Prognosis and course of work-participation in patients with chronic non-specific low back pain: a 12-month follow-up cohort study

AbstractOBJECTIVE:To investigate the clinical course of, and prognostic factors for, work-participation in patients with chronic non-specific low back pain.METHODS:A total of 1,608 patients with chronic non-specific low back pain received a multidisciplinary therapy and were evaluated at baseline and 2-, 5- and 12-month follow-ups. Recovery was defined as absolute recovery if the patient worked 90% of his contract hours at follow-up. Potential factors were identified using multivariable logistic regression analysis.RESULTS:Patients reported a mean increase in work-participation from 38% at baseline to 82% after 12 months. Prognostic factors for ≥ 90% work-participation at 5 months were being married (odds ratio (OR) 1.72 (95% confidence interval (95% CI) 1.12-2.65)), male (OR 1.99 (95% CI 1.24-3.20)), a higher score on disability (OR 1.00 (95% CI 0.997-1.02)) and physical component scale (Short-Form 36 (SF-36)) (OR 1.05 (95% CI 1.02-1.07)), previous rehabilitation (OR 1.85 (95% CI 1.14-2.98)), not receiving sickness benefits (OR 0.52 (95% CI 0.24-1.10)) and more work-participation (OR 4.86 (95% CI 2.35-10.04)). More work-participation (OR 5.22 (95% CI 3.47-7.85)) and male sex (OR 1.79 (95% CI 1.25-2.55)) were also prognostic factors at 12-month follow-up.CONCLUSION:At 12 months 52% of patients reported ≥ 90% work-participation. The strongest prognostic factor was more work-participation at baseline for the recovery of chronic non-specific low back pai

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Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study.

BACKGROUND: To establish mortality rates, causes of death, and determinants of mortality in children with end-stage renal disease (ESRD), we performed a national long-term follow up study. METHODS: Mortality rate was determined in all Dutch patients with onset of ESRD at ages 0 to 14 years in the period between 1972 and 1992. Causes of death and mortality determinants were investigated in all patients of this cohort who were born before 1979. Data were derived from the Dutch Registry for patients on renal replacement therapy (RRT), medical charts and National Health Database. RESULTS: Of all 381 patients 85 had died. The overall mortality rate (MR) was 1.57/100 patient-years, and the standardized mortality rate (SMR) was 31.0. The MR for patients 0 to 5 and 6 to 10 years old at onset of ESRD decreased from, respectively, 7.0 (range 0-14.9) to 3.9 (1.2-6.7) and 4.3 (1.1-7.5) to 1.6 (0.3-2.8) between the periods 1972-1981 and 1982-1992. The mortality hazard ratio of relatively long standing dialysis and of long standing hypertension were, respectively, 7.2 (4.4-11.8) and 3.1 (2.1-4.6), of cyclosporine-introduction in transplanted patients 0.3 (0.1-0.4). Overall cerebrovascular accidents (24%) and infections (21%) were the most common causes of death; after 10 years of RRT cardiac death (7/21) was most prevalent. Cardiovascular death was most prominent in dialysis as well as transplanted patients. CONCLUSION: Survival in children with ESRD has increased over the last 20 years, but the SMR remains high. Early transplantation and a more vigorous approach toward hypertension and infection may be mandatory in order to further reduce mortality

The Role of Migration and Acculturation in Moderating Risk of Schizophrenia: An Australian Case-Control Study

Background: Compared to Native Born (NB) populations, elevated rates of schizophrenia have been identified in the First-Generation Migrants (FGMs) and Second-Generation Migrants (SGMs) of numerous countries (‘the migration effect’). However, recent data suggest that FGMs have a reduced risk of psychotic illness in Australia. Methods: Study 1 utilised data from the Australian Schizophrenia Research Bank (ASRB) (N= 1528, cases N=714) and Study 2 consisted of 217 participants recruited from the ASRB (cases N=103). Bivariate and multivariate logistic regression models were employed to examine the effects of migrant status and other psychosocial factors on risk of schizophrenia (expressed as odds ratios (OR)). Results: Overall, FGM status was associated with a significantly reduced relative-risk of schizophrenia compared to NB participants (Study 1 OR = 0.53, p0.05). These effects were moderated by cannabis abuse as well as childhood adversity, which were found to strongly predict schizophrenia in Study 1. Experiences of discrimination increased the odds of schizophrenia in Study 2 (OR=1.27, p<0.05), however this effect was rendered non-significant when substance abuse history was taken into account. Study 2 also found that having a negative affiliation towards mainstream Australian culture and a Marginalised acculturation style more than doubled risk of schizophrenia in the overall sample ((OR = 2.12 and OR = 2.67, p<0.05, respectively) but reduced risks for FGMs who more often had a Separated Identity style. Conclusions: The normalisation of risk for SGMs may be attributed to comparative levels of childhood adversity and substance use compared to NBs, coupled with the deleterious effects of being treated as an subordinate position in one’s own country of birth. Conclusions are discussed in relation to sociodevelopmental model of schizophrenia