Labour Force Participation in Adults with Osteoarthritis (OA) or Joint Symptoms Typical of OA: Findings from a Canadian Longitudinal Study on Aging.

OBJECTIVE: The purpose of the study is to examine the relationship between osteoarthritis (OA) and joint symptoms typical of OA and labour force participation. METHODS: Data are from the baseline questionnaire of the Canadian Longitudinal Study on Aging for respondents aged 45-74 years at baseline (n=24,427). Individuals were categorized into one of five mutually exclusive arthritis status groups: diagnosed OA; diagnosed other type of arthritis; 2-3 symptomatic joint sites/no diagnosed arthritis; 1 symptomatic joint site/no diagnosed arthritis; no arthritis/no joint symptoms. Age-stratified robust log-Poisson regression analysis was used to examine the association between arthritis status and labour force participation. RESULTS: Overall 39% of the analytic sample reported being out of the labour force. Those with OA aged 45-54 and 55-64 years were significantly more likely to be out of the labour force than those with no arthritis/no joint symptoms, prevalence ratio (PR) 1.34 [95% CI 1.10-1.65] and PR 1.13 [95% CI 1.06-1.21] respectively, with similar results for those with 2-3 joint symptoms/no OA in the 45-54 year age group (PR 1.37 [95% CI 1.07-1.76]). There was no difference for those aged 65-74 years. Being an informal caregiver increased the likelihood of non-participation in the labour force for those aged 55-64 years, PR 1.09 [95% CI 1.04-1.15]. CONCLUSION: Our results suggest that an exclusive reliance on an OA diagnosis to understand impact on labour force participation may miss a large segment of the middle-aged population which may have undiagnosed OA or are at greater risk of OA because of joint problems.

Cardiovascular Risk Profile and Osteoarthritis-Considering Sex and Multisite Joint Involvement: A Canadian Longitudinal Study on Aging.

OBJECTIVE: The objective of this study was to investigate a profile of cardiovascular disease (CVD) risk factors by sex among individuals with and without osteoarthritis (OA) and to consider single-site and multisite joint OA. METHODS: Data were sourced from Cycle 1, Comprehensive Cohort, Canadian Longitudinal Study on Aging, a national sample of individuals ages 45 to 85 years. Systemic inflammatory/metabolic CVD risk factors collected were high-sensitivity C-reactive protein (hsCRP) level, high-density lipoprotein, triglycerides, total cholesterol, body mass index (BMI), systolic blood pressure, and hemoglobin A1c. Smoking history was also collected. Respondents indicated doctor-diagnosed OA in the knees, hips, and/or hands and were characterized as yes/no OA and single site/multisite OA. Individuals with OA were age- and sex-matched to non-OA controls. Covariates were age, sex, education, income, physical activity, timed up and go test findings, and comorbidities. A latent CVD risk variable was derived in women and men; standardized scores were categorized as follows: lowest, mid-low, mid-high, and highest risk. Associations with OA were quantified using ordinal logistic regressions. RESULTS: A total of 6,098 respondents (3,049 with OA) had a median age of 63 years, and 55.8% were women. One-third of OA respondents were in the highest risk category versus one-fifth of non-OA respondents. Apart from BMI (the largest contributor in both sexes), hsCRP level (an inflammation marker) was predominant in women, and metabolic factors and smoking were predominant in men. Overall, OA was associated with worse CVD risk quartiles compared with non-OA. OA was increasingly associated with worse CVD risk quartiles with increasing risk thresholds among women with multisite OA, but not men. CONCLUSION: Findings suggest unique CVD risks by sex/multisite subgroups and point to a potentially important role for inflammation in OA over and above traditional CVD risk factors.

Relationship Between Body Mass Index and Osteoarthritis for Single and Multisite Osteoarthritis of the Hand, Hip, or Knee: Findings From a Canadian Longitudinal Study on Aging.

OBJECTIVE: To determine whether an apparent association between hand osteoarthritis (OA) and adiposity is explained by the presence of OA at other joint sites. METHODS: Data from the Canadian Longitudinal Study on Aging, first cycle, comprehensive cohort, were used. Respondents age 45-85 years (n = 18,279) were asked separate questions about doctor-diagnosed OA in the hand, hip, or knee. Multinomial logistic regression was used to investigate the relationship between all combinations of hand, hip, and knee OA and body mass index (BMI) and waist-to-height ratio (WHtR). RESULTS: OA was reported by 34.6% of respondents, 28.0% with OA at >1 joint site. Hand OA was not significantly associated with BMI after accounting for OA at other joint sites, with similar findings for WHtR. All joint site combinations containing the knee were strongly associated with BMI, with odds ratios (ORs) ranging from OR 2.92 (95% confidence interval [95% CI] 2.53-3.37) for knee OA only with obesity class I to OR 9.98 (95% CI 7.12-13.88) for multi-joint knee, hip, hand OA with obesity class II/III. BMI distributions including knee OA were broader and shifted to higher BMI levels than those for hand or hip OA. CONCLUSION: Apparent associations between hand OA and BMI may be explained by concurrent OA at other joint sites. Recognizing that OA is a multi-joint disease is crucial for studies of the associations of adiposity with OA in a particular joint, especially the hand. The association between knee OA and BMI appears to be distinct from those for OA at other joint sites.

Quality of life measures in older adults after traumatic brain injury: a systematic review.

BACKGROUND: On average older adults experiencing TBI are hospitalized four times as often, have longer hospital stays, and experience slower recovery trajectories and worse functional outcomes compared to younger populations with the same injury severity. A standard measure of Qol for older adults with TBI would facilitate accurate and reliable data across the individual patient care continuum and across clinical care settings, as well as support more rigorous research studies of metadata. PURPOSE: The aim of this systematic review was to investigate patient reported Qol measures in studies with older adults post TBI. METHOD: A systematic review was carried out focusing on the various tools to measure Qol in older adults, ≥ 65 years of age with a diagnosis of TBI. Data bases searched included Medline, Embase, PubMed, CINAHL, and PsychInfo from date of inception to September 25, 2017. RESULTS: A total of 20 articles met the inclusion criteria. Nine different tools were identified. CONCLUSIONS: Findings based on the comparison of reliability and construct validity of the Qol measures reported in this review suggest that no single instrument is superior to all others for our study population. Future research in this field should include the enrollment of larger study samples of older adults. Without these future efforts, the ability to detect an optimal Qol measure will be hindered.

Transitional care for formerly incarcerated persons with HIV: protocol for a realist review.

BACKGROUND: Little is known about the mechanisms that influence the success or failure of programs to facilitate re-engagement with health and social services for formerly incarcerated persons with HIV. This review aims to identify how interventions to address such transitions work, for whom and under what circumstances. METHODS: We will use realist review methodology to conduct our analysis. We will systematically search electronic databases and grey literature for English language qualitative and quantitative studies of interventions. Two investigators will independently screen citations and full-text articles, abstract data, appraise study quality and synthesize the literature. Data analysis will include identifying context-mechanism-outcome configurations, exploring and comparing patterns in these configurations, making comparisons across contexts and developing explanatory frameworks. DISCUSSION: This review will identify mechanisms that influence the success or failure of transition interventions for formerly incarcerated individuals with HIV. The findings will be integrated with those from complementary qualitative and quantitative studies to inform future interventions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016040054.