Frequency of food allergy in Europe:an updated systematic review and meta-analysis

Food allergy (FA) is increasingly reported in Europe, however, the latest prevalence estimates were based on studies published a decade ago. The present work provides the most updated estimates of the prevalence and trends of FA in Europe. Databases were searched for studies published between 2012 and 2021, added to studies published up to 2012. In total, 110 studies were included in this update. Most studies were graded as moderate risk of bias. Pooled lifetime and point prevalence of self-reported FA were 19.9% (95% CI 16.6–23.3) and 13.1% (95% CI 11.3–14.8), respectively. The point prevalence of sensitization based on specific IgE (slgE) was 16.6% (95% CI 12.3–20.8), skin prick test (SPT) 5.7% (95% CI 3.9–7.4), and positive food challenge 0.8% (95% CI 0.5–0.9). While lifetime prevalence of self-reported FA and food challenge positivity only slightly changed, the point prevalence of self-reported FA, sIgE and SPT positivity increased from previous estimates. This may reflect a real increase, increased awareness, increased number of foods assessed, or increased number of studies from countries with less data in the first review. Future studies require rigorous designs and implementation of standardized methodology in diagnosing FA, including use of double-blinded placebo-controlled food challenge to minimize potential biases

Prevalence estimates of eight big food allergies in Europe: Updated systematic review and meta-analysis

In 2014, the European Academy of Allergy and Clinical Immunology published prevalence estimates for food allergy (FA) and food sensitization (FS) to the so-called eight big food allergens (i.e. cow's milk, egg, wheat, soy, peanut, tree nuts, fish and shellfish) in Europe for studies published between 2000 and 2012. The current work provides 10-year updated prevalence estimates for these food allergens. A protocol was registered on PROSPERO before starting the research (reference number CRD42021266657). Six databases were searched for studies published 2012–2021, added to studies published up to 2012, resulting in a total of 93 studies. Most studies were graded as at moderate risk of bias. The overall pooled estimates for all age groups of self-reported lifetime prevalence were as follows: cow's milk (5.7%, 95% confidence interval 4.4–6.9), egg (2.4%, 1.8–3.0), wheat (1.6%, 0.9–2.3), soy (0.5%, 0.3–0.7), peanut (1.5%, 1.0–2.1), tree nuts (0.9%, 0.6–1.2), fish (1.4%, 0.8–2.0) and shellfish (0.4%, 0.3–0.6). The point prevalence of food challenge-verified allergy were as follows: cow's milk (0.3%, 0.1–0.5), egg (0.8%, 0.5–1.2), wheat (0.1%, 0.01–0.2), soy (0.3%, 0.1–0.4), peanut (0.1%, 0.0–0.2), tree nuts (0.04%, 0.02–0.1), fish (0.02%, 0.0–0.1) and shellfish (0.1%, 0.0–0.2). With some exceptions, the prevalence of allergy to common foods did not substantially change during the last decade; variations by European regions were observed

Chronic pain and sex differences:Women accept and move, while men feel blue

Purpose The aim of this study is to explore differences between male and female patients entering a rehabilitation program at a pain clinic in order to gain a greater understanding of different approaches to be used in rehabilitation. Method 1371 patients referred to a specialty pain rehabilitation clinic, completed sociodemographic and pain related questionnaires. They rated their pain acceptance (CPAQ-8), their kinesiophobia (TSK), the impact of pain in their life (MPI), anxiety and depression levels (HAD) and quality of life scales: the SF-36, LiSat-11, and the EQ-5D. Because of the large sample size of the study, the significance level was set at the p amp;lt;= .01. Results Analysis by t-test showed that when both sexes experience the same pain severity, women report significantly higher activity level, pain acceptance and social support while men report higher kinesiophobia, mood disturbances and lower activity level. Conclusion Pain acceptance (CPAQ-8) and kinesiophobia (TSK) showed the clearest differences between men and women. Pain acceptance and kinesiophobia are behaviorally defined and have the potential to be changed.Funding Agencies|Swedish Association of Local Authorities and Regions (SALAR); Vardal Foundation; RehSAM; AFA insurance, Sweden; Swedish Association for Survivors of Accident and Injury (RTP); Renee Eanders Foundation</p

Indicators for Behavioral Pain Rehabilitation. Impact and predictive value on assessment, patient selection, treatment and outcome.

Chronic musculoskeletal ‘non-specific’ pain is still highly prevalent, despite advances of the biopsychosocial model in pain care and interprofessional rehabilitation. According to national and international reports, one of the areas in need of empirical evidence and development is the selection of patients to appropriate rehabilitation programs. Pain assessment instruments are often packaged without consideration of underlying models, and this mixture can create further confusion in the field. Furthermore, the instruments used do not indicate to potentially modifiable variables, and thus clinicians are still left guessing when assessing and planning rehabilitation for patients with chronic pain. In order to improve the selection of patients to the appropriated rehabilitation program, this thesis investigates which widely used pain instruments are pragmatic and useful to identifying rehabilitation needs, provide clear guide for therapeutic actions to take in the rehabilitation program. To be clinically relevant, indicators may be also sensitive to capture differential response to treatment and have a good predictive value. The thesis describes four studies that used existing data, gathered in clinical practice, by the Swedish Quality Registry for Pain Rehabilitation (SQRP) as routine monitoring of assessment and outcome in pain rehabilitation settings. The SQRP data from one big rehabilitation clinic was analyzed using a variety of statistical techniques, including cluster analysis and general linear models. Since the SQRP made changes in the package of instruments, of packages were used, the old one (for Study I) and the new for Studies II to IV. Results based on the older data (instruments from the 1980’s and 1990’s), results showed that signs and symptoms such as pain intensity, anxiety and depression, emerged as variables that correlated with quality of life and functioning. These results were consistent with the pain models in force at that time. Signs and symptoms express a topography that is clinically linked to diagnostic considerations, and further expected to be indicators that will lead to effective treatment. These topographical (formistic) variables indicated a certain level of utility at the primary care to identify patients in need for referral. However at the rehabilitation clinic, signs, symptoms or diagnoses were not useful to find distinct groups that indicate their needs or predicted of response to rehabilitation. On the other hand, clustering the patients according to the core therapeutic processes of Pain Acceptance, from the Acceptance and Commitment Therapy (ACT) emerged as the most useful indicator for rehabilitation when investigating the new package of instruments of the SQRP. Combining the two behaviors and therapeutic processes of pain acceptance (Pain Willingness and Activity Engagement) effectively differentiated four groups with differential pattern of psychosocial status and needs and response to rehabilitation. Pain acceptance could also distinguish differences between the sexes before rehabilitation, suggesting clinical utility in terms of treatment matching and potentially developing alternative treatment modalities for each group and each sex. Finally, given the number of items in the SQRP and its burden for the individual and the organization, this study also investigated the properties of a shortened version of the Chronic Pain Acceptance Questionnaire (CPAQ) as a step towards a scientific approach to streamlining assessment procedures. The data showed that the CPAQ-8, with less than half the length of the full version, carried similar information, demonstrating good predictive value and sensitivity to track rehabilitation changes. In conclusion, this thesis presents several methods for investigating indicators that could be used to identify clinically relevant and distinct groups. The usefulness of these indicators depends upon their function and setting. The overall aim was to bring a scientific focus to assessment and triage. Although primarily pragmatic in its focus, the thesis inevitably touches upon the ‘usefulness’ of different forms of knowing and understanding in the assessment and treatment of pain. These are discussed in relation to psychological theories and their philosophical roots. SWEDISH Denna avhandling undersöker kliniskt användbara indikatorer för att gruppera patienter utifrån deras rehabiliterings-behov, och på så sätt säkra urvalsprocessen till rätt rehabiliteringsprogram samt för att kunna predicera utfall. Avhandlingen visar att det finns ett vetenskapligt grundat och pragmatiskt sätt att utföra en säker och effektiv ’triage’ inför smärt-rehabilitering med stöd av registerdata och att indikatorer kan potentiellt användas för att planera rehabiliteringsprogram för dessa distinkta grupper. Långvarig smärta är ett av de största hälsoproblemen nationellt och internationellt, såväl för individen som för vården och samhället. Utveckling och uppbyggnad av smärtvården är därför prioriterat. Ett exempel är Rehabiliteringsgarantin, en insats i miljardklass som syftar till att öka tillgängligheten till så kallad ’multimodal smärtrehabilitering’. Denna har visats ge goda resultat för somliga patienter, dock inte för alla. Utvärderingar visar att man framöver måste bli bättre på att selektera vilka patienter som kan bli hjälpta av de specificerade insatserna . Empirisk evidens och systematik i hur man bedömer och väljer patienter till olika rehabiliteringsprogram är i princip obefintlig. Smärtforskning utifrån den biopsykosociala modellen och med en beteendeterapeutisk inriktning har under de senaste 30 åren varit omfattande och har visat goda effekter av kognitiv beteendeterapi (KBT). För att förklara och förstå det multidimensionella vidden av långvarig smärta har KBT forskare ständigt utvecklat nya begrepp och det finns mer än 200 frågeformulär som skattar dessa begrepp. Traditionellt används ett batteri med flera instrument i tron att ju fler variabler som bedöms desto bättre kan patienten förstås och behandlas. Det Nationella kvalitetsregister över Smärtrehabilitering (NRS) inkluderar ett gediget batteri av frågeformulär som omfattar mer än 250 variabler som patienten fyller in före- och efter rehabilitering samt ett år efter avslutad rehabilitering. Syftet med NRS är att erbjuda ett underlag för kvalitetsförbättring och stimulera till forskning för de deltagande rehabiliteringsklinikerna. Frågeformulären kombineras av kliniker eller forskare, ofta utan större hänsyn till vilka teorier som ligger till grund för de frågor som ställs. Blandning av olika instrument som inte stämmer överens med de terapeutiska processerna i rehabiliteringen kan skapa förvirring i det kliniska sammanhanget. I beteendeinriktad rehabilitering är det först och främst individens funktion som ska bedömas och som sedan ska rehabiliteras genom beteendeförändring. Det är då inte symptom och symptomlindring som står i fokus. Indikatorer ska inte enbart identifiera en funktionsnedsättning, utan de ska även tydligt identifiera ett beteende som ska ändras, och helst också synliggöra den relaterad terapeutiska processen under rehabiliteringen. Detta är högt ställda krav och därför brukar alla i rehabteamet göra egna professionella bedömningar som därefter diskuteras i teamet. Genom att det saknas underlag för en systematisk beslutsprocess selekteras patienter med stöd av ’kvalificerade gissningar’ hos personalen (som i och för sig ofta har goda kunskaper). I syfte att säkra och systematisera bedömnings- och urvalsprocessen, utforskar denna avhandling registerdata. Två batterier av instrument från NRS används, ett äldre som användes före 2009 dels ett nyare som används sedan dess. I avhandlingen utforskas instrumentens förmåga att användas som pragmatiska och kliniskt relevanta indikatorer för smärtrehabilitering. Med hjälp av linjära statistiska modeller och klusteranalys grupperades patienter efter olika potentiella indikatorer för att testa de olika grupperingsalternativ förmågan att identifiera rehabiliteringsbehov hos patienterna i varje grupp samt gruppens respons på rehabilitering. Det äldre batteriet av instrument analyserades med Principal Component Analysis som visar att när det används variabler som tillhör äldre smärtmodeller, erhålls resultat i enlighet med dessa modeller. Resultat i Studie I framhäver att smärtintensitet, ångest och depression är viktiga variabler att använda som indikatorer och grupperingsalternativ. Dessa är redan kända riskfaktorer för ”kronifiering” av smärta och potentiellt användbara i primärvården för att identifiera patienter som är i behov av vidare remittering till andra instanser. Smärtintensitet, ångest och depression beskriver dock inte vad patienter gör eller inte gör, det vill säga deras beteende. Rehabilitering påverkar beteende och de tre variablerna är därför otillräckliga som indikatorer till rehabilitering. Att gruppera patienterna i 8 grupper genom en kombination av dessa variabler är tveksam ur kliniskt perspektiv. När det nyare batteriet av instrument undersöks förändras bilden. Smärtacceptans framträder som en pragmatisk indikator, som visar på ett beteende som kan förändras genom en tydlig och empiriskt testad terapeutisk strategi, en av processerna som ingår i Acceptance & Commitment Therapy, känd som ACT. I Studie II visas att instrumentet som skattar smärtacceptans, The Chronic Pain Acceptance Questionnaire kan kortas från 20 till 8 frågor med fortsatt bibehållna goda egenskaper för att användas både som bedömning och processinstrument for en ACT-baserad rehabilitering. Studie III påvisar hur smärtacceptansens två underliggande beteende- och terapeutiska processer; ’Öppenhet för smärta’ och ’Engagemang i aktiviteter’ kan generera fyra distinkta kluster, en grupp med höga värden i båda, en grupp med låga värden i båda och de andra två grupper med ojämnt fördelade kombinationer. Dessa grupper samvarierar i sin tur med andra variabler såsom smärta, ångest, depression, livskvalitet och funktionsmått. I studie IV, kunde även smärtacceptans identifiera kliniskt relevanta skillnader mellan könen. Tillsammans visar dessa resultat att smärtacceptans tydligt kan differentiera behov hos olika patientgrupper och kön och kan därmed stödja selektering av patienter till rätt vård och rehabilitering. Detta kan i framtiden leda till bättre utformning av anpassade och acceptansbaserade rehabiliteringsprogram utifrån varje patientgrupps behov. Avhandlingen visat att olika resultat kan erhållas, beroende på vilka instrument som inkluderas i studien och tolkningen är också beroende av instrumentets underliggande smärtmodell och kunskaper hos den som tolkar resultaten. Dessutom, indikatorer användbarhet kan vara beroende av dess funktion, bland annat var och hur de ska användas. Denna avhandling omfattar främst klinisk forskning och implementering, men diskuterar också hur olika förförståelse av smärta kan påverka klinisk och vetenskaplig praxis. Resultatet ramas in och relateras till olika psykologiska modeller utifrån filosofiska teorier

Psychometric properties of the 8-item Chronic Pain Acceptance Questionnaire (CPAQ-8) in a Swedish Chronic Pain Cohort

Background: Acceptance and Commitment Therapy for chronic pain has good empirical support. Pain acceptance is most often assessed with the Chronic Pain Acceptance Questionnaire (CPAQ). Recently a shorter 8-item version,the CPAQ-8, was developed.Objectives: To further validate the CPAQ-8 in a Swedish context and to test its sensitivity to treatment effects, an as-yet unknown property of the instrument.Methods: A total of 891 patients completed the CPAQ, along with scales for anxiety and depression (Hospital Anxiety and Depression scale), kinesiophobia (Tampa Scale for Kinesiophobia) and quality of life (Short Form-36). Confirmatoryfactor analyses were performed to examine the factor structure. Convergent validity was tested with Pearson’s correlations. Changes over time were evaluated with paired t-test.Results: The confirmatory factor analyses showed that the CPAQ 2-factor model had a better fit compared with the 1-factor model, both for the 8- and 20-item versions. All CPAQ-8 scales demonstrated good internal consistency (alpha≥ 0.80). They also correlated significantly with related constructs, supporting convergent validity. The CPAQ-8 explained a large share of the total variance in CPAQ-20 and was also able to track rehabilitation changes (large effectsize, d = 0.89).Conclusion: CPAQ-8 demonstrated good psychometric properties and sensitivity to rehabilitation changes. Further research that considers other cultural contexts may lead enhance the applications of this instrument

Psychometric properties of the 8-item Chronic Pain Acceptance Questionnaire (CPAQ-8) in a Swedish Chronic Pain Cohort

Background: Acceptance and Commitment Therapy for chronic pain has good empirical support. Pain acceptance is most often assessed with the Chronic Pain Acceptance Questionnaire (CPAQ). Recently a shorter 8-item version, the CPAQ-8, was developed. Objectives: To further validate the CPAQ-8 in a Swedish context and to test its sensitivity to treatment effects, an as-yet unknown property of the instrument. Methods: A total of 891 patients completed the CPAQ, along with scales for anxiety and depression (Hospital Anxiety and Depression scale), kinesiophobia (Tampa Scale for Kinesiophobia) and quality of life (Short Form-36). Confirmatory factor analyses were performed to examine the factor structure. Convergent validity was tested with Pearson's correlations. Changes over time were evaluated with paired t-test. Results: The confirmatory factor analyses showed that the CPAQ 2-factor model had a better fit compared with the 1-factor model, both for the 8- and 20-item versions. All CPAQ-8 scales demonstrated good internal consistency (alpha ≥ 0.80). They also correlated significantly with related constructs, supporting convergent validity. The CPAQ-8 explained a large share of the total variance in CPAQ-20 and was also able to track rehabilitation changes (large effect size, d = 0.89). Conclusion: CPAQ-8 demonstrated good psychometric properties and sensitivity to rehabilitation changes. Further research that considers other cultural contexts may lead enhance the applications of this instrument

http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-96714 Is Pain Intensity Really That Important to Assess in Chronic Pain Patients? A Study Based on the Swedish Quality Registry for Pain Rehabilitation (SQRP)

Background: Incorporating the patient’s view on care and treatment has become increasingly important for health care. Patients describe the variety of consequences of their chronic pain conditions as significant pain intensity, depression, and anxiety. We hypothesised that intensities of common symptoms in chronic pain conditions carry important information that can be used to identify clinically relevant subgroups. This study has three aims: 1) to determine the importance of different symptoms with respect to participation and ill-health; 2) to identify subgroups based on data concerning important symptoms; and 3) to determine the secondary consequences for the identified subgroups with respect to participation and health factors