Psychological distress among people with probable COVID-19 infection: analysis of the UK Household Longitudinal Study

Studies exploring the longer-term effects of experiencing coronavirus disease-2019 (COVID-19) on mental health are lacking. We explored the relationship between reporting probable COVID-19 symptoms in April 2020 and psychological distress (measured using the General Health Questionnaire) 1, 2, 3, 5 and 7 months later. Data were taken from the UK Household Longitudinal Study, a nationally representative household panel survey of UK adults. Elevated levels of psychological distress were found up to 7 months after probable COVID-19, compared with participants with no likely infection. Associations were stronger among younger age groups and men. Further research into the psychological sequalae of COVID-19 is urgently needed

Novel Approach to Estimate Osteoarthritis Progression:Use of the Reliable Change Index in the Evaluation of Joint Space Loss

OBJECTIVE: Osteoarthritis-related changes in joint space measurements over time are small and sensitive to measurement error. The Reliable Change Index (RCI) determines whether the magnitude of change observed in an individual can be attributed to true change. This study aimed to examine the RCI as a novel approach to estimating osteoarthritis progression.METHODS: Data were from 167 men and 392 women with knee osteoarthritis (diagnosed using the American College of Rheumatology criteria) randomized to the placebo arm of the 3-year Strontium Ranelate Efficacy in Knee Osteoarthritis trial (SEKOIA) and assessed annually. The RCI was used to determine whether the magnitude of change in joint space width (JSW) on radiographs between study years was likely to be true or due to measurement error.RESULTS: Between consecutive years, 57-69% of participants had an apparent decrease (change &lt;0) in JSW, while 31-43% of participants had annual changes indicating improvement in JSW. The RCI identified JSW decreases in only 6.0% of patients between baseline and year 1, and in 4.5% of patients between the remaining study years. The apparent increases in JSW were almost eliminated between baseline and year 1, and between years 1 and 2 only 1.3% of patients had a significant increase, dropping to 0.9% between years 2 and 3.CONCLUSION: The RCI provides a method to identify change in JSW, removing many apparent changes that are likely to be due to measurement error. This method appears to be useful for assessing change in JSW from radiographs in clinical and research settings.</p

Osteoarthritis and other long-term health conditions in former elite cricketers

Objectives This study aimed to describe the prevalence and risk of chronic conditions in former elite cricketers compared to a normal population, and describe wellbeing in former elite cricketers. Design Cross-sectional study. Methods Former elite cricketers, recruited from the Professional Cricketers’ Association, completed a self-report cross-sectional questionnaire. The English Longitudinal Study of Ageing (ELSA) served as the normal population. The prevalence of self-reported, GP-diagnosed conditions (heart problems, hyper-tension, stroke, diabetes, asthma, dementia, osteoarthritis (OA), total hip replacement (THR), total knee replacement (TKR), anxiety, depression) were reported for both population samples. Standardised mor-bidity ratios (SMRs) compared chronic conditions in sex-, age- and BMI-matched former cricketers(n = 113) and normal population (n = 4496). Results Heart problems were reported by 13.3% of former cricketers, significantly lower than the normal population, SMR 0.55 (0.33–0.91). Former cricketers reported 31.9% hypertension, 1.8% stroke, 6.2% diabetes, 15.0% asthma, and no dementia, none significantly different to the normal population. OA, THR,and TKR were reported by 51.3%, 14.7% and 10.7% of former cricketers, respectively, significantly higher than the normal population, SMRs 3.64 (2.81–4.71), 3.99 (2.21–7.20) and 3.84 (1.92–7.68). Anxiety and depression were reported by 12.4% and 8.8% of former cricketers, respectively, SMRs 3.95 (2.34–6.67)and 2.22 (1.20–4.14). 97% of former cricketers reflected they would undertake their cricket career again, 98% agreed that cricket enriched their lives. Conclusions Heart problems were significantly lower, while OA, THR, TKR, anxiety, and depression were significantly higher in the former cricketers compared to the normal population (ELSA). Most former cricketers reflected positively on their career.</p

Ethnic and social inequalities in COVID-19 outcomes in Scotland:protocol for early pandemic evaluation and enhanced surveillance of COVID-19 (EAVE II)

Introduction: Evidence from previous pandemics, and the current COVID-19 pandemic, has found that risk of infection/severity of disease is disproportionately higher for ethnic minority groups, and those in lower socioeconomic positions. It is imperative that interventions to prevent the spread of COVID-19 are targeted towards high-risk populations. We will investigate the associations between social characteristics (such as ethnicity, occupation and socioeconomic position) and COVID-19 outcomes and the extent to which characteristics/risk factors might explain observed relationships in Scotland. The primary objective of this study is to describe the epidemiology of COVID-19 by social factors. Secondary objectives are to (1) examine receipt of treatment and prevention of COVID-19 by social factors; (2) quantify ethnic/social differences in adverse COVID-19 outcomes; (3) explore potential mediators of relationships between social factors and SARS-CoV-2 infection/COVID-19 prognosis; (4) examine whether occupational COVID-19 differences differ by other social factors and (5) assess quality of ethnicity coding within National Health Service datasets. Methods and analysis: We will use a national cohort comprising the adult population of Scotland who completed the 2011 Census and were living in Scotland on 31 March 2020 (~4.3 million people). Census data will be linked to the Early Assessment of Vaccine and Anti-Viral Effectiveness II cohort consisting of primary/secondary care, laboratory data and death records. Sensitivity/specificity and positive/negative predictive values will be used to assess coding quality of ethnicity. Descriptive statistics will be used to examine differences in treatment and prevention of COVID-19. Poisson/Cox regression analyses and mediation techniques will examine ethnic and social differences, and drivers of inequalities in COVID-19. Effect modification (on additive and multiplicative scales) between key variables (such as ethnicity and occupation) will be assessed. Ethics and dissemination: Ethical approval was obtained from the National Research Ethics Committee, South East Scotland 02. We will present findings of this study at international conferences, in peer-reviewed journals and to policy-makers

The association between radiographic knee osteoarthritis and pain: an epidemiological analysis of a twenty-year community-based cohort

Background: Knee osteoarthritis (OA) is one of the leading musculoskeletal burdens in the world, causing both structural damage and pain to the joint. Radiographs are the most common imaging method for diagnosing OA, however the relationship between radiographic changes (ROA) and symptoms is not well understood. This thesis will establish the natural history of twenty-year ROA, compare diagnostic methods of ROA assessment, evaluate the cross-sectional relationship between ROA and pain, and will determine the long-term predictive validity of features of ROA with future knee replacements (TKRs). Methods: Data from the Chingford women's study, a twenty-year prospective UK-based cohort was used for the analysis. Risk factors included atlas-based ROA scoring methods and quantitative joint space width (JSW), which were analysed against pain and TKR outcome measures. A novel method for assessing joint space on low-contrast x-rays was developed which had high reproducibility and validity. Results: The twenty-year natural history of ROA showed relatively low levels of annual incidence (3.8&amp;percnt;), progression (3.6&amp;percnt;), and worsening (4.5&amp;percnt;), and emphasised the involvement of both medial and lateral osteophytes. Severe joint space narrowing (JSN) had the best construct validity with pain, while any size of lateral tibial osteophyte had good construct validity. Medial quantitative JSW had good construct validity, but no predictive validity with future TKRs. Lateral JSN and osteophytes had the best predictive validity for future TKR. Conclusion: This research demonstrates that radiographic scoring methods have strong construct and predictive validity with symptomatic knee OA. These results support the use of x-rays to identify early disease changes which indicate future joint failure.</p

The association between radiographic knee osteoarthritis and pain: an epidemiological analysis of a twenty-year community-based cohort

Background: Knee osteoarthritis (OA) is one of the leading musculoskeletal burdens in the world, causing both structural damage and pain to the joint. Radiographs are the most common imaging method for diagnosing OA, however the relationship between radiographic changes (ROA) and symptoms is not well understood. This thesis will establish the natural history of twenty-year ROA, compare diagnostic methods of ROA assessment, evaluate the cross-sectional relationship between ROA and pain, and will determine the long-term predictive validity of features of ROA with future knee replacements (TKRs). Methods: Data from the Chingford women's study, a twenty-year prospective UK-based cohort was used for the analysis. Risk factors included atlas-based ROA scoring methods and quantitative joint space width (JSW), which were analysed against pain and TKR outcome measures. A novel method for assessing joint space on low-contrast x-rays was developed which had high reproducibility and validity. Results: The twenty-year natural history of ROA showed relatively low levels of annual incidence (3.8&percnt;), progression (3.6&percnt;), and worsening (4.5&percnt;), and emphasised the involvement of both medial and lateral osteophytes. Severe joint space narrowing (JSN) had the best construct validity with pain, while any size of lateral tibial osteophyte had good construct validity. Medial quantitative JSW had good construct validity, but no predictive validity with future TKRs. Lateral JSN and osteophytes had the best predictive validity for future TKR. Conclusion: This research demonstrates that radiographic scoring methods have strong construct and predictive validity with symptomatic knee OA. These results support the use of x-rays to identify early disease changes which indicate future joint failure.</p