Patients' treatment beliefs in low back pain: development and validation of a questionnaire in primary care

Choosing the most appropriate treatment for individual patients with low back pain (LBP) can be challenging, and clinical guidelines recommend taking into account patients' preferences. However, no tools exist to assess or compare patients' views about LBP treatments. We report the development and validation of the LBP Treatment Beliefs Questionnaire (LBP-TBQ) for use across different treatments in clinical practice and research. Using qualitative data we developed a pool of items assessing perceived credibility, effectiveness, concerns about and individual 'fit' of specific treatments. These items were included in a survey completed by 429 primary care patients with LBP, of whom 115 completed it again 1 to 2 weeks later. We performed psychometric analyses using non-parametric item response theory and classical test theory. The four subscales of the resulting 16-item LBP-TBQ showed good homogeneity (H=.46-.76), internal consistency (α =.73-.94), and stability (r=.63-.83), confirmed most convergent and discriminant validity hypotheses, and had acceptable structural validity for four guideline-recommended treatments: pain medication, exercise, manual therapy and acupuncture. Participants with stronger positive treatment beliefs were more likely to rank that treatment as their first choice, indicating good criterion validity (t values=3.11-9.80, all p<.01, except pain medication effectiveness beliefs, t(339)=1.35; p=.18). A short 4-item version also displayed good homogeneity (H=.43-.66), internal consistency (α=.70-.86), and stability (r=.82-.85), and was significantly related to treatment choice (t values=4.33-9.25, all p<.01). The LBP-TBQ can be used to assess treatment beliefs in primary care patients with LBP and to investigate the effects of treatment beliefs on treatment uptake and adherence.This is an open access article distributed under the terms of the Creative Commons Attribution-Noncommercial No Derivatives 3.0 License, which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially

Sleep duration and risk of fatal and nonfatal stroke: a prospective study and meta-analysis.

OBJECTIVE: To study the association between sleep duration and stroke incidence in a British population and to synthesize our findings with published results through a meta-analysis. METHODS: The prospective study included 9,692 stroke-free participants aged 42-81 years from the European Prospective Investigation into Cancer-Norfolk cohort. Participants reported sleep duration in 1998-2000 and 2002-2004, and all stroke cases were recorded until March 31, 2009. For the meta-analysis, we searched Ovid Medline, EMBASE, and the Cochrane Library for prospective studies published until May 2014, and pooled effect estimates using a weighted random-effect model. RESULTS: After 9.5 years of follow-up, 346 cases of stroke occurred. Long sleep was significantly associated with an increased risk of stroke (hazard ratio [HR] = 1.46 [95% confidence interval (CI) 1.08, 1.98]) after adjustment for all covariates. The association remained robust among those without preexisting diseases and those who reported sleeping well. The association for short sleep was smaller (and not statistically significant) (HR = 1.18 [95% CI 0.91, 1.53]). There was a higher stroke risk among those who reported persistently long sleep or a substantial increase in sleep duration over time, compared to those reporting persistently average sleep. These were compatible with the pooled HRs from an updated meta-analysis, which were 1.15 (1.07, 1.24) and 1.45 (1.30, 1.62) for short and long sleep duration, respectively. CONCLUSIONS: This prospective study and meta-analysis identified prolonged sleep as a potentially useful marker of increased future stroke risk in an apparently healthy aging population.The design and conduct of the EPIC-Norfolk study was supported by program grants from the Medical Research Council of the United Kingdom (grants G9502233 and G1000143) and Cancer Research UK (grants SP2024/0204 and C864/A14136). Ms. Leng is supported by Cambridge Commonwealth, European & International Trusts. Prof. Cappuccio leads the Sleep Health & Society Programme at the University of Warwick supported, in part, by the University of Warwick RDF and IAS. It has received funding by the NHS National Workforce Projects and the Economic & Social Research Council (ES/K002910/1).This is the final published version. It first appeared at http://www.neurology.org/content/early/2015/02/25/WNL.0000000000001371.short

Daytime napping and increased risk of incident respiratory diseases: symptom, marker, or risk factor?

BACKGROUND: We have identified a strong association between daytime napping and increased mortality risk from respiratory diseases, but little is known about the relationship between daytime napping and respiratory morbidity. METHODS: Data were drawn from the European Prospective Investigation into Cancer and Nutrition-Norfolk cohort. Participants reported napping habits during 1998-2000 and were followed up for respiratory disease hospital admissions until March 2009. Cox proportional hazards regression was used to examine the association between daytime napping and respiratory disease incidence risk. RESULTS: The study sample included 10,978 men and women with a mean age of 61.9 years, and a total of 946 incident respiratory disease cases were recorded. After adjustment for age, sex, social class, education, marital status, employment status, nightshift work, body mass index, physical activity, smoking, alcohol intake, self-reported general health, hypnotic drug use, habitual sleep duration, and preexisting health conditions, daytime napping was associated with an increase in the overall respiratory disease incidence risk (hazard ratio (HR) = 1.32, 95% confidence interval (CI) 1.15, 1.52 for napping <1 h; HR = 1.54, 95% CI 1.14, 2.09 for napping ≥1 h). This association was more pronounced for lower respiratory diseases, especially for the risk of chronic lower respiratory diseases (HR = 1.52, 95% CI: 1.18, 1.96 for napping <1 h; HR = 1.72, 95% CI: 1.01, 2.92 for napping ≥1 h, overall p = 0.003). CONCLUSIONS: Excessive daytime napping might be a useful marker of future respiratory disease incidence risk. Further studies are required to confirm these findings and help understand potential mechanisms.Medical Research Council (Grant IDs: G9502233, G1000143); Cancer Research UK (Grant IDs: SP2024/0204, C864/A14136)This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.sleep.2016.06.01

Daytime napping, sleep duration and serum C reactive protein: a population-based cohort study.

OBJECTIVES: To explore whether daytime napping and sleep duration are linked to serum C reactive protein (CRP), a pro-inflammatory marker, in an older aged British population. DESIGN: Cross-sectional study. SETTING: European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk study. PARTICIPANTS: A total of 5018 men and women aged 48-92 years reported their sleep habits and had serum CRP levels measured. OUTCOME AND MEASURES: CRP was measured (mg/L) during 2006-2011 in fresh blood samples using high-sensitivity methods. Participants reported napping habits during 2002-2004, and reported sleep quantity during 2006-2007. Multivariable linear regression models were used to examine the association between napping and log-transformed CRP, and geometric mean CRP levels were calculated. RESULTS: After adjustment for age and sex, those who reported napping had 10% higher CRP levels compared with those not napping. The association was attenuated but remained borderline significant (β=0.05 (95% CI 0.00 to 0.10)) after further adjustment for social class, education, marital status, body mass index, physical activity, smoking, alcohol intake, self-reported health, pre-existing diseases, systolic blood pressure, hypnotic drug use, depression and in women-only hormone replacement therapy use. The geometric means (95% CI) of CRP levels were 2.38 (2.29 to 2.47) mg/L and 2.26 (2.21 to 2.32) mg/L for those who reported napping and no napping, respectively. A U-shaped association was observed between time spent in bed at night and CRP levels, and nighttime sleep duration was not associated with serum CRP levels. The association between napping and CRP was stronger for older participants, and among extremes of time spent in bed at night. CONCLUSIONS: Daytime napping was associated with increased CRP levels in an older aged British population. Further studies are needed to determine whether daytime napping is a cause for systemic inflammation, or if it is a symptom or consequence of underlying health problems.The design and conduct of the EPIC-Norfolk study and collection and management of the data was supported by programme grants from the Medical Research Council UK (G9502233, G0300128) and Cancer Research UK (C865/A2883). YL is supported by the Cambridge Overseas Trust. FPC leads the Sleep Health & Society Programme at the University of Warwick supported, in part, by the University of Warwick RDF and IAS. It has received funding by the NHS National Workforce Projects and the Economic & Social Research Council (ES/K002910/1).This is the final version. It was first published by BMJ Group at http://bmjopen.bmj.com/content/4/11/e006071.full

Daytime napping and the risk of all-cause and cause-specific mortality: a 13-year follow-up of a British population.

Epidemiologic studies have reported conflicting results on the relationship between daytime napping and mortality risk, and there are few data on the potential association in the British population. We investigated the associations between daytime napping and all-cause or cause-specific mortality in the European Prospective Investigation Into Cancer-Norfolk study, a British population-based cohort study. Among the 16,374 men and women who answered questions on napping habits between 1998 and 2000, a total of 3,251 died during the 13-year follow-up. Daytime napping was associated with an increased risk of all-cause mortality (for napping less than 1 hour per day on average, hazard ratio = 1.14, 95% confidence interval: 1.02, 1.27; for napping 1 hour or longer per day on average, hazard ratio = 1.32, 95% confidence interval: 1.04, 1.68), independent of age, sex, social class, educational level, marital status, employment status, body mass index, physical activity level, smoking status, alcohol intake, depression, self-reported general health, use of hypnotic drugs or other medications, time spent in bed at night, and presence of preexisting health conditions. This association was more pronounced for death from respiratory diseases (for napping less than 1 hour, hazard ratio = 1.40, 95% confidence interval: 0.95, 2.05; for napping 1 hour or more, hazard ratio = 2.56, 95% confidence interval: 1.34, 4.86) and in individuals 65 years of age or younger. Excessive daytime napping might be a useful marker of underlying health risk, particularly of respiratory problems, especially among those 65 years of age or younger. Further research is required to clarify the nature of the observed association.The funding sources did not have a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript

Sex differences in the association between area deprivation and generalised anxiety disorder: British population study

OBJECTIVE Studies have shown that area-level deprivation measured by factors, such as, non-home ownership, non-car ownership, and household overcrowding, can increase the risk for mental disorders over and above individual-level circumstances, such as, education and social class. Whether area-level deprivation is associated with generalised anxiety disorder independent of personal circumstances, and whether this association is different between British women and men is unknown. DESIGN Large, population study. SETTING UK population-based cohort. PARTICIPANTS 30,445 people from the general population aged 40 years and older and living in England consented to participate at study baseline, and of these, 21,000 participants completed a structured health and lifestyle questionnaire used to capture generalised anxiety disorder. Area deprivation was measured in 1991 using Census data, and generalised anxiety disorder was assessed in 1996-2000. 10,275 women and 8,219 men had complete data on all covariates. MAIN OUTCOME MEASURE Past-year generalised anxiety disorder defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). RESULTS In this study, 2.5% (261/10,275) of women and 1.8% (145/8,219) of men had generalised anxiety disorder. Women living in the most deprived areas were over 60% more likely to develop anxiety than those living in areas that were not deprived (OR=1.63, 95%CI: 1.21 to 2.21; p=0.001), but this association between deprivation and generalised anxiety disorder was not apparent in men (OR=1.13, 95% CI: 0.72 to 1.77; p=0.598). CONCLUSION The absolute numbers of people living in deprived conditions are large worldwide. This, combined with a growing mental health burden means that the findings obtained in this study remain highly relevant. The World Health Organisation has emphasised the need to reduce social and health inequalities. Our findings provide a strong evidence base to this call, showing that the environment needs to be taken into account when developing mental health policy; gender is clearly an important factor when it comes to assessing the impacts of the environment, and promoting good mental health.This work was supported by the Medical Research Council UK (grant number G9502233) and Cancer Research UK (grant number SP2024- 0201 and SP2024-0204)

Characterization and applications of a Crimean-Congo hemorrhagic fever virus nucleoprotein-specific Affimer: Inhibitory effects in viral replication and development of colorimetric diagnostic tests

Crimean-Congo hemorrhagic fever orthonairovirus (CCHFV) is one of the most widespread medically important arboviruses, causing human infections that result in mortality rates of up to 60%. We describe the selection of a high-affinity small protein (Affimer-NP) that binds specifically to the nucleoprotein (NP) of CCHFV. We demonstrate the interference of Affimer-NP in the RNA-binding function of CCHFV NP using fluorescence anisotropy, and its inhibitory effects on CCHFV gene expression in mammalian cells using a mini-genome system. Solution of the crystallographic structure of the complex formed by these two molecules at 2.84 Å resolution revealed the structural basis for this interference, with the Affimer-NP binding site positioned at the critical NP oligomerization interface. Finally, we validate the in vitro application of Affimer-NP for the development of enzyme-linked immunosorbent and lateral flow assays, presenting the first published point-of-care format test able to detect recombinant CCHFV NP in spiked human and animal sera

Development of a multiplex microsphere immunoassay for the detection of antibodies against highly pathogenic viruses in human and animal serum samples

Surveillance of highly pathogenic viruses circulating in both human and animal populations is crucial to unveil endemic infections and potential zoonotic reservoirs. Monitoring the burden of disease by serological assay could be used as an early warning system for imminent outbreaks as an increased seroprevalance often precedes larger outbreaks. However, the multitude of highly pathogenic viruses necessitates the need to identify specific antibodies against several targets from both humans as well as from potential reservoir animals such as bats. In order to address this, we have developed a broadly reactive multiplex microsphere immunoassay (MMIA) for the detection of antibodies against several highly pathogenic viruses from both humans and animals. To this aim, nucleoproteins (NP) of Ebola virus (EBOV), Marburg virus (MARV) and nucleocapsid proteins (NP) of Crimean-Congo haemorrhagic fever virus, Rift Valley fever virus and Dobrava-Belgrade hantavirus were employed in a 5-plex assay for IgG detection. After optimisation, specific binding to each respective NP was shown by testing sera from humans and non-human primates with known infection status. The usefulness of our assay for serosurveillance was shown by determining the immune response against the NP antigens in a panel of 129 human serum samples collected in Guinea between 2011 and 2012 in comparison to a panel of 88 sera from the German blood bank. We found good agreement between our MMIA and commercial or in-house reference methods by ELISA or IIFT with statistically significant higher binding to both EBOV NP and MARV NP coupled microspheres in the Guinea panel. Finally, the MMIA was successfully adapted to detect antibodies from bats that had been inoculated with EBOV- and MARV- virus-like particles, highlighting the versatility of this technique and potentially enabling the monitoring of wildlife as well as human populations with this assay. We were thus able to develop and validate a sensitive and broadly reactive high-throughput serological assay which could be used as a screening tool to detect antibodies against several highly pathogenic viruses

Bio-psychosocial determinants of cardiovascular disease in a rural population on Crete, Greece: formulating a hypothesis and designing the SPILI-III study

Background: In 1988, the SPILI project was established in order to evaluate the cardiovascular disease (CVD) risk profile of the inhabitants of Spili, in rural Crete, Greece. The first reports from this project revealed that against the unfavourable risk factors’ profile observed, only a few men with a previous myocardial infarction were encountered. A follow-up study (SPILI II) was performed twelve years after the initial examination, and the unfavourable cardiovascular risk profile was re-confirmed. Presentation of the Hypothesis: This paper presents a hypothesis formulated on the basis of previous research to investigate if dynamic psycho-social determinants, including social coherence of the local community, religiosity and spirituality, are protective against the development of coronary heart disease in a well-defined population. Testing the Hypothesis: A follow-up examination of this Cretan cohort is currently being performed to assess the link between psychosocial factors and CVD. Psychosocial factors including sense of control, religiosity and spirituality are assessed in together with conventional CVD risk factors. Smoking and alcohol consumption, as well as dietary habits and activity levels are recorded. Oxidative stress and inflammatory markers, as well as ultrasound measurement of carotid intima media thickness, a preclinical marker of atherosclerosis, will also be measured. Implications of the hypothesis tested: The issue of the cardio-protective effect of psycho-social factors would be revisited based on the results of this Cretan cohort; nevertheless, further research is needed across different subpopulations in order to establish a definite relationship. A comprehensive approach based on the aspects of biosocial life may result in more accurate CVD risk management