Background: Children and young adults with JIA have increased levels of poor oral hygiene and den... more Background: Children and young adults with JIA have increased levels of poor oral hygiene and dental decay [1]. Periodontitis and types of arthritis are linked by similar components of blood cytokine profiles. Good dental health can be directly affected in JIA patients due to physical limitations in upper limb movements making brushing and flossing teeth difficult. An important factor in oral care is good dental hygiene and access to dental health practitioners. NHS advice is that all children should be reviewed by a dentist annually and be offered both sealant of their teeth and fluoride varnish at the appropriate time. Our aim was to establish if our patients had any barriers to accessing dental care. Methods: All patients (age 18 and under) diagnosed with JIA in the paediatric rheumatology clinic over a period of 3 months were asked to complete a dental care questionnaire. Parents completed the questionnaire for their children if necessary. Data were analysed using Excel. Results: 30 questionnaires were completed. Demographics were M:F 1:1.3, all children were diagnosed with JIA, average age 10.5 years with range 2–18. 27 children were registered with an NHS dentist with the exception of one child with a private dentist. 26 children had seen a dentist at least annually and one child in the past 2 years. 2 children, one aged 16, were not registered with a dentist because their parents didn’t think it was important. 11 children had 25 fillings in total, 9 of these children were not supervised during dental hygiene. 13 children admitted to drinking sugary drinks daily and had 16 dental fillings. None of the children admitted to smoking. Conclusions: Whilst our audit showed that most children were registered with a dentist and were reviewed annually, only 1 child had been offered sealant and fluoride varnish. The NHS advises that children with chronic medical conditions can be seen either by their NHS dentist or by the local Community specialist dental service which can be accessed by referral from their rheumatology department or NHS dentist. None of the children were seen by the specialist dental service. We have developed an information leaflet informing parents and children with JIA of the importance of dental health explaining the benefits of both sealant and fluoride for teeth.
Pain is common in adult life, and the extent to which pain interferes with daily activities rises... more Pain is common in adult life, and the extent to which pain interferes with daily activities rises with age. Little is known about the social factors associated with disabling pain. The objective was to determine the individual and neighbourhood social factors that predict pain that interferes with daily activities. This was a prospective cohort study set within the North Staffordshire Osteoarthritis Project (NorStOP). People aged 50 and over registered with six general practices were sent baseline and 3-year questionnaires. Individual predictors of the onset of pain interference were determined through multilevel modelling. Neighbourhood impact was examined using measures of deprivation taken from the UK Index of Multiple Deprivation 2004. 19% of the 3644 people without pain interference at baseline reported it at follow-up. Baseline social factors were weaker predictors than baseline age, multiple-site pain and anxiety or depression. However, perceived financial strain was a significant predictor (OR 1.5; 95% CI: 1.2, 1.8). Onset of pain interference varied by local area deprivation status. Those living in areas of high health deprivation had an increased risk of developing pain interference (OR 1.6; 95% CI: 1.1, 2.3). Whilst the onset of pain which disrupts daily life is influenced mainly by the characteristics of the pain and by the psychological factors, there are links with the social factors, particularly individual measures of perceived income adequacy. The onset of disabling pain is also influenced by the place where one lives. Policies to prevent disabling pain need to consider the contribution of neighbourhood deprivation and income inequalities to the extent of the problem.
ObjectiveTo investigate the links between knee pain characteristics and restricted mobility outsi... more ObjectiveTo investigate the links between knee pain characteristics and restricted mobility outside the home, and how these are influenced by mobility‐specific activity limitation, age, sex, socioeconomic status, environmental factors, and comorbidity.MethodsWe conducted a cross‐sectional survey of community‐dwelling adults age ≥50 years. A total of 2,252 responders reporting pain in and around the knee in the last year were eligible. The primary outcome was self‐reported restricted mobility outside the home in the previous 4 weeks (dichotomized as present or absent).ResultsKnee pain severity was strongly associated with restricted mobility outside the home, an association largely mediated by perceived limitation in walking. After adjusting for demographic and socioeconomic characteristics, individual contributions from selected comorbidities, knee pain severity, limitation in walking, and specific environmental factors remained. These environmental factors included perceived need o...
Job lock, one form of restricted job mobility that often prevents older workers from retiring, i... more Job lock, one form of restricted job mobility that often prevents older workers from retiring, is linked to existing health and work place problems. This study explored (i) the rate of change in work limitation for job locked and non-job locked older workers and (ii) the factors associated with these changes over a 12-month period following a work injury. Prospective observational cohort study of adults aged ≥55 years. Data were collected using self-completed questionnaires. Individual growth modelling was used to examine the pre- and post- injury influences on work limitation. Work limitation was greater in the job locked older workers pre-injury. Both job-locked and non-job locked respondents had initial post-injury decreases in work limitations, suggesting a positive impact of temporary post-injury accommodations. However, both groups had increases in work limitations over time, but the increases were greater in the non-job locked group. In those with job lock, return to work problems were associated with increases in work limitations; in those without job lock, greater increases were associated only with low education. These results suggest that job accommodations may be important in moderating increasing work limitation in job-locked older workers. Results support prior findings that job-locked older workers have unique characteristics, perhaps requiring more tailored interventions to maintain them in the workforce.
To determine whether the extent of multiple-site lower extremity joint pain contributes to disabi... more To determine whether the extent of multiple-site lower extremity joint pain contributes to disability in middle and old age and describe patterns of severity in site-specific measures amongst those with multiple-site pain. Population-based, cross-sectional postal survey. Adults aged 50 years and over registered with three general practices and reporting pain lasting one month or longer in the previous year in at least one hip, knee, or foot were included. Respondents completed a generic measure of physical function and site-specific measures of severity for each relevant joint pain. Of 2429 eligible participants, 1801 reported multiple-site lower limb joint pain. Lower limb joint pain count was independently associated with reduced physical function after adjusting for a range of covariates. The severity of pain and disability attributed to each site increased as the number of painful sites increased. Many older people with joint pain in the lower limb have more than one joint affected. Generic and site-specific measures of disability both show the same pattern of reduced physical function. Treatment targeted at a single joint may have only a marginal effect on reducing disability in individuals with multiple joint involvement unless treatment is also conferring benefit at other sites.
To determine why multimorbidity causes participation restriction in adults ages ≥50 years who con... more To determine why multimorbidity causes participation restriction in adults ages ≥50 years who consult primary care with lower extremity osteoarthritis (OA). This was a population-based prospective cohort study of 1,053 consulters for lower extremity OA who were free of participation restriction at baseline. Path analysis was used to test proposed mechanisms by examining for mediation of the association between multimorbidity at baseline, defined by self-report and consultation data separately, and incident participation restriction at 3 years by lower extremity pain severity, obesity, locomotor disability, and depression. Multimorbidity was associated with incident participation restriction (adjusted odds ratio [OR] 2.83, 95% confidence interval [95% CI] 2.03-3.94 for multimorbidity [self-report]; OR 1.59, 95% CI 1.15-2.21 for multimorbidity [consultation data]). The extent of mediation of the association of baseline multimorbidity, defined by self-report, and incident participation restriction was greater for severe lower extremity pain than obesity (standardized beta coefficients for indirect effect 0.032 [SE 0.015] and 0.020 [SE 0.019], respectively). The addition of depression and locomotor disability increased the amount of mediation (0.115 [SE 0.028]) and reduced the proportion explained by severe lower extremity pain (0.014 [SE 0.015]) and obesity (0.006 [SE 0.010]). Locomotor disability was the strongest mediator. The additional impact on participation in social and domestic life that multimorbidity places on individuals with lower extremity OA appears to be mediated through further restriction of locomotor disability, as well as through depression. The results suggest that the effect of multimorbidity on the daily lives of people with lower extremity OA will be ameliorated by active management of depression and locomotor disability.
Objective We wanted to determine whether socioeconomic inequalities in primary care consultation ... more Objective We wanted to determine whether socioeconomic inequalities in primary care consultation rates for two major, disabling musculoskeletal conditions in England narrowed or widened between 2004 and 2019. Methods We analysed data from Clinical Practice Research Datalink Aurum, a national general practice electronic health records database, linked to national deprivation ranking of each patient’s registered residential postcode. For each year, we estimated the age- and sex-standardized consultation incidence and prevalence for low back pain and OA for the most deprived 10% of neighbourhoods through to the least deprived 10%. We then calculated the slope index of inequality and relative index of inequality overall and by sex, age group and geographical region. Results Inequalities in low back pain incidence and prevalence over socioeconomic status widened between 2004 and 2013 and stabilized between 2014 and 2019. Inequalities in OA incidence remained stable over socioeconomic sta...
Background: Children and young adults with JIA have increased levels of poor oral hygiene and den... more Background: Children and young adults with JIA have increased levels of poor oral hygiene and dental decay [1]. Periodontitis and types of arthritis are linked by similar components of blood cytokine profiles. Good dental health can be directly affected in JIA patients due to physical limitations in upper limb movements making brushing and flossing teeth difficult. An important factor in oral care is good dental hygiene and access to dental health practitioners. NHS advice is that all children should be reviewed by a dentist annually and be offered both sealant of their teeth and fluoride varnish at the appropriate time. Our aim was to establish if our patients had any barriers to accessing dental care. Methods: All patients (age 18 and under) diagnosed with JIA in the paediatric rheumatology clinic over a period of 3 months were asked to complete a dental care questionnaire. Parents completed the questionnaire for their children if necessary. Data were analysed using Excel. Results: 30 questionnaires were completed. Demographics were M:F 1:1.3, all children were diagnosed with JIA, average age 10.5 years with range 2–18. 27 children were registered with an NHS dentist with the exception of one child with a private dentist. 26 children had seen a dentist at least annually and one child in the past 2 years. 2 children, one aged 16, were not registered with a dentist because their parents didn’t think it was important. 11 children had 25 fillings in total, 9 of these children were not supervised during dental hygiene. 13 children admitted to drinking sugary drinks daily and had 16 dental fillings. None of the children admitted to smoking. Conclusions: Whilst our audit showed that most children were registered with a dentist and were reviewed annually, only 1 child had been offered sealant and fluoride varnish. The NHS advises that children with chronic medical conditions can be seen either by their NHS dentist or by the local Community specialist dental service which can be accessed by referral from their rheumatology department or NHS dentist. None of the children were seen by the specialist dental service. We have developed an information leaflet informing parents and children with JIA of the importance of dental health explaining the benefits of both sealant and fluoride for teeth.
Pain is common in adult life, and the extent to which pain interferes with daily activities rises... more Pain is common in adult life, and the extent to which pain interferes with daily activities rises with age. Little is known about the social factors associated with disabling pain. The objective was to determine the individual and neighbourhood social factors that predict pain that interferes with daily activities. This was a prospective cohort study set within the North Staffordshire Osteoarthritis Project (NorStOP). People aged 50 and over registered with six general practices were sent baseline and 3-year questionnaires. Individual predictors of the onset of pain interference were determined through multilevel modelling. Neighbourhood impact was examined using measures of deprivation taken from the UK Index of Multiple Deprivation 2004. 19% of the 3644 people without pain interference at baseline reported it at follow-up. Baseline social factors were weaker predictors than baseline age, multiple-site pain and anxiety or depression. However, perceived financial strain was a significant predictor (OR 1.5; 95% CI: 1.2, 1.8). Onset of pain interference varied by local area deprivation status. Those living in areas of high health deprivation had an increased risk of developing pain interference (OR 1.6; 95% CI: 1.1, 2.3). Whilst the onset of pain which disrupts daily life is influenced mainly by the characteristics of the pain and by the psychological factors, there are links with the social factors, particularly individual measures of perceived income adequacy. The onset of disabling pain is also influenced by the place where one lives. Policies to prevent disabling pain need to consider the contribution of neighbourhood deprivation and income inequalities to the extent of the problem.
ObjectiveTo investigate the links between knee pain characteristics and restricted mobility outsi... more ObjectiveTo investigate the links between knee pain characteristics and restricted mobility outside the home, and how these are influenced by mobility‐specific activity limitation, age, sex, socioeconomic status, environmental factors, and comorbidity.MethodsWe conducted a cross‐sectional survey of community‐dwelling adults age ≥50 years. A total of 2,252 responders reporting pain in and around the knee in the last year were eligible. The primary outcome was self‐reported restricted mobility outside the home in the previous 4 weeks (dichotomized as present or absent).ResultsKnee pain severity was strongly associated with restricted mobility outside the home, an association largely mediated by perceived limitation in walking. After adjusting for demographic and socioeconomic characteristics, individual contributions from selected comorbidities, knee pain severity, limitation in walking, and specific environmental factors remained. These environmental factors included perceived need o...
Job lock, one form of restricted job mobility that often prevents older workers from retiring, i... more Job lock, one form of restricted job mobility that often prevents older workers from retiring, is linked to existing health and work place problems. This study explored (i) the rate of change in work limitation for job locked and non-job locked older workers and (ii) the factors associated with these changes over a 12-month period following a work injury. Prospective observational cohort study of adults aged ≥55 years. Data were collected using self-completed questionnaires. Individual growth modelling was used to examine the pre- and post- injury influences on work limitation. Work limitation was greater in the job locked older workers pre-injury. Both job-locked and non-job locked respondents had initial post-injury decreases in work limitations, suggesting a positive impact of temporary post-injury accommodations. However, both groups had increases in work limitations over time, but the increases were greater in the non-job locked group. In those with job lock, return to work problems were associated with increases in work limitations; in those without job lock, greater increases were associated only with low education. These results suggest that job accommodations may be important in moderating increasing work limitation in job-locked older workers. Results support prior findings that job-locked older workers have unique characteristics, perhaps requiring more tailored interventions to maintain them in the workforce.
To determine whether the extent of multiple-site lower extremity joint pain contributes to disabi... more To determine whether the extent of multiple-site lower extremity joint pain contributes to disability in middle and old age and describe patterns of severity in site-specific measures amongst those with multiple-site pain. Population-based, cross-sectional postal survey. Adults aged 50 years and over registered with three general practices and reporting pain lasting one month or longer in the previous year in at least one hip, knee, or foot were included. Respondents completed a generic measure of physical function and site-specific measures of severity for each relevant joint pain. Of 2429 eligible participants, 1801 reported multiple-site lower limb joint pain. Lower limb joint pain count was independently associated with reduced physical function after adjusting for a range of covariates. The severity of pain and disability attributed to each site increased as the number of painful sites increased. Many older people with joint pain in the lower limb have more than one joint affected. Generic and site-specific measures of disability both show the same pattern of reduced physical function. Treatment targeted at a single joint may have only a marginal effect on reducing disability in individuals with multiple joint involvement unless treatment is also conferring benefit at other sites.
To determine why multimorbidity causes participation restriction in adults ages ≥50 years who con... more To determine why multimorbidity causes participation restriction in adults ages ≥50 years who consult primary care with lower extremity osteoarthritis (OA). This was a population-based prospective cohort study of 1,053 consulters for lower extremity OA who were free of participation restriction at baseline. Path analysis was used to test proposed mechanisms by examining for mediation of the association between multimorbidity at baseline, defined by self-report and consultation data separately, and incident participation restriction at 3 years by lower extremity pain severity, obesity, locomotor disability, and depression. Multimorbidity was associated with incident participation restriction (adjusted odds ratio [OR] 2.83, 95% confidence interval [95% CI] 2.03-3.94 for multimorbidity [self-report]; OR 1.59, 95% CI 1.15-2.21 for multimorbidity [consultation data]). The extent of mediation of the association of baseline multimorbidity, defined by self-report, and incident participation restriction was greater for severe lower extremity pain than obesity (standardized beta coefficients for indirect effect 0.032 [SE 0.015] and 0.020 [SE 0.019], respectively). The addition of depression and locomotor disability increased the amount of mediation (0.115 [SE 0.028]) and reduced the proportion explained by severe lower extremity pain (0.014 [SE 0.015]) and obesity (0.006 [SE 0.010]). Locomotor disability was the strongest mediator. The additional impact on participation in social and domestic life that multimorbidity places on individuals with lower extremity OA appears to be mediated through further restriction of locomotor disability, as well as through depression. The results suggest that the effect of multimorbidity on the daily lives of people with lower extremity OA will be ameliorated by active management of depression and locomotor disability.
Objective We wanted to determine whether socioeconomic inequalities in primary care consultation ... more Objective We wanted to determine whether socioeconomic inequalities in primary care consultation rates for two major, disabling musculoskeletal conditions in England narrowed or widened between 2004 and 2019. Methods We analysed data from Clinical Practice Research Datalink Aurum, a national general practice electronic health records database, linked to national deprivation ranking of each patient’s registered residential postcode. For each year, we estimated the age- and sex-standardized consultation incidence and prevalence for low back pain and OA for the most deprived 10% of neighbourhoods through to the least deprived 10%. We then calculated the slope index of inequality and relative index of inequality overall and by sex, age group and geographical region. Results Inequalities in low back pain incidence and prevalence over socioeconomic status widened between 2004 and 2013 and stabilized between 2014 and 2019. Inequalities in OA incidence remained stable over socioeconomic sta...
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