scholarly journals Barriers to applying for medical rehabilitation: a time-to-event analysis of employees with severe back pain in Germany

2022 ◽  
Author(s):  
Julia-Marie Zimmer ◽  
David Fauser ◽  
André Golla ◽  
Andreas Wienke ◽  
Nadine Schmitt ◽  
...  
Keyword(s):  
Back Pain ◽  
Cox Regression ◽  
Medical Rehabilitation ◽  
Event Analysis ◽  
Pension Insurance ◽  
Randomized Sampling ◽  
Severe Back Pain ◽  
Physician Support ◽  
Age Range

Objective: Longitudinal studies on barriers to applying for rehabilitation in Germany are lacking in light of the suspected underutilization of rehabilitation services. The aim of this study was to examine application behaviour in persons with disabling back pain and to identify relevant predictors for making an application. Design: A prospective cohort study with randomized sampling of insurants in the German Pension Insurance, using a questionnaire at baseline and follow-up with linked administrative data for 1.5 years. Subjects/patients: Employed persons (age range 45–59 years) with a high degree of limitations due to back pain and a self-reported risk of permanent work disability (not applied for disability pension, no medical rehabilitation within the last 4 years). Methods: Multivariable Cox regression was used to examine the influence of pre-selected variables on making an application in the follow-up period. Results: Of 690 persons, only 12% applied for rehabilitation. Predictors for making an application were: support from physicians (hazard ratio (HR)=2.24; 95% confidence interval (95% CI) 1.32–3.80), family, and friends (HR=1.67; 95% CI 1.02–2.73), more pain-related disability days (HR=1.02; 95% CI 1.01–1.03), and worse work ability (HR=0.86; 95% CI 0.75–0.97). An intention to apply at baseline mediated the effect of family and physician support on the application. Conclusion: The low number of applications for rehabilitation despite disabling back pain indicates access barriers to, and underuse of, medical rehabilitation.

scholarly journals High-level Exposure of Uric Acid in Asymptomatic Hyperuricemia Could Be An Isolated Risk Factors of Cardio-Cerebrovascular Diseases: A Prospective Cohort Study

2021 ◽  
Author(s):  
Zhiyuan Cheng ◽  
Tongzhang Zheng ◽  
Desheng Zhang ◽  
Jingli Yang ◽  
Xiaobin Hu ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Uric Acid ◽  
Cox Regression ◽  
Cerebrovascular Diseases ◽  
Healthy Population ◽  
Incidence Risk ◽  
High Level ◽  
Age Range ◽  
Fourth Quartile

Abstract Background: Whether the asymptomatic hyperuricemia (AH) raises the risk of cardiovascular disease with or without hyperuricemia-related comorbidities still remains contentious. Our study was aimed to quantitatively access the incidence risk of coronary heart disease (CHD) and stroke associated with AH.Methods: Multivariate-adjusted Cox regression models were applied to evaluate the risk of cardiovascular disease (CVD). Serum uric acid beyond normouricemia was quarterly stratified based on the distribution of healthy population without CVD onset.Results: 1,062 CVD first attack cases were collected among the 48,001 cohort participants (age range: 18-92, mean age: 47.2±13.9 years-old) with a mean follow-up duration of 5.78±0.83 years. 14,464 baseline population with comorbidities were excluded to further study the association between AH and CVD incidence. The AH showed overall non-association with CVD incident. However, significantly increased adjusted hazard ratio (HR) of CVD with 95% confidence interval (CI) were observed when the fourth quartile compared with normouricemia stratum in the total cohort population (CHD: 1.70, 1.34-2.16; stroke: 1.55, 1.13-2.13), male (CHD: 1.94, 1.47-2.56), female (CHD: 1.71, 1.03-2.35; stroke: 2.02, 1.14-3.58) and aged over 50 years-old population. Meanwhile, the age-standardized incidence rate of CVD in the fourth quartile was 2 to 3 time higher than the normouricemia population. Consistent results were also observed in the AH population in absence of comorbidities (CHD: 2.40, 1.39-4.14; stroke: 1.85, 1.12-3.59).Conclusion: Asymptomatic hyperuricemia patients exposed to higher level of uric acid (male>487 mmol/L, female>422 mmol/L) could significantly increase the incidence risk of CHD and stroke, with or without hyperuricemia-related comorbidities.

Efficiency and toxicity of mifamurtid in childhood osteosarcoma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e22010-e22010 ◽  
Author(s):  
Nurdan Tacyildiz ◽  
Sonay incesoy Ozdemir ◽  
Emel Cabi Unal ◽  
Handan Dincaslan ◽  
Gulsan Yavuz ◽  
...  
Keyword(s):  
Back Pain ◽  
Side Effects ◽  
Progressive Disease ◽  
Liver Enzymes ◽  
Complete Surgical Resection ◽  
Severe Back Pain ◽  
Grade 3 ◽  
Few Data ◽  
Disease Location

e22010 Background: There are only few data concerning efficiency and toxicity of mifamurtide in children with osteosarcoma (OS). The aim of this study was to evaluate efficiency and side effects of mifamurtide in childhood OS. Methods: We retrospectively analyzed the data of 18 patients with OS and who received mifamurtide between January 2012 and December 2016. Four hundred seventy seven doses of 2 mg/m2intravenous mifamurtide, along with paracetamol premedication were given in 15 patients with primary non-metastatic OS after complete surgical resection and 3 patients with progressive OS. Results: There were 11 males and 7 females, and the median age was 14 years (ranged, 9-18). The median follow-up time was 20 months (ranged, 7-51). The metaphyseal plates around the knee was the most frequent disease location with 94.4%. The median necrosis percentage was 94 (range, 35-100). All patients received Euromos protocol. The most common side effects were chills and fever (17/18). These reactions were observed in 4 patients during every administration, in only one patient at last administration and in the remaining 12 patients during first or first two administration. Headache, myalgia and arthralgia were observed in 2 patients during every infusion. In another one case, headache was observed during only first two infusions and he also hearing loss was developed (could be related CisPlatin) Back pain was observed in two patient during first infusion but one them suffered with severe back pain after few doses and stoped Mifamurtid. . Grade 3-4 neutropenia, trombocytopenia, abnormal liver enzymes and abnormal BUN and creatinin levels were not observed in patients who received mifamurtide alone after completion of chemotherapy. Of the 15 patients with primary non-metastatic OS treated with the addition of mifamurtide to chemotherapy, 13 showed complet remission for median 24 months (ranged,16-36) and 2 patients are still under treatment with complet remission. Of the 3 patients with progressive disease, 2 died and 1 had progressive disease for 51 months. Conclusions: Mifamurtide therapy is safe and well tolerated in childhood OS. Chills and fever were the major side effects, These events were transient and often no longer observed in subsequent administrations.

scholarly journals Observational Study of Chlorpromazine in Hospitalized Patients with Covid-19

2020 ◽  
Author(s):  
Nicolas Hoertel ◽  
Marina Sanchez Rico ◽  
Raphael Vernet ◽  
Anne-Sophie Jannot ◽  
Antoine Neuraz ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Cox Regression ◽  
Cox Model ◽  
Event Analysis ◽  
Time To Event ◽  
Rt Pcr ◽  
University Hospitals ◽  
Inverse Probability ◽  
Antiviral Effects

On the grounds of its anti-inflammatory and potential antiviral effects, chlorpromazine has been suggested to be effective treatment for Covid-19. We examined the association between chlorpromazine use and respiratory failure among all hospitalized adults with Covid-19 at the 39 Greater Paris University hospitals since the beginning of the epidemic. Study baseline was defined as the date of hospital admission. The primary endpoint was a composite of intubation or death in a time-to-event analysis adjusting for numerous potential confounders. We used a multivariable Cox model with inverse probability weighting according to the propensity score. Of the 12,217 adult inpatients with a positive Covid-19 RT-PCR test included in the analyses, 57 (0.47%) received chlorpromazine. Over a mean follow-up of 20.8 days, the primary endpoint occurred in 29 patients (50.9%) exposed to chlorpromazine and 1,899 patients (15.6%) who were not. In the main analysis, there was a positive significant association between chlorpromazine use and the outcome (HR, 1.67; 95% CI, 1.09 to 2.56, p=0.019), while a Cox regression in a matched analytic sample yielded non-significant association (1.38; 95% CI, 0.91 to 2.09, p=0.123). These findings suggest that chlorpromazine is unlikely to have a clinical efficacy for Covid-19.

Abstract P226: D-Dimer Levels and Risk of Stroke: Findings from the EPICOR Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Augusto Di Castelnuovo ◽  
Claudia Agnoli ◽  
Amalia de Curtis ◽  
Maria Concetta Giurdanella ◽  
Sara Grioni ◽  
...  
Keyword(s):  
Cox Regression ◽  
Vascular Diseases ◽  
Reactive Protein ◽  
Cohort Design ◽  
Hazard Ratios ◽  
Potential Risk Factors ◽  
Age Range ◽  
Fourth Quartile ◽  
D Dimer

Background: Elevated D-dimer levels are reportedly associated with higher risk of vascular diseases. We investigated the association of baseline D-dimer levels with stroke events occurred in the European Prospective Investigation into Cancer and Nutrition-Italy cohort. Methods: Using a nested case-cohort design, a center-stratified random sample of 832 subjects (66% women, age range 35 to 71) was selected as subcohort and compared with 289 strokes in a mean follow-up of 9 years. D-dimer was measured on fresh citrated plasma by an automated latex-enhanced immunoassay (HemosIL-IL, Milan). The hazard ratios and 95% confidence intervals, adjusted by relevant confounders and stratified by center, were estimated by a Cox regression model using Prentice method. Results: Individuals in the second, third or fourth quartile compared with the lowest quartile of D-dimer had significantly higher risk of stroke (Table). The association was independent from several potential confounders, including C-Reactive protein (Table). It was evident starting from the second quartile (D-dimer >100 ng/ml) and persisted almost unchanged for higher D-dimer levels (Table). No differences were observed in men and women. The increase in risk was essentially the same both for ischemic and hemorrhagic strokes (Table). Conclusions: Our data provide a clear evidence that elevated levels of D-dimer are potential risk factors for ischemic or hemorrhagic strokes.

Self-Reported Prognosis of Employability as an Indicator of Need for Rehabilitation: A Cohort Study in People with Back Pain

2021 ◽  
Author(s):  
David Fauser ◽  
Julia-Marie Zimmer ◽  
André Golla ◽  
Nadine Schmitt ◽  
Wilfried Mau ◽  
...  
Keyword(s):  
Cohort Study ◽  
Back Pain ◽  
Work Disability ◽  
Disability Pension ◽  
Medical Rehabilitation ◽  
Logistic Regression Models ◽  
Administrative Records ◽  
Increased Risk ◽  
Permanent Work

Abstract Purpose Rehabilitation is a key strategy to enable people with disabilities or chronic diseases to participate in society and employment. In Germany, the approval of rehabilitation services is linked to personal requirements, including significantly compromised work ability due to illness. The subjective prognosis of employability (SPE) is a brief 3-item scale. The total score assesses the self-rated risk of permanent work disability and was therefore proposed to be an indicator to operationalize the requirements to determine the need for a medical rehabilitation measure. This cohort study examined whether rehabilitation and disability pensions can be predicted by the SPE in employees with back pain. Moreover, the study tested the applicability of the SPE regarding interrupted employment. Methods Employees aged 45 to 59 years who reported back pain in the last three months completed the SPE in 2017. The total score ranges from 0 to 3 points, with higher values indicating a higher risk of permanent work disability. Data on rehabilitation, disability pensions, and interrupted employment were extracted from administrative records covering the period until the end of 2018. Proportional hazard and logistic regression models were fitted. Results Data of 6,742 participants were included (mean age: 52.3 years; 57.8% women). Maximum follow-up was 21 months. Of the participants, 38.8, 33.6, 21.4, and 6.2% had an SPE score of 0, 1, 2, and 3 points, respectively. During follow-up, 535 individuals were approved for a rehabilitation measure and 49 individuals for a disability pension. Fully adjusted analyses showed an increased risk of a rehabilitation in employees with an SPE score of 3 points (HR=2.20; 95% CI 1.55; 3.11) and 2 points (HR=1.76; 95% CI 1.33; 2.31) compared to employees with an SPE score of 0 points. The risk of a disability pension (HR=13.60; 95% CI 4.56; 40.57) and the odds of interrupted employment (OR=2.58; 95% CI 1.72; 3.86) were also significantly increased for those with an SPE score of 3 points. Conclusions The brief SPE is an appropriate tool to identify individuals reporting back pain at risk of rehabilitation, poor work participation outcomes, and permanent work disability.

Does Hospitalization Predict the Disease Course in Ulcerative Colitis? Prevalence and Predictors of Hospitalization and Re- Hospitalization in Ulcerative Colitis in a Population-based Inception Cohort (2000-2012)

2015 ◽  
Vol 24 (3) ◽  
pp. 287-292 ◽  
Author(s):  
Petra A. Golovics ◽  
Laszlo Lakatos ◽  
Michael D. Mandel ◽  
Barbara D. Lovasz ◽  
Zsuzsanna Vegh ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Cox Regression ◽  
Diagnostic Procedures ◽  
Population Based ◽  
Disease Course ◽  
Inception Cohort ◽  
Disease Extent ◽  
Cox Regression Analysis ◽  
Hospitalization Rates

Background & Aims: Limited data are available on the hospitalization rates in population-based studies. Since this is a very important outcome measure, the aim of this study was to analyze prospectively if early hospitalization is associated with the later disease course as well as to determine the prevalence and predictors of hospitalization and re-hospitalization in the population-based ulcerative colitis (UC) inception cohort in the Veszprem province database between 2000 and 2012. Methods: Data of 347 incident UC patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (M/F: 200/147, median age at diagnosis: 36, IQR: 26-50 years, follow-up duration: 7, IQR 4-10 years). Both in- and outpatient records were collected and comprehensively reviewed. Results: Probabilities of first UC-related hospitalization were 28.6%, 53.7% and 66.2% and of first re-hospitalization were 23.7%, 55.8% and 74.6% after 1-, 5- and 10- years of follow-up, respectively. Main UC-related causes for first hospitalization were diagnostic procedures (26.7%), disease activity (22.4%) or UC-related surgery (4.8%), but a significant percentage was unrelated to IBD (44.8%). In Kaplan-Meier and Cox-regression analysis disease extent at diagnosis (HR extensive: 1.79, p=0.02) or at last follow-up (HR: 1.56, p=0.001), need for steroids (HR: 1.98, p<0.001), azathioprine (HR: 1.55, p=0.038) and anti-TNF (HR: 2.28, p<0.001) were associated with the risk of UC-related hospitalization. Early hospitalization was not associated with a specific disease phenotype or outcome; however, 46.2% of all colectomies were performed in the year of diagnosis. Conclusion: Hospitalization and re-hospitalization rates were relatively high in this population-based UC cohort. Early hospitalization was not predictive for the later disease course.

PERCUTANEOUS EPIDURAL NEUROPLASTY (PEN) USING COMBINATION OF HYALURONIDASE AND HYPERTONIC SALINE (NaCl 3%) IN TREATING FAILED BACK SURGERY SYNDROME

2018 ◽  
Vol 1 (1) ◽  
pp. 1
Author(s):  
Wawan Mulyawan ◽  
Yudi Yuwono Wiwoho ◽  
Syaiful Ichwan
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Hypertonic Saline ◽  
Failed Back Surgery Syndrome ◽  
Favourable Outcome ◽  
Lumbar Spine Surgery ◽  
Low Back ◽  
Failed Back Surgery ◽  
Scale Scores

Background: Following surgical treatments for low back pain, lower extremity pain or neurologic symptoms would last or recur, this is defined as failed sack surgery syndrome (FBSS). FBSS usually occurs in 5-40% of these surgical patients. The most common cause is an epidural scar adhesion. Percutaneous epidural neuroplasty is the non-mechanical treatment for this condition. Previously, the use of hyaluronidase and hypertonic saline separately is commonly used for epidurolysis but the combination of hyaluronidase and hypertonic saline 3% has not been explored.Objective: To investigate the two-year outcomes of percutaneous epidural neuroplasty using a combination of hyaluronidase and hypertonic saline 3% in patients with FBSS.Methods: Twelve patients who experience low back pain, with or without radiculopathy, who have underwent lumbar spine surgery previously were assigned to the study. Parameters, such as the visual analogue scale scores for the back (VAS-B) and legs (VAS-L), and the Oswestry disability index (ODI), were recorded and compared between pretreatment, 1 week, 1 month, 3 months, 1 year and 2 years follow-up.Results: For all 12 patients, the postoperative VAS-B, VAS-L, and ODI were significantly different from the preoperative values in all follow-up periods: 1 month, 3 months, 1 year, and 2 years.Conclusion: Based off this study group, percutaneous epidural neuroplasty using a combination of hyaluronidase and hypertonic saline 3% has a favourable outcome in the 2 years follow-up

Low back pain in pregnancy and post-partum period. Principles for medical rehabilitation

2018 ◽  
Vol 1 (19) ◽  
pp. 22
Author(s):  
Iulia Filipescu ◽  
Mihai Berteanu ◽  
George Alexandru Filipescu ◽  
Radu Vlădăreanu
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Post Partum ◽  
Medical Rehabilitation ◽  
Low Back ◽  
Post Partum Period ◽  
In Pregnancy

The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms

2020 ◽  
Vol 133 (1) ◽  
pp. 182-189
Author(s):  
Tae-Jin Song ◽  
Seung-Hun Oh ◽  
Jinkwon Kim
Keyword(s):  
Statin Therapy ◽  
Coil Embolization ◽  
Primary Outcome ◽  
Cox Regression ◽  
Cerebral Aneurysms ◽  
Time Dependent ◽  
Lipid Lowering ◽  
Surgical Clipping ◽  
The Impact

OBJECTIVECerebral aneurysms represent the most common cause of spontaneous subarachnoid hemorrhage. Statins are lipid-lowering agents that may expert multiple pleiotropic vascular protective effects. The authors hypothesized that statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes.METHODSThis was a retrospective cohort study using the National Health Insurance Service–National Sample Cohort Database in Korea. Patients who underwent coil embolization or surgical clipping for cerebral aneurysm between 2002 and 2013 were included. Based on prescription claims, the authors calculated the proportion of days covered (PDC) by statins during follow-up as a marker of statin therapy. The primary outcome was a composite of the development of stroke, myocardial infarction, and all-cause death. Multivariate time-dependent Cox regression analyses were performed.RESULTSA total of 1381 patients who underwent coil embolization (n = 542) or surgical clipping (n = 839) of cerebral aneurysms were included in this study. During the mean (± SD) follow-up period of 3.83 ± 3.35 years, 335 (24.3%) patients experienced the primary outcome. Adjustments were performed for sex, age (as a continuous variable), treatment modality, aneurysm rupture status (ruptured or unruptured aneurysm), hypertension, diabetes mellitus, household income level, and prior history of ischemic stroke or intracerebral hemorrhage as time-independent variables and statin therapy during follow-up as a time-dependent variable. Consistent statin therapy (PDC > 80%) was significantly associated with a lower risk of the primary outcome (adjusted hazard ratio 0.34, 95% CI 0.14–0.85).CONCLUSIONSConsistent statin therapy was significantly associated with better prognosis after coil embolization or surgical clipping of cerebral aneurysms.

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