The prevalence and management of chronic pain in the Chinese population: findings from the China Pain Health Index (2020).

BACKGROUND: Chronic pain is a common disease; about 20% of people worldwide suffer from it. While compared with the research on the prevalence and management of chronic pain in developed countries, there is a relative lack of research in this field in China. This research aims to construct the China Pain Health Index (CPHI) to evaluate the current status of the prevalence and management of chronic pain in the Chinese population. METHODS: The dimensions and indicators of CPHI were determined through literature review, Delphi method, and analytical hierarchy process model, and the original values ​​of relevant indicators were obtained by collecting multi-source data. National and sub-provincial scores of CPHI (2020) were calculated by co-directional transformation, standardization, percentage transformation of the aggregate, and weighted summation. RESULTS: The highest CPHI score in 2020 is Beijing, and the lowest is Tibet. The top five provinces are Beijing (67.64 points), Shanghai (67.04 points), Zhejiang (65.74 points), Shandong (61.16 points), and Tianjin (59.99 points). The last five provinces are Tibet (33.10 points), Ningxia (37.24 points), Guizhou (39.85 points), Xinjiang (39.92 points), and Hainan (40.38 points). The prevalence of chronic pain is severe in Heilongjiang, Chongqing, Guizhou, Sichuan, and Fujian. Guizhou, Hainan, Xinjiang, Beijing, and Guangdong display a high burden of chronic pain. The five provinces of Guangdong, Shanghai, Beijing, Jiangsu, and Zhejiang have better treatment for chronic pain, while Tibet, Qinghai, Jilin, Ningxia, and Xinjiang have a lower quality of treatment. Beijing, Shanghai, Qinghai, Guangxi, and Hunan have relatively good development of chronic pain disciplines, while Tibet, Sichuan, Inner Mongolia, Hebei, and Guizhou are relatively poor. CONCLUSION: The economically developed provinces in China have higher CPHI scores, while economically underdeveloped areas have lower scores. The current pain diagnosis and treatment situation in economically developed regions is relatively good, while that in financially underdeveloped areas is rather poor. According to the variations in the prevalence and management of chronic pain among populations in different provinces in China, it is necessary to implement chronic pain intervention measures adapted to local conditions.

Trends of self-reported non-adherence among type 2 diabetes medication users in the United States across three years using the self-reported Medication Adherence Reasons Scale.

BACKGROUND & AIMS: To determine the trends of self-reported non-adherence rates among adults taking Type 2 medicines (T2D) medicines between 2017 and 2019 and to identify the patterns for the frequently reported reasons for non-adherence in the United States. METHODS & RESULTS: Data from the National Health and Wellness Survey, a self-administered, internet-based cross-sectional survey of US adults from 2017 to 2019 was used. Non-adherence was measured using the self-reported Medication Adherence Reasons Scale (MAR-Scale). Frequencies were used to identify the reasons for non-adherence for insulin and non-insulin therapies for T2D. Data were obtained from 2983 respondents in 2017, 5416 in 2018, and 5268 in 2019. Based on the MAR-Scale, the self-reported medication non-adherence rate was 25% in 2017, 21% in 2018, and 27% in 2019. The most common reason for non-adherence across all the three years was simple forgetfulness, yet patients reported the lowest mean number of days missing medication for that reason. Though less frequently reported, non-adherence lasted longer when patient did not know how to take their medicines, cost was a reason, or had concerns about the long term effects of the medicines. CONCLUSIONS: With no significant improvement in adherence with T2D medicines over time, regardless of better awareness and extensive diabetes education, focus should be on individualized non-adherence reasons-based interventions.

Health-related characteristics and unmet needs of men with erectile dysfunction: a survey in five European countries.

INTRODUCTION: Data suggest that ED is still an underdiagnosed and undertreated condition. In addition, it seems that men with ED are unsatisfied about their relationship with their physician and with the available drugs. AIM: The study aims to identify health-related characteristics and unmet needs of patients suffering from erectile dysfunction (ED) in big 5 European Union (EU) nations (France, Germany, Italy, Spain, and UK). METHODS: Data were collected from the 2011 5EU National Health and Wellness-Survey on a population of 28,511 adult men (mean age: 47.18; SD 16.07) and was focused on men (5,184) who self-reported ED in the past 6 months. In addition, the quality of life (QoL) and work productivity/activity were explored. MAIN OUTCOME MEASURES: Health-related QoL (HRQoL) and work productivity were measured with SF-12v2 and WPAI validated psychometric tools. RESULTS: One in every 20 young men (age 18-39) across 5EU experienced ED in the past 6 months. About half of men (2,702/5,184; [52%]) with ED across all ages did not discuss their condition with their physician. Interestingly, among those men who did discuss their condition with their physician, 68% (1,668/2,465) do not currently use medication. These findings were more evident in the age group of 18-39 years. Only 48% (2,465/5,184) had a closer relationship with their physician, suggesting that this quality of relationship may be unsatisfactory. Compared with controls, ED patients have a significantly higher intrapsychic and relational psychopathological comorbid burden and relevant decreasing in HRQoL, with a significantly higher impairment on work productivity/activity. CONCLUSION: Data suggest that there is a need for a new therapeutic paradigm in ED treatment which images the achievement of a new alliance between physician and patient. Hence, alternative drug delivery strategies may reduce the psychological and social impact of this disease.

Using the Medication Adherence Reasons Scale (MAR-Scale) in asthma and chronic obstructive pulmonary disease to determine the extent and identify the reasons for non-adherence.

INTRODUCTION: Adherence to medications for asthma and COPD can reduce exacerbation rates, decrease healthcare costs, and improve health-related quality of life. In spite of the advantages to treatment adherence, individuals with asthma and COPD often fail to take medicines as prescribed. The objectives of this study were to determine the extent of non-adherence with asthma and COPD medicines and to describe the reasons for non-adherence in these conditions. MATERIALS AND METHODS: Data from the National Health and Wellness Study (NHWS), a self-administered, annual, internet-based cross-sectional survey of US adults from 2018 was used. NHWS participants who self-reported taking daily prescription medication(s) to treat asthma and COPD responded to the 19 reasons for non-adherence and one global item in the Medication Adherence Reasons Scale (MAR-Scale). Frequencies were used to identify the reasons for non-adherence. RESULTS: The non-adherence rate in asthma (N = 2810) was 38.4% and 28.4% in COPD (N = 1632). For both conditions, "simply missing the medicine" was the most common cause of non-adherence. Additionally, for both conditions, there was a difference between the non-adherence reason reported by more individuals and the reason for which the medicine was missed for the most number of days. CONCLUSION: The MAR-Scale identified the most frequent reasons for non-adherence with asthma and COPD in a nationwide sample in the US. The MAR-Scale can be used as a tool in a clinic setting or at a population level to measure the extent and the reasons for non-adherence.

Adult Obesity and Health-Related Quality of Life, Patient Activation, Work Productivity, and Weight Loss Behaviors in the United States.

INTRODUCTION: While it is generally believed that people living with more severe obesity experience greater negative impacts on health-related quality of life (HRQoL), their experience may be impacted by other factors such as age, gender, and type 2 diabetes mellitus (T2DM). METHODS: The 36-Item Short Form Health Survey physical component score and mental component score, Work Productivity and Activity Impairment, and Patient Activation Measure® data from the 2018 National Health and Wellness Survey were analyzed in adults by body mass index (BMI) categories (normal weight: ≥18.5-<25kg/m2, overweight: ≥25-<30kg/m2, class 1 obesity: ≥30-<35kg/m2, class 2 obesity: ≥35-<40kg/m2, class 3 obesity: ≥40kg/m2, combined class 2/3 obesity: ≥35kg/m2). Findings were further stratified across age groups (young: 18-35y, middle-aged: 36-64y, older: ≥65y), by gender, and by T2DM status. RESULTS: Overall, as BMI increased people had greater negative effects on HRQoL, felt less involved with and in control of their healthcare, and had greater work productivity and activity impairments. The largest declines were generally observed between class 2 and 3 obesity categories. Young adults with obesity were more likely to feel less engaged with their health care than middle-aged/older adults with obesity. The effects of obesity on HRQoL and patient activation were generally consistent by gender. People with T2DM and obesity tended to have greater declines in physical functioning and more work and activity impairments than people with obesity without T2DM. The proportion of people trying to lose weight increased with increasing BMI category, and people with T2DM were less likely to exercise and more likely to diet than those without T2DM. CONCLUSION: Increasing levels of obesity tended to have a greater negative impact on HRQoL, patient activation, work productivity, and weight loss behaviors, but some differences in effects by age, gender, and T2DM status were observed.

Using the Medication Adherence Reasons Scale (MAR-Scale) to identify the reasons for non-adherence across multiple disease conditions.

Purpose: With more than 50% of the individuals on chronic conditions not taking medicines as prescribed, it is essential for health care providers to understand the reasons, so that adherence-related conversations can be initiated and focused appropriately. Measuring medication non-adherence is complex, because patients are often on multiple medications and take them via various modes of administration such as orally, by injection, or topically, and at various frequencies such as daily or weekly. The Medication Adherence Reasons Scale (MAR-Scale) is a twenty-item, self-reported, comprehensive scale developed to measure two aspects of medication non-adherence: the extent or frequency of non-adherence and reasons for non-adherence. The objective of this study was to identify the top reasons, in 17 distinct chronic disease conditions, reported by patients for being non-adherent across various modes and frequencies of the corresponding medications. Internal reliability of the MAR-Scale was also assessed in each condition. Patients and methods: Results were derived from Kantar Health's US 2017 National Health and Wellness Survey (NHWS), a self-administered, annual, Internet-based cross-sectional survey of 75,000 adults (≥18 years). The survey sample was drawn from an Internet panel and was stratified according to age, gender, and ethnicity in order to represent the US adult population based on the US Census Bureau. Respondents to the 2017 NHWS who self-reported taking prescription medication(s) to treat one of the 17 conditions were invited to complete the MAR-Scale in a follow-up online survey, reporting on reasons for non-adherence in the past 7 days (daily medications) or four weeks (weekly), with non-adherence defined as any reported non-adherence in the corresponding timeframe for medicines taken orally, by injection, and topically. Results: MAR-Scale data were obtained from 15,672 respondents in one or more conditions, modes, and frequencies. MAR-Scale reliability ranged from Cronbach's alpha of 0.861 in multiple sclerosis to 0.973 in psoriasis. For daily orals, non-adherence ranged from 25.2% in diabetes to 63.7% in eczema. The most common reasons across conditions were "simply missed it," "side effects," and "concern about long-term effects." Conclusion: The MAR-Scale demonstrates acceptable reliability in multiple chronic disease conditions and across modes and frequencies of administration.