Daily smoking and lower back pain in adult Canadians: the Canadian Community Health Survey

Fahad Alkherayf1,2,3, Eugene K Wai4,5,6, Eve C Tsai1,3,4,6, Charles Agbi1,3,41University of Ottawa, Division of Neurosurgery, Ottawa, Ontario; 2University of Ottawa, Department of Clinical Epidemiology, Ottawa, Ontario; 3The Ottawa Hospital, Civic campus, Division of Neurosurgery, Ottawa, Ontario; 4The Ottawa Hospital, Civic Campus, Spine Unit Ottawa, Ontario; 5The Ottawa Hospital, Civic Campus, Division of Orthopedic Surgery, Ottawa, Ontario; 6The Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaBackground: Lower back pain (LBP) is one of the primary causes of disability in the Canadian community. However, only a limited number of studies have addressed the association between daily smoking and LBP in Canada. Of the studies that have explored this association, many had small sample sizes and failed to control for confounders.Objective: The primary objective of the study was to determine if daily smoking is associated with an increased risk of having LBP. The secondary objectives were to assess the risk for LBP among occasional smokers and to determine the prevalence of LBP in relation to different covariates.Data and study design: Using the Canadian Community Health Survey (cycle 3.1) data, 73,507 Canadians between the ages of 20 and 59 years were identified. LBP status, smoking level, sex, age, body mass index (BMI), level of activity and level of education were assessed in these subjects.Methods: Stratified analysis and logistic regression analysis were used to detect effect modifications and to adjust for covariates. Population weight and design were taken into consideration.Results: The prevalence of LBP was 23.3% among daily smokers and 15.7% among non-smokers. Age and sex were found to be effect modifiers. The association between LBP and daily smoking was statistically significant in all ages and genders; this association was stronger for younger age groups. The adjusted odds ratio for male daily smokers aged 20 to 29 was 1.87 (95% CI = 1.62, 2.17); findings were similar for women. Occasional smoking slightly increased the odds of having back pain.Conclusion: Young Canadian daily smokers are at higher risk for LBP. This study also suggests a positive correlation between smoking dose and the risk of LBP. These findings indicate that smoking behavioral modification may have an impact on reducing back pain especially among young adults.Keywords: lower back pain, smoking, Canadian Community Health Survey, sex, adult Canadian

Oral anticoagulant re-initiation following intracerebral hemorrhage in non-valvular atrial fibrillation: Global survey of the practices of neurologists, neurosurgeons and thrombosis experts

<div><p>Background</p><p>While oral anticoagulants (OACs) are highly effective for ischemic stroke prevention in atrial fibrillation, intracerebral hemorrhage (ICH) remains the most feared complication of OAC. Clinical controversy remains regarding OAC resumption and its timing for ICH survivors with atrial fibrillation because the balance between risks and benefits has not been investigated in randomized trials.</p><p>Aims/Hypothesis</p><p>To survey the practice of stroke neurologists, thrombosis experts and neurosurgeons on OAC re-initiation following OAC-associated ICH.</p><p>Methods</p><p>An online survey was distributed to members of the International Society for Thrombosis and Haemostasis, Canadian Stroke Consortium, NAVIGATE-ESUS trial investigators (Clinicatrials.gov identifier NCT02313909) and American Association of Neurological Surgeons. Demographic factors and 11 clinical scenarios were included.</p><p>Results</p><p>Two hundred twenty-eight participants from 38 countries completed the survey. Majority of participants were affiliated with academic centers, and >20% managed more than 15 OAC-associated ICH patients/year. Proportion of respondents suggesting OAC anticoagulant resumption varied from 30% (for cerebral amyloid angiopathy) to 98% (for traumatic ICH). Within this group, there was wide distribution in response for timing of resumption: 21.4% preferred to re-start OACs after 1–3 weeks of incident ICH, while 25.3% opted to start after 1–3 months. Neurosurgery respondents preferred earlier OAC resumption compared to stroke neurologists or thrombosis experts in 5 scenarios (p<0.05 by Kendall’s tau).</p><p>Conclusions</p><p>Wide variations in current practice exist among management of OAC-associated ICH, with decisions influenced by patient- and provider-related factors. As these variations likely reflect the lack of high quality evidence, randomized trials are direly needed in this population.</p></div

Cigarette smoking and chronic low back pain in the adult population

Purpose: Chronic low back pain (LBP) is one of the main causes of disability in the community. Although there have been studies suggesting an association between smoking and LBP, these studies were limited by the small numbers of patients, and they did not control for confounders. The objective of this study was to determine whether cigarette smoking is associated with an increased risk of chronic LBP among adults. Methods: Using Canadian Community Health Survey (cycle 3.1) data, 73,507 Canadians aged 20 to 59 yr were identified. Self-reported chronic LBP status, smoking habits, sex, age, height, weight, level of activity and level of education were identified as well. Back pain secondary to fibromyalgia was excluded. Multivariate logistic regression analysis was used to detect effect modification and to adjust for covariates. Design effects associated with complex survey design were taken into consideration. Results: The prevalence of chronic LBP was 23.3% in daily smokers and only 15.7% in non-smokers. Age and sex were found to be effect modifiers (P < 0.0001), and the relationship between smoking and chronic LBP risk was dependent on sex and age. The association between daily smoking and the risk of chronic LBP was stronger among younger individuals. Occasional smoking slightly increased the odds of having chronic LBP. Conclusion: Daily smoking increases the risk of LBP among young adults, and this effect seems to be dose-dependent. Back pain treatment programs may benefit from integrating smoking habit modification. Further research is required to develop effective prevention strategies

Idiopathic intracranial hypertension presenting as bilateral spontaneous lateral intrasphenoidal and transethmoidal meningoceles: a case report and review of the literature

Abstract Background Basal meningoceles are rare herniations of the meninges that tend to present unilaterally with cerebrospinal fluid rhinorrhea. Growing evidence suggests that intracranial hypertension contributes considerably to the formation of spontaneous basal meningoceles. Case presentation A 50-year-old man of Middle East ethnicity presented with a 16-week history of cerebrospinal fluid rhinorrhea, short-term memory loss, and slight decline in cognitive function. We present a case of bilateral spontaneous meningoceles with bone defects in the left lateral sphenoid sinus and right anterior cribriform plate, as well as with a remodeled sella. A neuronavigation-assisted expanded endoscopic endonasal surgery was performed to resect the meningoceles. Postoperative imaging demonstrated complete resolution of the bilateral meningoceles. Conclusions This case reports the first bilateral basal spontaneous meningoceles in the literature. Furthermore, based on this case’s imaging results and the literature reviewed, elevated intracranial pressure may be a determining factor behind the development of spontaneous meningoceles

Cost-effectiveness of direct surgery versus preoperative octreotide therapy for growth-hormone secreting pituitary adenomas

Purpose The objective of this study was to compare the cost-effectiveness of preoperative octreotide therapy followed by surgery versus the standard treatment modality for growth-hormone secreting pituitary adenomas, direct surgery (that is, surgery without preoperative treatment) from a public third-party payer perspective. Methods We developed an individual-level state-transition microsimulation model to simulate costs and outcomes associated with preoperative octreotide therapy followed by surgery and direct surgery for patients with growth-hormone secreting pituitary adenomas. Transition probabilities, utilities, and costs were estimated from recent published data and discounted by 3% annually over a lifetime time horizon. Model outcomes included lifetime costs [2020 United States (US) Dollars], quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Results Under base case assumptions, direct surgery was found to be the dominant strategy as it yielded lower costs and greater health effects (QALYs) compared to preoperative octreotide strategy in the second-order Monte Carlo microsimulation. The ICER was most sensitive to probability of remission following primary therapy and duration of preoperative octreotide therapy. Accounting for joint parameter uncertainty, direct surgery had a higher probability of demonstrating a cost-effective profile compared to preoperative octreotide treatment at 77% compared to 23%, respectively. Conclusions Using standard benchmarks for cost-effectiveness in the US ($100,000/QALY), preoperative octreotide therapy followed by surgery may not be cost-effective compared to direct surgery for patients with growth-hormone secreting pituitary adenomas but the result is highly sensitive to initial treatment failure and duration of preoperative treatment

Demographic characteristics of survey respondents.

<p>Demographic characteristics of survey respondents.</p

Choice of anticoagulant for re-initiation across thrombosis experts, stroke neurologists and neurosurgeons.

<p>Choice of anticoagulant for re-initiation across thrombosis experts, stroke neurologists and neurosurgeons.</p

Overall response from survey participants on timing of OAC re-initiation across 11 clinical scenarios.

<p>ICH, intracerebral haemorrhage; DOAC, direct oral anticoagulants; IPH, intraparenchymal haemorrhage; HTN, hypertension; CHADS2, Congestive heart failure, hypertension, age (≥75), diabetes, stroke/TIA score.</p