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Marcus Schiltenwolf - One of the best experts on this subject based on the ideXlab platform.
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the influence of the grade of Chronicity on the outcome of multidisciplinary therapy for chronic low back pain
Spine, 2007Co-Authors: Matthias Buchner, Eva Neubauer, A Zahltenhinguranage, Marcus SchiltenwolfAbstract:STUDY DESIGN Prospective longitudinal clinical study. OBJECTIVE The objective of the study was to analyze the outcome of different stages of Chronicity in patients with chronic low back pain treated with a multidisciplinary therapy. SUMMARY OF BACKGROUND DATA Results of studies comparing different grades of Chronicity in therapy for chronic low back pain have not been published so far. METHODS A total of 387 patients with chronic low back pain for 3 months or longer and a corresponding sick leave for longer than 6 weeks underwent a 3-week standardized multidisciplinary therapy. At baseline (T0), patients were assigned into 3 groups of Chronicity grades according to the classification of von Korff et al (Group A, Grades I and II; Group B, Grade III; Group C, Grade IV) and were prospectively followed. At the the 6-month follow-up (T1), 5 different therapy outcomes were analyzed and compared in the 3 groups: back-to-work status, generic health status (SF-36), pain intensity (visual analogue scale), functional capacity (Hannover back capacity score), and satisfaction with the therapy. RESULTS At T0, patients in Group C had a higher pain level, a longer history of pain, and more general and more psychosomatic comorbidities than patients with lower levels of Chronicity. All 3 treatment groups improved significantly in all outcome criteria between T0 and T1. In the total group, the back-to-work rate was 67.4%. At the final follow-up, there were significantly better results in terms of functional capacity and pain level in patients with lower grades of Chronicity but mostly due also to worse initial baseline values. Back-to-work rate, satisfaction with therapy, and the Mental Component Summary of the SF-36 did not show a significant difference at T1 between the groups analyzed. CONCLUSION According to the results of this study, patients with chronic low back pain also derive significant benefit from a multidisciplinary treatment strategy in higher stages of Chronicity. Therefore, therapy should not be limited to the patients in lower stages of Chronicity.
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hkf r 10 screening for predicting Chronicity in acute low back pain lbp a prospective clinical trial
European Journal of Pain, 2006Co-Authors: Eva Neubauer, Astrid Junge, Peter Pirron, Hanne Seemann, Marcus SchiltenwolfAbstract:Abstract Study design Prospective cohort study. Objectives To develop a short instrument to reliably predict Chronicity in low back pain (LBP). Summary of background data Health care expenditures on the treatment of low back pain continue to increase. It is therefore important to prevent the development of Chronicity. In Germany, there is at present no early risk assessment tool to predict the risk of developing chronic LBP for patients presenting with acute LBP. Undertaken in an orthopedic practice setting, this study examined known risk factors for Chronicity. It resulted in the development of a short questionnaire that successfully predicted the course of Chronicity with an accuracy of 78%. Methods A cohort of 192 orthopaedic outpatients was assessed for clinical, behavioral, emotional, and cognitive parameters bsed on a self-report test battery of 167 established items predictive for Chronicity in LBP. Chronicity was defined as back pain persisting for longer than six months. Logistic regression analysis was performed to evaluate the predictive value of all items significantly associated with the dependent variable. Results The study found the following items to have the strongest predictive value in the development of Chronicity: “How strong was your back pain during the last week when it was most tolerable?” and the question “How much residual pain would you be willing to tolerate while still considering the therapy successful?” These were followed by the variables for “Duration of existing LBP” (more than eight days), the patient’s educational level (low levels are related to higher risks of Chronicity) and pain being experienced elsewhere in the body. Other significant factors were five items assessing depression (Zung) and the palliative effect of therapeutic massage (where a positive correlation was found). Female patients have a higher risk for Chronicity, as do patients with a high total score on the scales assessing “catastrophizing thoughts” and thoughts of “helplessness”. Conclusion Using the items listed above, the study was able to predict a patient’s risk of developing chronic LBP with a probability of 78%. These items were assembled in a brief questionnaire and were paired with a corresponding evaluative tool. This enables practitioners to assess an individual patient’s risk for Chronicity by means of a simple calculator in just a few minutes. A validation study for the questionnaire is currently being prepared. Mini abstract The objective of this study was the development of a brief questionnaire to assess the risk for Chronicity for LBP.
Patricia A Brennan - One of the best experts on this subject based on the ideXlab platform.
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severity Chronicity and timing of maternal depression and risk for adolescent offspring diagnoses in a community sample
Archives of General Psychiatry, 2003Co-Authors: Constance Hammen, Patricia A BrennanAbstract:Background Risk for depression and other disorders is known to be high among children of depressed mothers, but little is known about the parameters of severity, Chronicity, and timing of depression and its effects on children. The study addresses these issues, disaggregating their overlapping effects. Methods A sample of 816 women and their 15-year-old children in an Australian community were selected from a large birth cohort study to represent variation in maternal depression history during the child's first 10 years of life. Quantification of maternal depression severity and duration, and dates of occurrence, permitted analyses of youth depression and nondepressive disorders as a function of relative severity, Chronicity, and timing of maternal depression. Results Diagnosable depression in children as old as 15 years was twice as likely among offspring of depressed, as compared with never-depressed mothers. After controls for demographic factors, severity of maternal depression contributed more to children's risk for depression than did Chronicity. Children exposed even to 1 to 2 months of maternal major depression, or to more than 12 months of mild depression had elevated risks of depression; however, Chronicity of maternal depression was associated more with nondepressive outcomes than was severity. Timing of exposure did not differentially predict risk for the disorder in children when separated from confounding Chronicity and severity parameters. Conclusions Even relatively brief maternal major depression, but more prolonged mild depression, predicted children's risk for depressive disorders by age 15 years in a community sample. Nondepressive outcomes were more complex to predict, which was due in part to difficulty dating disorder onset in relation to maternal depression. Exposure to maternal depression at any period in the first 10 years equally predicted youth depression if the mother was depressed only once. Further studies are needed to shed light on the mechanisms by which maternal depression has its effects.
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Chronicity severity and timing of maternal depressive symptoms relationships with child outcomes at age 5
Developmental Psychology, 2000Co-Authors: Patricia A Brennan, Constance Hammen, M J Andersen, William Bor, Jake M Najman, Gail M WilliamsAbstract:The relationships between severity, Chronicity, and timing of maternal depressive symptoms and child outcomes were examined in a cohort of 4,953 children. Mothers provided self-reports of depressive symptoms during pregnancy, immediately postpartum, and when the child was 6 months old and 5 years old. At the age 5 follow-up, mothers reported on children's behavior and children completed a receptive vocabulary test. Results suggest that both the severity and the Chronicity of maternal depressive symptoms are related to more behavior problems and lower vocabulary scores in children. The interaction of severity and Chronicity of maternal depressive symptoms was significantly related to higher levels of child behavior problems. Timing of maternal symptoms was not significantly related to child vocabulary scores, but more recent reports of maternal depressive symptoms were associated with higher rates of child behavior problems.
Ikuo Nakamura - One of the best experts on this subject based on the ideXlab platform.
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temporal pathogenesis of experimental neonatal woodchuck hepatitis virus infection increased initial viral load and decreased severity of acute hepatitis during the development of chronic viral infection
Hepatology, 2000Co-Authors: Ilia Toshkov, Christine A Bellezza, Mary Ascenzi, Carol A Roneker, Lou Ann Graham, Karen Gaye, Ikuo NakamuraAbstract:Acute hepatitis B virus (HBV) infections either resolve or progress to Chronicity. Identification of early deviations in host-virus responses associated with these outcomes can further differentiate cause-effect mechanisms that initiate and maintain Chronicity. Neonatal woodchucks were infected experimentally with the woodchuck hepatitis virus (WHV) at 3 days of age. At 8 or 14 weeks of age (i.e., the early- or mid-acute stage of infection), whole blood and large surgical biopsies of the liver were obtained from infected animals and uninfected controls. These were stored for later correlating histopathologic responses and viral load with the subsequently determined outcome of infection. As of 1 year postinfection, half of the surgically treated infected woodchucks had developed self-limited infections, while the other half developed chronic infections. The self-limited outcome was characterized by decreased viral load in acute-phase liver and plasma and a generally robust acute hepatic inflammatory response. Comparisons at the same early time points revealed that the chronic outcome was characterized by increasing initial viral load in liver and plasma, and a detectable, but diminished, acute hepatic inflammation. These cotemporal comparisons indicate that there is an early host-response deviation during the acute phase of a developing chronic infection. Continued analysis of the tissues banked from this study will facilitate further temporal characterization of acute-phase mechanisms that determine resolution versus Chronicity in WHV infection. Understanding such mechanisms may be useful in the rational design of therapy for established chronic HBV infection.
Jesse T Young - One of the best experts on this subject based on the ideXlab platform.
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comorbid attention deficit hyperactivity disorder and substance use disorder complexity and Chronicity in treatment seeking adults
Drug and Alcohol Review, 2015Co-Authors: Jesse T Young, Susan Carruthers, Sharlene Kaye, Steve Allsop, Joanne Gilsenan, Louisa Degenhardt, Geurt Van De GlindAbstract:Introduction and Aims Attention deficit hyperactivity disorder (ADHD) is a known risk factor for substance use disorder (SUD); however, the potential additive contribution of comorbid ADHD to drug-specific dependence in SUD populations is largely unknown. The current study aimed to assess this association between ADHD symptoms and drug-specific SUD complexity and Chronicity. Design and Methods A cross-sectional survey was administered to a convenience sample of 489 adults receiving SUD treatment at 16 Australian drug and alcohol treatment centres between September 2010 and August 2011. Participants were screened for adult ADHD symptoms using the Adult ADHD Self-Report Scale. Associations between ADHD screening status and drug-specific SUD complexity and Chronicity were assessed using multivariate logistic and modified Poisson regression analysis, controlling for a range of potential confounders. Results Overall, 215 (44%) patients screened positive for concurrent adult ADHD and SUD. After Simes' correction, a significant positive association was observed between ADHD screening status and current amphetamine SUD (odds ratio (OR) = 1.85; 95% confidence interval (CI): 1.19–2.36). Patients who screened positive for ADHD were significantly more likely to report SUD history for heavy alcohol use (OR = 2.05; 95% CI: 1.21–3.45) and amphetamine (OR = 1.96; 95% CI: 1.26–3.06) as well as significantly increased risk of moderate (3–4 years) duration for benzodiazepine and amphetamine SUDs and long (≥5 years) duration for alcohol, opiates other than heroin or methadone, and amphetamine SUDs. Discussion and Conclusions The findings provide evidence that there is increased drug dependence complexity and Chronicity in treatment-seeking SUD patients who screen positively for ADHD, specifically for amphetamine, alcohol, opiates other than heroin or methadone, and benzodiazepines. [Young JT, Carruthers S, Kaye S, Allsop S, Gilsenan J, Degenhardt L, van de Glind G, van den Brink W, Preen D. Comorbid attention deficit hyperactivity disorder and substance use disorder complexity and Chronicity in treatment-seeking adults. Drug Alcohol Rev 2015;34:683–93]
Brenda W.j.h. Penninx - One of the best experts on this subject based on the ideXlab platform.
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Inflammatory and Metabolic Dysregulation and the 2-Year Course of Depressive Disorders in Antidepressant Users
Neuropsychopharmacology, 2014Co-Authors: Nicole Vogelzangs, Arianne Kb Van Reedt Dortland, Peter De Jonge, Aartjan T. F. Beekman, Robert A. Schoevers, Erik J. Giltay, Brenda W.j.h. PenninxAbstract:Scarce evidence suggests that inflammatory and metabolic dysregulation predicts poor response to antidepressants, which could result in worse depression outcome. This study prospectively examined whether inflammatory and metabolic dysregulation predicted the 2-year course of depressive disorders among antidepressant users. Data were from the Netherlands Study of Depression and Anxiety, including 315 persons (18–65 years) with a current depressive disorder (major depressive disorder, dysthymia) at baseline according to the DSM-IV criteria and using antidepressants. Inflammatory (C-reactive protein, interleukin-6 (IL-6), tumor-necrosis factor- α ) and metabolic (waist circumference, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, fasting glucose) factors were measured at baseline. Primary outcome for course of depression was indicated by whether or not a DSM-IV depressive disorder diagnosis was still/again present at 2-year follow-up, indicating Chronicity of depression. Elevated IL-6, low HDL cholesterol, hypertriglyceridemia, and hyperglycemia were associated with Chronicity of depression in antidepressant users. Persons showing ⩾4 inflammatory or metabolic dysregulations had a 1.90 increased odds of depression Chronicity (95% CI=1.12–3.23). Among persons who recently (ie, at most 3 months) started antidepressant medication ( N =103), having ⩾4 dysregulations was associated with a 6.85 increased odds of depression Chronicity (95% CI=1.95–24.06). In conclusion, inflammatory and metabolic dysregulations were found to predict a more chronic course of depressive disorders among patients using antidepressants. This could suggest that inflammatory and metabolic dysregulation worsens depression course owing to reduced antidepressant treatment response and that alternative intervention treatments may be needed for depressed persons with inflammatory and metabolic dysregulation.
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the importance of childhood trauma and childhood life events for Chronicity of depression in adults
The Journal of Clinical Psychiatry, 2009Co-Authors: Jenneke E Wiersma, Aartjan T. F. Beekman, Erik J. Giltay, Jacqueline G F M Hovens, Patricia Van Oppen, Digna J F Van Schaik, Brenda W.j.h. PenninxAbstract:Background: Childhood trauma is linked to adult depression and might be a risk factor for a more chronic course of depression. However, the link between childhood trauma and Chronicity of depression has not been investigated using a large and representative sample in which other depression characteristics, such as severity; age at onset, and comorbid psychopathology, were taken into account. Method: Baseline data, collected during 2004 through 2007, were drawn from the Netherlands Study of Depression and Anxiety (NESDA). Participants had a current DSM-IV-TR diagnosis of major depressive disorder (MDD) and were recruited from the community, primary care settings, and specialized mental health care facilities (N = 1230). Relationships between both childhood trauma and childhood life events and Chronicity of depression were examined using multiple logistic regression models. Chronicity of depression was defined as being depressed for 24 months or more in the past 4 years. Results: Chronicity of depression was associated with a significantly higher prevalence of childhood trauma but was not associated with childhood life events. We found the strongest association for those with the highest score on a cumulative index summarizing frequency of childhood trauma (OR = 3.26; 95% CI = 1.86 to 5.72, p <.001). After controlling for comorbid anxiety disorders, severity of depressive symptoms, and age at onset of depression, we found that the association between childhood trauma index and Chronicity of depression remained significant (OR = 2.06; 95% CI = 1.13 to 3.73, p = .02). Conclusions. These results suggest that multiple childhood traumas can be seen as an independent determinant of Chronicity of depression. For treatment of depressed patients, it is therefore important to detect the presence of childhood trauma. J Clin Psychiatry 2009;70(7):983-989 (c) Copyright 2009 Physicians Postgraduate Press, Inc.