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Lindholm, A., Roswall, J., Alm, B., Almquist-Tangen, G., Bremander, A., Dahlgren, J., . . . Bergman, S. (2018). Body mass index classification misses to identify children with an elevated waist-to-height ratioat 5 years of age. Pediatric Research
Open this publication in new window or tab >>Body mass index classification misses to identify children with an elevated waist-to-height ratioat 5 years of age
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2018 (English)In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447Article in journal, Editorial material (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Abdominal adiposity is an important risk factor in the metabolic syndrome. Since BMI does not reveal fatdistribution, waist-to-height ratio (WHtR) has been suggested as a better measure of abdominal adiposity in children, but only a fewstudies cover the preschool population. The aim of the present study was to examine BMI and WHtR growth patterns and theirassociation regarding their ability to identify children with an elevated WHtR at 5 years of age.METHODS: A population-based longitudinal birth cohort study of 1540 children, followed from 0 to 5 years with nine measurementpoints. The children were classified as having WHtR standard deviation scores (WHtRSDS) <1 or ≥1 at 5 years. Student’s t-tests andChi-squared tests were used in the analyses.RESULTS: Association between BMISDS and WHtRSDS at 5 years showed that 55% of children with WHtRSDS ≥1 at 5 years had normalBMISDS (p < 0.001). Children with WHtRSDS ≥1 at 5 years had from an early age significantly higher mean BMISDS and WHtRSDS thanchildren with values <1.CONCLUSIONS: BMI classification misses every second child with WHtRSDS ≥1 at 5 years, suggesting that WHtR adds value inidentifying children with abdominal adiposity who may need further investigation regarding cardiometabolic risk factors.

Place, publisher, year, edition, pages
Nature Publishing Group, 2018
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-38474 (URN)10.1038/s41390-018-0188-4 (DOI)30287892 (PubMedID)2-s2.0-85054473136 (Scopus ID)
Projects
Halland Health and Growth Study
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2018-12-05
Malm, K., Bergman, S., Bremander, A., Larsson, I. & Andersson, M. L. (2018). Discussions of lifestyle habits as an integral part of care management in patients with established rheumatoid arthritis. Paper presented at Annual European Congress of Rheumatology EULAR, Amsterdam, Netherlands, 13-16 June, 2018. Annals of the Rheumatic Diseases, 77, 1817-1817, Article ID FRI10741-HPR.
Open this publication in new window or tab >>Discussions of lifestyle habits as an integral part of care management in patients with established rheumatoid arthritis
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2018 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 1817-1817, article id FRI10741-HPRArticle in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background: Rheumatoid arthritis (RA) is associated with an increased risk of developing comorbidities which are known to be associated with lifestyle-related habits; such as having a sedentary lifestyle, having an unhealthy diet, smoking, and over-consumption of alcohol. In 2010, the European League Against Rheumatism (EULAR) published general guidelines on risk management in patients with RA, with an update 2017 (1,2) in which health professionals are encouraged to prioritize discussions with patients regarding their lifestyle and it is of interest to study the extent to which these discussions actually occur.

Objectives: To study if lifestyle habits; physical activity, diet, smoking and alcohol had been discussed with patients having RA during health care visits.

Methods: A cross-sectional postal survey in 2017 included 1542 eligible patients from the BARFOT (Better Anti-Rheumatic Pharmacotherapy) study. All patients received a questionnaire including lifestyle habits (physical activity, diet, smoking, and alcohol), and whether these habits had been discussed during health care visits. There was also a question regarding if they would have wanted such a discussion.

Results: 1,061 patients (68%) responded to the survey (mean age 67 years (SD 13); 73% women). Physical activity was discussed with 49% of the patients (figure 1A). Those who reported that they were active on a health-enhancing level were more likely to have discussed physical activity with health professionals. Diet had been discussed with 23% of the patients (figure 1B). Patients who reported a non-traditional mixed diet were more likely to have discussed diet. Smoking was discussed with 25% of the patients (figure 1C). Current smokers had more often discussed smoking habits with healthcare professionals compared with never smokers (32% vs. 17%; p=0.000). Alcohol had been discussed with 17% of the patients (figure 1D). Of the patients with hazardous drinking habits, 77% had not had a discussion regarding alcohol.

Place, publisher, year, edition, pages
London: BMJ Publishing Group Ltd, 2018
Keywords
lifestyle habits, rheumatoid arthritis
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-37137 (URN)
Conference
Annual European Congress of Rheumatology EULAR, Amsterdam, Netherlands, 13-16 June, 2018
Note

On behalf of The BARFOT study group

Available from: 2018-06-18 Created: 2018-06-18 Last updated: 2018-07-27Bibliographically approved
Karlsson, J., Winroth, J., Bremander, A., Haglund, E., Holmquist, M., Lindgren, E.-C., . . . Staland Nyman, C. (2018). Förändringsledarskap vid digital transformation inom vård och omsorg: En sammanfattande rapport från kompetensutvecklingsprojektet ”Trygg motivation och inspiration” i Kungsbacka kommun 2018. Halmstad
Open this publication in new window or tab >>Förändringsledarskap vid digital transformation inom vård och omsorg: En sammanfattande rapport från kompetensutvecklingsprojektet ”Trygg motivation och inspiration” i Kungsbacka kommun 2018
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2018 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Halmstad: , 2018. p. 49
Keywords
Digitalisering, förändringsledarskap, hälsa, arbetsmiljö, lärande, kompetensutveckling, aktionsforskning
National Category
Work Sciences
Identifiers
urn:nbn:se:hh:diva-38303 (URN)
Projects
HIcube Kompetenta vården
Funder
European Social Fund (ESF)
Available from: 2018-11-11 Created: 2018-11-11 Last updated: 2018-12-10Bibliographically approved
Bremander, A., Haglund, E. & Bergman, S. (2018). Measures of Physical Activity and Fear Avoidance in People with Chronic Pain. Paper presented at Annual European Congress of Rheumatology EULAR, Amsterdam, Netherlands, 13-16 June, 2018. Annals of the Rheumatic Diseases, 77(Suppl. 2), 1829-1830, Article ID SAT0737-HPR.
Open this publication in new window or tab >>Measures of Physical Activity and Fear Avoidance in People with Chronic Pain
2018 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, no Suppl. 2, p. 1829-1830, article id SAT0737-HPRArticle in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background Lifestyle factors such as physical activity (PA) has the possibility to contribute to improved health and quality of life in the population as well as in chronic diseases. Most often PA is self-reported while measures of the aerobic capacity are more seldom measured in subjects with chronic pain.

Objectives To describe physical activity levels (self-reported and aerobic capacity) in people with chronic pain classified as regional or widespread and to compare the findings with a group that report no pain.

Methods From the 2016 follow-up of the Swedish population based Epipain cohort (n 1321), 146 subjects were invited to a clinical assessment where the aerobic capacity was assessed by using a submaximal bicycle test, the Ekblom-Bak test, together with assessment of the Borg scale for perceived exertion (RPE). Aerobic capacity was also classified as low, average or high according to data from the general population. Self-reported physical activity was coded as MVPArec if recommended levels of PA was reported (physically active on a moderate level ≥150 min/week (MPA) or on an vigorous level ≥75 min/week (VPA) or not). The Fear Avoidance Beliefs Questionnaire for PA (FABQ-PA, 0–24 best to worst) and for work (FABQ-W, 0–48 best to worst) were also assessed. The participants were classified as having chronic widespread pain (CWP), chronic regional pain (CRP) or no chronic pain (NCP) based on a pain mannequin presenting 0–18 pain regions and if pain had lasted for 3 months or more. Chi2 and Kruskal-Wallis tests were performed to study differences between the three pain groups.

Results 141/146 (97%) subjects (mean (SD) age 59.4 (8.2) years) whereof 61% were women, could be classified into pain groups; 43 as CWP (84% women), 43 as CRP (42% women) and 55 as NCP (58% women). The group with CWP was slightly older than those with CRP (mean (SD) age 57.0 (7.6) years vs. 61.9 (6.9) years, p 0.02). The CWP group also had lower aerobic capacity (mean (SD) 2.2 (0.5) l/min vs. 2.6 (0.6) l/min, p 0.03), and a larger proportion was classified as having low aerobic capacity (CWP 21%, CRP 7% and NCP 10%, p 0.04). The proportion of MVPArec did not differ between the groups; CWP 70%, CRP 81% and NCP 74% (p 0.5). There was neither a difference between the groups in BMI, RPE or in sitting hours/week (p>0.6). However, differences were found in the FABQ where in the PA scale those with CRP had worse scores compared with NCP (mean (SD) 11.2 (7.3) vs. 6.0 (6.0), p<0.001), the difference between CWP (mean (SD) 8.9 (6.7)) and NCP was p 0.06. In the work subscale of FABQ, CWP had worse scores compared with CRP (mean (SD) 18.9 (15.7) vs. 10.0 (12.5), p 0.002) and CRP had worse scores compared to those with NCP (mean (SD) 10.0 (12.5) vs. 6.5 (9.1), p<0.001).

Conclusions In this sample of subjects with chronic pain or no pain, having widespread pain tended to affect the aerobic capacity negatively while self-reports of reaching recommended levels of physical activity did not differ between groups. Fear avoidance in relation to physical activity and especially in relation to work was more noticeable in subjects with chronic pain compared to those with no pain. Measures of aerobic capacity and information of fear avoidance beliefs might help health professionals to better tailor the non-pharmacological treatment for subjects with chronic pain.

Disclosure of Interest None declared

© 2018, Published by the BMJ Publishing Group Limited.

Place, publisher, year, edition, pages
London: BMJ Publishing Group Ltd, 2018
National Category
Clinical Medicine Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:hh:diva-36809 (URN)
Conference
Annual European Congress of Rheumatology EULAR, Amsterdam, Netherlands, 13-16 June, 2018
Available from: 2018-05-23 Created: 2018-05-23 Last updated: 2018-07-30Bibliographically approved
Malmborg, J., Olsson, M. C., Bergman, S. & Bremander, A. (2018). Musculoskeletal pain and its association with maturity and sports performance in 14-year-old sport school students. BMJ Open Sport & Exercise Medicine, 4(1), Article ID e000395.
Open this publication in new window or tab >>Musculoskeletal pain and its association with maturity and sports performance in 14-year-old sport school students
2018 (English)In: BMJ Open Sport & Exercise Medicine, ISSN 2055-7647, Vol. 4, no 1, article id e000395Article in journal (Refereed) Published
Abstract [en]

Objectives: In youth sports, musculoskeletal pain is often studied from the standpoint of sports injuries, but little is known about pain conditions in which athletes still participate. The aim was to study the frequency of pain and associations with maturity offset, health status and sports performance in 14-year-old sport school students.

Methods: Cross-sectional design. One hundred and seventy-eight students (108 boys and 70 girls) completed anthropometric measures for maturity offset (height, weight and sitting height), questionnaires (pain mannequin and EQ-5D for health status) and sports performance tests (sprint, agility, counter-movement jump and grip strength). Differences between groups were analysed with Student’s t-test and analysis of covariance.

Results: Thirty-one students (18.6%) reported infrequent pain, 85 (50.9%) frequent pain and 51 (30.5%) constant pain. Students in the constant pain group had worse health status than those in the infrequent pain group. Boys with constant pain (n=27) had a lower mean maturity offset (–0.38 vs 0.07 years; p=0.03) than boys with infrequent pain (n=22), and pain was associated with worse sports performance. There was no difference in maturity or sports performance between girls with constant pain (n=24) and girls with infrequent pain (n=9).

Conclusion: Musculoskeletal pain is common in sport school students and coincides with worse health status and with a younger biological age in boys. The high prevalence of pain should be acknowledged by coaches and student healthcare workers in order to promote a healthy and sustainable development in young athletes. © Author(s) (or their employer(s)) 2018.

Place, publisher, year, edition, pages
London: BMJ Publishing Group Ltd, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology Sport and Fitness Sciences
Identifiers
urn:nbn:se:hh:diva-37488 (URN)10.1136/bmjsem-2018-000395 (DOI)
Note

Funding: Halmstad University; Spenshult Research and Development Center, Halmstad; Region Halland (grant numbers HALLAND-469111 and HALLAND-639101); and the Mayflower Charity Foundation, Sweden.

Available from: 2018-07-04 Created: 2018-07-04 Last updated: 2018-07-05Bibliographically approved
Landgren, E., Bremander, A., Lindqvist, E., van der Elst, K. & Larsson, I. (2018). Patients’ experiences of health in early rheumatoid arthritis – a qualitative study. Paper presented at Annual European Congress of Rheumatology EULAR, Amsterdam, Netherlands, 13-16 June, 2018. Annals of the Rheumatic Diseases, 77, 1802-1803, Article ID FRI10707-HPR.
Open this publication in new window or tab >>Patients’ experiences of health in early rheumatoid arthritis – a qualitative study
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2018 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 1802-1803, article id FRI10707-HPRArticle in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background: The World Health Organization defines health as ”a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Health changes dramatically when a person becomes ill in a chronic disease as rheumatoid arthritis (RA). RA is a disease with great impact on all aspects of life. Living with RA affects patients’ health including physical, emotional, psychological and social aspects. The purpose of a person-centered care is to see patients as experts; sharing decisions with them and helping them manage their health. Therefore it is important to understand how patients in early disease stage of RA experience the concept of health.

Objectives: The purpose of this study was to describe patients’ experiences of health in early RA.

Methods: The study had a descriptive design with a qualitative content analysis approach. Individual interviews were conducted with 24 patients with early RA. In this study the patients had disease duration less than 12 months. A manifest qualitative content analysis was used to analyze the question: “What does health mean to you?”

Results: In the early stage of RA, patients experienced health as the most important goal in their life. They described health as well-being, independence, life satisfaction and vitality. Health as well-being meant to feel good, be painless and have a good sleep to feel rested. Health as independence meant to have both physical and financial prerequisites to perform everyday activities, to exercise and being able to travel. Health as life satisfaction meant to feel joy in life, enjoy the family and to believe in the future. Health as vitality meant to have the energy, power and strength to cope with everyday life. The patients expressed that their health had been adversely affected by the RA disease and they had a strong desire for full health including well-being, independence, life satisfaction and vitality.

Conclusions: Patients in an early stage of RA describe a strong desire to regain health in terms of well-being, independence, life satisfaction and vitality. The concept of health at early RA is similar to health at established RA in terms of well-being, independence and life satisfaction. Unique findings for patients with early RA are the description of health as vitality, and the emphasis of having energy, power and strength to cope with everyday life. Health professionals should have these different ways of experiencing health in mind when providing person-centred care to patients with early RA. Depending on the patients’ perception of health, different support strategies are needed.

Place, publisher, year, edition, pages
London: BMJ Publishing Group Ltd, 2018
Keywords
Early rheumatoid arthritis, Health, Patients’ experiences, Qualitative study
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-37133 (URN)
Conference
Annual European Congress of Rheumatology EULAR, Amsterdam, Netherlands, 13-16 June, 2018
Available from: 2018-06-18 Created: 2018-06-18 Last updated: 2018-07-27Bibliographically approved
Bremander, A., Malm, K. & Andersson, M. L. (2018). Physical Activity in Established RA and Variables Associated with Physical Activity Maintenance Over a Seven Year Period. Paper presented at Annual European Congress of Rheumatology EULAR, Amsterdam, Netherlands, 13-16 June, 2018. Annals of the Rheumatic Diseases, 77(Suppl. 2), 188-188, Article ID OP0280-HPR.
Open this publication in new window or tab >>Physical Activity in Established RA and Variables Associated with Physical Activity Maintenance Over a Seven Year Period
2018 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, no Suppl. 2, p. 188-188, article id OP0280-HPRArticle in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background: Interventions to promote a healthy lifestyle also in patients with rheumatoid arthritis (RA) have been in focus over the last years. Physical activity (PA) defined as moderate-to-vigorous physical activity (MVPA) has the possibility to reduce disease burden in RA and may contribute to improved quality of life (QoL). It is well known that a large number of patients with RA have a sedentary life style and are less active than their healthy peers. However, less information is known about the long term change of MVPA and possible associated variables.

Objectives: To study self-reported change of MVPA over seven years in a well-defined RA cohort.

Methods: A lifestyle questionnaire was sent twice to patients in the BARFOT cohort, in 2010 (n 1525) and in 2017 (n 1046) with a response rate of 73% and 68% respectively and 950 patients responded to both questionnaires. All patients fulfilled the ACR criteria for classification of RA and had a disease duration at inclusion (1992 to 2006) of ≤12 months. Patients were dichotomized as being active on recommended levels of MVPA (MVPArec ;physically active on a moderate level ≥150 min/week (MPA) or on an intense level ≥75 min/week (VPA)) or not (sedentary). The patients reported body mass index, smoking habits, tender (TJC) and swollen joint count (SJC, 28-joints), patient global assessment (PatGA), pain intensity (NRS) and distribution (pain mannequin), fatigue (NRS), physical function (HAQ), health related QoL (EQ5D), comorbidities and medical treatment. Possible associated variables with meeting MVPArec at both time points or not (dependent variable) was studied by using a logistic regression analysis. All variables were adjusted for age, gender and smoking habits.

Results: Forty-one percent (n 389) of the patients met MVPArec at both occasions, and they reported better EQ5D scores compared with the sedentary group (mean 0.77 (SD 0.18) vs 0.68 (0.27). The patients who met MVPArec were younger, (mean age (SD) 5913 years vs 6213 years, p<0.001) and were to higher extent never smokers 46% vs 38%, p=0.021. There was a negative association with meeting MVPArec and being overweight (OR 0.58, 95% CI: 0.43 to 0.96) or obese (OR 0.38, 95% CI: 0.25 to 0.59), the presence of cardiovascular (OR 0.56, 95% CI: 0.41 to 0.75) and pulmonary diseases (OR 0.51, 95% CI: 0.31 to 0.85), TJC (OR 0.98, 95% CI: 0.95 to 0.995), high pain intensity (OR 0.99, 95% CI: 0.987 to 0.998), and pain distribution (OR 0.93, 95% CI: 0.90 to 0.96), worse fatigue (OR 0.99, 95% CI: 0.998 to 0.997) and a worse physical function (HAQ, OR 0.58, 95% CI: 0.45 to 0.76). Patients with higher values in QoL (EQ5D, OR 3.1, 95% CI: 1.52 to 6.2) were positively associated with meeting MVPArec. In 2010 there were no differences in medical treatment between the groups, p=0.377. In 2017 the group meeting MVPArec included a lower number of untreated patients compared to 2010 (25% vs 34%, p=0.017).

Conclusions: Only four out of ten patients with established RA reported to maintain recommended levels of PA over a seven year period. Experiencing high quality of life seems to be important for PA maintenance together with lower levels of pain, fatigue and better physical function. Health care professionals need to take the patient perspective into account andsupport maintenance of physical activities accordingly.

Disclosure of Interest: None declared

Place, publisher, year, edition, pages
London: BMJ Publishing Group Ltd, 2018
National Category
Clinical Medicine Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:hh:diva-36808 (URN)
Conference
Annual European Congress of Rheumatology EULAR, Amsterdam, Netherlands, 13-16 June, 2018
Note

On behalf of The BARFOT study.

Available from: 2018-05-23 Created: 2018-05-23 Last updated: 2018-07-31Bibliographically approved
Meesters, J., Bergman, S., Haglund, E., Jacobsson, L., Petersson, I. & Bremander, A. (2018). Prognostic factors for change in self-reported anxiety and depression in spondyloarthritis patients: data from the population-based SpAScania cohort from southern Sweden. Scandinavian Journal of Rheumatology, 47(3), 185-193
Open this publication in new window or tab >>Prognostic factors for change in self-reported anxiety and depression in spondyloarthritis patients: data from the population-based SpAScania cohort from southern Sweden
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2018 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 47, no 3, p. 185-193Article in journal (Refereed) Published
Abstract [en]

Objectives: Anxiety and depression symptoms are more common in patients with spondyloarthritis (SpA) than in the general population. This study describes prognostic factors for change in self-reported anxiety and depression over 2 years in a well-defined SpA cohort. Method: In 2009, 3716 adult patients from the SpAScania cohort received a postal questionnaire to assess quality of life (QoL) and physical and mental functioning. A follow-up survey was performed in 2011. The Hospital Anxiety and Depression Scale indicated ‘no’, ‘possible’, and ‘probable’ cases of anxiety and depression. Transitions between the three different categories were analysed and logistic regression analysis determined prognostic factors (patient-reported outcomes and characteristics) for improvement or deterioration. Results: In total, 1629 SpA patients responded to both surveys (44%) (mean ± SD age 55.8 ± 13.1 years, disease duration 14.6 ± 11.7 years); 27% had ankylosing spondylitis, 55% psoriatic arthritis, and 18% undifferentiated SpA. The proportion of patients reporting possible/probable anxiety decreased from 31% to 25% over 2 years, while no changes in depression were seen. Factors associated with deterioration or improvement were largely the same for anxiety as for depression: fatigue, general health, QoL, level of functioning, disease activity, and self-efficacy. However, reporting chronic widespread pain (CWP) at baseline increased the risk of becoming depressed and decreased the probability of recovering from anxiety. Conclusion: Self-reported anxiety and depression is common and fairly stable over time in SpA patients. The association between mental health and CWP indicates that both comorbidities need to be acknowledged and treated in the clinic. © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Place, publisher, year, edition, pages
Abingdon: Taylor & Francis, 2018
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:hh:diva-36502 (URN)10.1080/03009742.2017.1350744 (DOI)000432559500003 ()28812455 (PubMedID)2-s2.0-85027517223 (Scopus ID)
Note

This study was funded by Region Skåne and with research grants from the Faculty of Medicine at Lund University, Sweden, the Norrbacka-Eugenia Foundation, Sweden, and the Swedish Rheumatism Association. The follow-up survey was funded by Abbvie and Pfizer.

Available from: 2018-03-26 Created: 2018-03-26 Last updated: 2018-07-03Bibliographically approved
Aili, K., Andersson, M., Bremander, A., Haglund, E. & Bergman, S. (2018). Sleep problems and fatigue as a predictor for the onset of chronic widespread pain over a 5- and 18-year perspective: a 20-year prospective study. Paper presented at Annual European Congress of Rheumatology EULAR, Amsterdam, Netherlands, 13-16 June, 2018. Annals of the Rheumatic Diseases, 77(Suppl. 2), 87-87
Open this publication in new window or tab >>Sleep problems and fatigue as a predictor for the onset of chronic widespread pain over a 5- and 18-year perspective: a 20-year prospective study
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2018 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, no Suppl. 2, p. 87-87Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background: If localised pain represent one end of a pain spectra, with overall better general health, chronic widespread pain (CWP) and fibromyalgia represent the other end of the spectra with worse general health and more comorbidities with other somatic diseases and mental illness. Sleep problems and fatigue are common among individuals reporting CWP and previous research indicate that sleep problems may be an important predictor for pain prognosis.

Objectives: The aim of this population-based study was to investigate if sleep problems and fatigue predict the onset of CWP 5 and 18 years later.

Methods: In order to get more stable baseline classifications of CWP, a wash-out period was used, including only individuals who had not reported CWP (according to ACR 1990 criteria for fibromyalgia) at baseline (−98) and three years prior baseline (−95). In all, data from 1249 individuals entered the analyses for the 5 year follow-up (−03) and 791 entered for the 18 year follow-up (−16). Four parameters related to sleep (difficulties initiating sleep, maintaining sleep, early morning awakening and non-restorative sleep), and one parameter related to fatigue (SF-36 vitality scale) were investigated as predictors for CWP. Binary logistic regression analysis were used for analyses.

Results: All investigated parameters predicted the onset of CWP five years later (problems with initiating sleep (OR 1.91; 1.16–3.14), maintaining sleep (OR 1.85; 1.14–3.01), early awakening (OR 2.0; 1.37–3.75), non-restorative sleep (OR 2.27; 1.37–3.75) and fatigue (OR 3.70; 1.76–7.84)) in a model adjusted for age, gender, socio-economy and mental health. All parameters except problems with early awakening predicted the onset of CWP also 18 years later. In all, 785 individuals did not report any of the sleeping problems at baseline (fatigue not included), 268 reported one of the problems, 167 two, 128 three and 117 subjects reported to have all four sleep problems. Reporting all four sleep problems was significantly associated with CWP at follow-up at both time points when adjusting for age, gender, socio economy and mental health (OR 4.00; 2.03–7.91 and OR 3.95; 1.90–8.20); adjusting for age, gender, socio economy and number of pain regions (OR 2.94; 1.48–5.82 and OR 2.65; 1.24–5.64) and in a model adjusting for age, gender, socio economy and pain severity (OR 2.97;1.53–5.76; and OR 3.02;1.47–6.21) for the 5 year and 18 year follow-up respectively, compared to not reporting any of the sleep problems at baseline.

Conclusions: Both sleeping problems and fatigue predicts the onset of CWP 5- and 18 years later. The results highlight the importance of the assessment of sleep quality in the clinic.

Place, publisher, year, edition, pages
London: BMJ Publishing Group Ltd, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hh:diva-38333 (URN)
Conference
Annual European Congress of Rheumatology EULAR, Amsterdam, Netherlands, 13-16 June, 2018
Available from: 2018-11-14 Created: 2018-11-14 Last updated: 2018-11-15Bibliographically approved
Aili, K., Andersson, M., Bremander, A., Haglund, E., Larsson, I. & Bergman, S. (2018). Sleep problems and fatigue as a predictor for the onset of chronic widespread painover a 5- and 18-year perspective: a 20-year prospective study. Paper presented at Annual European Congress of Rheumatology EULAR, Amsterdam, Netherlands, 13-16 June, 2018. Annals of the Rheumatic Diseases, 77, 87-87, Article ID OP0072.
Open this publication in new window or tab >>Sleep problems and fatigue as a predictor for the onset of chronic widespread painover a 5- and 18-year perspective: a 20-year prospective study
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2018 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 87-87, article id OP0072Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background: If localised pain represent one end of a pain spectra, with overall better general health, chronic widespread pain (CWP) and fibromyalgia represent the other end of the spectra with worse general health and more comorbidities with other somatic diseases and mental illness. Sleep problems and fatigue are common among individuals reporting CWP and previous research indicate that sleep problems may be an important predictor for pain prognosis.

Objectives: The aim of this population-based study was to investigate if sleep problems and fatigue predict the onset of CWP 5 and 18 years later.

Methods: In order to get more stable baseline classifications of CWP, a wash-out period was used, including only individuals who had not reported CWP (according to ACR 1990 criteria for fibromyalgia) at baseline (−98) and three years prior baseline (−95). In all, data from 1249 individuals entered the analyses for the 5 year follow-up (−03) and 791 entered for the 18 year follow-up (−16). Four parameters related to sleep (difficulties initiating sleep, maintaining sleep, early morning awakening and non-restorative sleep), and one parameter related to fatigue (SF-36 vitality scale) were investigated as predictors for CWP. Binary logistic regression analysis were used for analyses.

Results: All investigated parameters predicted the onset of CWP five years later (problems with initiating sleep (OR 1.91; 1.16–3.14), maintaining sleep (OR 1.85; 1.14–3.01), early awakening (OR 2.0; 1.37–3.75), non-restorative sleep (OR 2.27; 1.37–3.75) and fatigue (OR 3.70; 1.76–7.84)) in a model adjusted for age, gender, socio-economy and mental health. All parameters except problems with early awakening predicted the onset of CWP also 18 years later. In all, 785 individuals did not report any of the sleeping problems at baseline (fatigue not included), 268 reported one of the problems, 167 two, 128 three and 117 subjects reported to have all four sleep problems. Reporting all four sleep problems was significantly associated with CWP at follow-up at both time points when adjusting for age, gender, socio economy and mental health (OR 4.00; 2.03–7.91 and OR 3.95; 1.90–8.20); adjusting for age, gender, socio economy and number of pain regions (OR 2.94; 1.48–5.82 and OR 2.65; 1.24–5.64) and in a model adjusting for age, gender, socio economy and pain severity (OR 2.97;1.53–5.76; and OR 3.02;1.47–6.21) for the 5 year and 18 year follow-up respectively, compared to not reporting any of the sleep problems at baseline.

Conclusions: Both sleeping problems and fatigue predicts the onset of CWP 5- and 18 years later. The results highlight the importance of the assessment of sleep quality in the clinic.

Place, publisher, year, edition, pages
London: BMJ Publishing Group Ltd, 2018
Keywords
Chronic widespread pain, Sleep problems
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-37138 (URN)
Conference
Annual European Congress of Rheumatology EULAR, Amsterdam, Netherlands, 13-16 June, 2018
Available from: 2018-06-18 Created: 2018-06-18 Last updated: 2018-07-26Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8081-579X

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