Gender difference among smoking, adiponectin, and high-sensitivity C-reactive protein.

BACKGROUND: Subclinical inflammation is a novel risk factor of cardiovascular diseases and type 2 diabetes. An inverse association between plasma adiponectin and insulin resistance has been previously shown. Elevated levels of high-sensitivity C-reactive protein (hs-CRP) predict future cardiovascular events. Smoking has been proven to connect with inflammatory markers. There is also evidence of a difference between genders in pro-inflammation. This study aimed to examine the connections among adiponectin, hs-CRP, and smoking and to determine possible gender differences in these associations. METHODS: Included were 365 men and 476 women; all were nondiabetic and middle-aged. Daily smoking subjects were considered to be smokers. Adiponectin and hs-CRP were analyzed. Data were collected in 1997-1998, and cytokines were analyzed in 2003. RESULTS: Thirty-five percent of the men and 22% of the women were smokers. In women, the adiponectin level was significantly lower in smokers (6.94+/-3.27 microg/ml) compared to nonsmokers (8.27+/-4.72 microg/ml, p=0.0017). This association remained significant after adjustment for age and BMI (p=0.0061). The hs-CRP level was significantly higher in smoking men (1.59+/-1.71 pg/ml) compared to nonsmoking men (1.17+/-1.41 pg/ml, p=0.018). This result remained after adjustment for age and BMI (p=0.0056). When smokers were compared to nonsmokers, there was no difference in adiponectin among men or in hs-CRP among women. CONCLUSIONS: In the nondiabetic population, smoking associates differently with subclinical inflammation between genders, with a decreased adiponectin level in women and with an increased hs-CRP level in men.

Frequent analgesic use at population level: prevalence and patterns of use.

Statistics and prescription database studies show that analgesics are widely utilized, but do not tell anything about either the factors behind analgesic use or how over-the-counter (OTC) analgesics are being used. We aimed to study the prevalence of frequent use of prescribed and OTC analgesics. We also investigated the background factors related to frequent analgesic use and assessed rationality of analgesic usage patterns. We addressed a postal survey to a random stratified population sample of 6500 Finnish people aged 15-74 years. The response rate was 71% (n=4542) after exclusion of unobtainable addressees (n=68). Individuals reporting analgesic use 'daily' or 'a few times a week' were categorized as frequent users. After adjusting for age and sex, the overall prevalence of daily analgesic use was 8.5%, and the prevalence of analgesic use a few times a week 13.6%. The adjusted prevalence of using exclusively prescribed analgesics daily or a few times a week was 8.7%, and that of utilizing purely OTC analgesics 8.8%. The overall prevalence of concomitant frequent use of both prescribed and OTC analgesics was 4.6%. Multinominal logistic regression analyses showed that frequent analgesic use was related especially to daily or continuous pain and high pain intensity. Low mood and not being employed also increased the probability for daily analgesic use. Frequent analgesic use seems to be common at population level. Concomitant use of both prescribed and OTC analgesics can be considered irrational, as it increases the risk of adverse events.

How do people ease their pain? A population-based study.

UNLABELLED: We investigated how a general population treat their pain and determined factors affecting use of different pain management strategies. From the respondents of a cross-sectional postal survey we selected those who had experienced pain during the past 7 days (n = 3641) and analyzed how they had tried to manage their pain during the past 6 months. The most common pain management strategies were use of over-the-counter medicines (53% of 3641 respondents), physical exercise (52%), prescription medicines (35%), and visiting a physician (33%). The location of pain was related to which pain management strategy was chosen. Use of multiple (>4) treatments was related to prolonged pain, having several (>3) painful locations, high intensity and frequency of pain. PERSPECTIVE: This study indicates that people with pain are active in trying different treatments. Self-care strategies, especially over-the-counter medicines and physical exercise, are common ways to manage pain at the population level.

Chronic pain and poor self-rated health.

CONTEXT: Chronic pain is common in Western societies. Self-rated health is an important indicator of morbidity and mortality, but little is known about the relation between chronic pain and self-rated health in the general population. OBJECTIVE: To analyze the association between chronic pain and self-rated health. DESIGN, SETTING, AND POPULATION: A questionnaire survey carried out during the spring of 2002 of an age- and sex-stratified population sample of 6500 individuals in Finland aged 15 to 74 years, with a response rate of 71% (N = 4542) after exclusion of those with unobtainable data (n = 38). Chronic pain was defined as pain with a duration of at least 3 months and was graded by frequency: (1) at most once a week; (2) several times a week; and (3) daily or continuously. On the basis of a 5-item questionnaire on self-rated health, individuals were classified as having good, moderate, or poor health. Multinominal logistic regression analysis was used to assess the determinants of health. Analysis included sex, age, education, working status, chronic diseases, and mood. MAIN OUTCOME MEASURES: Perceived chronic pain graded by frequency and self-rated health status. RESULTS: The prevalence of any chronic pain was 35.1%; that of daily chronic pain, 14.3%. The prevalence of moderate self-rated health was 26.6% and of poor health, 7.6%. For moderate self-rated health among individuals having chronic pain at most once a week compared with individuals having no chronic pain, the adjusted odds were 1.36 (95% confidence interval [CI], 1.05-1.76); several times a week, 2.41 (95% CI, 1.94-3.00); and daily, 3.69 (95% CI, 2.97-4.59). Odds for poor self-rated health were as follows: having chronic pain at most once a week, 1.16 (95% CI, 0.65-2.07); several times a week, 2.62 (95% CI, 1.76-3.90); and daily, 11.82 (95% CI, 8.67-16.10). CONCLUSION: Chronic pain is independently related to low self-rated health in the general population.

Direct and indirect costs of managing patients with musculoskeletal pain-challenge for health care.

Musculoskeletal pain is an outstanding symptom among the patients of primary health care. However, there are few studies of management and costs of musculoskeletal pain at primary health care level. The aim of this study was to describe the diagnostic investigations, management, referral rate and sick leaves related to visits prompted by musculoskeletal pain as well as to assess their costs. A total of 28 general practitioners (GPs) at 25 randomly selected health centres throughout Finland collected the data for this 4 week study, which covered 1 week from each of the four seasons. All visits, except those occurring after hours, were recorded. Altogether 1123 patients visited GPs because of musculoskeletal pain. Laboratory tests were ordered for 12% and imaging investigations for 24%. A total of 16% of the patients suffering from musculoskeletal pain received a prescription for physiotherapy, and analgesics were prescribed to 61% of them. Physicians referred 7% of the pain patients to specialist care. One out of every four patients was prescribed sick leave. The mean cost of the investigations, therapy, referrals, and sick leaves was as high as 530 EUR per visit, with absenteeism from work constituting two-fifths of the total costs. Musculoskeletal pain is not just a frequent complaint but also has extensive economic consequences for society. Investigations and therapy at the primary health care level play a minor role in the costs as compared with specialist care and sick leaves.