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OBJECTIVE: To design and validate a nomophobia scale in children aged 9-13 years. DESIGN: Cross-sectional descriptive observational study. SITE: The pilot study was carried out in December 2019 with students from a school in Ávila and another in Madrid. The field study was carried out during the months of January to March 2020, collecting data from 592 students from a school in Badajoz and 3 from Ávila. PARTICIPANTS: Students of both sexes from 4th, 5th and 6th of Primary Education and from 1st and 2nd of Compulsory Secondary Education, from public and private schools. METHOD: The study has been divided in 2 phases. PHASE I: consisted of the preparation of a 40-item questionnaire with the advice of a panel of experts. This questionnaire was passed, within the pilot study, to 312 children enrolled in Primary Education or Compulsory Secondary Education. After analyzing the results, the 40-item scale was modified to improve the understanding of the schoolchildren and a field study was carried out with 592 participants. PHASE II: consisted of an exploratory factorial analysis carried out using the principal components method, which provided the distribution of the items in 7 components. After the confirmatory factorial analysis, the final 32-item scale was defined. RESULTS: This scale was shown to produce valid and reliable scores. CONCLUSIONS: The validation of this scale will be useful to identify children at risk of nomophobia, allowing educators, parents and health professionals to detect this phenomenon early in order to prevent pathological smartphone use.
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Smartphone , Estudantes , Masculino , Feminino , Humanos , Criança , Adolescente , Estudos Transversais , Projetos Piloto , Inquéritos e QuestionáriosRESUMO
BACKGROUND: With implementation of stricter blood pressure (BP) treatment targets, potential for excessive BP lowering becomes an important issue, especially in older patients. OBJECTIVES: Assess the magnitude, indicators and detection effort of BP levels below-target-range (BTR-BP) recommended by the European hypertension guidelines in older treated hypertensive patients (130-139/70-79 mmHg). DESIGN: Cross-sectional, retrospective study (Seniors-ENRICA-2 cohort). SETTING: General population. SUBJECTS: 1,329 treated hypertensive patients aged ≥65, assessed with three home casual BP measurements and 24-hour ambulatory BP monitoring (ABPM). METHODS: Based on the European hypertension guidelines and the literature, BTR-BPs were defined as mean BP <130/70, <125/65, <130/70 and <110/55 mmHg, for casual BP, 24-hour BP, daytime BP and nighttime BP, respectively, and hypotension as <110/70, <105/65, <110/70 and <90/55 mmHg, respectively. RESULTS: Participants' mean age was 72 ± 4.4 (50.3%, women). Based on casual BP, 7.2% of patients were in target range (130-139/70-79 mmHg), 44.3% in BTR-BP (<130/70) and 20.8% hypotensive (<110/70). Some 44.9, 54.9 and 22.0% of patients were in BTR-BP for 24-hour BP, daytime BP and nighttime BP, respectively, and 11.0, 21.1 and 5.6%, respectively, were hypotensive. The number of patients needed for ABPM to detect one case of 24-hour-, daytime-, and nighttime-BTR-BP was 3, 2 and 5, respectively, and 10, 5 and 18, respectively, for detecting one hypotensive case. Cardiovascular disease and female sex were associated with both BTR-BP and hypotension, and the number of antihypertensive drugs was only associated with hypotension. CONCLUSIONS: BTR-BP levels were common in older treated patients at home and in everyday life, more frequent than many trials report, and daytime ABPM is highly size-efficient for detecting the low ambulatory BP conditions.
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Monitorização Ambulatorial da Pressão Arterial , Hipertensão , Idoso , Pressão Sanguínea/fisiologia , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Masculino , Estudos RetrospectivosRESUMO
BACKGROUND: Osteoarthritis (OA) is the most common cause of disability in the elderly. Clinical frailty is associated with high mortality, but few studies have explored the relationship between OA and frailty. The objective of this study was to consider the association between OA and frailty/pre-frailty in an elderly population comprised of six European cohorts participating in the EPOSA project. METHODS: Longitudinal study using baseline data and first follow-up waves, from EPOSA; 2,455 individuals aged 65-85 years were recruited from pre-existing population-based cohorts in Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom. Data were collected on clinical OA at any site (hand, knee or hip), based on the clinical classification criteria developed by the American College of Rheumatology (ACR). Frailty was defined according to Fried's criteria. The covariates considered were age, gender, educational level, obesity and country. We used multinomial logistic regression to analyse the associations between OA, frailty/pre-frailty and other covariates. RESULTS: The overall prevalence of clinical OA at any site was 30.4 % (95 % CI:28.6-32.2); frailty was present in 10.2 % (95 % CI:9.0-11.4) and pre-frailty in 51.0 % (95 % CI:49.0-53.0). The odds of frailty was 2.96 (95 % CI:2.11-4.16) and pre-frailty 1.54 (95 % CI:1.24-1.91) as high among OA individuals than those without OA. The association remained when Knee OA, hip OA or hand OA were considered separately, and was stronger in those with increasing number of joints. CONCLUSIONS: Clinical OA is associated with frailty and pre-frailty in older adults in European countries. This association might be considered when designing appropriate intervention strategies for OA management.
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Idoso Fragilizado , Articulação da Mão/patologia , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Itália/epidemiologia , Estudos Longitudinais , Masculino , Países Baixos/epidemiologia , Espanha/epidemiologia , Suécia/epidemiologia , Reino Unido/epidemiologiaRESUMO
BACKGROUND: poor physical performance (PP) is known to be associated with disability, lower quality of life and higher mortality rates. Knee and hip osteoarthritis (OA) might be expected to contribute to poor PP, through joint pain and restricted range of movement. Both clinical and self-reported OA are often used for large-scale community and epidemiological studies. OBJECTIVE: to examine the relationships between hip and knee OA and PP in a large data set comprising cohorts from six European countries. METHODS: a total of 2,942 men and women aged 65-85 years from the Germany, Italy, Netherlands, Spain, Sweden and the UK were recruited. Assessment included an interview and clinical assessment for OA. PP was determined from walking speed, chair rises and balance (range 0-12); low PP was defined as a score of ≤9. RESULTS: the mean (SD) age was 74.2 (5.1) years. Rates of self-reported OA were much higher than clinical OA. Advanced age, female gender, lower educational attainment, abstinence from alcohol and higher body mass index were independently associated with low PP. Clinical knee OA, hip OA or both were associated with a higher risk of low PP; OR (95% CI) 2.93 (2.36, 3.64), 3.79 (2.49, 5.76) and 7.22 (3.63, 14.38), respectively, with relationships robust to adjustment for the confounders above as well as pain. CONCLUSION: lower limb OA at the hip and knee is associated with low PP, and for clinical diagnosis relationships are robust to adjustment for pain. Those at highest risk have clinical OA at both sites.
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Nível de Saúde , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Artralgia/epidemiologia , Artralgia/fisiopatologia , Distribuição de Qui-Quadrado , Europa (Continente)/epidemiologia , Feminino , Marcha , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/epidemiologia , Exame Físico , Equilíbrio Postural , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Autorrelato , CaminhadaRESUMO
BACKGROUND: People with osteoarthritis (OA) frequently report that their joint pain is influenced by weather conditions. This study aimed to examine whether there are differences in perceived joint pain between older people with OA who reported to be weather-sensitive versus those who did not in six European countries with different climates and to identify characteristics of older persons with OA that are most predictive of perceived weather sensitivity. METHODS: Baseline data from the European Project on OSteoArthritis (EPOSA) were used. ACR classification criteria were used to determine OA. Participants with OA were asked about their perception of weather as influencing their pain. Using a two-week follow-up pain calendar, average self-reported joint pain was assessed (range: 0 (no pain)-10 (greatest pain intensity)). Linear regression analyses, logistic regression analyses and an independent t-test were used. Analyses were adjusted for several confounders. RESULTS: The majority of participants with OA (67.2%) perceived the weather as affecting their pain. Weather-sensitive participants reported more pain than non-weather-sensitive participants (M = 4.1, SD = 2.4 versus M = 3.1, SD = 2.4; p < 0.001). After adjusting for several confounding factors, the association between self-perceived weather sensitivity and joint pain remained present (B = 0.37, p = 0.03). Logistic regression analyses revealed that women and more anxious people were more likely to report weather sensitivity. Older people with OA from Southern Europe were more likely to indicate themselves as weather-sensitive persons than those from Northern Europe. CONCLUSIONS: Weather (in)stability may have a greater impact on joint structures and pain perception in people from Southern Europe. The results emphasize the importance of considering weather sensitivity in daily life of older people with OA and may help to identify weather-sensitive older people with OA.
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Osteoartrite/psicologia , Percepção da Dor , Tempo (Meteorologia) , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Analgésicos/uso terapêutico , Ansiedade/epidemiologia , Índice de Massa Corporal , Clima , Comorbidade , Uso de Medicamentos , Escolaridade , Europa (Continente) , Feminino , Humanos , Masculino , Atividade Motora , Osteoartrite/tratamento farmacológico , Osteoartrite/epidemiologia , Medição da Dor , Estudos Prospectivos , Estações do Ano , Autoeficácia , Fatores SocioeconômicosRESUMO
OBJECTIVE: To estimate the prevalence and incidence of self-reported diabetes and to study its association with medium- and long-term mortality from all causes in persons ≥ 65 years. DESIGN: A population-based cohort study begun in 1993. SETTING: "Envejecer en Leganés" cohort (Madrid). PARTICIPANTS: A random sample of persons ≥ 65 years (n=1277 in the 1993 baseline sample). METHODS: Participants were classified as having diabetes if they so reported and had consulted a physician for this reason within the last year. Diabetes history was categorized in <10 and ≥ 10 years in 1993. Incidence density was calculated in 2-year periods in non-diabetic individuals (1965 persons/2 years). Vital status was recorded on 31 December 2011. The association between diabetes history ≥ 10 years and mortality at 6 and 18 years follow-up was studied by the Kaplan-Meier and Cox regression analyses after adjusting for age, sex, heart disease and comorbidity. RESULTS: The prevalence of self-reported diabetes rose from 10.3% in 1993 to 16.1% in 1999 (p ≤ 0.001) and was higher in women than men (p ≤ 0.05). Total incidence density was 2.6 cases/100 persons/2 years (95% CI: 2.0-3.3). Medium- and long-term mortality was higher in persons with diabetes history ≥ 10 years than in non-diabetic individuals (HR: 2.0; 95% CI: 1.2-3.3 and HR: 1.7; 95% CI: 1.1-2.5, respectively). In diabetics with history <10 years the HR was 1.3 (95% CI: 0.9-1.9) and HR: 1.5 (95% CI: 1.2-1.9, respectively). CONCLUSIONS: Although diabetes is clearly associated with increased risk of mortality, it is significant only for patients with ≥ 10 years' history of diabetes.
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Diabetes Mellitus/epidemiologia , Idoso , Causas de Morte , Estudos de Coortes , Diabetes Mellitus/mortalidade , Feminino , Humanos , Incidência , Masculino , Prevalência , Fatores de TempoRESUMO
In Spain, 33% of adults aged 30 to 79 years (10 million) were hypertensive in 2019. Among them, 68% were diagnosed, 57% received drug therapy, and effective therapeutic coverage (control) reached 33%. Both diagnosis and control show geographical and social disparities. Approximately 46 000 cardiovascular deaths per year are attributable to hypertension. In recent decades, the control of hypertension has increased, due to improvements in lifestyle measures and increased use of polytherapy, coinciding with a reduction in stroke mortality. There are several modifiable determinants of the lack of hypertension control: a) white-coat phenomenon affects 22% to 33% of treated individuals, partly due to the limited availability of ambulatory blood pressure monitoring (ABPM) (49%) and self-measured BP (SMBP) (78%); b) inadequate patient adherence to medication and healthy lifestyles (weight loss, the most effective measure, is the least used, ≈40%); and c) insufficient use of polytherapy (≈55%). The remaining challenges include: a) technological aspects, such as measuring BP with more accurate techniques (ABPM, SMBP) and using cardiovascular-risk estimation tools (eg, SCORE); b) clinical challenges, such as reducing therapeutic inertia (≈59%), involving patients in their own management (medication adherence, ≈62%) and effectively implementing clinical guidelines); and c) public health challenges, such as reducing the burden of obesity (≈24%), monitoring progress with updated surveys, and setting national BP control targets.
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The impact of ambulatory resistant hypertension (ARH) on the occurrence of heart failure (HF) is not yet completely known. We performed for the first time a meta-analysis, by using published data or available data from published databases, on the risk of HF in ARH. Patients with ARH (24-h BP ≥ 130/80 mmHg during treatment with ≥3 drugs) were compared with those with controlled hypertension (CH, clinic BP < 140/90 mmHg and 24-h BP < 130/80 mmHg regardless of the number of drugs used), white coat uncontrolled resistant hypertension (WCURH, clinic BP ≥ 140/90 mmHg and 24-h BP < 130/80 mmHg in treated patients) and ambulatory nonresistant hypertension (ANRH, 24-h BP ≥ 130/80 mmHg during therapy with ≤2 drugs). We identified six studies/databases including 21,365 patients who experienced 692 HF events. When ARH was compared with CH, WCURH, or ANRH, the overall adjusted hazard ratio for HF was 2.32 (95% confidence interval (CI) 1.45-3.72), 1.72 (95% CI 1.36-2.17), and 2.11 (95% CI 1.40-3.17), respectively, (all P < 0.001). For some comparisons a moderate heterogeneity was found. Though we did not find variables that could explain the heterogeneity, sensitivity analyses demonstrated that none of the studies had a significant influential effect on the overall estimate. When we evaluated the potential presence of publication bias and small-study effect and adjusted for missing studies identified by Duval and Tweedie's method the estimates were slightly lower but remained significant. This meta-analysis shows that treated hypertensive patients with ARH are at approximately twice the risk of developing HF than other ambulatory BP phenotypes.
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Insuficiência Cardíaca , Hipertensão , Humanos , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial , Hipertensão/tratamento farmacológico , Hipertensão/complicações , Estudos Observacionais como Assunto , Fatores de RiscoRESUMO
BACKGROUND: Osteoarthritis (OA), the most common form of arthritis, is a major contributor to functional impairment and loss of independence in older persons. The European Project on OSteoArthritis (EPOSA) is a collaborative study involving six European cohort studies on ageing. This project focuses on the personal and societal burden and its determinants of osteoarthritis. This paper describes the design of the project, and presents some descriptive analyses on selected variables across countries. METHODS/DESIGN: EPOSA is an observational study including pre-harmonized data from European cohort studies (Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom) on older community-dwelling persons aged 65 to 85 years. In total, 2942 persons were included in the baseline study with a mean age of 74.2 years (SD 5.1), just over half were women (51,9%). The baseline assessment was conducted by a face-to-face interview followed by a clinical examination. Measures included physical, cognitive, psychological and social functioning, lifestyle behaviour, physical environment, wellbeing and care utilisation. The clinical examination included anthropometry, muscle strength, physical performance and OA exam. A follow-up assessment was performed 12-18 months after baseline. DISCUSSION: The EPOSA study is the first population-based study including a clinical examination of OA, using pre-harmonized data across European countries. The EPOSA study provides a unique opportunity to study the determinants and consequences of OA in general populations of older persons, including both care-seeking and non care-seeking persons.
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Efeitos Psicossociais da Doença , Osteoartrite/diagnóstico , Osteoartrite/epidemiologia , Medição da Dor/métodos , Vigilância da População/métodos , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Alemanha/epidemiologia , Humanos , Itália/epidemiologia , Masculino , Países Baixos/epidemiologia , Osteoartrite/psicologia , Medição da Dor/psicologia , Espanha/epidemiologia , Suécia/epidemiologia , Reino Unido/epidemiologiaRESUMO
BACKGROUND: The European Project on OSteoArthritis (EPOSA), here presented for the first time, is a collaborative study involving five European cohort studies on aging. This project focuses on the personal and societal burden and its determinants of osteoarthritis (OA). The aim of the current report is to describe the purpose of the project, the post harmonization of the cross-national data and methodological challenges related to the harmonization process METHODS: The study includes data from cohort studies in five European countries (Germany, Italy, the Netherlands, Spain and the United Kingdom) on older community-dwelling persons aged ≥ 59 years. The study design and main characteristics of the five cohort studies are described. Post harmonization algorithms are developed by finding a "common denominator" to merge the datasets and weights are calculated to adjust for differences in age and sex distribution across the datasets. RESULTS: A harmonized database was developed, consisting of merged data from all participating countries. In total, 10107 persons are included in the harmonized dataset with a mean age of 72.8 years (SD 6.1). The female/male ratio is 53.3/46.7%. Some variables were difficult to harmonize due to differences in wording and categories, differences in classifications and absence of data in some countries. The post harmonization algorithms are described in detail in harmonization guidelines attached to this paper. CONCLUSIONS: There was little evidence of agreement on the use of several core data collection instruments, in particular on the measurement of OA. The heterogeneity of OA definitions hampers comparing prevalence rates of OA, but other research questions can be investigated using high quality harmonized data. By publishing the harmonization guidelines, insight is given into (the interpretation of) all post harmonized data of the EPOSA study.
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Envelhecimento , Bases de Dados Factuais/normas , Osteoartrite/epidemiologia , Distribuição por Idade , Idoso , Algoritmos , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Distribuição por SexoRESUMO
OBJECTIVES: Unlike the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guideline, the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline has recommended a shift in hypertension definition from blood pressure (BP) 140/90-130/80âmmHg. Further, they proposed somewhat different indications for antihypertensive medication. No data are available on the comprehensive impact of these guidelines in European countries, where physicians do not always follow guidelines from their own continent. We estimated the prevalence of hypertension, recommendations for antihypertensive medication, and cardiometabolic goals achieved in Spain using the ESC/ESH versus ACC/AHA guidelines. METHODS: We analyzed data from a national survey on 12074 individuals representative of the population aged at least 18 years in Spain. BP was measured with standardized procedures. RESULTS: According to the ESC/ESH and ACC/AHA guidelines, hypertension prevalence was 33.1% (95% confidence interval: 32.2-33.9%) and 46.9% (46.0-47.8%), respectively, and antihypertensive medication was recommended for 33.5% (32.7-34.3%) and 37.2% (36.3-38.1%) of adults, respectively. This represents 5.3 more million hypertensive patients and 1.4 more million candidates for medication (for a 40-million-adults' country) using the ACC/AHA versus the ESC/ESH guideline. Participants who were hypertensive under the ACC/AHA but not the ESC/ESH guideline achieved less frequently some cardiometabolic goals (e.g. nonsmoking, reduced salt consumption, LDL cholesterol if hypercholesterolemic, lifestyle medical advice, and treatment with renin-angiotensin-system blockers where indicated) than those who were hypertensive under the ESC/ESH guideline. CONCLUSION: The implementation of the ACC/AHA versus the ESC/ESH guideline would result in a substantial increase in the prevalence of hypertension and the number of adults who should receive medication. There is room for improvement in lifestyles and cardioprotective treatment in individuals with BP of 130-9/80-9âmmHg whether they are called hypertensive (ACC/AHA) or not (ESC/ESH). We suggest that clinical-practice guidelines should consider the public health and costs implications, and not only the evidence on effectiveness and cost-effectiveness, of their recommendations.
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Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Cardiologia/normas , Hipertensão/epidemiologia , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , American Heart Association , Anti-Hipertensivos/administração & dosagem , Determinação da Pressão Arterial , Análise Custo-Benefício , Europa (Continente)/epidemiologia , Feminino , Objetivos , Humanos , Hipertensão/fisiopatologia , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Chronic kidney disease (CKD) is a public health problem worldwide. We aimed to estimate the CKD prevalence in Spain and to examine the impact of the accumulation of cardiovascular risk factors (CVRF). MATERIAL AND METHODS: We performed a nationwide, population-based survey evaluating 11,505 individuals representative of the Spanish adult population. Information was collected through standardised questionnaires, physical examination, and analysis of blood and urine samples in a central laboratory. CKD was graded according to current KDIGO definitions. The relationship between CKD and 10CVRF was assessed (age, hypertension, general obesity, abdominal obesity, smoking, high LDL-cholesterol, low HDL-cholesterol, hypertriglyceridaemia, diabetes and sedentary lifestyle). RESULTS: Prevalence of CKD was 15.1% (95%CI: 14.3-16.0%). CKD was more common in men (23.1% vs 7.3% in women), increased with age (4.8% in 18-44 age group, 17.4% in 45-64 age group, and 37.3% in ≥65), and was more common in those with than those without cardiovascular disease (39.8% vs 14.6%); all P<.001. CKD affected 4.5% of subjects with 0-1CVRF, and then progressively increased from 10.4% to 52.3% in subjects with 2 to 8-10CVRF (P trend <.001). CONCLUSIONS: CKD affects one in seven adults in Spain. The prevalence is higher than previously reported and similar to that in the United States. CKD was particularly prevalent in men, older people and people with cardiovascular disease. Prevalence of CKD increased considerably with the accumulation of CVRF, suggesting that CKD could be considered as a cardiovascular condition.
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Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Insuficiência Renal Crônica/complicações , Adolescente , Adulto , Idoso , Estudos Transversais , Estudos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Espanha/epidemiologia , Adulto JovemRESUMO
Pain is a key symptom of osteoarthritis (OA) and has been linked to poor mental health. Pain fluctuates over time within individuals, but a paucity of studies have considered day-to-day fluctuations of joint pain in relation to affective symptoms in older persons with OA. This study investigated the relationship of pain severity as well as within-person pain variability with anxiety and depression symptoms in 832 older adults with OA who participated in the European Project on OSteoArthritis (EPOSA): a 6-country cohort study. Affective symptoms were examined with the Hospital Anxiety and Depression Scale, pain severity was assessed with the Western Ontario and McMaster Universities OA Index and the Australian/Canadian Hand Osteoarthritis Index, and intraindividual pain variability was measured using pain calendars assessed at baseline, 6, and 12 to 18 months. Age-stratified multiple linear regression analyses adjusted for relevant confounders showed that more pain was associated with more affective symptoms in older-old participants (74.1-85 years). Moreover, older-old participants experienced fewer symptoms of anxiety (ratio = .85, 95% confidence interval [CI], .77-.94), depression (ratio = .90, 95% CI, .82-.98), and total affective symptoms (ratio = .87, 95% CI, .79-.94) if their pain fluctuated more. No such association was evident in younger-old participants (65-74.0 years). These findings imply that stable pain levels are more detrimental to mental health than fluctuating pain levels in older persons. PERSPECTIVE: This study showed that more severe and stable joint pain levels were associated with anxiety and depressive symptoms in older persons with OA. These findings emphasize the importance of measuring pain in OA at multiple time points, because joint pain fluctuations may be an indicator for the presence of affective symptoms.
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Artralgia/psicologia , Osteoartrite/psicologia , Idoso , Idoso de 80 Anos ou mais , Artralgia/epidemiologia , Artralgia/etiologia , Estudos de Coortes , Europa (Continente) , Feminino , Humanos , Estudos Longitudinais , Masculino , Osteoartrite/complicações , Medição da Dor/métodosRESUMO
OBJECTIVE: Social support has been associated with greater nocturnal decline (dipping) in blood pressure (BP) in younger and middle-aged individuals. However, it is uncertain if aggregated measures of social support are related to ambulatory SBP in older adults, where high SBP is frequent and clinically challenging. METHODS: We studied 1047 community-living individuals aged at least 60 years in Spain. Twenty-four-hour ambulatory BP was determined under standardized conditions. Social support was assessed with a seven-item questionnaire on marital status, cohabitation, frequency of contact with relatives, or with friends and neighbors, emotional support, instrumental support, and outdoor companionship. A social support score was built by summing the values of the items that were significantly associated with SBP variables, such that the higher the score, the better the support. RESULTS: Participants' mean age was 71.7 years (50.8% men). Being married, cohabiting, and being accompanied when out of home were the support items significantly associated with SBP variables. After adjustment for sociodemographic (age, sex, education), behavioral (BMI, alcohol, tobacco, salt consumption, physical activity, Mediterranean diet score), and clinical variables [sleep quality, mental stress, comorbidity, BP medication, and ambulatory BP levels and heart rate (HR)], one additional point in the social support score built with the abovementioned three support variables, was associated with a decrease of 0.93âmmHg in night-time SBP (Pâ=â0.039), totaling 2.8âmmHg decrease for a score of 3 vs. 0. The three-item social support score was also inversely associated with the night/day SBP ratio (ßâ=â-0.006, Pâ=â0.010). CONCLUSION: In older adults, social support is independently associated with lower nocturnal SBP and greater SBP dipping. Further research is needed in prospective studies to confirm these results.
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Pressão Sanguínea , Hipertensão/fisiopatologia , Apoio Social , Idoso , Monitorização Ambulatorial da Pressão Arterial , Ritmo Circadiano/fisiologia , Feminino , Humanos , Vida Independente , Masculino , Estado Civil , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To evaluate the role of comorbidity and pain in the association between hip/knee osteoarthritis (OA) with self-reported as well as performance-based functional limitations in a general elderly population. METHODS: We analyzed the data of 2,942 individuals, ages between 65 and 85 years, who participated in the European Project on Osteoarthritis, which was made up of 6 European cohorts (from Germany, Italy, The Netherlands, Spain, Sweden, and the UK). Outcomes included self-reported physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the participants' performance-based physical function was evaluated using the walking test. RESULTS: While comorbidity did not affect the significant association between hip/knee OA and physical function limitations found in the participants, pain reduced the effect of OA on self-reported physical function, and it cancelled the effect of OA on the walking test. Obesity, anxiety, depression, and cardiovascular diseases were associated with the worst WOMAC scores. Obesity, cognitive impairment, depression, peripheral artery disease, and stroke were associated with the worst walking times. CONCLUSION: These findings demonstrate that while comorbidity is strongly and independently associated with functional limitations, it does not affect the OA-physical function association. Hip/knee OA is associated with self-reported impairment in physical function, which was only partially mediated by pain. Its association with physical function, as evaluated by the walking test, was instead completely mediated by pain.
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Atividades Cotidianas , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Joelho/epidemiologia , Dor/etiologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estudos Transversais , Avaliação da Deficiência , Europa (Continente) , Feminino , Nível de Saúde , Humanos , Masculino , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Joelho/fisiopatologiaRESUMO
BACKGROUND: Older adults with osteoarthritis (OA) often report that their disease symptoms are exacerbated by weather conditions. This study examines the association between outdoor physical activity (PA) and weather conditions in older adults from 6 European countries and assesses whether outdoor PA and weather conditions are more strongly associated in older persons with OA than in those without the condition. METHODS: The American College of Rheumatology classification criteria were used to diagnose OA. Outdoor PA was assessed using the LASA Physical Activity Questionnaire. Data on weather parameters were obtained from weather stations. RESULTS: Of the 2439 participants (65-85 years), 29.6% had OA in knee, hand and/or hip. Participants with OA spent fewer minutes in PA than participants without OA (Median = 42.9, IQR = 20.0 to 83.1 versus Median = 51.4, IQR = 23.6 to 98.6; P < .01). In the full sample, temperature (B = 1.52; P < .001) and relative humidity (B = -0.77; P < .001) were associated with PA. Temperature was more strongly associated with PA in participants without OA (B = 1.98; P < .001) than in those with the condition (B = 0.48; P = .47). CONCLUSIONS: Weather conditions are associated with outdoor PA in older adults in the general population. Outdoor PA and weather conditions were more strongly associated in older adults without OA than in their counterparts with OA.
Assuntos
Exercício Físico , Osteoartrite/reabilitação , Tempo (Meteorologia) , Idoso , Idoso de 80 Anos ou mais , Europa (Continente) , Feminino , Serviços de Saúde para Idosos , Humanos , MasculinoRESUMO
OBJECTIVE: This study examined whether daily weather conditions, 3-day average weather conditions, and changes in weather conditions influence joint pain in older people with osteoarthritis (OA) in 6 European countries. METHODS: Data from the population-based European Project on OSteoArthritis were used. The American College of Rheumatology classification criteria were used to diagnose OA in older people (65-85 yrs). After the baseline interview, at 6 months, and after the 12-18 months followup interview, joint pain was assessed using 2-week pain calendars. Daily values for temperature, precipitation, atmospheric pressure, relative humidity, and wind speed were obtained from local weather stations. Multilevel regression modelling was used to examine the pain-weather associations, adjusted for several confounders. RESULTS: The study included 810 participants with OA in the knee, hand, and/or hip. After adjustment, there were significant associations of joint pain with daily average humidity (B = 0.004, p < 0.01) and 3-day average humidity (B = 0.004, p = 0.01). A significant interaction effect was found between daily average humidity and temperature on joint pain. The effect of humidity on pain was stronger in relatively cold weather conditions. Changes in weather variables between 2 consecutive days were not significantly associated with reported joint pain. CONCLUSION: The associations between pain and daily average weather conditions suggest that a causal relationship exist between joint pain and weather variables, but the associations between day-to-day weather changes and pain do not confirm causation. Knowledge about the relationship between joint pain in OA and weather may help individuals with OA, physicians, and therapists to better understand and manage fluctuations in pain.
Assuntos
Meio Ambiente , Umidade , Osteoartrite/fisiopatologia , Tempo (Meteorologia) , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Analgésicos/uso terapêutico , Artralgia/tratamento farmacológico , Artralgia/fisiopatologia , Ritmo Circadiano , Estudos de Coortes , Europa (Continente) , Feminino , Avaliação Geriátrica , Humanos , Masculino , Análise Multivariada , Osteoartrite/tratamento farmacológico , Osteoartrite/epidemiologia , Medição da Dor , Percepção da Dor , Análise de Regressão , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , TemperaturaRESUMO
INTRODUCTION AND OBJECTIVES: Few studies have used time-dependent correction to analyze the relationship between blood pressure and all-cause mortality, and to our knowledge none has been performed in older people from the Mediterranean area. This study aimed to estimate the relationship between baseline blood pressure and blood pressure as a time-dependent covariate with the risk of all-cause mortality in a population cohort of persons aged 65 or older in Spain. METHODS: Data were taken from the population-based study "Aging in Leganés" with 17 years of follow-up, launched in 1993 in a random sample (n=1560) of persons aged ≥65 years. Mortality was assessed in 2010. Cox proportional hazards models were fitted to examine the effects on mortality of blood pressure at baseline and of blood pressure as a time-dependent covariate. RESULTS: The lowest mortality was observed at baseline systolic blood pressure of 136 mmHg and time-dependent covariate value of 147 mmHg. The highest risk of mortality for time-dependent covariates occurred with systolic blood pressure <115 mmHg and >93 mmHg and diastolic blood pressure <80 mmHg. Diastolic blood pressure over 85 mmHg did not increase the risk of death. CONCLUSIONS: Based on the dynamic association between blood pressure and mortality, a U-shaped relationship was found for systolic blood pressure and a negative relationship for diastolic blood pressure and all-cause mortality. The lowest mortality corresponded to a systolic blood pressure level slightly over the diagnostic hypertension value and suggests that a value of 140 mmHg is not adequate as a diagnostic and therapeutic threshold in an elderly population.
Assuntos
Pressão Sanguínea/fisiologia , Mortalidade/tendências , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/mortalidade , Masculino , Fatores de Risco , Espanha/epidemiologiaRESUMO
OBJECTIVE: To determine the type of Internet use carried out by adolescent schoolchildren and identify factors associated with high use. DESIGN: Descriptive, cross-sectional study using a self-administered questionnaire. SETTING: Secondary and High School Education Centres of the Autonomous Community of Madrid (rural and urban areas). PARTICIPANTS: Third and fourth year Secondary and 1st and 2nd year High School pupils from 9 centres. A total of 1328 of the 1330 pupils present in the classrooms during the school term January-April 2007. PRINCIPAL MEASUREMENTS: Dependent variable: intensity of Internet use: very high, high, medium, low and none. Information on socioeconomic variables, smoking, drugs and drinking habits, mental health, academic failure and use of mobile telephone. An analysis was made using a two-step logical regression. RESULTS: The mean age of the sample was 15 years, with an equal number of males and females. A total of 93.1% used the Internet, of which 5.3% (95% CI: 4-6.5%) had a very high use, 16.7% (95% CI: 14.5-18.6%) high use, 71.1% (95% CI: 68.2-73.2%) low to medium use, and 6.9% (95% CI: 5.6-8.4%), did not use it. Very high use of the Internet is associated with the male sex (OR=4.28;95% CI:2.37-7.72), being 16 years or over (OR=2.14;95% CI:1.23-3.72) and is dependent on the mobile phone (OR=5.19;95% CI: 2.97-9.08). An association with alcohol consumption was observed in the high use group (OR=1.89; 95% CI:1,35-2,65). Academic failure is more common among those who do not use the Internet (OR=1.61; 95% CI:1.02-2.55). CONCLUSIONS: Given the relationship found between high Internet use and mental health problems and bad habits, it is important to perfect standardised tools to detect and evaluate the compulsive use of the Internet as well as aid to its responsible use.