization was performed later in women. b) The frequency of rehospitalization between months 3 and 6 of follow-up was higher in women c) Women had lower baseline scores in the SF-36. d) Men had progressed favourably in most of the physical dimensions of the SF-36 at 6 months, while at the same time womens scores had only improved for Physical Component Summary, Role Physical and Social Functioning; e) the variables determining the decrease in HRQL in men were: worse mental health and angina frequency; and in women: worse mental health, history of the disease, revascularization, and angina frequency.ConclusionsThere are differences in the evolution of HRQL, between men and women after a coronary attack. Mental health is the determinant most frequently associated with HRQL in both genders. However, other clinical determinants of HRQL differed with gender, emphasizing the importance of individualizing the intervention and the content of rehabilitation programs. Likewise, the recognition and treatment of mental disorders in these patients could be crucial.

A review of chronic pain impact on patients, their social environment and the health care system

Chronic pain (CP) seriously affects the patient’s daily activities and quality of life, but few studies on CP have considered its effects on the patient’s social and family environment. In this work, through a review of the literature, we assessed several aspects of how CP influences the patient’s daily activities and quality of life, as well as its repercussions in the workplace, and on the family and social environment. Finally, the consequences of pain on the health care system are discussed. On the basis of the results, we concluded that in addition to the serious consequences on the patient’s life, CP has a severe detrimental effect on their social and family environment, as well as on health care services. Thus, we want to emphasize on the need to adopt a multidisciplinary approach to treatment so as to obtain more comprehensive improvements for patients in familial and social contexts. Accordingly, it would be beneficial to promote more social- and family-oriented research initiatives.

Undiagnosed Mood Disorders and Sleep Disturbances in Primary Care Patients with Chronic Musculoskeletal Pain

OBJECTIVE The study aims to determine the prevalence of undiagnosed comorbid mood disorders in patients suffering chronic musculoskeletal pain in a primary care setting and to identify sleep disturbances and other associated factors in these patients, and to compare the use of health services by chronic musculoskeletal pain patients with and without comorbid mood disorders. DESIGN Cross-sectional study. SUBJECTS A total of 1,006 patients with chronic musculoskeletal pain from a representative sample of primary care centers were evaluated. OUTCOME MEASURES Pain was measured using a visual analog scale and the Primary Care Evaluation of Mental Disorders questionnaire was used to measure mood disorders. RESULTS We observed a high prevalence of undiagnosed mood disorders in chronic musculoskeletal pain patients (74.7%, 95% confidence interval [CI] 71.9-77.4%), with greater comorbidity in women (adjusted odds ratio [OR] = 1.91, 95% CI 1.37-2.66%) and widow(er)s (adjusted OR = 1.87, 95% CI 1.19-2.91%). Both sleep disturbances (adjusted OR = 1.60, 95% CI 1.17-2.19%) and pain intensity (adjusted OR = 1.02, 95% CI 1.01-1.02%) displayed a direct relationship with mood disorders. Moreover, we found that chronic musculoskeletal pain patients with comorbid mood disorders availed of health care services more frequently than those without (P < 0.001). CONCLUSIONS The prevalence of undiagnosed mood disorders in patients with chronic musculoskeletal pain is very high in primary care settings. Our findings suggest that greater attention should be paid to this condition in general practice and that sleep disorders should be evaluated in greater detail to achieve accurate diagnoses and select the most appropriate treatment.

A Nationwide Study of Chronic Pain Prevalence in the General Spanish Population: Identifying Clinical Subgroups Through Cluster Analysis

OBJECTIVE This study aims to assess the prevalence of chronic pain, its characteristics, and its impact on the general Spanish population. Also, to establish chronic pain patient subgroups according to the characteristics of pain and to identify variables specifically associated with each subgroup. DESIGN Telephone-based, cross-sectional nationwide study. SUBJECTS A sample of 1,957 individuals representative of the Spanish population. METHODS Data were collected through telephone interviews. A subject was considered to have chronic pain if they had suffered pain (at least 4 days a week) during the last 3 months. The subjects were divided into two subgroups through a cluster analysis, and a regression model was established to determine the variables most specifically associated with these subgroups. RESULTS The prevalence of chronic pain was 16.6% (95% confidence interval: 14.9-18.3) and among these subjects, more than 50% referred to limitations in their daily activities, 30% felt sad and/or anxious, and 47.2% indicated that their pain was affecting their family life. Two subgroups of subjects with pain were identified: 1) characterized by generalized pain in more than one location and of a long evolution (150 months); and 2) characterized by pain localized to only one site with a shorter duration (100 months). Individuals who felt anxious because of their pain and those who considered that their pain was affecting their family were more likely to belong to group 1. CONCLUSIONS Pain affects an important proportion of the Spanish adult population and that it has a strong personal impact. Two pain groups were clearly distinguished by their clinical characteristics.

The Impact of Chronic Pain: The Perspective of Patients, Relatives, and Caregivers

To assess the impact of chronic pain on the family environment from the patients, relatives and caregivers perspective, we undertook cross-sectional study on a representative sample of Spanish adults who suffered pain at least 4 days a week for ≥3 months and on relatives and caregivers of patients that fulfilled these criteria. The characteristics of pain and the perception of its impact on the family environment were assessed, using logistic regression models to reveal the variables associated with the impact of pain on the family. From a total of 1,957 subjects, 325 experienced chronic pain and 34.6% of them perceived that their pain affected their family environment. These patients recognized a stronger impact when their relatives were sad (OR = 3.61; CI:1.57, 8.27) and had modified the leisure activities because of the pain (OR = 3.62; CI:1.56, 8.38). Among the 131 relatives, 51.2% perceived that pain was affecting the family, causing changes in their leisure activities (OR = 1.17; CI:1.04, 9.94) and sleep disturbance (OR = 1.40; CI:1.32, 12.58). Of the 36 caregivers, mainly women over 50 years of age, 66.7% indicated that pain affected the family, although 72.8% were satisfied with the help they provided. Chronic pain has a very strong impact on the family, although this is perceived distinctly by patients, relatives, and caregivers. Recognizing that factors related to pain affect the familys well-being, and adopting a global approach to pain that takes into consideration the familys experiences, should improve the therapeutic response, and enhance the patients and relatives quality of life. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Factors associated with chronic pain in patients with bipolar depression: a cross-sectional study

BackgroundWhile pain is frequently associated with unipolar depression, few studies have investigated the link between pain and bipolar depression. In the present study we estimated the prevalence and characteristics of pain among patients with bipolar depression treated by psychiatrists in their regular clinical practice. The study was designed to identify factors associated with the manifestation of pain in these patients.MethodsPatients diagnosed with bipolar disorder (n=121) were selected to participate in a cross-sectional study in which DSM-IV-TR criteria were employed to identify depressive episodes. The patients were asked to describe any pain experienced during the study, and in the 6 weeks beforehand, by means of a Visual Analogical Scale (VAS).ResultsOver half of the bipolar depressed patients (51.2%, 95% CI: 41.9%–60.6%), and 2/3 of the female experienced concomitant pain. The pain was of moderate to severe intensity and prolonged duration, and it occurred at multiple sites, significantly limiting the patient’s everyday activities. The most important factors associated with the presence of pain were older age, sleep disorders and delayed diagnosis of bipolar disorder.ConclusionsChronic pain is common in bipolar depressed patients, and it is related to sleep disorders and delayed diagnosis of their disorder. More attention should be paid to study the presence of pain in bipolar depressed patients, in order to achieve more accurate diagnoses and to provide better treatment options.

Simple generalized estimating equations (GEEs) and weighted generalized estimating equations (WGEEs) in longitudinal studies with dropouts: guidelines and implementation in R

Missing data are a common problem in clinical and epidemiological research, especially in longitudinal studies. Despite many methodological advances in recent decades, many papers on clinical trials and epidemiological studies do not report using principled statistical methods to accommodate missing data or use ineffective or inappropriate techniques. Two refined techniques are presented here: generalized estimating equations (GEEs) and weighted generalized estimating equations (WGEEs). These techniques are an extension of generalized linear models to longitudinal or clustered data, where observations are no longer independent. They can appropriately handle missing data when the missingness is completely at random (GEE and WGEE) or at random (WGEE) and do not require the outcome to be normally distributed. Our aim is to describe and illustrate with a real example, in a simple and accessible way to researchers, these techniques for handling missing data in the context of longitudinal studies subject to dropout and show how to implement them in R. We apply them to assess the evolution of health-related quality of life in coronary patients in a data set subject to dropout. Copyright

Association of Painful Musculoskeletal Conditions and Migraine Headache With Mental and Sleep Disorders Among Adults With Disabilities, Spain, 2007–2008

Introduction The aim of this study was to determine the prevalence of painful musculoskeletal conditions and migraine headache or any other headache in a sample of Spanish adults with disabilities and their association with anxiety, depression, and sleep disorders. Methods This cross-sectional study analyzed data from the Spanish national disability and dependence survey (2007–2008) of 16,932 adults aged 18 or older who have disabilities. The prevalence (95% confidence interval [CI]) of painful musculoskeletal conditions was determined according to a diagnosis of arthritis, osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, muscular dystrophy, and neck or back pain. The prevalence of migraine or other headache was also calculated. Factors associated with these painful conditions were analyzed separately for men and women by using a logistic regression model. Results The prevalence of painful musculoskeletal conditions was 66.9% (95% CI, 66.2%–67.6%) and that of migraine or other headache was 23.4% (95% CI, 22.8%–24.1%), both of which were higher in women than in men. Factors associated with these conditions in both men and women included older age, a sleep disorder, and concomitant chronic anxiety and/or depression. Conclusion The prevalence of painful musculoskeletal conditions and migraine or other headache is high in people with disability in Spain, especially in women, and these conditions often coexist with depression, anxiety, and/or a sleep disorder. To design programs for rehabilitating and improving the quality of life of adults with disability and painful conditions, treatments for mental and/or sleep disorders should be considered in addition to conventional treatments.

Nationwide cross-sectional study of the impact of chronic pain on an individual’s employment: relationship with the family and the social support

Objectives To determine the prevalence and the factors related to sick leave and job loss among individuals suffering from chronic pain (CP), and to analyse specifically the effect of family and social support on the individuals employment. Design Observational cross-sectional study. Setting Data were collected using structured computer-assisted telephone interviews between February and June 2011. Participants A nationwide study of 1543 Spanish adults of working age (<65), 213 of whom suffered from CP (pain suffered at least 4 or 5 days a week during the past 3 months, according to the criteria of the International Association for the Study of Pain (IASP)). Main outcome measure Information was collected regarding the individuals sociodemographic status, pain characteristics, healthcare use and satisfaction, limitations in daily activities, mood status, perception of the impact of pain on their families, and their satisfaction with the family and social support. To identify factors associated with sick leave and job loss among those suffering CP, 2 logistic regression models were generated. Results The prevalence of sick leave due to CP in the general Spanish population was 4.21% (95% CI 3.2% to 5.2%). Sick leave were more likely for individuals who considered their family were affected by their pain (OR=2.18), needed help to dressing and grooming (OR=2.98), taking medication (OR=2.18), had a shorter pain duration (OR=0.99) and higher educational level. The prevalence of job loss due to CP was 1.8% (95% CI 1.1% to 2.5%). It was related to feelings of sadness (OR=4.25), being unsatisfied with the care provided by health professionals (OR=2.60) and consulting a doctor more often due to CP (OR=1.09). Conclusions CP is negatively associated with an individuals employment. This detrimental effect could be ameliorated if the factors related to sick leave and job loss provoked by CP are identified, especially those related to the effect of CP on the family and social environment.

Health Related Quality of Life in Coronary Patients

The increase observed in the survival of patients with ischemic cardiopathy, together with the effect of the disease on the social, professional, and family life of those suffering from it, have led researchers to consider that the traditional ways of measuring morbidity and mortality are not adequate for assessing the potential benefits of health care interventions. For this reason, there is common agreement on the need to use an indicator of subjective assessment of health, and of health related quality of life (HRQL), as a complementary criterion for monitoring the results of medical interventions in these patients.