Fear of movement, quality of life, and self-reported disability in obese patients with chronic lumbar pain.

OBJECTIVE: To compare fear of movement between obese and non-obese individuals seeking therapy for chronic low back pain and to examine whether fear of movement predicted disability due to back pain, self-reported walking disability, and flexibility. DESIGN: This was a cross-sectional study. SETTING: Outpatient physical therapy clinic associated with a tertiary care hospital. PATIENTS: Patients with chronic low back pain (N=192; 48.2±18.8 years) were stratified into obese (average body mass index [BMI] 36.9±7.1 kg/m(2) ) or non-obese status (average BMI 24.5±3.4 kg/m(2) ). OUTCOME MEASURES: The Tampa Scale of Kinesiophobia (TSK), Short-Form 8 (SF-8), and Oswestry Disability Survey results were main outcome measures. METHODS: Retrospective review of medical charts was performed. Hierarchical regression modeling determined the contribution of TSK scores to the variance of self-reported disability with walking, overall Oswestry score, and flexibility. RESULTS: TSK scores were higher in obese than non-obese patients (26.2±7.5 vs 23.9±6.8 points; P=0.032). The SF-8 physical and mental subscores were 6-10% lower in the obese than non-obese patients. Oswestry survey scores were higher in the obese patients (40.6 vs 31.6 points; P<0.001). TSK scores contributed to self-reported disability with walking and Oswestry disability score (both P<0.001), but not flexibility. CONCLUSIONS: Among obese patients with chronic lumbar pain, pain-related fear of movement enhanced prediction of self-reported disability with walking and overall Oswestry scores. The TSK might be a useful clinical assessment to identify obese patients at higher risk for future low back disability.

Absence of combined effects of anemia and bilateral surgical status on inpatient rehabilitation outcomes following total knee arthroplasty.

PURPOSE: To examine the effects of anemia on inpatient rehabilitation outcomes following unilateral and bilateral total knee arthroplasty (TKA). METHOD: This was a multicenter, retrospective study from 15 inpatient rehabilitation facilities. Patients (N = 5421) with very low hematocrit (Hct <30%), low Hct (30-36% women, 30-41% men), or normal Hct (>36% women, 41% men) were included. Inpatient rehabilitation occurred following TKA. Functional independence measure (FIM) scores, length of stay (LOS), itemized hospital charges, discharge destination were main outcomes. RESULTS: LOS was 13% longer and hospital charges were 12.5-18.0% higher in the very low Hct than remaining groups (p = 0.0001). The FIM score and subscores for walking, stair climbing, bathing, transfers, and dressing changes were comparable for all Hct groups for the overall score. Hct <30% did not correspond to worse outcomes in patients with bilateral surgeries compared with unilateral surgeries; total FIM scores improved 47-53% across all Hct groups, regardless of bilateral surgical status. Discharge to home ranged 92.6-94.7% across all Hct groups (p > 0.05). CONCLUSIONS: Rehabilitation teams can expect comparable functional improvements and discharge to home in anemic and non-anemic patients with either unilateral or bilateral surgeries without hematologic correction in the rehabilitation setting, but might need an additional day to accomplish these outcomes.

The negative consequences of other students' drinking: inventory development and assessment of differences by student characteristics and risk behaviors.

UNLABELLED: College students continue to report being disrupted by other students' alcohol use. OBJECTIVE: This study was designed to develop measures to document the consequences resulting from other students' drinking and identify differences in experiencing these consequences by student characteristics and drinking behaviors. STUDY GROUP: A stratified random sample of undergraduate students (N = 3,908) from ten universities in North Carolina, USA, completed a web-based assessment. METHODS: Exploratory factor analysis (EFA) was performed on the random first split-half sample (n = 1,954) to identify factor structure. Confirmatory factor analysis (CFA) was performed on the remaining half sample (n = 1,954) using structural equation modeling. RESULTS: EFA revealed two inventories: interpersonal and community consequences of others' drinking inventories. CFA on the second split-half sample identified model fits for the two factor structure suggested by EFA. Of 3,908 participants, 78% reported experiencing one or more consequences due to others' drinking during the past 30 days. Multivariable generalized linear mixed modeling further validated the inventories and resulted in several associations. Male students who reported getting drunk experienced significantly more interpersonal consequences from others' drinking (p < .001). Minority students, students who lived on campus and students who reported getting drunk experienced significantly more community consequences from others' drinking (p < .01). CONCLUSIONS: These findings demonstrate that 4 out of 5 college students experience consequences from others' drinking, and consequences vary for different subgroups of students. Although these inventories should be tested further, these findings propose standardized measures that may be useful to assess the consequences of others' drinking among college students.

Drink specials and the intoxication levels of patrons exiting college bars.

OBJECTIVES: To determine whether drink specials independently increase patrons' risk of achieving a high level of intoxication upon exiting drinking establishments. METHODS: In a campus community, data were collected from exiting patrons (N=291) via sidewalk interviews and breath tests on 6 nights of 2 consecutive semesters. RESULTS: A multivariate model revealed that taking advantage of a drink special was associated with a fourfold increase in risk of achieving a BAC >or= 80 mg/dl. CONCLUSIONS: These findings are the first to document that the drink discounting practices of college bars can be linked to higher intoxication levels among exiting patrons.

Exploring the health behavior disparities of gay men in the United States: comparing gay male university students to their heterosexual peers.

Little is known about the health disparities that affect gay men in the United States. Using data collected from an online Internet-based assessment, we sought to compare health-compromising behaviors of gay male university students to their heterosexual peers. Participants included 1,014 self-reported males. Mean age was 20 years (+/-2.5; range 17-30). Of these men, 43 (4.2%) self identified as gay and 971 (95.8%) self identified as heterosexual. After adjusting for age, race, academic classification, residence type, and clustering within university, gay men had higher odds of reporting inconsistent condom use; reporting multiple partners within the past 30 days; reporting a lifetime history of illicit drug use. Understanding the health behavior disparities between gay and heterosexual men is crucial to identifying associated factors and intervening upon them using appropriate and meaningful tailored strategies to reduce these disparities and improve health outcomes.

Characteristics of a sample of men who have sex with men, recruited from gay bars and Internet chat rooms, who report methamphetamine use.

Crystal methamphetamine is a highly addictive stimulant that initially gained popularity in the western region of the United States and has spread to all regions of the country. This study was designed to identify factors associated with methamphetamine use among men who have sex with men (MSM) in North Carolina. Participants were recruited in five gay bars and in five geographically defined Internet chat rooms concurrently in 2005 to complete a brief assessment of drug use and other risk behaviors. Of the 1189 MSM who completed the assessment, mean age was 29 years. Two thirds self-identified as black/African American or other minorities, and 25% as bisexual. Nearly 6% reported using methamphetamines during the past 30 days. In multivariable analysis, MSM who reported using methamphetamines were more likely to report higher education; health insurance coverage; inconsistent condom use during anal sex within the past 3 months; a history of sexually transmitted disease (STD) infection; positive HIV serostatus; and use of medications designed to treat erectile dysfunction. A lack of data exists on methamphetamine use among MSM in the southeastern United States, particularly in nonurban regions. Because the southeastern United States carries a disproportionate HIV, AIDS, and STD burden, our findings underscore the need for further research and intervention.