Association Between Self-Reported Spinal Morning Stiffness and Radiographic Evidence of Lumbar Disk Degeneration in Participants of the Cohort Hip and Cohort Knee (CHECK) Study

BACKGROUND: Low back pain (LBP) is very common and is a main cause of limited activity and work absence. Patients with LBP may also report spinal morning stiffness; this symptom could be useful for identifying subgroups with signs and symptoms related to spinal osteoarthritis. OBJECTIVE: This study investigated whether an association exists between reported spinal morning stiffness and radiographic evidence of lumbar disk degeneration (LDD) in people with LBP and a history of pain of the hip and/or knee. DESIGN: This cross-sectional study used 8-year follow-up data from the Cohort Hip and Coh

The Association Between Self-reported Low Back Pain and Radiographic Lumbar Disc Degeneration of the Cohort Hip and Cohort Knee (CHECK) Study

Abstract Study design. Cross-sectional study, nested in a prospective cohort (Cohort Hip and Knee, CHECK). Objective.Low back pain (LBP) is very common and the main cause of activity limitations and work absence throughout the world. Although lumbar disc degeneration (LDD) is suggested as a cause of LBP, this association remains debatable. Therefore, this study assessed the association between the radiographic features of LDD and the presence of self-reported LBP, LBP persisting longer than three months, the perceived severity of LBP and presence of neuropathic pain. Summary of Background Data. Previous literature suggest an association between LBP and both the LDD definitions osteophytes and disc space narrowing. There are no studies that have explored the association between LDD and neuropathic pain. Methods. Associations between the radiographic LDD using two definitions (i.e. osteophytes, disc space narrowing) versus the presence of LBP, LBP > 3 months, severe LBP and neuropathic pain,were analyzed with logistic regression models. Results. A total of 699 participantscompleted the questionnaire and had a lumbar radiograph. Radiographs were scored by two independent observers. Osteophytes were present in 98% of the population and disc space narrowing in 67%. Osteophytes were not significantly associated with LBP (OR=1.2, 95% CI 0.9-1.7).Disc space narrowing was significantly associated with the presence of LBP and neuropathic pain.(OR=1.7, 95% CI=1.2-2.4 and OR 1.7, 95% CI 1.1-2.7, respectively). The presence of a LBPseverity score of ≥4, and LBP persisting >3 months were not significantly associated with the two definitions of LDD. Conclusions.This study shows the presence of an association between disc space narrowing, whereas no association was found between osteophytes and LBP. We are the first t

A global research priority agenda to advance public health responses to fatty liver disease

Background & aims An estimated 38% of adults worldwide have non-alcoholic fatty liver disease (NAFLD). From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised fatty liver disease research agenda for the global health community. Methods Nine co-chairs drafted initial research priorities, subsequently reviewed by 40 core authors and debated during a three-day in-person meeting. Following a Delphi methodology, over two rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. The core group revised the draft priorities between rounds. In R2, panellists also ranked the priorities within six domains: epidemiology, models of care, treatment and care, education and awareness, patient and community perspectives, and leadership and public health policy. Results The consensus-built fatty liver disease research agenda encompasses 28 priorities. The mean percentage of ‘agree’ responses increased from 78.3 in R1 to 81.1 in R2. Five priorities received unanimous combined agreement (‘agree’ + ‘somewhat agree’); the remaining 23 priorities had >90% combined agreement. While all but one of the priorities exhibited at least a super-majority of agreement (>66.7% ‘agree’), 13 priorities had 90% combined agreement. Conclusions Adopting this multidisciplinary consensus-built research priorities agenda can deliver a step-change in addressing fatty liver disease, mitigating against its individual and societal harms and proactively altering its natural history through prevention, identification, treatment, and care. This agenda should catalyse the global health community’s efforts to advance and accelerate responses to this widespread and fast-growing public health threat. Impact and implications An estimated 38% of adults and 13% of children and adolescents worldwide have fatty liver disease, making it the most prevalent liver disease in history. Despite substantial scientific progress in the past three decades, the burden continues to grow, with an urgent need to advance understanding of how to prevent, manage, and treat the disease. Through a global consensus process, a multidisciplinary group agreed on 28 research priorities covering a broad range of themes, from disease burden, treatment, and health system responses to awareness and policy. The findings have relevance for clinical and non-clinical researchers as well as funders working on fatty liver disease and non-communicable diseases more broadly, setting out a prioritised, ranked research agenda for turning the tide on this fast-growing public health threat

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3�6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55 of the global rise in mean BMI from 1985 to 2017�and more than 80 in some low- and middle-income regions�was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing�and in some countries reversal�of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories. © 2019, The Author(s)