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  • 1.
    Abou Ghayda, Ramy
    et al.
    Case Western Reserve Univ, OH 44106 USA.
    Lee, Keum Hwa
    Yonsei Univ, South Korea.
    Han, Young Joo
    Inje Univ, South Korea.
    Ryu, Seohyun
    Yonsei Univ, South Korea.
    Hong, Sung Hwi
    Yonsei Univ, South Korea.
    Yoon, Sojung
    Yonsei Univ, South Korea.
    Jeong, Gwang Hum
    Gyeongsang Natl Univ, South Korea.
    Yang, Jae Won
    Yonsei Univ, South Korea.
    Lee, Hyo Jeong
    Yonsei Univ, South Korea.
    Lee, Jinhee
    Yonsei Univ, South Korea.
    Lee, Jun Young
    Yonsei Univ, South Korea.
    Effenberger, Maria
    Med Univ Innsbruck, Austria.
    Eisenhut, Michael
    Luton & Dunstable Univ Hosp NHS Fdn Trust, England.
    Kronbichler, Andreas
    Med Univ Innsbruck, Austria.
    Solmi, Marco
    Univ Ottawa, Canada; Ottawa Hosp, Canada; Univ Ottawa, Canada; Univ Ottawa, Canada.
    Li, Han
    Univ Florida, FL USA.
    Jacob, Louis
    Univ Versailles St Quentin En Yvelines, France; CIBERSAM, Spain.
    Koyanagi, Ai
    CIBERSAM, Spain; ICREA, Spain.
    Radua, Joaquim
    Inst Invest Biomed August Pi & Sunyer IDIBAPS, Spain; Kings Coll London, England; Karolinska Inst, Sweden.
    Park, Myung Bae
    Pai Chai Univ, South Korea.
    Aghayeva, Sevda
    Azerbaijan Med Univ, Azerbaijan.
    Ahmed, Mohamed L. C. B.
    Univ Nouakchott Al Aasriya, Mauritania.
    Al Serouri, Abdulwahed
    Yemen Field Epidemiol Training Program, Yemen.
    Al-Shamsi, Humaid O.
    Univ Sharjah, U Arab Emirates; Burjeel Canc Inst, U Arab Emirates.
    Amir-Behghadami, Mehrdad
    Tabriz Univ Med Sci, Iran; Tabriz Univ Med Sci, Iran; Tabriz Univ Med Sci, Iran.
    Baatarkhuu, Oidov
    Mongolian Natl Univ Med Sci, Mongolia.
    Bashour, Hyam
    Damascus Univ, Syria.
    Bondarenko, Anastasiia
    Shupyk Natl Healthcare Univ Ukraine, Ukraine.
    Camacho-Ortiz, Adrian
    Univ Autonoma Nuevo Leon, Mexico.
    Castro, Franz
    Gorgas Mem Inst Hlth Studies, Panama.
    Cox, Horace
    Minist Hlth Guyana, Guyana.
    Davtyan, Hayk
    TB Res & Prevent Ctr NGO, Armenia.
    Douglas, Kirk
    Univ West Indies, Barbados.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Ebrahim, Shahul
    Univ Sci Tech & Technol, Mali.
    Ferioli, Martina
    IRCCS Azienda Osped Univ Bologna, Italy.
    Harapan, Harapan
    Univ Syiah Kuala, Indonesia.
    Mallah, Saad I
    Royal Coll Surg Ireland Bahrain, Indonesia.
    Ikram, Aamer
    Natl Inst Hlth, Pakistan.
    Inoue, Shigeru
    Tokyo Med Univ, Japan.
    Jankovic, Slobodan
    Univ Kragujevac, Serbia.
    Jayarajah, Umesh
    Univ Colombo, Sri Lanka.
    Jesenak, Milos
    Comenius Univ, Slovakia.
    Kakodkar, Pramath
    Natl Univ Galway Ireland, Ireland.
    Kebede, Yohannes
    Jimma Univ, Ethiopia.
    Kifle, Meron
    Univ Oxford, England.
    Koh, David
    Natl Univ Singapore, Singapore.
    Males, Visnja K.
    Sch Med Split, Croatia.
    Kotfis, Katarzyna
    Pomeranian Med Univ, Poland.
    Lakoh, Sulaiman
    Univ Sierra Leone, Sierra Leone.
    Ling, Lowell
    Chinese Univ Hong Kong, Peoples R China.
    Llibre-Guerra, Jorge
    Washington Univ, MO USA.
    Machida, Masaki
    Tokyo Med Univ, Japan.
    Makurumidze, Richard
    Univ Zimbabwe, Zimbabwe.
    Mamun, Mohammed
    Chinese Univ Hong Kong, Peoples R China; Jahangirnagar Univ, Bangladesh; Daffodil Int Univ, Bangladesh; CHINTA Res Bangladesh, Bangladesh.
    Masic, Izet
    Acad Med Sci Bosnia & Herzegovina, Bosnia & Herceg.
    Van Minh, Hoang
    Hanoi Univ Publ Hlth, Vietnam.
    Moiseev, Sergey
    Sechenov First Moscow State Med Univ, Russia.
    Nadasdy, Thomas
    St Parascheva Clin Hosp Infect Dis, Romania.
    Nahshon, Chen
    Carmel Hosp, Israel.
    Namendys-Silva, Silvio A.
    Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Mexico.
    Yongsi, Blaise N.
    Univ Yaounde II, Cameroon.
    Nielsen, Henning B.
    Zealand Univ Hosp Roskilde, Denmark.
    Nodjikouambaye, Zita A.
    Mobile Lab Hemorrhag & Resp Viruses Ndjamena, Chad.
    Ohnmar, Ohnmar
    Myanmar Hlth Minist, Myanmar.
    Oksanen, Atte
    Tampere Univ, Finland.
    Owopetu, Oluwatomi
    Univ Coll Hosp, Nigeria.
    Parperis, Konstantinos
    Univ Cyprus Med Sch, Cyprus.
    Perez, Gonzalo E.
    Clin Olivos, Argentina.
    Pongpirul, Krit
    Chulalongkorn Univ, Thailand.
    Rademaker, Marius
    Auckland Univ Med Sch, New Zealand.
    Rosa, Sandro
    Fed Fluminense Univ, Brazil; Natl Inst Ind Property, Brazil.
    Sah, Ranjit
    Natl Publ Hlth Lab, Nepal.
    Sallam, Dina
    Ain Shams Univ, Egypt.
    Schober, Patrick
    Vrije Univ Amsterdam, Netherlands.
    Singhal, Tanu
    Kokilaben Dhirubhai Ambani Hosp & Med Res Inst, India.
    Tafaj, Silva
    Univ Hosp Shefqet Ndroqi, Albania.
    Torres, Irene
    Fdn Octaedro, Ecuador.
    Smith Torres-Roman, J.
    Univ Cient Sur, Peru.
    Tsartsalis, Dimitrios
    Hippokrateion Hosp, Greece.
    Tsolmon, Jadamba
    Mongolian Natl Univ Med Sci, Mongolia.
    Tuychiev, Laziz
    Tashkent Med Acad, Uzbekistan.
    Vukcevic, Batric
    Univ Montenegro, Montenegro.
    Wanghi, Guy
    Univ Kinshasa, DEM REP CONGO.
    Wollina, Uwe
    Stadt Klinikum Dresden, Germany.
    Xu, Ren-He
    Univ Macau, Peoples R China.
    Yang, Lin
    Alberta Hlth Serv, Canada; Univ Calgary, Canada; Univ Calgary, Canada.
    Zaidi, Zoubida
    Univ Ferhat Abbas, Algeria.
    Smith, Lee
    Anglia Ruskin Univ, England.
    Shin, Jae Il
    Yonsei Univ, South Korea.
    The global case fatality rate of coronavirus disease 2019 by continents and national income: A meta-analysis2022In: Journal of Medical Virology, ISSN 0146-6615, E-ISSN 1096-9071, Vol. 94, no 6, p. 2402-2413Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to provide a more accurate representation of COVID-19s case fatality rate (CFR) by performing meta-analyses by continents and income, and by comparing the result with pooled estimates. We used multiple worldwide data sources on COVID-19 for every country reporting COVID-19 cases. On the basis of data, we performed random and fixed meta-analyses for CFR of COVID-19 by continents and income according to each individual calendar date. CFR was estimated based on the different geographical regions and levels of income using three models: pooled estimates, fixed- and random-model. In Asia, all three types of CFR initially remained approximately between 2.0% and 3.0%. In the case of pooled estimates and the fixed model results, CFR increased to 4.0%, by then gradually decreasing, while in the case of random-model, CFR remained under 2.0%. Similarly, in Europe, initially, the two types of CFR peaked at 9.0% and 10.0%, respectively. The random-model results showed an increase near 5.0%. In high-income countries, pooled estimates and fixed-model showed gradually increasing trends with a final pooled estimates and random-model reached about 8.0% and 4.0%, respectively. In middle-income, the pooled estimates and fixed-model have gradually increased reaching up to 4.5%. in low-income countries, CFRs remained similar between 1.5% and 3.0%. Our study emphasizes that COVID-19 CFR is not a fixed or static value. Rather, it is a dynamic estimate that changes with time, population, socioeconomic factors, and the mitigatory efforts of individual countries.

  • 2.
    Alföldi, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Wiklund, Tobias
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    SPREADING OF PAIN AND INSOMNIA IN PATIENTS WITH CHRONIC PAIN: RESULTS FROM A NATIONAL QUALITY REGISTRY (SQRP)2017In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 1, p. 63-70Article in journal (Refereed)
    Abstract [en]

    Objective: To explore how demographics, pain, psychosocial factors and insomnia relate to the spread of chronic pain. Methods: The study included 708 patients (68% women; median age 46 years; interquartile range 3557 years) with chronic pain who were referred to a multidisciplinary pain centre. Spreading of pain was assessed using a questionnaire covering 36 anatomically predefined pain regions. Data were collected on demographics, pain symptoms, psychological distress, and insomnia (Insomnia Severity Index). Four sub-categories of chronic pain were established: chronic local pain, chronic regional pain medium, chronic regional pain heavy, and chronic widespread pain. Results: The median number of pain regions was 10 (interquartile range 6-18). Prevalence of chronic pain was as follows: chronic local pain 9%, chronic regional pain medium 21%, chronic regional pain heavy 39%, and chronic widespread pain 31%. In the regression models, being a woman and persistent pain duration had the strongest associations with spreading of pain, but anxiety, pain interference, and insomnia were also important factors. Conclusion: Spreading of chronic pain can only partly be explained by the simultaneous levels of insomnia. Female sex, pain duration, pain interference and anxiety appear to have more significant relationships with the spread of pain. Targeting these factors may lead to improvements in treatment and prevention strategies.

  • 3.
    Apostolidi, Dimitra Maria
    et al.
    Univ West Attica, Greece.
    Pantelaki, Nikoletta
    Univ West Attica, Greece.
    Sarantaki, Antigoni
    Univ West Attica, Greece.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Metallinou, Dimitra
    Univ West Attica, Greece.
    Neonatal Palliative Care as an Integral Component of the Greek National Healthcare System: Time to Act2023In: Cureus, E-ISSN 2168-8184, Vol. 15, no 9, article id e45498Article in journal (Other academic)
    Abstract [en]

    Neonatal palliative care aims to provide multidisciplinary support to families and neonates suffering from life-threatening or life-limiting diseases. Many countries worldwide have recognized the importance of enhancing the quality of life in critically ill neonates and thus have created and systematically implemented palliative care protocols in neonatal intensive care units (NICUs). Europe has a very low neonatal mortality rate, which has been steadily decreasing over the last 30 years. Greece in particular, a country located in Southeast Europe, reported a neonatal mortality rate of 2.29/1,000 live births in 2020. Nevertheless, neonatal palliative care facilities are scarce on a national level. In this paper, several reasons are presented to support the integration of neonatal palliative care in the Greek national healthcare system with the vision to ensure that all neonates and their families will receive in the near future the care, support, and dignity they deserve when facing life-threatening or life-limiting illnesses.

  • 4.
    Arango, Celso
    et al.
    Hosp Gen Univ Gregorio Maranon, Spain; Univ Complutense Madrid, Spain; Biomed Res Ctr Mental Hlth CIBERSAM, Spain.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Solmi, Marco
    Kings Coll London, England; Univ Padua, Italy; Univ Ottawa, Canada; Ottawa Hosp, Canada.
    Cortese, Samuele
    Univ Southampton, England; Univ Southampton, England; Univ Nottingham, England; NYU Langone, NY USA.
    Domschke, Katharina
    Univ Freiburg, Germany; Univ Freiburg, Germany; Univ Freiburg, Germany.
    Murray, Robin M.
    Kings Coll London, England.
    Jones, Peter B.
    Univ Cambridge, England; Cambridgeshire & Peterborough Natl Hlth Serv Fdn, England.
    Uher, Rudolf
    Dalhousie Univ, Canada; Nova Scotia Hlth, Canada; IWK Hlth Ctr, Canada; Dalhousie Univ, Canada.
    Carvalho, Andre F.
    Deakin Univ, Australia; Univ Toronto, Canada; Ctr Addict & Mental Hlth, Canada.
    Reichenberg, Abraham
    Icahn Sch Med Mt Sinai, NY 10029 USA; Icahn Sch Med Mt Sinai, NY 10029 USA; Icahn Sch Med Mt Sinai, NY 10029 USA.
    Shin, Jae Ii
    Yonsei Univ, South Korea; Severance Childrens Hosp, South Korea.
    Andreassen, Ole A.
    Univ Oslo, Norway; Oslo Univ Hosp, Norway.
    Correll, Christoph U.
    Northwell Hlth, NY USA; Zucker Sch Med Hofstra Northwell, NY USA; Feinstein Inst Med Res, NY USA; Charite, Germany.
    Fusar-Poli, Paolo
    Kings Coll London, England; South London & Maudsley NHS Fdn Trust, England; Univ Pavia, Italy.
    Risk and protective factors for mental disorders beyond genetics: an evidence-based atlas2021In: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 20, no 3, p. 417-436Article in journal (Refereed)
    Abstract [en]

    Decades of research have revealed numerous risk factors for mental disorders beyond genetics, but their consistency and magnitude remain uncer-tain. We conducted a "meta-umbrella" systematic synthesis of umbrella reviews, which are systematic reviews of meta-analyses of individual studies, by searching international databases from inception to January 1, 2021. We included umbrella reviews on non-purely genetic risk or protective factors for any ICD/DSM mental disorders, applying an established classification of the credibility of the evidence: class I (convincing), class II (highly suggestive), class III (suggestive), class IV (weak). Sensitivity analyses were conducted on prospective studies to test for temporality (reverse causation), TRANSD criteria were applied to test transdiagnosticity of factors, and A Measurement Tool to Assess Systematic Reviews (AMSTAR) was employed to address the quality of meta-analyses. Fourteen eligible umbrella reviews were retrieved, summarizing 390 meta-analyses and 1,180 associations between putative risk or protective factors and mental disorders. We included 176 class I to III evidence associations, relating to 142 risk/protective factors. The most robust risk factors (class I or II, from prospective designs) were 21. For dementia, they included type 2 diabetes mellitus (risk ratio, RR from 1.54 to 2.28), depression (RR from 1.65 to 1.99) and low frequency of social contacts (RR=1.57). For opioid use disorders, the most robust risk factor was tobacco smoking (odds ratio, OR=3.07). For non-organic psychotic disorders, the most robust risk factors were clinical high risk state for psychosis (OR=9.32), cannabis use (OR=3.90), and childhood adversities (OR=2.80). For depressive disorders, they were widowhood (RR=5.59), sexual dysfunction (OR=2.71), three (OR=1.99) or four-five (OR=2.06) metabolic factors, childhood physical (OR=1.98) and sexual (OR=2.42) abuse, job strain (OR=1.77), obesity (OR=1.35), and sleep disturbances (RR=1.92). For autism spectrum disorder, the most robust risk factor was maternal overweight pre/during pregnancy (RR=1.28). For attention-deficit/hyperactivity disorder (ADHD), they were maternal pre-pregnancy obesity (OR=1.63), maternal smoking during pregnancy (OR=1.60), and maternal overweight pre/during pregnancy (OR=1.28). Only one robust protective factor was detected: high physical activity (hazard ratio, HR=0.62) for Alzheimers disease. In all, 32.9% of the associations were of high quality, 48.9% of medium quality, and 18.2% of low quality. Transdiagnostic class I-III risk/protective factors were mostly involved in the early neurodevelopmental period. The evidence-based atlas of key risk and protective factors identified in this study represents a benchmark for advancing clinical characterization and research, and for expanding early intervention and preventive strategies for mental disorders.

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  • 5.
    Arrondo, Gonzalo
    et al.
    Univ Navarra, Spain; Univ Southampton, England.
    Solmi, Marco
    Univ Southampton, England; Univ Ottawa, Canada; Ottawa Hosp, Canada; Kings Coll London, England.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Eudave, Luis
    Univ Navarra, Spain.
    Ruiz-Goikoetxea, Maite
    Serv Navarro Salud Osasunbidea, Spain.
    Ciaurriz-Larraz, Amaia M.
    Univ Navarra, Spain.
    Magallon, Sara
    Univ Navarra, Spain.
    Carvalho, Andre F.
    Deakin Univ, Australia.
    Cipriani, Andrea
    Univ Oxford, England; Warneford Hosp, England.
    Fusar-Poli, Paolo
    Kings Coll London, England; South London & Maudsley NHS Fdn Trust, England; South London & Maudsley NHS Fdn Trust, England; Univ Pavia, Italy.
    Larsson, Henrik
    Karolinska Inst, Sweden; Orebro Univ, Sweden.
    Correll, Christoph U.
    Northwell Hlth, NY USA; Donald & Barbara Zucker Sch Med Hofstra Northwell, NY USA; Charite, Germany.
    Cortese, Samuele
    Univ Southampton, England; Univ Southampton, England; Solent NHS Trust, England; Univ Nottingham, England; NYU, NY USA.
    Associations between mental and physical conditions in children and adolescents: An umbrella review2022In: Neuroscience and Biobehavioral Reviews, ISSN 0149-7634, E-ISSN 1873-7528, Vol. 137, article id 104662Article, review/survey (Refereed)
    Abstract [en]

    We mapped the evidence on the type and strength of associations between a broad range of mental and physical conditions in children and adolescents, by carrying out an umbrella review, i.e., a quantitative synthesis of previous systematic reviews and meta-analyses. We also assessed to which extent the links between mental and physical conditions vary across disorders or, by contrast, are transdiagnostic. Based on a pre-established protocol, we retained 45 systematic reviews/meta-analyses, encompassing around 12.5 million of participants. In analyses limited to the most rigorous estimates, we found evidence for the following associations: ADHD-asthma, ADHDobesity, and depression-asthma. A transdiagnostic association was confirmed between asthma and anxiety/ASD/depression/bipolar disorder, between obesity and ADHD/ASD/depression, and between dermatitis and ASD/ADHD. We conclude that obesity and allergic conditions are likely to be associated with mental disorders in children and adolescents. Our results can help clinicians explore potential links between mental and physical conditions in children/adolescent and provide a road map for future studies aimed at shading light on the underlying factors.

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  • 6.
    Biazus, Tais Boeira
    et al.
    Univ Sao Paulo, Brazil.
    Beraldi, Gabriel Henrique
    Univ Sao Paulo, Brazil.
    Tokeshi, Lucas
    Univ Sao Paulo, Brazil.
    Rotenberg, Luisa de Siqueira
    Univ Sao Paulo, Brazil.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Carvalho, Andre F.
    Deakin Univ, Australia.
    Solmi, Marco
    Univ Ottawa, Canada; Charite, Germany.
    Lafer, Beny
    Univ Sao Paulo, Brazil.
    All-cause and cause-specific mortality among people with bipolar disorder: a large-scale systematic review and meta-analysis2023In: Molecular Psychiatry, ISSN 1359-4184, E-ISSN 1476-5578, Vol. 28, no 6, p. 2508-2524Article, review/survey (Refereed)
    Abstract [en]

    ObjectiveBipolar disorder (BD) is associated with premature mortality. All-cause and specific mortality risks in this population remain unclear, and more studies are still needed to further understand this issue and guide individual and public strategies to prevent mortality in bipolar disorder Thus, a systematic review and meta-analysis of studies assessing mortality risk in people with BD versus the general population was conducted. The primary outcome was all-cause mortality, whilst secondary outcomes were mortality due to suicide, natural, unnatural, and specific-causes mortality.ResultsFifty-seven studies were included (BD; n = 678,353). All-cause mortality was increased in people with BD (RR = 2.02, 95% CI: 1.89-2.16, k = 39). Specific-cause mortality was highest for suicide (RR = 11.69, 95% CI: 9.22-14.81, k = 25). Risk of death due to unnatural causes (RR = 7.29, 95% CI: 6.41-8.28, k = 17) and natural causes (RR = 1.90, 95% CI: 1.75-2.06, k = 17) were also increased. Among specific natural causes analyzed, infectious causes had the higher RR (RR = 4,38, 95%CI: 1.5-12.69, k = 3), but the analysis was limited by the inclusion of few studies. Mortality risk due to respiratory (RR = 3.18, 95% CI: 2.55-3.96, k = 6), cardiovascular (RR = 1.76, 95% CI: 1.53-2.01, k = 27), and cerebrovascular (RR = 1.57, 95% CI: 1.34-1.84, k = 13) causes were increased as well. No difference was identified in mortality by cancer (RR = 0.99, 95% CI: 0.88-1.11, k = 16). Subgroup analyses and meta-regression did not affect the findings.ConclusionResults presented in this meta-analysis show that risk of premature death in BD is not only due to suicide and unnatural causes, but somatic comorbidities are also implicated. Not only the prevention of suicide, but also the promotion of physical health and the prevention of physical conditions in individuals with BD may mitigate the premature mortality in this population. Notwithstanding this is to our knowledge the largest synthesis of evidence on BD-related mortality, further well-designed studies are still warranted to inform this field.

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  • 7.
    Björk, Mathilda
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Alexandersson, Helene
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Esbensen, Bente Appel
    Rigshosp, Denmark; Univ Copenhagen, Denmark.
    Bostrom, Carina
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Friden, Cecilia
    Karolinska Inst, Sweden.
    Hjalmarsson, Sara
    Swedish Rheumatism Assoc, Sweden.
    Hornberg, Kristina
    Umea Univ, Sweden.
    Kjeken, Ingvild
    Diakonhjemmet Hosp, Norway.
    Regardt, Malin
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Sundelin, Gunnevi
    Umea Univ, Sweden.
    Sverker, Annette M.
    Linköping University, Department of Culture and Society, Division of Social Work. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Primary Care Center, Operations management PVC.
    Welin, Elisabet
    Orebro Univ, Sweden.
    Brodin, Nina
    Karolinska Inst, Sweden; Danderyd Hosp Corp, Sweden.
    Inflammatory Arthritis and the Effect of Physical Activity on Quality of Life and Self-Reported Function: A Systematic Review and Meta-Analysis2022In: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 74, no 1, p. 31-43Article, review/survey (Refereed)
    Abstract [en]

    Objective Although physical activity is an evidence-based intervention that reduces disease-related symptoms and comorbidity in rheumatoid arthritis (RA), the effect of physical activity on self-reported function and quality of life (QoL) has not yet been analyzed. The present study synthesizes the evidence for the effectiveness of physical activity on QoL and self-reported function in adults with RA, spondyloarthritis (SpA), and psoriatic arthritis (PsA). Methods The databases PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify relevant randomized controlled trials (RCTs). Screening, risk of bias assessment (using the RoB 2.0 tool), and data extraction were independently performed by 2 or more of the authors. Meta-analyses were conducted with a random-effects model. Results Systematic review included 55 RCTs, and meta-analysis included 37 RCTs. Of the 55 studies included, 76%, 20%, and 4% were designed to investigate RA, SpA, and PsA, respectively. In the RA studies, effects of physical activity on QoL and function were found compared to the group of inactive controls; no effects were found compared to the group of active controls. In the SpA studies, the effects of physical activity on QoL were in favor of the control group. Effects of physical activity on function were found compared to the group of inactive controls and sustained in fatigue and pain when compared to the group of active controls. In the PsA studies, no effects on QoL were found, but effects on function were noted when compared to the group of inactive controls. The effect size was below 0.30 in the majority of the comparisons. Conclusion Physical activity may improve QoL and self-reported function in individuals with RA, SpA, and PsA. However, larger trials are needed, especially in SpA and PsA.

  • 8.
    Björk, Mathilda
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Liedberg, Gunilla
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Svanholm, Frida
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Solmi, Marco
    Univ Padua, Italy.
    Thompson, Trevor
    Univ Greenwich, England.
    Chaimani, Anna
    Univ Paris, France.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Interventions to facilitate return to work in adults with chronic non-malignant pain: a protocol for a systematic review and network meta-analysis2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 11, article id e040962Article, review/survey (Refereed)
    Abstract [en]

    Introduction Work absenteeism due to chronic non-malignant pain (CNMP) is a major societal and individual cause of concern that requires effective treatments. Objective We present a protocol for a systematic review and network meta-analysis (NMA) aiming to compare available interventions for return to work (RTW) in adults with CNMP. Methods and analysis PubMed, Embase, PsycINFO, Web of Knowledge and Cochrane Central Register of Controlled Trials databases will be searched till 31 August 2020 for randomised controlled trials (RCTs) examining interventions for RTW outcomes among patients with CNMP. Two independent investigators will search the databases, perform data extraction and assess the methodological quality of the selected RCTs. The primary outcome will be RTW, if possible, full-time or part-time after work absence due to chronic pain from baseline to the last available follow-up. Secondary outcomes will include self-reported workability or work capacity, or self-reported physical functioning and quality of life as measured by any validated scale. Pairwise meta-analysis and NMA will be conducted for each outcome using a random-effects model. For the primary outcomes, we will also obtain the ranking of all competing interventions within each NMA using surface under the cumulative ranking curve. The assumption of coherence (ie, that direct and indirect evidence are in statistical agreement) will be examined using both a local and a global approach. We will also conduct subgroup and meta-regression analyses, whenever feasible, to investigate the unexplained variation in effect size. The comparison-adjusted funnel plot will be used to evaluate small-study effects. The overall quality of evidence will be rated with the Confidence in Network Meta-Analysis tool. Data analysis will be conducted using Stata V.16.0. Ethics and dissemination This systematic review does not require ethical approval since it will not disseminate any private patient data. The results of this study will be disseminated through peer-reviewed publication. PROSPERO registration number CRD42020171429.

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  • 9.
    Briseniou, Evangelia
    et al.
    Univ Thessaly, Greece.
    Skenteris, Nikolaos
    Univ Thessaly, Greece.
    Hatzoglou, Chryssi
    Univ Thessaly, Greece.
    Tsitsas, George
    Harokopio Univ, Greece.
    Diamantopoulos, Epaminondas
    Univ Ioannina, Greece.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Gouva, Mary
    Univ Ioannina, Greece.
    The effects of psychopathology and shame on social representations of health and lifestyle behaviours via free association: a graph analysis approach2021In: BMC Psychology, E-ISSN 2050-7283, Vol. 9, no 1, article id 168Article in journal (Refereed)
    Abstract [en]

    Background There is a knowledge gap in whether psychopathology aspects can shape and mark the social representations about health and lifestyle. In this work, we investigated the association of psychopathology and shame with the centrality of the words describing eight common social representations of health and lifestyle. Methods A convenience sample of 288 adults participated with an average age of 44.7, and 62.6% were women. The participants were asked to express three consecutive words associated with eight different health and lifestyle experiences by utilizing the free association method. The participants also were completed the Symptom Checklist-90-Revised (SCL-90-R), the Experiences of Shame Scale (ESS), and the Other as Shamer Scale (OAS). Canonical correlation analysis was applied to investigate the relationship between the set of the eight-word centralities and the psycho-demographic variables consisting of the subjects age and gender, the SCL 90 subscales, the OAS, and the ESS. Based on these findings, a structural equation explorative model was formed to test the unidimensionality of the five centralities construct. Results tau he psychological characteristics of interpersonal sensitivity, depression, external shame, and hostility were found to affect the word selection process on the social representations concerning nightlife, health, diet, lifestyle, and alcohol consumption. Participants with increased levels of depression tend to choose more centrally positioned words when the stimulus word was diet and more decentralized responses when the stimulus word was health. At the same time, higher external shame corresponded to more decentralized words for the categories of health and lifestyle. Conclusions Our results indicate that there is a potential interaction between the psychological state and how a social representation of health and lifestyle is constructed through selected words. Graph theory emerged as an additional tool to use to study these relations.

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  • 10.
    Carvalho, Andre F.
    et al.
    Univ Toronto, Canada; Ctr Addict and Mental Hlth CAMH, Canada.
    Solmi, Marco
    Univ Padua, Italy; Kings Coll London, England.
    Sanches, Marcos
    Ctr Addict and Mental Hlth CAMH, Canada; Krembil Ctr NeuroInformat, Canada.
    Machado, Myrela O.
    Womens Coll Hosp, Canada.
    Stubbs, Brendon
    South London and Maudsley NHS Fdn Trust, England; Kings Coll London, England.
    Ajnakina, Olesya
    Kings Coll London, England.
    Sherman, Chelsea
    Sunnybrook Res Inst, Canada.
    Sun, Yue Ran
    Sunnybrook Res Inst, Canada.
    Liu, Celina S.
    Sunnybrook Res Inst, Canada.
    Brunoni, Andre R.
    Univ Sao Paulo, Brazil.
    Pigato, Giorgio
    Univ Padua, Italy.
    Fernandes, Brisa S.
    Univ Texas Hlth Sci Ctr Houston, TX 77030 USA.
    Bortolato, Beatrice
    Dept Mental Hlth ULSS 8 Berica, Italy.
    Husain, Muhammad I
    Univ Toronto, Canada; Ctr Addict and Mental Hlth CAMH, Canada.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Firth, Joseph
    Western Sydney Univ, Australia; Univ Manchester, England.
    Cosco, Theodore D.
    Simon Fraser Univ, Canada; Univ Oxford, England.
    Maes, Michael
    Chulalongkorn Univ, Thailand; Deakin Univ, Australia.
    Berk, Michael
    Deakin Univ, Australia; Orygen, Australia; Univ Melbourne, Australia; Univ Melbourne, Australia.
    Lanctot, Krista L.
    Univ Toronto, Canada; Ctr Addict and Mental Hlth CAMH, Canada; Sunnybrook Res Inst, Canada; Sunnybrook Res Inst, Canada; Univ Toronto, Canada.
    Vieta, Eduard
    Univ Barcelona, Spain.
    Pizzagalli, Diego A.
    Harvard Med Sch, MA 02478 USA.
    Smith, Lee
    Anglia Ruskin Univ, England.
    Fusar-Poli, Paolo
    Kings Coll London, England; South London and Maudsley Natl Hlth Serv Fdn Trust, England; Univ Pavia, Italy.
    Kurdyak, Paul A.
    Univ Toronto, Canada; Canada Inst Clin Evaluat Sci ICES, Canada; Ctr Addict and Mental Hlth CAMH, Canada.
    Fornaro, Michele
    Univ Sch Med Federico II, Italy.
    Rehm, Jurgen
    Univ Toronto, Canada; Ctr Addict and Mental Hlth CAMH, Canada; CAMH, Canada; Univ Toronto, Canada; Tech Univ Dresden, Germany; Tech Univ Dresden, Germany; Univ Toronto, Canada; IM Sechenov First Moscow State Med Univ, Russia.
    Herrmann, Nathan
    Univ Toronto, Canada; Sunnybrook Res Inst, Canada; Sunnybrook Res Inst, Canada.
    Evidence-based umbrella review of 162 peripheral biomarkers for major mental disorders2020In: Translational Psychiatry, E-ISSN 2158-3188, Vol. 10, no 1Article, review/survey (Refereed)
    Abstract [en]

    The literature on non-genetic peripheral biomarkers for major mental disorders is broad, with conflicting results. An umbrella review of meta-analyses of non-genetic peripheral biomarkers for Alzheimers disease, autism spectrum disorder, bipolar disorder (BD), major depressive disorder, and schizophrenia, including first-episode psychosis. We included meta-analyses that compared alterations in peripheral biomarkers between participants with mental disorders to controls (i.e., between-group meta-analyses) and that assessed biomarkers after treatment (i.e., within-group meta-analyses). Evidence for association was hierarchically graded using a priori defined criteria against several biases. The Assessment of Multiple Systematic Reviews (AMSTAR) instrument was used to investigate study quality. 1161 references were screened. 110 met inclusion criteria, relating to 359 meta-analytic estimates and 733,316 measurements, on 162 different biomarkers. Only two estimates met a priori defined criteria for convincing evidence (elevated awakening cortisol levels in euthymic BD participants relative to controls and decreased pyridoxal levels in participants with schizophrenia relative to controls). Of 42 estimates which met criteria for highly suggestive evidence only five biomarker aberrations occurred in more than one disorder. Only 15 meta-analyses had a power >0.8 to detect a small effect size, and most (81.9%) meta-analyses had high heterogeneity. Although some associations met criteria for either convincing or highly suggestive evidence, overall the vast literature of peripheral biomarkers for major mental disorders is affected by bias and is underpowered. No convincing evidence supported the existence of a trans-diagnostic biomarker. Adequately powered and methodologically sound future large collaborative studies are warranted.

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  • 11.
    Charitakis, Emmanouil
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Stratinaki, Maria
    Venizeleio Gen Hosp, Greece.
    Korela, Dafni
    Venizeleio Gen Hosp, Greece.
    Tzeis, Stylianos
    Mitera Hosp Hygeia Grp, Greece.
    Almroth, Henrik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Liuba, Ioan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Hassel Jönsson, Anders
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Charalambous, Georgios
    Hippokrateion Hosp, Greece.
    Karlsson, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Tsartsalis, Dimitrios
    Hippokrateion Hosp, Greece.
    Predictors of recurrence after catheter ablation and electrical cardioversion of atrial fibrillation: an umbrella review of meta-analyses2023In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 25, no 1, p. 40-48Article, review/survey (Refereed)
    Abstract [en]

    Aims The recurrence rates after catheter ablation (CA) and direct current (DC) cardioversion remain high, although they have been established treatments of rhythm control of atrial fibrillation (AF). This umbrella review systematically appraises published meta-analyses of both observational and randomized controlled trials (RCTs) for the association of risk and protective factors for arrhythmia recurrence after CA and DC cardioversion of AF. Methods and results Three bibliographic databases were searched up to June 2021. Evidence of association was rated as convincing, highly suggestive, suggestive, weak, or not significant with respect to observational studies and as high, moderate, low, or very low with respect to RCTs, according to established criteria. Thirty-one meta-analyses were included. Of the 28 associations between CA and the risk of arrhythmia recurrence, none presented convincing evidence, and only the time from diagnosis to ablation over 1 year provided highly suggestive evidence. The association between hypertension and metabolic profile provided suggestive evidence. The associations of Class IC and III antiarrhythmic drugs use with the recurrence after DC cardioversion were supported by an intermediate level of evidence. Conclusion Although AF is a major health issue, few risk- and protective factors for AF recurrence have been identified. None of these factors examined were supported by convincing evidence, whereas established factors such as female gender and left atrial volume showed only weak association. An early CA strategy combined with treatment of metabolic syndrome and hypertension prior to CA may reduce the risk of arrhythmia recurrence. The use of antiarrhythmics can increase the success rate of DC cardioversion. Systematic review registration PROSPERO registry number: CRD42021270613.

  • 12.
    Charitakis, Emmanouil
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Karlsson, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Rizas, Kostantinos
    LMU Munchen, Germany.
    Almroth, Henrik
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jönsson, Anders Hassel
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Schweiler, Jonas
    Karolinska Univ Hosp, Sweden.
    Sideris, Skevos
    Natl & Kapodistrian Univ Athens, Greece.
    Tsartsalis, Dimitrios
    Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Chaimani, Anna
    Univ Paris, France.
    Comparing efficacy and safety in catheter ablation strategies for atrial fibrillation: protocol of a network meta-analysis of randomised controlled trials2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 11, article id e041819Article in journal (Refereed)
    Abstract [en]

    Introduction Atrial fibrillation (AF) is the most common sustained arrhythmia. Catheter ablation (CA) of AF is an increasingly offered therapeutic approach, primary to relieve AF-related symptoms. Despite the development of new ablation approaches, there is no consensus regarding the most efficient ablation strategy. The objective of this network meta-analysis (NMA) is to compare the efficacy and safety of all different CA approaches for the treatment of patients with paroxysmal (PAF) and non-PAF (non-PAF). Methods and analysis We will perform a systematic search to identify randomised controlled trials of different CA approaches for the treatment of PAF and non-PAF, through the final search date of 1 March 2020. Information sources will include major bibliographic databases (MEDLINE, Web of Science and CENTRAL) and clinical trial registries. Our primary outcomes will be the efficacy (recurrence-free survival) and safety of different CA approaches for the treatment of AF. Secondary outcomes will be all-cause mortality and procedural time. An NMA will be performed to determine the relative effects of different catheter ablation approaches (such as pulmonary vein isolation alone or in combination with ablation lines, ablation of complex fractionated atrial electrograms, etc). In PAF, a separate analysis will be performed including different energy sources (such as radiofrequency, cryogenic and laser energy). Risk of bias assessment and sensitivity analyses will be conducted to assess the robustness of the findings to potential bias. Ethics and dissemination No ethical approval will be needed because data are collected from previous studies. The results will be presented through peer-review journals and conference presentation. PROSPERO registration number CRD42020169494.

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  • 13.
    Charitakis, Emmanouil
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Metelli, Silvia
    Univ Paris, France.
    Karlsson, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Antoniadis, Antonios P.
    Aristotle Univ Thessaloniki, Greece.
    Liuba, Ioan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Almroth, Henrik
    Region Östergötland, Heart Center, Department of Cardiology in Linköping. Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Jönsson, Anders Hassel
    Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Schwieler, Jonas
    Karolinska Univ Hosp, Sweden.
    Sideris, Skevos
    Hippokrateion Hosp, Greece.
    Tsartsalis, Dimitrios
    Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Fragakis, Nikolaos
    Aristotle Univ Thessaloniki, Greece.
    Chaimani, Anna
    Univ Paris, France.
    Comparing Efficacy and Safety in Catheter Ablation Strategies for Paroxysmal Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials2022In: Diagnostics, ISSN 2075-4418, Vol. 12, no 2, article id 433Article, review/survey (Refereed)
    Abstract [en]

    Although catheter ablation (CA) is an established treatment for paroxysmal atrial fibrillation (PAF), there is no consensus regarding the most efficient CA strategy. The objective of this network meta-analysis (NMA) was to compare the efficacy and safety of different CA strategies for PAF. A systematic search was performed in PubMed, Web of Science, and CENTRAL until the final search date, 5 October 2020. Randomised controlled trials (RCT) comparing different CA strategies and methods for pulmonary vein isolation (PVI) were included. Efficacy was defined as lack of arrhythmia recurrence after CA and safety as any reported complication related to the procedure during a minimum follow-up time of six months. In total, 43 RCTs comparing 11 different CA strategies involving 6701 patients were included. The risk of recurrence was significantly decreased in comparison with PVI with radiofrequency only for the following treatments: PVI with adjuvant ablation (RR: 0.79, CI: 0.65-0.97) and PVI with sympathetic modulation (RR: 0.64, CI: 0.46-0.88). However, PVI with radiofrequency was superior to non-PVI strategies (RR: 1.65, CI: 1.2-2.26). No statistically significant difference was found in safety between different CA strategies. Concerning different PVI strategies, no difference was observed either in efficacy or in safety between tested strategies. This NMA suggests that different PVI strategies are generally similar in terms of efficacy, while PVI with additional ablation or sympathetic modulation may be more effective than PVI alone. This study provides decision-makers with insights into the efficacy and safety of different CA strategies.

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  • 14.
    Charitakis, Emmanouil
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Metelli, Silvia
    Univ Paris Cite, France.
    Karlsson, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Antoniadis, Antonios P.
    Aristotle Univ Thessaloniki, Greece.
    Rizas, Konstantinos D.
    Ludwig Maximilians Univ Munchen, Germany.
    Liuba, Ioan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Almroth, Henrik
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jönsson, Anders Hassel
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Schwieler, Jonas
    Karolinska Univ Hosp, Sweden.
    Tsartsalis, Dimitrios
    Hippokrateion Hosp, Greece.
    Sideris, Skevos
    Natl & Kapodistrian Univ Athens, Greece.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Fragakis, Nikolaos
    Aristotle Univ Thessaloniki, Greece.
    Chaimani, Anna
    Univ Paris Cite, France.
    Comparing efficacy and safety in catheter ablation strategies for atrial fibrillation: a network meta-analysis2022In: BMC Medicine, E-ISSN 1741-7015, Vol. 20, no 1, article id 193Article in journal (Refereed)
    Abstract [en]

    Background: There is no consensus on the most efficient catheter ablation (CA) strategy for patients with atrial fibrillation (AF). The objective of this study was to compare the efficacy and safety of different CA strategies for AF ablation through network meta-analysis (NMA). Methods: A systematic search of PubMed, Web of Science, and CENTRAL was performed up to October 5th, 2020. Randomized controlled trials (RCT) comparing different CA approaches were included. Efficacy was defined as arrhythmia recurrence after CA and safety as any reported complication related to the procedure during a minimum follow-up time of 6 months. Results: In total, 67 RCTs (n = 9871) comparing 19 different CA strategies were included. The risk of recurrence was significantly decreased compared to pulmonary vein isolation (PVI) alone for PVI with renal denervation (RR: 0.60, CI: 0.38-0.94), PVI with ganglia-plexi ablation (RR: 0.62, CI: 0.41-0.94), PVI with additional ablation lines (RR: 0.8, CI: 0.68-0.95) and PVI in combination with bi-atrial modification (RR: 0.32, CI: 0.11-0.88). Strategies including PVI appeared superior to non-PVI strategies such as electrogram-based approaches. No significant differences in safety were observed. Conclusions: This NMA showed that PVI in combination with additional CA strategies, such as autonomic modulation and additional lines, seem to increase the efficacy of PVI alone. These strategies can be considered in treating patients with AF, since, additionally, no differences in safety were observed. This study provides decision-makers with comprehensive and comparative evidence about the efficacy and safety of different CA strategies.

  • 15.
    Charitakis, Emmanouil
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Tsartsalis, Dimitrios
    Hippokrateion Hosp, Greece; Hippokrateion Hosp, Greece.
    Korela, Dafni
    Venizeleio Gen Hosp, Greece.
    Stratinaki, Maria
    Venizeleio Gen Hosp, Greece.
    Vanky, Farkas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Charitos, Efstratios I
    Kerckhoff Hosp, Germany.
    Alfredsson, Joakim
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Karlsson, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Foukarakis, Emmanouil
    Venizeleio Gen Hosp, Greece.
    Aggeli, Constantina
    Hippokrateion Hosp, Greece.
    Tsioufis, Costas
    Hippokrateion Hosp, Greece.
    Walfridsson, Håkan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Risk and protective factors for atrial fibrillation after cardiac surgery and valvular interventions: an umbrella review of meta-analyses2022In: Open heart, E-ISSN 2053-3624, Vol. 9, no 2, article id e002074Article, review/survey (Refereed)
    Abstract [en]

    Objective Postoperative atrial fibrillation (POAF) is a common complication affecting approximately one-third of patients after cardiac surgery and valvular interventions. This umbrella review systematically appraises the epidemiological credibility of published meta-analyses of both observational and randomised controlled trials (RCT) to assess the risk and protective factors of POAF. Methods Three databases were searched up to June 2021. According to established criteria, evidence of association was rated as convincing, highly suggestive, suggestive, weak or not significant concerning observational studies and as high, moderate, low or very low regarding RCTs. Results We identified 47 studies (reporting 61 associations), 13 referring to observational studies and 34 to RCTs. Only the transfemoral transcatheter aortic valve replacement (TAVR) approach was associated with the prevention of POAF and was supported by convincing evidence from meta-analyses of observational data. Two other associations provided highly suggestive evidence, including preoperative hypertension and neutrophil/lymphocyte ratio. Three associations between protective factors and POAF presented a high level of evidence in meta-analyses, including RCTs. These associations included atrial and biatrial pacing and performing a posterior pericardiotomy. Nineteen associations were supported by moderate evidence, including use of drugs such as amiodarone, b-blockers, glucocorticoids and statins and the performance of TAVR compared with surgical aortic valve replacement. Conclusions Our study provides evidence confirming the protective role of amiodarone, b-blockers, atrial pacing and posterior pericardiotomy against POAF as well as highlights the risk of untreated hypertension. Further research is needed to assess the potential role of statins, glucocorticoids and colchicine in the prevention of POAF.

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  • 16.
    Cho, Kyuyeon
    et al.
    Yonsei Univ, South Korea.
    Park, Seoyeon
    Yonsei Univ, South Korea.
    Kim, Eun-Young
    Chung Ang Univ, South Korea.
    Koyanagi, Ai
    ICREA, Spain; CIBERSAM, Spain.
    Jacob, Louis
    CIBERSAM, Spain; Univ Versailles St Quentin En Yvelines, France.
    Yon, Dong K.
    Seoul Natl Univ, South Korea.
    Lee, Seung Won
    Sejong Univ, South Korea.
    Kim, Min Seo
    Sungkyunkwan Univ, South Korea.
    Radua, Joaquim
    Kings Coll London, England; Mental Hlth Networking Biomed Res Ctr CIBERSAM, Spain; Karolinska Inst, Sweden; Inst Invest Biomed August Pi & Sunyer IDIBAPS, Spain.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Il Shin, Jae
    Yonsei Univ, South Korea.
    Smith, Lee
    Anglia Ruskin Univ, England.
    Immunogenicity of COVID-19 vaccines in patients with diverse health conditions: A comprehensive systematic review2022In: Journal of Medical Virology, ISSN 0146-6615, E-ISSN 1096-9071, Vol. 94, no 9, p. 4144-4155Article, review/survey (Refereed)
    Abstract [en]

    It remains unclear how effective COVID-19 vaccinations will be in patients with weakened immunity due to diseases, transplantation, and dialysis. We conducted a systematic review comparing the efficacy of COVID-19 vaccination in patients with solid tumor, hematologic malignancy, autoimmune disease, inflammatory bowel disease, and patients who received transplantation or dialysis. A literature search was conducted twice using the Medline/PubMed database. As a result, 21 papers were included in the review, and seropositivity rate was summarized by specific type of disease, transplantation, and dialysis. When different papers studied the same type of patient group, a study with a higher number of participants was selected. Most of the solid tumor patients showed a seropositivity rate of more than 80% after the second inoculation, but a low seropositivity was found in certain tumors such as breast cancer. Research in patients with certain types of hematological malignancy and autoimmune diseases has also reported low seropositivity, and this may have been affected by the immunosuppressive treatment these patients receive. Research in patients receiving dialysis or transplantation has reported lower seropositivity rates than the general population, while all patients with inflammatory bowel disease have converted to be seropositive. Meta-analysis validating these results will be needed, and studies will also be needed on methods to protect patients with reduced immunity from COVID-19.

  • 17.
    Choi, Hangnyoung
    et al.
    Yonsei Univ, South Korea.
    Kim, Jae Han
    Yonsei Univ, South Korea.
    Yang, Hee Sang
    Yonsei Univ, South Korea.
    Kim, Jong Yeob
    Yonsei Univ, South Korea; Sungkyunkwan Univ, South Korea.
    Cortese, Samuele
    Univ Southampton, England; Solent NHS Trust, England; NYU, NY USA; Univ Bari Aldo Moro, Italy.
    Smith, Lee
    Anglia Ruskin Univ, England.
    Koyanagi, Ai
    Parc Sanitari St Joan Deu, Spain.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Radua, Joaquim
    Univ Barcelona, Spain.
    Fusar-Poli, Paolo
    Kings Coll London, England; Univ Pavia, Italy; South London & Maudsley NHS Fdn Trust, England; Ludwig Maximilian Univ Munich, Germany.
    Shin, Jae Il
    Yonsei Univ, South Korea; Yonsei Univ Hlth Syst, South Korea; Yonsei Univ, South Korea.
    Cheon, Keun-Ah
    Yonsei Univ, South Korea.
    Solmi, Marco
    Univ Ottawa, Canada; Charite, Germany.
    Pharmacological and non-pharmacological interventions for irritability in autism spectrum disorder: a systematic review and meta-analysis with the GRADE assessment2024In: Molecular Autism, ISSN 2040-2392, Vol. 15, no 1, article id 7Article, review/survey (Refereed)
    Abstract [en]

    BackgroundNumerous interventions for irritability in autism spectrum disorder (ASD) have been investigated. We aimed to appraise the magnitude of pharmacological and non-pharmacological interventions for irritability in ASD without any restrictions in terms of eligible interventions.MethodsWe systematically searched PubMed/MEDLINE, Scopus, and Web of Science until April 15, 2023. We included randomized controlled trials (RCTs) with a parallel design that examined the efficacy of interventions for the treatment of irritability in patients of any age with ASD without any restrictions in terms of eligible interventions. We performed a random-effects meta-analysis by pooling effect sizes as Hedges' g. We classified assessed interventions as follows: pharmacological monotherapy, risperidone plus adjuvant therapy versus risperidone monotherapy, non-pharmacological intervention, and dietary intervention. We utilized the Cochrane tool to evaluate the risk of bias in each study and the GRADE approach to assess the certainty of evidence for each meta-analyzed intervention.ResultsOut of 5640 references, we identified 60 eligible articles with 45 different kinds of interventions, including 3531 participants, of which 80.9% were males (mean age [SD] = 8.79 [3.85]). For pharmacological monotherapy, risperidone (Hedges' g - 0.857, 95% CI - 1.263 to - 0.451, certainty of evidence: high) and aripiprazole (Hedges' g - 0.559, 95% CI - 0.767 to - 0.351, certainty of evidence: high) outperformed placebo. Among the non-pharmacological interventions, parent training (Hedges' g - 0.893, 95% CI - 1.184 to - 0.602, certainty of evidence: moderate) showed a significant result. None of the meta-analyzed interventions yielded significant effects among risperidone + adjuvant therapy and dietary supplementation. However, several novel molecules in augmentation to risperidone outperformed risperidone monotherapy, yet from one RCT each.LimitationsFirst, various tools have been utilized to measure the irritability in ASD, which may contribute to the heterogeneity of the outcomes. Second, meta-analyses for each intervention included only a small number of studies and participants.ConclusionsOnly risperidone, aripiprazole among pharmacological interventions, and parent training among non-pharmacological interventions can be recommended for irritability in ASD. As an augmentation to risperidone, several novel treatments show promising effects, but further RCTs are needed to replicate findings.Trial registration PROSPERO, CRD42021243965.ConclusionsOnly risperidone, aripiprazole among pharmacological interventions, and parent training among non-pharmacological interventions can be recommended for irritability in ASD. As an augmentation to risperidone, several novel treatments show promising effects, but further RCTs are needed to replicate findings.Trial registration PROSPERO, CRD42021243965.

  • 18.
    Choi, Jungwoo
    et al.
    Kyung Hee Univ, South Korea.
    Kim, Minji
    Kyung Hee Univ, South Korea.
    Lee, Seung Won
    Sungkyunkwan Univ, South Korea.
    Rhee, Sang Youl
    Kyung Hee Univ, South Korea.
    Yang, Hwi
    Kyung Hee Univ, South Korea.
    Kim, Hyeon Jin
    Kyung Hee Univ, South Korea.
    Kwon, Rosie
    Kyung Hee Univ, South Korea.
    Koyanagi, Ai
    Parc Sanitari St Joan de Deu, Spain; Inst Salud Carlos III, Spain.
    Smith, Lee
    Anglia Ruskin Univ, England.
    Kim, Min Seo
    Broad Inst MIT & Harvard, MA USA.
    Fond, Guillaume
    Aix Marseille Univ, France.
    Boyer, Laurent
    Aix Marseille Univ, France.
    Sanchez Lopez, Guillermo F.
    Univ Murcia, Spain.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Cortese, Samuele
    Univ Southampton, England; Solent NHS Trust, England; NYU, NY USA; Univ Nottingham, England.
    Shin, Jae Il
    Yonsei Univ, South Korea.
    Lee, Hayeon
    Kyung Hee Univ, South Korea.
    Lee, Jinseok
    Kyung Hee Univ, South Korea.
    Rahmati, Masoud
    Lorestan Univ, Iran.
    Cho, Wonyoung
    Kyung Hee Univ, South Korea.
    Yon, Dong Keon
    Kyung Hee Univ, South Korea.
    National trends in prevalence of sadness, counseling for sadness, and sleep time among Koreans amid pandemic, 2009-2021: A nationwide representative study of over 2.8 million individuals2023In: Asian Journal of Psychiatry, ISSN 1876-2018, E-ISSN 1876-2026, Vol. 87, article id 103695Article in journal (Other academic)
  • 19.
    Choi, M. J.
    et al.
    Yonsei Univ, South Korea.
    Yang, J. W.
    Yonsei Univ, South Korea.
    Lee, S.
    Dept Psychiat, South Korea; Inst Behav Sci Med, South Korea; Yonsei Univ, South Korea; Sejong Univ, South Korea.
    Kim, J. Y.
    Yonsei Univ, South Korea.
    Oh, J. W.
    Yonsei Univ, South Korea.
    Lee, J.
    Case Western Reserve Univ, OH 44106 USA.
    Stubbs, B.
    Kings Coll London, England; South London & Maudsley NHS Fdn Trust, England; Anglia Ruskin Univ, England.
    Lee, K. H.
    Yonsei Univ, South Korea.
    Koyanagi, A.
    Univ Barcelona, Spain; ICREA, Spain.
    Hong, S. H.
    Yonsei Univ, South Korea.
    Ghayda, R. A.
    Case Western Reserve Univ, OH 44106 USA.
    Hwang, J.
    Johns Hopkins Bloomberg Sch Publ Hlth, MD USA.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Jacob, L.
    Univ Barcelona, Spain; Univ Versailles St Quentin En Yvelines, France.
    Carvalho, A. F.
    Ctr Addict & Mental Hlth CAMH, Canada; Univ Toronto, Canada.
    Radua, J.
    Inst Invest Biomed August Pi i Sunyer IDIBAPS, Spain; Mental Hlth Res Networking Ctr CIBERSAM, Spain; Kings Coll London, England; Karolinska Inst, Sweden.
    Thompson, T.
    Univ Greenwich, England.
    Smith, L.
    Anglia Ruskin Univ, England.
    Fornaro, M.
    Univ Naples Federico II, Italy.
    Stickley, A.
    Natl Ctr Neurol & Psychiat, Japan; Sodertorn Univ, Sweden.
    Bettac, E. L.
    Washington State Univ Vancouver, WA USA.
    Han, Y. J.
    Inje Univ, South Korea.
    Kronbichler, A.
    Med Univ Innsbruck, Austria.
    Yon, D. K.
    Seoul Natl Univ, South Korea.
    Lee, S. W.
    Sejong Univ, South Korea.
    Shin, J. I
    Yonsei Univ, South Korea.
    Lee, E.
    Dept Psychiat, South Korea; Inst Behav Sci Med, South Korea.
    Solmi, M.
    Univ Ottawa, Canada; Ottawa Hosp, Canada; Univ Ottawa, Canada.
    Suicide associated with COVID-19 infection: an immunological point of view2021In: European Review for Medical and Pharmacological Sciences, ISSN 1128-3602, Vol. 25, no 20, p. 6397-6407Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Coronavirus disease 2019 (COVID-19) is a pandemic and leading cause of death. Beyond the deaths directly caused by the virus and the suicides related to the psychological response to the dramatic changes as socioeconomic related to the pandemic, there might also be suicides related to the inflammatory responses of the infection. Infection induces inflammation as a cytokine storm, and there is an increasing number of studies that report a relationship between infection and suicide.

    MATERIALS AND METHODS: We searched the World Health Organization status report and the PubMed database for keywords (COVID-19, suicide, infection, inflammation, cytokines), and reviewed five cytokine pathways between suicide and inflammation using two meta-analyses and two observational studies starting from November 31, 2020, focusing on the relationship between suicide and inflammation by infection. First, we discussed existing evidence explaining the relationship between suicidal behaviors and inflammation. Second, we summarized the inflammatory features found in COVID-19 patients. Finally, we highlight the potential for these factors to affect the risk of suicide in COVID-19 patients.

    RESULTS: Patients infected with COVID-19 have high amounts of IL-1 beta, IFN-gamma, IP10, and MCP1, which may lead to Th1 cell response activation. Also, Th2 cytokines (e.g., IL-4 and IL-10) were increased in COVID-19 infection. In COVID-19 patients, neurological conditions, like headache, dizziness, ataxia, seizures, and others have been observed.

    CONCLUSIONS: COVID-19 pandemic can serve as a significant environmental factor contributing directly to increased suicide risk; the role of inflammation by an infection should not be overlooked.

  • 20.
    Choi, Sungchul
    et al.
    Yonsei Univ, South Korea.
    Kim, Beom Kyung
    Yonsei Univ, South Korea; Yonsei Univ, South Korea; Yonsei Univ Hlth Syst, South Korea.
    Yon, Dong Keon
    Kyung Hee Univ, South Korea.
    Lee, Seung Won
    Sungkyunkwan Univ, South Korea.
    Lee, Han Gyeol
    Yonsei Univ, South Korea.
    Chang, Ho Hyeok
    Yonsei Univ, South Korea.
    Park, Seoyeon
    Yonsei Univ, South Korea.
    Koyanagi, Ai
    CIBERSAM, Spain; Pg Lluis Co 23, Spain.
    Jacob, Louis
    CIBERSAM, Spain; Univ Paris Cite, France.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Radua, Joaquim
    Univ Barcelona, Spain; Karolinska Inst, Sweden; Kings Coll London, England.
    Shin, Jae Il
    Yonsei Univ, South Korea.
    Kim, Seung Up
    Yonsei Univ, South Korea; Yonsei Univ, South Korea; Yonsei Univ Hlth Syst, South Korea.
    Smith, Lee
    Anglia Ruskin Univ, England.
    Global burden of primary liver cancer and its asso- ciation with underlying aetiologies, sociodemo- graphic status, and sex differences from 1990-2019: A DALY-based analysis of the Global Burden of Disease 2019 study2023In: Clinical and Molecular Hepatology, ISSN 2287-2728, E-ISSN 2287-285X, Vol. 29, no 2, p. 433-452Article in journal (Refereed)
    Abstract [en]

    Background/Aims: Global distribution of dominant liver cancer aetiologies has significantly changed over the past decades. This study analyzed the updated temporal trends of liver cancer aetiologies and sociodemographic status in 204 countries and territories from 1990 to 2019.Methods: The Global Burden of Disease 2019 report was used for statistical analysis. In addition, we performed stratification analysis to five quintiles using sociodemographic index and 21 geographic regions.Results: The crude numbers of liver cancer disease-adjusted life years (DALYs) and deaths significantly increased during the study period (DALYs; 11,278,630 in 1990 and 12,528,422 in 2019, deaths; 365,215 in 1990 and 484,577 in 2019). However, the Age-standardized DALY and mortality rates decreased. Hepatitis B virus (HBV) remains the leading cause of liver cancer DALYs and mortality, followed by hepatitis C virus (HCV), alcohol consumption, and non-alcoholic steatohepatitis/non-alcoholic fatty liver disease (NASH/NAFLD). Although Age-standardized DALY and mortality rates of liver cancer due to HBV and HCV have decreased, the rates due to alcohol consumption and NASH/NAFLD have increased. In 2019, the population of the East Asia region had the highest Age-standardized DALY and mortality rates, followed by high-income Asia-Pacific and Central Asia populations. Although East Asia and high-income Asia-Pacific regions showed a decrease during the study period, Age-standardized DALY rates increased in Central Asia. High-income North American and Australasian populations also showed a significant increase in Age-standardized DALY.Conclusions: Liver cancer remains an ongoing global threat. The burden of liver cancer associated with alcohol consumption and NASH/NAFLD is markedly increasing and projected to continuously increase. (Clin Mol Hepatol 2023;29:433-452)

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  • 21.
    Cortese, Samuele
    et al.
    Univ Southampton, England; Solent NHS Trust, England; NYU, NY 10012 USA; Univ Nottingham, England.
    Song, Minjin
    Yonsei Univ, South Korea.
    Farhat, Luis C.
    Univ Sao Paulo, Brazil.
    Yon, Dong Keon
    Kyung Hee Univ, South Korea.
    Lee, Seung Won
    Sungkyunkwan Univ, South Korea.
    Kim, Min Seo
    Sungkyunkwan Univ, South Korea.
    Park, Seoyeon
    Yonsei Univ, South Korea.
    Oh, Jae Won
    Yonsei Univ, South Korea.
    Lee, San
    Yonsei Univ, South Korea.
    Cheon, Keun-Ah
    Yonsei Univ, South Korea.
    Smith, Lee
    Anglia Ruskin Univ, England.
    Gosling, Corentin J.
    Univ Southampton, England; Paris Nanterre Univ, France; Univ Paris, France.
    Polanczyk, Guilherme V.
    Univ Sao Paulo, Brazil.
    Larsson, Henrik
    Orebro Univ, Sweden; Karolinska Inst, Sweden.
    Rohde, Luis A.
    Univ Fed Rio Grande do Sul, Brazil; Natl Inst Dev Psychiat, Brazil.
    Faraone, Stephen V.
    SUNY Upstate Med Univ, NY USA.
    Koyanagi, Ai
    ISCIII, Spain; ICREA, Spain.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Radua, Joaquim
    Univ Barcelona, Spain.
    Carvalho, Andre F.
    Deakin Univ, Australia.
    Shin, Jae Il
    Yonsei Univ, South Korea.
    Solmi, Marco
    Univ Southampton, England; Univ Ottawa, Canada; Ottawa Hosp, Canada; Charite, Germany.
    Incidence, prevalence, and global burden of ADHD from 1990 to 2019 across 204 countries: data, with critical re-analysis, from the Global Burden of Disease study2023In: Molecular Psychiatry, ISSN 1359-4184, E-ISSN 1476-5578Article in journal (Refereed)
    Abstract [en]

    Data on incidence, prevalence and burden of ADHD are crucial for clinicians, patients, and stakeholders. We present the incidence, prevalence, and burden of ADHD globally and across countries from 1990 to 2019 from the Global Burden of Disease (GBD) study. We also: (1) calculated the ADHD prevalence based on data actually collected as opposed to the prevalence estimated by the GBD with data imputation for countries without prevalence data; (2) discussed the GBD estimated ADHD burden in the light of recent meta-analytic evidence on ADHD-related mortality. In 2019, GBD estimated global age-standardized incidence and prevalence of ADHD across the lifespan at 0.061% (95%UI = 0.040-0.087) and 1.13% (95%UI = 0.831-1.494), respectively. ADHD accounted for 0.8% of the global mental disorder DALYs, with mortality set at zero by the GBD. From 1990 to 2019 there was a decrease of -8.75% in the global age-standardized prevalence and of -4.77% in the global age-standardized incidence. The largest increase in incidence, prevalence, and burden from 1990 to 2019 was observed in the USA; the largest decrease occurred in Finland. Incidence, prevalence, and DALYs remained approximately 2.5 times higher in males than females from 1990 to 2019. Incidence peaked at age 5-9 years, and prevalence and DALYs at age 10-14 years. Our re-analysis of data prior to 2013 showed a prevalence in children/adolescents two-fold higher (5.41%, 95% CI: 4.67-6.15%) compared to the corresponding GBD estimated prevalence (2.68%, 1.83-3.72%), with no significant differences between low- and middle- and high-income countries. We also found meta-analytic evidence of significantly increased ADHD-related mortality due to unnatural causes. While it provides the most detailed evidence on temporal trends, as well as on geographic and sex variations in incidence, prevalence, and burden of ADHD, the GBD may have underestimated the ADHD prevalence and burden. Given the influence of the GBD on research and policies, methodological issues should be addressed in its future editions.

  • 22.
    Dong, Huan-Ji
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Rivano Fischer, Marcelo
    Department of Health Sciences, Research Group Rehabilitation Medicine, Lund University, Lund, Sweden; Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Lose Pain, Lose Weight, and Lose Both: A Cohort Study of Patients with Chronic Pain and Obesity Using a National Quality Registry2021In: Journal of Pain Research, E-ISSN 1178-7090, Vol. 14, p. 1863-1873Article in journal (Refereed)
    Abstract [en]

    Background: It is known that chronic pain makes it difficult to lose weight, but it is unknown whether obese patients (body mass index ≥30 kg/m2) who experience significant pain relief after interdisciplinary multimodal pain rehabilitation (IMMPR) lose weight.

    Objective: This study investigated whether obese patients with chronic pain lost weight after completing IMMPR in specialist pain units. The association of pain relief and weight change over time was also examined.

    Methods: Data from obese patients included in the Swedish Quality Registry for Pain Rehabilitation for specialized pain units were used (N=224), including baseline and 12-month follow-up after IMMPR from 2016 to 2018. Patients reported body weight and height, pain aspects (eg, pain intensity), physical activity behaviours, psychological distress, and health-related quality of life (HRQoL). A reduction of at least 5% of initial weight indicates clinically significant weight loss. Patients were classified into three groups based on the pain relief levels after IMMPR: pain relief of clinical significance (30% or more reduction of pain intensity); pain relief without clinical significance (less than 30% reduction of pain intensity); and no pain relief. Linear mixed regression models were used to examine the weight changes among the groups with different pain relief levels.

    Results: A significant reduction of pain intensity was found after IMMPR (p < 0.01, effect size Cohen's d = 0.34). A similar proportion of patients in the three groups with different pain relief levels had clinically significant weight loss (20.2%~24.3%, p = 0.47). Significant improvements were reported regarding physical activity behaviour, psychological distress, and HRQoL, but weight change was not associated with changes of pain intensity.

    Conclusion: About one-fifth of obese patients achieved significant weight reduction after IMMPR. Obese patients need a tailored pain rehabilitation program incorporating a targeted approach for weight management.

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  • 23.
    Dong, Huan-Ji
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bernfort, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Pain Catastrophizing in Older Adults with Chronic Pain: The Mediator Effect of Mood Using a Path Analysis Approach2020In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 9, no 7, article id 2073Article in journal (Refereed)
    Abstract [en]

    Cognitive models of pain propose that catastrophic thinking is negatively associated with chronic pain. However, pain catastrophizing is a complex phenomenon requiring a multivariate examination. This study estimates the effects of mood variables (anxiety and depression) on pain catastrophizing in older adults with chronic pain. A postal survey addressing pain aspects was sent to 6611 people &gt;= 65 years old living in south-eastern Sweden. Pain catastrophizing was measured using the pain catastrophizing scale. Anxiety and depression were assessed using two subscales of the general well-being schedule. Data were analysed using a path analysis approach. A total of 2790 respondents (76.2 +/- 7.4 years old) reported chronic pain (&gt;= three months). The mediation model accounted for 16.3% of anxiety, 17.1% of depression, and 30.9% of pain catastrophizing variances. Pain intensity, insomnia, number of comorbidities, and lifestyle factors (smoking, alcohol consumption, and weight) significantly affected both pain catastrophizing and mood. Anxiety (standardized path coefficient (b(std)) = 0.324,p&lt; 0.001) in comparison to depression (b(std)= 0.125,p&lt; 0.001) had a greater effect on pain catastrophizing. Mood mediated the relationship between pain catastrophizing and pain-related factors accounting for lifestyle and sociodemographic factors.

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  • 24.
    Dong, Huan-Ji
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Reported Outcomes in Interdisciplinary Pain Treatment: An Overview of Systematic Reviews and Meta-Analyses of Randomised Controlled Trials2022In: Journal of Pain Research, E-ISSN 1178-7090, Vol. 15, p. 2557-2576Article, review/survey (Refereed)
    Abstract [en]

    Background: There is considerable diversity of outcome selections and methodologies for handling the multiple outcomes across all systematic reviews (SRs) of Interdisciplinary Pain Treatment (IPT) due to the complexity. This diversity presents difficulties for healthcare decision makers. Better recommendations about how to select outcomes in SRs (with or without meta-analysis) are needed to explicitly demonstrate the effectiveness of IPT.Objective: This overview systematically collates the reported outcomes and measurements of IPT across published SRs and identifies the methodological characteristics. Additionally, we provide some suggestions on framing the selection of outcomes and on conducting SRs of IPT.Methods: Three electronic databases (PubMed, Cochrane Library, and Epistemonikos) and the PROSPERO registry for ongoing SR were supplemented with hand-searching ending on 30 September 2021. Results: We included 18 SRs with data on 49007 people from 356 primary randomised controlled trials (RCTs); eight were followed by meta-analysis and ten used narrative syntheses of data. For all the SRs, pain was the most common reported outcome (72%), followed by disability/functional status (61%) and working status (61%). Psychological well-being and quality of life were also reported in half of the included SR (50%). The core outcome domains according to VAPAIN, IMMPACT, and PROMIS were seldom met. The methodological quality varied from critically low to moderate according to AMSTAR2. The AMSTAR2 rating was negatively correlated to the number of outcome domains in PROMIS, and VAPAIN was positively correlated with IMMPACT and PROMIS, indicating the intercorrelations between the reported outcomes. Conclusion: This systematic overview showed wide-ranging disparity in reported outcomes and applied outcome domains in SRs evaluating IPT interventions for chronic pain conditions. The intercorrelations between the reported outcomes should be appropriately handled in future research. Some approaches are discussed as well.

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  • 25.
    Dong, Huan-Ji
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linköping University, Faculty of Medicine and Health Sciences.
    Larsson, Britt
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bernfort, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Factors Associated with Life Satisfaction in Older Adults with Chronic Pain (PainS65+)2020In: Journal of Pain Research, E-ISSN 1178-7090, Vol. 13, p. 475-489Article in journal (Refereed)
    Abstract [en]

    Background: Chronic pain in later life is a worldwide problem. In younger patients, chronic pain affects life satisfaction negatively; however, it is unknown whether this outcome will extend into old age.

    Objective: This study examines which factors determine life satisfaction in older adults who suffer from chronic pain with respect to socio-demographics, lifestyle behaviors, pain, and comorbidities.

    Methods: This cross-sectional study recruited a random sample of people ≥ 65 years old living in south-eastern Sweden (N= 6611). A postal survey addressed pain aspects and health experiences. Three domains from the Life Satisfaction Questionnaire (LiSat-11) were used to capture the individual’s estimations of overall satisfaction (LiSat-life), somatic health (LiSat-somhealth), and psychological health (LiSat-psychhealth).

    Results: Respondents with chronic pain (2790, 76.2± 7.4 years old) rated lower on life satisfaction than those without chronic pain, with medium effect size (ES) on LiSat-somhealth (r = 0.38, P < 0.001) and small ES on the other two domains (r < 0.3). Among the respondents with chronic pain, severe pain (OR 0.29– 0.59) and pain spreading (OR 0.87– 0.95) were inversely associated with all three domains of the LiSat-11. Current smoking, alcohol overconsumption, and obesity negatively affected one or more domains of the LiSat-11. Most comorbidities were negatively related to LiSat-somhealth, and some comorbidities affected the other two domains. For example, having tumour or cancer negatively affected both LiSat-life (OR 0.62, 95% CI 0.44– 0.88) and LiSat-somhealth (OR 0.42, 95% CI 0.24– 0.74). Anxiety or depression disorders had a negative relationship both for LiSat-life (OR 0.54, 95% CI 0.38– 0.78) and LiSat-psychhealth (OR 0.10, 95% CI 0.06– 0.14).Conclusion: Older adults with chronic pain reported lower life satisfaction but the difference from their peers without chronic pain was trivial, except for satisfaction with somatic health. Pain management in old age needs to consider comorbidities and severe pain to improve patients’ life satisfaction.

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  • 26.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Association of insomnia severity with well-being, quality of life and health care costs: A cross-sectional study in older adults with chronic pain (PainS65+)2018In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, no 2, p. 414-425Article in journal (Refereed)
    Abstract [en]

    BackgroundInsomnia is one of the most common complaints in chronic pain. This study aimed to evaluate the association of insomnia with well-being, quality of life and health care costs. MethodsThe sample included 2790 older individuals (median age=76; interquartile range [IQR]=70-82) with chronic pain. The participants completed a postal survey assessing basic demographic data, pain intensity and frequency, height, weight, comorbidities, general well-being, quality of life and the insomnia severity index (ISI). Data on health care costs were calculated as costs per year (Euro prices) and measured in terms of outpatient and inpatient care, pain drugs, total drugs and total health care costs. ResultsThe overall fraction of clinical insomnia was 24.6% (moderate clinical insomnia: 21.9% [95% CI: 18.8-23.3]; severe clinical insomnia: 2.7% [95% CI: 1.6-3.2]). Persons who reported clinical insomnia were more likely to experience pain more frequently with higher pain intensity compared to those reported no clinically significant insomnia. Mean total health care costs were Euro 8469 (95% CI: Euro4029-Euro14,271) for persons with severe insomnia compared with Euro 4345 (95% CI: Euro4033-Euro4694) for persons with no clinically significant insomnia. An association between severe insomnia, well-being, quality of life, outpatient care, total drugs costs and total health care costs remained after controlling for age, sex, pain intensity, frequency, body mass index and comorbidities using linear regression models. ConclusionsOur results determine an independent association of insomnia with low health-related quality of life and increased health care costs in older adults with chronic pain. SignificanceThe concurrence and the severity of insomnia among older adults with chronic pain were associated with decreased well-being and quality of life, and increased health care costs to society.

  • 27.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Björk, Mathilda
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    A Meta-Epidemiological Appraisal of the Effects of Interdisciplinary Multimodal Pain Therapy Dosing for Chronic Low Back Pain2019In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 8, no 6, article id 871Article in journal (Refereed)
    Abstract [en]

    Using a meta-analysis, meta-regression, and a meta-epidemiological approach, we conducted a systematic review to examine the influence of interdisciplinary multimodal pain therapy (IMPT) dosage on pain, disability, return to work, quality of life, depression, and anxiety in published randomised controlled trials (RCTs) in patients with non-specific chronic low back pain (CLBP). We considered all RCTs of IMPT from a Cochrane review and searched PubMed for additional RCTs through 30 September 2018. A subgroup random-effects meta-analysis by length, contact, and intensity of treatment was performed followed by a meta-regression analysis. Using random and fixed-effect models and a summary relative odds ratio (ROR), we compared the effect sizes (ES) from short-length, non-daily contact, and low-intensity RCTs with long-length, daily contact, and high-intensity RCTs. Heterogeneity was quantified with the I-2 metric. A total of 47 RCTs were selected. Subgroup meta-analysis showed that there were larger ES for pain and disability in RCTs with long-length, non-daily contact, and low intensity of treatment. Larger ES were also observed for quality of life in RCTs with short-length, non-daily contact, and low intensity treatment. However, these findings were not confirmed by the meta-regression analysis. Likewise, the summary RORs were not significant, indicating that the length, contact, and intensity of treatment did not have an overall effect on the investigated outcomes. For the outcomes investigated here, IMPT dosage is not generally associated with better ES, and an optimal dosage was not determined.

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  • 28.
    Dragioti, Elena
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dong, Huan-Ji
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Larsson, Britt
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Reported outcomes in published systematic reviews of interdisciplinary pain treatment: Protocol for a systematic overview2020In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 9, no 5, article id e17795Article, review/survey (Refereed)
    Abstract [en]

    Background: Interdisciplinary pain treatment (IPT) is a complex intervention; its outcomes are very diverse, as are the methodologies for handling those outcomes. This diversity may hamper evidence-based decision making. Presently, there is no gold standard recommendation of how to select reported outcomes in published systematic reviews and meta-analyses to explicitly demonstrate the effectiveness of IPT. Objective: In this systematic overview, we aim to evaluate the reported outcome domains and measurements across published systematic reviews and meta-analyses and to identify any methods, considerations, and discussion regarding the handling of the chosen outcome domains and measurements. Methods: This article describes the protocol for a systematic overview of the outcomes reported in published systematic reviews and meta-analyses of randomized control trials for the effectiveness of IPT versus any control. To this end, we searched the PubMed, Cochrane Library, and Epistemonikos databases from inception to December 2019. Two independent investigators screened the titles, the abstracts of the identified records, and the full texts of the potentially eligible systematic reviews and meta-analyses, performed data extraction according to predefined forms, and rated the quality of the included systematic reviews and meta-analyses. The quality of the included systematic reviews and meta-analyses will be rated with AMSTAR (A MeaSurement Tool to Assess systematic Reviews) 2. Data will be analyzed descriptively and stratified by AMSTAR 2. Results: We introduced the rationale and design of a systematic overview to summarize and map the chosen IPT outcome domains and the methods of handling these outcomes reported in published systematic reviews and meta-analyses. As of December 2019, we collected 5229 systematic reviews, of which 147 (2.81%) were examined in-depth for eligibility. Topline results are anticipated by September 2020. Conclusions: The results of this study will be published as soon as they are available. Our results will fill a gap in the related literature and will be used to inform the development of a set of recommendations that can be applied in systematic reviews and hopefully serve as a gold standard. © 2020 JMIR Publications. All rights reserved.

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  • 29.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Evangelou, Evangelos
    Univ Ioannina, Greece; Imperial Coll London, England.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    EFFECTIVENESS OF MULTIDISCIPLINARY PROGRAMMES FOR CLINICAL PAIN CONDITIONS: AN UMBRELLA REVIEW2018In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 9, p. 779-791Article, review/survey (Refereed)
    Abstract [en]

    Objective: To evaluate the strength of the evidence for multimodal/multidisciplinary rehabilitation programmes (MMRPs) for common pain outcomes. Data sources: PubMed, PsychInfo, PEDro and Co-chrane Library were searched from inception to August 2017. Study selection: Meta-analyses of randomized controlled trials or controlled clinical trials and qualitative systematic reviews of randomized controlled trials and non-randomized controlled trials were considered eligible. Data extraction: Two independent reviewers abstracted data and evaluated the methodological quality of the reviews. The strength of the evidence was graded using several criteria. Data synthesis: Twelve meta-analyses, including 134 associations, and 24 qualitative systematic reviews were selected. None of the associations in meta-analyses and qualitative systematic reviews were supported by either strong or highly suggestive evidence. In meta-analyses, only 8 (6%) associations that were significant at p-value amp;lt;= 0.05 were supported by suggestive evidence, whereas 44 (33%) associations were supported by weak evidence. Moderate evidence was found only in 4 (17%) qualitative systematic reviews, while 14 (58%) qualitative systematic reviews had limited evidence. Conclusion: There is no evidence that MMRPs are effective for prevalent clinical pain conditions. The majority of the evidence remains ambiguous and susceptible to biases due to the small sample size of participants and the limited number of studies included.

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  • 30.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Longitudinal Associations between Anatomical Regions of Pain and Work Conditions: A Study from The SwePain Cohort2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 12, article id 2167Article in journal (Refereed)
    Abstract [en]

    We investigated the time-based associations between workload (physical and mechanical), psychosocial work stressors (demands, control, and support), and the number of anatomical regions with pain (ARP). This population-based study with a two-year follow-up included 11,386 responders (5125 men, 6261 women; mean age: 48.8 years; SD: 18.5) living in south-eastern Sweden. Predictive associations were assessed through generalised linear models, and changes over time were examined using a generalised estimating equation. The results of both models were reported as parameter estimates (B) with 95% confidence interval (CIs). Mean changes in the number of ARP, workload, and psychosocial work stressors were stable over time. High mechanical workload and job demands were likely associated with the number of ARP at the two-year follow-up. In the reverse prospective model, we found that the number of ARP was also associated with high physical and mechanical workload and low job control and support. In the two time-based models of changes, we found a reciprocal association between number of ARP and mechanical workload. Our results add epidemiological evidence to the associations between work conditions and the extent of pain on the body. Components of work conditions, including job demands and mechanical strain, must be considered when organisations and health policy makers plan and employ ergonomic evaluations to minimise workplace hazards in the general population.

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  • 31.
    Dragioti, Elena
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Levin, Lars-Åke
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Dong, Huan-Ji
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Association between Participation Activities, Pain Severity, and Psychological Distress in Old Age: A Population-Based Study of Swedish Older Adults2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 6, article id 2795Article in journal (Refereed)
    Abstract [en]

    Although chronic pain is common in old age, previous studies on participation activities in old age seldom consider pain aspects and its related consequences. This study analyses associations between participation activities, pain severity, and psychological distress in an aging population of Swedish older adults (N = 6611). We examined older adults participation in five common leisure activities using the Multidimensional Pain Inventory (MPI), sociodemographic factors, pain severity, weight status, comorbidities, and pain-related psychological distress (anxiety, depression, insomnia severity, and pain catastrophising). We found that gender, body mass index (BMI) levels, and psychological distress factors significantly affected older adults participation in leisure activities. Pain severity and multimorbidity were not significantly associated with older adults participation in leisure activities nor with gender stratification in generalised linear regression models. The potentially modifiable factors, such as high levels of BMI and psychological distress, affected activity participation in men and women differently. Health professionals and social workers should consider gender and target potentially modifiable factors such as weight status and psychological distress to increase older adults participation in leisure activities.

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  • 32.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. University of Ioannina, Greece.
    Karathanos, V.
    University of Ioannina, Greece.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Evangelou, E.
    University of Ioannina, Greece; Imperial Coll London, England.
    Does psychotherapy work? An umbrella review of meta-analyses of randomized controlled trials2017In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 136, no 3, p. 236-246Article, review/survey (Refereed)
    Abstract [en]

    Objective: To map and evaluate the evidence across meta-analyses of randomized controlled trials (RCTs) of psychotherapies for various outcomes. Methods: We identified 173 eligible studies, including 247 meta-analyses that synthesized data from 5157 RCTs via a systematic search from inception to December 2016 in the PubMed, PsycINFO and Cochrane Database of Systematic Reviews. We calculated summary effects using random-effects models, and we assessed between-study heterogeneity. We estimated whether large studies had significantly more conservative results compared to smaller studies (small-study effects) and whether the observed positive studies were more than expected by chance. Finally, we assessed the credibility of the evidence using several criteria. Results: One hundred and ninety-nine meta-analyses were significant at P-value amp;lt;= 0.05, and almost all (n = 196) favoured psychotherapy. Large and very large heterogeneity was observed in 130 meta-analyses. Evidence for small-study effects was found in 72 meta-analyses, while 95 had evidence of excess of significant findings. Only 16 (7%) provided convincing evidence that psychotherapy is effective. These pertained to cognitive behavioural therapy (n = 6), meditation therapy (n = 1), cognitive remediation (n = 1), counselling (n = 1) and mixed types of psychotherapies (n = 7). Conclusions: Although almost 80% meta-analyses reported a nominally statistically significant finding favouring psychotherapy, only a few meta-analyses provided convincing evidence without biases.

  • 33.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    A cross-sectional study of factors associated with the number of anatomical pain sites in an actual elderly general population: results from the PainS65+cohort2017In: Journal of Pain Research, E-ISSN 1178-7090, Vol. 10, p. 2009-2019Article in journal (Refereed)
    Abstract [en]

    Background: Several studies have illustrated that multisite pain is more frequent than single pain site, and it is associated with an array of negative consequences. However, there is limited knowledge available about the potential factors associated with multisite pain in the elderly general population. Objective: This cross-sectional study examines whether the number of anatomical pain sites (APSs) is related to sociodemographic and health-related factors in older adults including oldestold ages using a new method (APSs) to assess the location of pain on the body. Materials and methods: The sample came from the PainS65+ cohort, which included 6,611 older individuals (mean age = 76.0 years; standard deviation [SD] = 7.4) residing in southeastern Sweden. All the participants completed and returned a postal survey that measured sociodemographic data, total annual income, pain intensity and frequency, general well-being, and quality of life. The number of pain sites (NPS) was marked on a body manikin of 45 sections, and a total of 23 APSs were then calculated. Univariable and multivariable models of regression analysis were performed. Results: Approximately 39% of the respondents had at least two painful sites. The results of the regression analysis showed an independent association between the APSs and the age group of 75-79 years, women, married, high pain intensity and frequency, and low well-being and quality of life, after adjustments for consumption of analgesics and comorbidities. The strongest association was observed for the higher frequency of pain. Conclusion: Our results suggest that APSs are highly prevalent with strong relationships with various sociodemographic and health-related factors and concur well with the notion that multisite pain is a potential indicator of increased pain severity and impaired quality of life in the elderly. Our comprehensive method of calculating the number of sites could be an essential part of the clinical presentation, assessment, and treatment of multisite pain.

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  • 34.
    Dragioti, Elena
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Allergy Center.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Prevalence of different pain categories based on pain spreading on the bodies of older adults in Sweden: a descriptive-level and multilevel association with demographics, comorbidities, medications, and certain lifestyle factors (PainS65+)2016In: Journal of Pain Research, E-ISSN 1178-7090, Vol. 9, p. 1131-1141Article in journal (Refereed)
    Abstract [en]

    Background and objective: There is limited knowledge about the prevalence of pain and its relation to comorbidities, medication, and certain lifestyle factors in older adults. To address this limitation, this cross-sectional study examined the spreading of pain on the body in a sample of 6611 subjects amp;gt;= 65 years old (mean age = 75.0 years; standard deviation [SD] = 7.7) living in southeastern Sweden. Methods: Sex, age, comorbidities, medication, nicotine, alcohol intake, and physical activity were analyzed in relation to the following pain categories: local pain (LP) (24.1%), regional pain medium (RP-Medium) (20.3%), regional pain heavy (RP-Heavy) (5.2%), and widespread pain (WSP) (1.7%). Results: RP-Medium, RP-Heavy, and WSP were associated more strongly with women than with men (all pamp;lt;0.01). RP-Heavy was less likely in the 80-84 and amp;gt;85 age groups compared to the 65-69 age group (both pamp;lt;0.01). Traumatic injuries, rheumatoid arthritis/osteoarthritis, and analgesics were associated with all pain categories (all pamp;lt;0.001). An association with gastrointestinal disorders was found in LP, RP-Medium, and RP-Heavy (all pamp;lt;0.01). Depressive disorders were associated with all pain categories, except for LP (all pamp;lt;0.05). Disorders of the central nervous system were associated with both RP-Heavy and WSP (all pamp;lt;0.05). Medication for peripheral vascular disorders was associated with RP-Medium (pamp;lt;0.05), and hypnotics were associated with RP-Heavy (pamp;lt;0.01). Conclusion: More than 50% of older adults suffered from different pain spread categories. Women were more likely to experience greater spreading of pain than men. A noteworthy number of common comorbidities and medications were associated with increased likelihood of pain spread from LP to RP-Medium, RP-Heavy, and WSP. Effective management plans should consider these observed associations to improve functional deficiency and decrease spreading of pain-related disability in older adults.

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  • 35.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Insomnia severity and its relationship with demographics, pain features, anxiety, and depression in older adults with and without pain: cross-sectional population-based results from the PainS65+cohort2017In: Annals of General Psychiatry, ISSN 1744-859X, E-ISSN 1744-859X, Vol. 16, article id 15Article in journal (Refereed)
    Abstract [en]

    Background: Insomnia is a major cause of concern in the elderly with and without pain. This study set out to examine the insomnia and its correlates in a large sample of community adults aged amp;gt;= 65 years. Methods: A cross-sectional postal survey was completed by 6205 older individuals (53.8% women; mean age = 76.2 years; SD = 7.5). The participants also completed the Insomnia Severity Index (ISI) and questionnaires assessing pain intensity, pain spreading, anxiety, depression, and basic demographic information. The sample was divided into three groups based on the presence and duration of pain: chronic pain (CP; n = 2790), subacute pain (SP; n = 510), and no pain (NP; n = 2905). Results: A proportion of each of the groups had an ISI score of 15 or greater (i.e., clinical insomnia): CP = 24.6%; SP = 21.3%; and NP = 13.0%. The average scores of ISI differed significantly among CP, SP, and NP groups (p amp;lt; 0.001). Stratified regression analyses showed that pain intensity, pain spreading, anxiety, and depression were independently related to insomnia in the CP group. Anxiety and depression were independently related to insomnia in the SP group, but only anxiety was significantly associated with insomnia in the NP group. Age and sex were not associated with insomnia. Conclusions: This study confirms that insomnia is not associated with chronological aging per se within the elderly population. Although the possible associations of insomnia with pain are complex, ensuing from pain intensity, pain spreading, anxiety, and depression, our results highlighted that anxiety was more strongly associated with insomnia in all groups than the depression and pain characteristics. Therapeutic plans should consider these relations during the course of pain, and a comprehensive assessment including both pain and psychological features is essential when older people are seeking primary health care for insomnia complaints.

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  • 36.
    Dragioti, Elena
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Li, Han
    Univ Florida, FL USA.
    Tsitsas, George
    Harokopio Univ, Greece.
    Lee, Keum Hwa
    Yonsei Univ, South Korea.
    Choi, Jiwoo
    Yonsei Univ, South Korea.
    Kim, Jiwon
    Yonsei Univ, South Korea.
    Choi, Young Jo
    Yonsei Univ, South Korea.
    Tsamakis, Konstantinos
    Kings Coll London, England.
    Estrade, Andres
    Univ Catolica, Uruguay; Kings Coll London, England.
    Agorastos, Agorastos
    Aristotle Univ Thessaloniki, Greece.
    Vancampfort, Davy
    Katholieke Univ Leuven, Belgium.
    Tsiptsios, Dimitrios
    Democritus Univ Thrace, Greece.
    Thompson, Trevor
    Univ Greenwich, England.
    Mosina, Anna
    Integrated Psychiat Winterthur, Switzerland.
    Vakadaris, Georgios
    Aristotle Univ Thessaloniki, Greece.
    Fusar-Poli, Paolo
    Kings Coll London, England; South London & Maudsley NHS Fdn Trust, England; Univ Pavia, Italy.
    Carvalho, Andre F.
    Univ Toronto, Canada.
    Correll, Christoph U.
    Northwell Hlth, NY USA; Donald & Barbara Zucker Sch Med Hofstra Northwell, NY USA; Charite, Germany.
    Han, Young Joo
    Inje Univ, South Korea.
    Park, Seoyeon
    Yonsei Univ, South Korea.
    Il Shin, Jae
    Yonsei Univ, South Korea.
    Solmi, Marco
    Univ Ottawa, Canada; Ottawa Hosp, Canada.
    A large-scale meta-analytic atlas of mental health problems prevalence during the COVID-19 early pandemic2022In: Journal of Medical Virology, ISSN 0146-6615, E-ISSN 1096-9071, Vol. 94, no 5, p. 1935-1949Article in journal (Refereed)
    Abstract [en]

    The COVID-19 pandemic and related restrictions can impact mental health. To quantify the mental health burden of COVID-19 pandemic, we conducted a systematic review and meta-analysis, searching World Health Organization COVID-19/PsycInfo/PubMed databases (09/29/2020), including observational studies reporting on mental health outcomes in any population affected by COVID-19. Primary outcomes were the prevalence of anxiety, depression, stress, sleep problems, posttraumatic symptoms. Sensitivity analyses were conducted on severe mental health problems, in high-quality studies, and in representative samples. Subgroup analyses were conducted stratified by age, sex, country income level, and COVID-19 infection status. One-hundred-seventy-three studies from February to July 2020 were included (n = 502,261, median sample = 948, age = 34.4 years, females = 63%). Ninety-one percent were cross-sectional studies, and 18.5%/57.2% were of high/moderate quality. The highest prevalence emerged for posttraumatic symptoms in COVID-19 infected people (94%), followed by behavioral problems in those with prior mental disorders (77%), fear in healthcare workers (71%), anxiety in caregivers/family members of people with COVID-19 (42%), general health/social contact/passive coping style in the general population (38%), depression in those with prior somatic disorders (37%), and fear in other-than-healthcare workers (29%). Females and people with COVID-19 infection had higher rates of almost all outcomes; college students/young adults of anxiety, depression, sleep problems, suicidal ideation; adults of fear and posttraumatic symptoms. Anxiety, depression, and posttraumatic symptoms were more prevalent in low-/middle-income countries, sleep problems in high-income countries. The COVID-19 pandemic adversely impacts mental health in a unique manner across population subgroups. Our results inform tailored preventive strategies and interventions to mitigate current, future, and transgenerational adverse mental health of the COVID-19 pandemic.

  • 37.
    Dragioti, Elena
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Radua, Joaquim
    Kings Coll London, England; Inst Invest Biomed August Pi & Sunyer, Spain; Karolinska Inst, Sweden.
    Solmi, Marco
    Kings Coll London, England; Univ Ottawa, Canada; Ottawa Hosp, Canada; Univ Southampton, England.
    Arango, Celso
    Hosp Gen Univ Gregorio Maranon, Spain; Univ Complutense Madrid, Spain; Biomed Res Ctr Mental Hlth CIBERSAM, Spain.
    Oliver, Dominic
    Kings Coll London, England.
    Cortese, Samuele
    Univ Southampton, England; Univ Southampton, England; Solent NHS Trust, England; Hassenfeld Childrens Hosp NYU Langone, NY USA; Univ Nottingham, England.
    Jones, Peter B.
    Univ Cambridge, England; Cambridgeshire & Peterborough Natl Hlth Serv Fdn, England.
    Il Shin, Jae
    Yonsei Univ, South Korea; Severance Childrens Hosp, South Korea.
    Correll, Christoph U.
    Northwell Hlth, NY USA; Zucker Sch Med Hofstra Northwell, NY USA; Feinstein Inst Med Res, NY USA; Charite, Germany.
    Fusar-Poli, Paolo
    Kings Coll London, England; South London & Maudsley NHS Fdn Trust, England; Univ Pavia, Italy.
    Global population attributable fraction of potentially modifiable risk factors for mental disorders: a meta-umbrella systematic review2022In: Molecular Psychiatry, ISSN 1359-4184, E-ISSN 1476-5578, Vol. 27, no 8, p. 3510-3519Article in journal (Refereed)
    Abstract [en]

    Numerous risk factors for mental disorders have been identified. However, we do not know how many disorders we could prevent and to what extent by modifying these risk factors. This study quantifies the Population Attributable Fraction (PAF) of potentially modifiable risk factors for mental disorders. We conducted a PRISMA 2020-compliant (Protocol: https://osf.io/hk2ag) meta-umbrella systematic review (Web of Science/PubMed/Cochrane Central Register of Reviews/Ovi/PsycINFO, until 05/12/2021) of umbrella reviews reporting associations between potentially modifiable risk factors and ICD/DSM mental disorders, restricted to highly convincing (class I) and convincing (class II) evidence from prospective cohorts. The primary outcome was the global meta-analytical PAF, complemented by sensitivity analyses across different settings, the meta-analytical Generalised Impact Fraction (GIF), and study quality assessment (AMSTAR). Seven umbrella reviews (including 295 meta-analyses and 547 associations) identified 28 class I-II risk associations (23 risk factors; AMSTAR: 45.0% high-, 35.0% medium-, 20.0% low quality). The largest global PAFs not confounded by indication were 37.84% (95% CI = 26.77-48.40%) for childhood adversities and schizophrenia spectrum disorders, 24.76% (95% CI = 13.98-36.49%) for tobacco smoking and opioid use disorders, 17.88% (95% CI = not available) for job strain and depression, 14.60% (95% CI = 9.46-20.52%) for insufficient physical activity and Alzheimers disease, 13.40% (95% CI = 7.75-20.15%) for childhood sexual abuse and depressive disorders, 12.37% (95% CI = 5.37-25.34%) for clinical high-risk state for psychosis and any non-organic psychotic disorders, 10.00% (95% CI = 5.62-15.95%) for three metabolic factors and depression, 9.73% (95% CI = 4.50-17.30%) for cannabis use and schizophrenia spectrum disorders, and 9.30% (95% CI = 7.36-11.38%) for maternal pre-pregnancy obesity and ADHD. The GIFs confirmed the preventive capacity for these factors. Addressing several potentially modifiable risk factors, particularly childhood adversities, can reduce the global population-level incidence of mental disorders.

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  • 38.
    Dragioti, Elena
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Radua, Joaquim
    Kings Coll London, England; Univ Barcelona, Spain; Karolinska Inst, Sweden.
    Solmi, Marco
    Kings Coll London, England; Univ Ottawa, Canada; Ottawa Hosp, Canada; Univ Southampton, England; Charite, Germany.
    Gosling, Corentin J.
    Univ Southampton, England; Paris Nanterre Univ, France; Univ Paris Cite, France.
    Oliver, Dominic
    Kings Coll London, England; Univ Oxford, England.
    Lascialfari, Filippo
    Univ Pavia, Italy.
    Ahmed, Muhammad
    Kings Coll London, England.
    Cortese, Samuele
    Univ Southampton, England; Univ Southampton, England; Solent NHS Trust, England; Univ Nottingham, England.
    Estrade, Andres
    Kings Coll London, England.
    Arrondo, Gonzalo
    Univ Southampton, England; NYU Langone, NY USA.
    Gouva, Mary
    Univ Ioannina, Greece.
    Fornaro, Michele
    Univ Navarra, Spain.
    Batiridou, Agapi
    Univ Ioannina, Greece.
    Dimou, Konstantina
    Univ Ioannina, Greece.
    Tsartsalis, Dimitrios
    Federico II Univ Naples, Italy.
    Carvalho, Andre F.
    Hippokrateion Hosp, Greece.
    Shin, Jae Il
    Deakin Univ, Australia; Barwon Hlth, Australia; Yonsei Univ, South Korea.
    Berk, Michael
    Hippokrateion Hosp, Greece.
    Stringhini, Silvia
    Severance Childrens Hosp, South Korea; Geneva Univ Hosp, Switzerland; Univ Lausanne, Switzerland; Univ Geneva, Switzerland.
    Correll, Christoph U.
    Charite, Germany; Zucker Hillside Hosp, NY USA.
    Fusar-Poli, Paolo
    Kings Coll London, England; Univ Pavia, Italy.
    Impact of mental disorders on clinical outcomes of physical diseases: an umbrella review assessing population attributable fraction and generalized impact fraction2023In: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 22, no 1, p. 86-104Article, review/survey (Refereed)
    Abstract [en]

    Empirical evidence indicates a significant bidirectional association between mental disorders and physical diseases, but the prospective impact of men-tal disorders on clinical outcomes of physical diseases has not been comprehensively outlined. In this PRISMA- and COSMOS-E-compliant umbrella review, we searched PubMed, PsycINFO, Embase, and Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, up to March 15, 2022, to identify systematic reviews with meta-analysis that examined the prospective association between any mental disorder and clinical outcomes of physical diseases. Primary outcomes were disease-specific mortality and all-cause mortality. Secondary outcomes were disease-specific incidence, functioning and/or disability, symptom severity, quality of life, recurrence or progression, major cardiac events, and treatment-related outcomes. Additional inclusion criteria were further applied to primary studies. Random effect models were employed, along with I-2 statistic, 95% prediction intervals, small-study effects test, excess significance bias test, and risk of bias (ROBIS) assessment. Associations were classified into five credibility classes of evidence (I to IV and non-significant) according to established criteria, complemented by sensitivity and subgroup analyses to examine the robustness of the main analysis. Statistical analysis was performed using a new package for conducting umbrella reviews (). Population attributable fraction (PAF) and generalized impact fraction (GIF) were then calculated for class I-III associations. Forty-seven systematic reviews with meta-analysis, encompassing 251 non-overlapping primary studies and reporting 74 associations, were included (68% were at low risk of bias at the ROBIS assessment). Altogether, 43 primary outcomes (disease-specific mortality: n=17; all-cause mortality: n=26) and 31 secondary outcomes were investigated. Although 72% of associations were statistically significant (p&lt;0.05), only two showed convincing (class I) evidence: that between depressive disorders and all-cause mortality in patients with heart failure (hazard ratio, HR=1.44, 95% CI: 1.26-1.65), and that between schizophrenia and cardiovascular mortality in patients with cardiovascular diseases (risk ratio, RR=1.54, 95% CI: 1.36-1.75). Six associations showed highly suggestive (class II) evidence: those between depressive disorders and all-cause mortality in patients with diabetes mellitus (HR=2.84, 95% CI: 2.00-4.03) and with kidney failure (HR=1.41, 95% CI: 1.31-1.51); that between depressive disorders and major cardiac events in patients with myocardial infarction (odds ratio, OR=1.52, 95% CI: 1.36-1.70); that between depressive disorders and dementia in patients with diabetes mellitus (HR=2.11, 95% CI: 1.77-2.52); that between alcohol use disorder and decompensated liver cirrhosis in patients with hepatitis C (RR=3.15, 95% CI: 2.87-3.46); and that between schizophrenia and cancer mortality in patients with cancer (standardized mean ratio, SMR=1.74, 95% CI: 1.41-2.15). Sensitivity/subgroup analyses confirmed these results. The largest PAFs were 30.56% (95% CI: 27.67-33.49) for alcohol use disorder and decompensated liver cirrhosis in patients with hepatitis C, 26.81% (95% CI: 16.61-37.67) for depressive disorders and all-cause mortality in patients with diabetes mellitus, 13.68% (95% CI: 9.87-17. 58) for depressive disorders and major cardiac events in patients with myocardial infarction, 11.99% (95% CI: 8.29-15.84) for schizophrenia and cardiovascular mortality in patients with cardiovascular diseases, and 11.59% (95% CI: 9.09-14.14) for depressive disorders and all-cause mortality in patients with kidney failure. The GIFs confirmed the preventive capacity of these associations. This umbrella review demonstrates that mental disorders increase the risk of a poor clinical outcome in several physical diseases. Prevention targeting mental disorders - particularly alcohol use disorders, depressive disorders, and schizophrenia - can reduce the incidence of adverse clinical outcomes in people with physical diseases. These findings can inform clinical practice and trans-speciality preventive approaches cutting across psychiatric and somatic medicine.

  • 39.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Solmi, Marco
    Univ Padua, Italy; Univ Padua, Italy; Kings Coll London, England.
    Favaro, Angela
    Univ Padua, Italy; Univ Padua, Italy.
    Fusar-Poli, Paolo
    Kings Coll London, England; South London & Maudsley NHS Natl Hlth Serv Fdn Tr, England; Univ Pavia, Italy.
    Dazzan, Paola
    Kings Coll London, England; South London & Maudsley NHS Fdn Trust, England.
    Thompson, Trevor
    Univ Greenwich, England.
    Stubbs, Brendon
    South London & Maudsley NHS Fdn Trust, England; Kings Coll London, England.
    Firth, Joseph
    Univ Western Sydney, Australia; Univ Manchester, England; Univ Melbourne, Australia.
    Fornaro, Michele
    Univ Naples Federico II, Italy.
    Tsartsalis, Dimitrios
    Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Carvalho, Andre F.
    Univ Toronto, Canada; Univ Toronto, Canada.
    Vieta, Eduard
    Univ Barcelona, Spain.
    McGuire, Philip
    Kings Coll London, England.
    Young, Allan H.
    Kings Coll London, England; South London & Maudsley NHS Fdn Trust, England.
    Shin, Jae Il
    Yonsei Univ, South Korea.
    Correll, Christoph U.
    Zucker Hillside Hosp, NY USA; Hofstra Northwell Sch Med, NY USA; Feinstein Inst Med Res, NY USA; Charite Univ Med Berlin, Germany.
    Evangelou, Evangelos
    Univ Ioannina, Greece; Imperial Coll London, England.
    Association of Antidepressant Use With Adverse Health Outcomes A Systematic Umbrella Review2019In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 76, no 12, p. 1241-1255Article, review/survey (Refereed)
    Abstract [en]

    This umbrella review searches PubMed, Scopus, and PsycINFO to summarize and grade the strength of evidence of the associations between antidepressants and adverse outcomes reported in multiple meta-analyses. Importance Antidepressant use is increasing worldwide. Yet, contrasting evidence on the safety of antidepressants is available from meta-analyses, and the credibility of these findings has not been quantified. Objective To grade the evidence from published meta-analyses of observational studies that assessed the association between antidepressant use or exposure and adverse health outcomes. Data Sources PubMed, Scopus, and PsycINFO were searched from database inception to April 5, 2019. Evidence Review Only meta-analyses of observational studies with a cohort or case-control study design were eligible. Two independent reviewers recorded the data and assessed the methodological quality of the included meta-analyses. Evidence of association was ranked according to established criteria as follows: convincing, highly suggestive, suggestive, weak, or not significant. Results Forty-five meta-analyses (17.9%) from 4471 studies identified and 252 full-text articles scrutinized were selected that described 120 associations, including data from 1012 individual effect size estimates. Seventy-four (61.7%) of the 120 associations were nominally statistically significant at P &lt;= .05 using random-effects models. Fifty-two associations (43.4%) had large heterogeneity (I-2 &gt; 50%), whereas small-study effects were found for 17 associations (14.2%) and excess significance bias was found for 9 associations (7.5%). Convincing evidence emerged from both main and sensitivity analyses for the association between antidepressant use and risk of suicide attempt or completion among children and adolescents, autism spectrum disorders with antidepressant exposure before and during pregnancy, preterm birth, and low Apgar scores. None of these associations remained supported by convincing evidence after sensitivity analysis, which adjusted for confounding by indication. Conclusions and Relevance This studys findings suggest that most putative adverse health outcomes associated with antidepressant use may not be supported by convincing evidence, and confounding by indication may alter the few associations with convincing evidence. Antidepressant use appears to be safe for the treatment of psychiatric disorders, but more studies matching for underlying disease are needed to clarify the degree of confounding by indication and other biases. No absolute contraindication to antidepressants emerged from this umbrella review. Question Is antidepressant use associated with adverse health outcomes, and how credible is the evidence behind this association in published meta-analyses of real-world data? Findings In this systematic umbrella review of 45 meta-analyses of observational studies, convincing evidence was found for the associations between antidepressant use and suicide attempt or completion among individuals younger than 19 years and between antidepressant use and autism risk among the offspring. However, none of these associations remained at the convincing evidence level after a sensitivity analysis that adjusted for confounding by indication. Meaning This studys findings suggest that claimed adverse health outcomes associated with antidepressants may not be supported by strong evidence and may be exaggerated by confounding by indication; no absolute contraindication to the use of antidepressants was found to be currently supported by convincing evidence.

  • 40.
    Dragioti, Elena
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Tsamakis, Konstantinos
    Kings Coll London, England.
    Larsson, Britt
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Predictive association between immigration status and chronic pain in the general population: results from the SwePain cohort2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, no 1, article id 1462Article in journal (Refereed)
    Abstract [en]

    BackgroundPrevious studies suggest that immigration may influence the experience of pain.ObjectiveThis population-based study examines whether immigration status is associated with chronic pain (CP), chronic widespread pain (CWSP), and severe CP at a two-year follow-up. We also tested mediation by mood status (i.e., anxiety and depression).Methods15, 563 participants from a representative stratified random sample of 34,000 individuals living in south-eastern Sweden completed a postal survey, during 2013-2015, that included the following data: immigration status; presence of CP (pain lasting at least 3 months) and CWSP (a modified classification of widespread pain for use in epidemiological studies); severity of CP based on a numeric rating scale; and depression, anxiety, economic situation, and sociodemographic information. We applied logistic regressions using the generalized estimating equations (GEE), with Swedish-born as the reference group and path analyses models.ResultsCompared to the Swedish-born participants (n =14,093;90%), the immigrants (n =1470;10%) had an elevated risk of all pain outcomes (CP: odds ratio [OR]=1.18; 95% confidence interval [CI=1.04-1.33, CWSP: OR=1.39; 95% CI: 1.15-1.69 and severe CP: 1.51; 95% CI: 1.23-1.87) after adjustments. Path analyses showed that baseline age, immigrant status, and financial hardship had a significant influence on chronic pain outcomes at follow-up with baseline mood status as the mediator. Immigration status was also associated with age and financial hardship.ConclusionImmigrants may have increased risk of chronic pain, widespread pain, and severe pain and this risk is mediated by mood status. Targeted interventions better tailored to the socio-economic and psychological status of immigrants with chronic pain are warranted.

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  • 41.
    Dragioti, Elena
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Tsartsalis, Dimitrios
    Hippokrateion Hosp, Greece.
    Mentis, Manolis
    Univ Patras, Greece.
    Mantzoukas, Stefanos
    Univ Ioannina, Greece.
    Gouva, Mary
    Univ Ioannina, Greece.
    Impact of the COVID-19 pandemic on the mental health of hospital staff: An umbrella review of 44 meta-analyses2022In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 131, article id 104272Article, review/survey (Refereed)
    Abstract [en]

    Background: Hospital staff is at high risk of developing mental health issues during the coronavirus (COVID-19) pandemic. However, the literature lacks an overall and inclusive picture of mental health problemswith comprehensive analysis among hospital staff during the COVID-19 pandemic. Objectives: To ascertain the prevalence of anxiety, depression and other mental health outcomes as reported in original articles among hospital staff during the COVID-19 pandemic. Design: A PRISMA 2020 and MOOSE 2000 compliant umbrella review of published meta-analyses of observational studies evaluating the prevalence of mental health problems in hospital staff during the pandemic. Review methods: Systematic searcheswere conducted in PubMed/Medline, CINAHL, EMBASE, and PsycINFO from December 1st, 2019, until August 13th 2021. The randomeffects model was used for the meta-analysis, and the I-2 indexwas employed to assess between-study heterogeneity. Publication bias using Egger test and LFK indexwas examined. Data was analyzed using STATA 17.0 software. AMSTAR-2 was applied for the quality assessment of systematic reviews, while we used GRADE to rate the quality of evidence. Results: Forty-four meta-analyses from1298 individual studieswere included in the final analysis, encompassing the prevalence of 16 mental health symptoms. One-third of hospital workers reported anxiety (Prevalence: 29.9%, 95% CI:27.1% to 32.7%) and depression (Prevalence: 28.4%, 95% CI:25.5% to 31.3%) symptomatology, while about 40% (95% CI: 36.9% to 42.0%) suffered from sleeping disorders. Fear-related symptoms, reduced well-being, poor quality of life, and acute stress symptoms had the highest prevalence among hospital staff. However, the quality of evidence in these areas varied from low to very low. Nurses suffered more often from sleep problems and symptoms of anxiety and depression than doctors, whereas doctors reported a higher prevalence of acute stress and post-traumatic disorders. The burden of anxiety, depression, and sleep disorders was higher among female employees than their male counterparts. Remarkably, acute stress and insomnia affected more than half of first-line medical staff. Conclusions: The prevalence of mental health problems among hospital staff during the COVID-19 pandemic is generally high, with anxiety, depression and insomnia symptoms representing the most robust evidence based on a large dataset of prevalence meta-analyses. However, there is no strong confidence in the body of evidence for each outcome assessed. (C) 2022 The Author(s). Published by Elsevier Ltd.

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  • 42.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Wiklund, Tobias
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Siamouli, Melina
    Aristotle University of Thessaloniki, Greece.
    Moutou, Katerina
    Aristotle University of Thessaloniki, Greece.
    Fountoulakis, Konstantinos N.
    Aristotle University of Thessaloniki, Greece.
    Could PANSS be a useful tool in the determining of the stages of schizophrenia? A clinically operational approach2017In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 86, p. 66-72Article in journal (Refereed)
    Abstract [en]

    Staging in schizophrenia might be an important approach for the better treatment and rehabilitation of patients. The purpose of this study was to empirically devise a staging approach in a sample of stabilized patients with schizophrenia. One hundred and seventy patients aged amp;gt;= 18 years (mean = 40.7, SD = 11.6) diagnosed by DSM-5 criteria were evaluated with the Positive and Negative Syndrome Scale (PANSS). Principal components analysis (PCA) with varimax rotation was used. The model was examined in the total sample and separately across a hypothesized stage of illness based on three age groups and between the two sexes. The PCA revealed a six factor structure for the total sample: 1) Negative, 2) Positive, 3) Depression and anxiety, 4) Excitement and Hostility, 5) Neurocognition and 6) Disorganization. The separate PCAs by stage of illness and sex revealed different patterns and quality of symptomatology. The Negative and Positive factors were stable across all examined groups. The models corresponding to different stages differed mainly in terms of neurocognition and disorganization and their interplay. Catatonic features appear more prominent in males while in females neurocognition takes two forms; one with disorganization and one with stereotype thinking with delusions. This study suggests that the three arbitrary defined stages of illness (on the basis of age) seem to reflect a progress from a preserved insight and more coherent mental functioning to disorganization and eventually neurocognitive impairment. Sexes differ in terms of the relationship of psychotic features with neurocognition. These results might have significant research and clinical implications. (C) 2016 Elsevier Ltd. All rights reserved.

  • 43.
    Fornaro, Michele
    et al.
    Univ Naples Federico II, Italy; Polyedra Res Fdn, Italy.
    Daray, Federico Manuel
    Univ Buenos Aires, Argentina.
    Hunter, Fernando
    Univ Buenos Aires, Argentina.
    Anastasia, Annalisa
    Polyedra Res Fdn, Italy.
    Stubbs, Brendon
    South London & Maudsley NHS Fdn Trust, England; Hlth Serv & Populat Res Dept, England; Dept Psychol, England.
    De Berardis, Domenico
    Polyedra Res Fdn, Italy; Mazzini Hosp, Italy.
    Shin, Jae Il
    Yonsei Univ, South Korea.
    Husain, Muhammad Ishrat
    Univ Toronto, Canada; Ctr Addict Mental Hlth CAMH, Canada.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Fusar-Poli, Paolo
    Kings Coll London, England; South London & Maudsley NHS Fdn Trust, England; Univ Pavia, Italy; South London & Maudsley NHS Fdn Trust, England.
    Solmi, Marco
    Kings Coll London, England; Univ Padua, Italy; Univ Padua, Italy.
    Berk, Michael
    Univ Melbourne, Australia; Deakin Univ, Australia; Univ Melbourne, Australia; Univ Melbourne, Australia.
    Vieta, Eduard
    Univ Barcelona, Spain.
    Carvalho, Andre Ferrer
    Univ Toronto, Canada; Ctr Addict Mental Hlth CAMH, Canada.
    The prevalence, odds and predictors of lifespan comorbid eating disorder among people with a primary diagnosis of bipolar disorders, and vice-versa: Systematic review and meta-analysis2021In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 280, p. 409-431Article, review/survey (Refereed)
    Abstract [en]

    Background: There are scarce and discrepant data about the prevalence and correlates of co-occurring eating disorders (EDs) among people with a primary diagnosis of bipolar disorder (BD), and vice-versa, compelling a systematic review and meta-analysis on the matter. Methods: MEDLINE/PsycINFO databases were systematically searched for original studies documenting BD reversible arrow ED comorbidity across the lifespan, from inception up until April 20th, 2020. Random-effects meta-analysis and meta-regression analyses were conducted, accounting for multiple moderators. Results: Thirty-six studies involved 15,084 primary BD patients. Eleven studies encompassed 15,146 people with primary EDs. Binge eating disorder (BED) occurred in 12.5% (95%C.I.=9.4-16.6%, I-2=93.48%) of BDs, while 9.1% (95%C.I.=3.3-22.6%) of BEDs endorsed BD. Bulimia Nervosa (BN) occurred in 7.4% (95%C.I.=6-10%) of people with BD, whereas 6.7% (95%C.I.=12-29.2%) of subjects with BN had a diagnosis of BD. Anorexia Nervosa (AN) occurred in 3.8% (95%C.I.=2-6%) of people with BDs; 2% (95%C.I.=1-2%) of BD patients had a diagnosis of AN. Overall, BD patients with EDs had higher odds of being female vs. non-ED controls. Several moderators yielded statistically significant differences both within- and between different types of BDs and EDs. Limitations: Scant longitudinal studies, especially across different EDs and pediatric samples. High heterogeneity despite subgroup comparisons. Limited discrimination of the quality of the evidence. Conclusions: The rates of BD reversible arrow ED comorbidity vary across different diagnostic groups, more than they do according to the "direction" of BD reversible arrow ED. Further primary studies should focus on the risks, chronology, clinical impact, and management of the onset of intertwined BD reversible arrow ED across different ages, promoting a continuum approach.

  • 44.
    Fornaro, Michele
    et al.
    Federico Ii Univ Naples, Italy.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    De Prisco, Michele
    Federico Ii Univ Naples, Italy.
    Billeci, Martina
    Federico Ii Univ Naples, Italy.
    Mondin, Anna Maria
    Federico Ii Univ Naples, Italy.
    Calati, Raffaella
    Univ Milano Bicocca, Italy; Nimes Univ Hosp, France.
    Smith, Lee
    Anglia Ruskin Univ, England.
    Hatcher, Simon
    Univ Ottawa, Canada; Ottawa Hosp, Canada; Ottawa Hosp Res Inst, Canada.
    Kaluzienski, Mark
    Univ Ottawa, Canada; Ottawa Hosp, Canada.
    Fiedorowicz, Jess G.
    Univ Ottawa, Canada; Ottawa Hosp, Canada; Ottawa Hosp Res Inst, Canada.
    Solmi, Marco
    Univ Ottawa, Canada; Ottawa Hosp, Canada; Ottawa Hosp Res Inst, Canada; Inst Psychiat Psychol, England; Univ Southampton, England.
    de Bartolomeis, Andrea
    Federico Ii Univ Naples, Italy; Univ Naples Federico II Naples, Italy.
    Carvalho, Andre F.
    Deakin Univ, Australia.
    Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials2022In: BMC Medicine, E-ISSN 1741-7015, Vol. 20, no 1, article id 224Article, review/survey (Refereed)
    Abstract [en]

    Background Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population. Methods Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted. Results Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p &lt;= 0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was "critically low." Interventional studies were scant. Conclusion While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.

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  • 45.
    Fountoulakis, K.N.
    et al.
    Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Stockholm Psychiatric Southwest Clinic, Karolinska Huddinge University Hospital, Sweden.
    Theofilidis, A.T.
    3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
    Wiklund, Tobias
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Stockholm Psychiatric Southwest Clinic, Karolinska Huddinge University Hospital, Huddinge, Sweden.
    Atmatzidis, Xenofon
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Stockholm Psychiatric Southwest Clinic, Karolinska Huddinge University Hospital, Huddinge, Sweden.
    Nimatoudis, I.
    3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
    Thys, E.
    University Psychiatric Center, Katholieke Universiteit Leuven, Kortenberg, Belgium.
    Wampers, M.
    University Psychiatric Center, Katholieke Universiteit Leuven, Kortenberg, Belgium; Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium.
    Hranov, L.
    University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry sveti Naum, Sofia, Bulgaria.
    Hristova, T.
    University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry sveti Naum, Sofia, Bulgaria.
    Aptalidis, D.
    University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry sveti Naum, Sofia, Bulgaria.
    Milev, R.
    Department of Psychiatry, Queens University, Providence Care Hospital, Kingston, ON, Canada.
    Iftene, F.
    Department of Psychiatry, Queens University, Providence Care Hospital, Kingston, ON, Canada.
    Spaniel, F.
    National Institute of Mental Health, Klecany, Czech Republic.
    Knytl, P.
    National Institute of Mental Health, Klecany, Czech Republic.
    Furstova, P.
    National Institute of Mental Health, Klecany, Czech Republic.
    From, T.
    Department of Psychiatry, University of Turku, Turku, Finland.
    Karlsson, H.
    Department of Psychiatry, University of Turku, Turku, Finland.
    Walta, M.
    Department of Psychiatry, University of Turku, Turku, Finland.
    Salokangas, R.K.R.
    Department of Psychiatry, University of Turku, Turku, Finland.
    Azorin, J.-M.
    Department of Psychiatry, Sainte Marguerite University Hospital, Marseille, France; Timone Institute of Neuroscience, Marseille, France.
    Bouniard, J.
    Department of Psychiatry, Sainte Marguerite University Hospital, Marseille, France; Timone Institute of Neuroscience, Marseille, France.
    Montant, J.
    Department of Psychiatry, Sainte Marguerite University Hospital, Marseille, France; Timone Institute of Neuroscience, Marseille, France.
    Juckel, G.
    Department of Psychiatry, Ruhr University Bochum, Bochum, Germany.
    Haussleiter, I.S.
    Department of Psychiatry, Ruhr University Bochum, Bochum, Germany.
    Douzenis, A.
    2nd Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece.
    Michopoulos, I.
    2nd Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece.
    Ferentinos, P.
    2nd Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece.
    Smyrnis, N.
    Department of Psychiatry, National and Kapodistrian University of Athens School of Medicine, Eginition Hospital, Athens, Greece.
    Mantonakis, L.
    Department of Psychiatry, National and Kapodistrian University of Athens School of Medicine, Eginition Hospital, Athens, Greece.
    Nemes, Z.
    Nyír Gyula Hospital, Budapest, Hungary.
    Gonda, X.
    Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
    Vajda, D.
    Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
    Juhasz, A.
    Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
    Shrivastava, A.
    Western University, London, ON, Canada.
    Waddington, J.
    Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland.
    Pompili, M.
    Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, SantAndrea Hospital, Sapienza University of Rome, Rome, Italy.
    Comparelli, A.
    Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, SantAndrea Hospital, Sapienza University of Rome, Rome, Italy.
    Corigliano, V.
    Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, SantAndrea Hospital, Sapienza University of Rome, Rome, Italy.
    Rancans, E.
    Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia.
    Navickas, A.
    Department of Clinic of Psychiatric, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Department of Psychosocial Rehabilitation, Vilnius Mental Health Center, Vilnius, Lithuania; Department for Psychosis Treatment, Vilnius Mental Health Center, Vilnius, Lithuania.
    Hilbig, J.
    Department of Clinic of Psychiatric, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Department of Psychosocial Rehabilitation, Vilnius Mental Health Center, Vilnius, Lithuania; Department for Psychosis Treatment, Vilnius Mental Health Center, Vilnius, Lithuania.
    Bukelskis, L.
    Department of Clinic of Psychiatric, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Department of Psychosocial Rehabilitation, Vilnius Mental Health Center, Vilnius, Lithuania; Department for Psychosis Treatment, Vilnius Mental Health Center, Vilnius, Lithuania.
    Stevovic, L.I.
    Clinical Department of Psychiatry, Clinical Centre of Montenegro, Podgorica, Montenegro; Department of Psychiatry, School of Medicine, University of Montenegro, Podgorica, Montenegro; Clinical Department of Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro.
    Vodopic, S.
    Clinical Department of Psychiatry, Clinical Centre of Montenegro, Podgorica, Montenegro; Department of Psychiatry, School of Medicine, University of Montenegro, Podgorica, Montenegro; Clinical Department of Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro.
    Esan, O.
    Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
    Oladele, O.
    Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
    Osunbote, C.
    Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
    Rybakowski, J.K.
    Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.
    Wojciak, P.
    Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.
    Domowicz, K.
    Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.
    Figueira, M.L.
    Department of Psychiatry and Mental Health, Santa Maria University Hospital, Lisbon, Portugal.
    Linhares, L.
    Department of Psychiatry and Mental Health, Santa Maria University Hospital, Lisbon, Portugal.
    Crawford, J.
    Department of Psychiatry and Mental Health, Santa Maria University Hospital, Lisbon, Portugal.
    Panfil, A.-L.
    University of Medicine and Pharmacy of Târgu Mures, Târgu Mures, Romania.
    Smirnova, D.
    Department of Psychiatry, Samara Psychiatric Hospital, Inpatient Unit, Samara State Medical University, Samara, Russian Federation.
    Izmailova, O.
    Department of Psychiatry, Samara Psychiatric Hospital, Inpatient Unit, Samara State Medical University, Samara, Russian Federation.
    Lecic-Tosevski, D.
    Institute of Mental Health, Belgrade, Serbia; Serbian Academy of Sciences and Arts, Belgrade, Serbia.
    Temmingh, H.
    Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
    Howells, F.
    Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
    Bobes, J.
    Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.
    Garcia-Portilla, M.P.
    Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.
    Garciá-Alvarez, L.
    Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.
    Erzin, G.
    Psychiatry Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
    Karada, H.
    Psychiatry Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
    De, Sousa A.
    Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India.
    Bendre, A.
    Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India.
    Hoschl, C.
    National Institute of Mental Health, Klecany, Czech Republic.
    Bredicean, C.
    University of Medicine, Pharmacy of Timisoara, Timisoara, Romania.
    Papava, I.
    University of Medicine, Pharmacy of Timisoara, Timisoara, Romania.
    Vukovic, O.
    Institute of Mental Health, School of Medicine, University of Belgrade, Belgrade, Serbia.
    Pejuskovic, B.
    Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
    Russell, V.
    Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
    Athanasiadis, L.
    1st Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
    Konsta, A.
    1st Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
    Stein, D.
    Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
    Berk, M.
    IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia; Orygen, National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, Parkville, VIC, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia.
    Dean, O.
    IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia; Orygen, National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, Parkville, VIC, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia.
    Tandon, R.
    Department of Psychiatry, University of Florida, Gainesville, FL, United States.
    Kasper, S.
    Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
    De, Hert M.
    University Psychiatric Center, Katholieke Universiteit Leuven, Kortenberg, Belgium; Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium; Antwerp Health Law and Ethics Chair, AHLEC University, Antwerpen, Belgium.
    Modeling psychological function in patients with schizophrenia with the PANSS: An international multi-center study2021In: CNS Spectrums, ISSN 1092-8529, E-ISSN 2165-6509, Vol. 26, no 3, p. 290-298Article in journal (Refereed)
    Abstract [en]

    Background.

    The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model.

    Methods.

    Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed.

    Results.

    The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage.

    Conclusions.

    The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct “cores” of schizophrenia, the “Positive” and the “Negative,” while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.

  • 46.
    Fountoulakis, Konstantinos N.
    et al.
    Aristotle Univ Thessaloniki, Greece.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Karolinska Huddinge Univ Hosp, Sweden.
    Theofilidis, Antonis T.
    Aristotle Univ Thessaloniki, Greece.
    Wiklund, Tobias
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Karolinska Huddinge Univ Hosp, Sweden.
    Atmatzidis, Xenofon
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Huddinge Univ Hosp, Sweden.
    Nimatoudis, Ioannis
    Aristotle Univ Thessaloniki, Greece.
    Thys, Erik
    Katholieke Univ Leuven, Belgium.
    Wampers, Martien
    Katholieke Univ Leuven, Belgium; Katholieke Univ Leuven, Belgium.
    Hranov, Luchezar
    Univ Multiprofile Hosp, Bulgaria.
    Hristova, Trayana
    Univ Multiprofile Hosp, Bulgaria.
    Aptalidis, Daniil
    Univ Multiprofile Hosp, Bulgaria.
    Milev, Roumen
    Queens Univ, Canada.
    Iftene, Felicia
    Queens Univ, Canada.
    Spaniel, Filip
    Natl Inst Mental Hlth, Czech Republic.
    Knytl, Pavel
    Natl Inst Mental Hlth, Czech Republic.
    Furstova, Petra
    Natl Inst Mental Hlth, Czech Republic.
    From, Tiina
    Univ Turku, Finland.
    Karlsson, Henry
    Univ Turku, Finland.
    Walta, Maija
    Univ Turku, Finland.
    Salokangas, Raimo K. R.
    Univ Turku, Finland.
    Azorin, Jean-Michel
    Sainte Marguerite Univ Hosp, France; Timone Inst Neurosci, France.
    Bouniard, Justine
    Sainte Marguerite Univ Hosp, France; Timone Inst Neurosci, France.
    Montant, Julie
    Sainte Marguerite Univ Hosp, France; Timone Inst Neurosci, France.
    Juckel, Georg
    Ruhr Univ Bochum, Germany.
    Haussleiter, Ida S.
    Ruhr Univ Bochum, Germany.
    Douzenis, Athanasios
    Natl & Kapodistrian Univ Athens, Greece.
    Michopoulos, Ioannis
    Natl & Kapodistrian Univ Athens, Greece.
    Ferentinos, Panagiotis
    Natl & Kapodistrian Univ Athens, Greece.
    Smyrnis, Nikolaos
    Natl & Kapodistrian Univ Athens, Greece.
    Mantonakis, Leonidas
    Natl & Kapodistrian Univ Athens, Greece.
    Nemes, Zsofia
    Nyiro Gyula Hosp, Hungary.
    Gonda, Xenia
    Semmelweis Univ, Hungary.
    Vajda, Dora
    Semmelweis Univ, Hungary.
    Juhasz, Anita
    Semmelweis Univ, Hungary.
    Shrivastava, Amresh
    Western Univ, Canada.
    Waddington, John
    Royal Coll Surgeons Ireland, Ireland.
    Pompili, Maurizio
    Sapienza Univ Rome, Italy.
    Comparelli, Anna
    Sapienza Univ Rome, Italy.
    Corigliano, Valentina
    Sapienza Univ Rome, Italy.
    Rancans, Elmars
    Riga Stradins Univ, Latvia.
    Navickas, Alvydas
    Vilnius Univ, Lithuania; Vilnius Mental Hlth Ctr, Lithuania; Vilnius Mental Hlth Ctr, Lithuania.
    Hilbig, Jan
    Vilnius Univ, Lithuania; Vilnius Mental Hlth Ctr, Lithuania; Vilnius Mental Hlth Ctr, Lithuania.
    Bukelskis, Laurynas
    Vilnius Univ, Lithuania; Vilnius Mental Hlth Ctr, Lithuania; Vilnius Mental Hlth Ctr, Lithuania.
    Stevovic, Lidija I.
    Clin Ctr Montenegro, Montenegro; Univ Montenegro, Montenegro; Clin Ctr Montenegro, Montenegro.
    Vodopic, Sanja
    Clin Ctr Montenegro, Montenegro; Univ Montenegro, Montenegro; Clin Ctr Montenegro, Montenegro.
    Esan, Oluyomi
    Univ Ibadan, Nigeria.
    Oladele, Oluremi
    Univ Ibadan, Nigeria.
    Osunbote, Christopher
    Univ Ibadan, Nigeria.
    Rybakowski, Janusz K.
    Poznan Univ Med Sci, Poland.
    Wojciak, Pawel
    Poznan Univ Med Sci, Poland.
    Domowicz, Klaudia
    Poznan Univ Med Sci, Poland.
    Figueira, Maria L.
    Santa Maria Univ Hosp, Portugal.
    Linhares, Ludgero
    Santa Maria Univ Hosp, Portugal.
    Crawford, Joana
    Santa Maria Univ Hosp, Portugal.
    Panfil, Anca-Livia
    Univ Med & Pharm Targu Mures, Romania.
    Smirnova, Daria
    Samara State Med Univ, Russia.
    Izmailova, Olga
    Samara State Med Univ, Russia.
    Lecic-Tosevski, Dusica
    Inst Mental Hlth, Serbia; Serbian Acad Arts & Sci, Serbia.
    Temmingh, Henk
    Univ Cape Town, South Africa.
    Howells, Fleur
    Univ Cape Town, South Africa.
    Bobes, Julio
    Univ Oviedo, Spain; Univ Oviedo, Spain.
    Garcia-Portilla, Maria P.
    Univ Oviedo, Spain; Univ Oviedo, Spain.
    Garcia-Alvarez, Leticia
    Univ Oviedo, Spain; Univ Oviedo, Spain.
    Erzin, Gamze
    Diskapi Yildirim Beyazit Training & Res Hosp, Turkey.
    Karadag, Hasan
    Diskapi Yildirim Beyazit Training & Res Hosp, Turkey.
    De Sousa, Avinash
    Lokmanya Tilak Municipal Gen Hosp & Med Coll, India.
    Bendre, Anuja
    Lokmanya Tilak Municipal Gen Hosp & Med Coll, India.
    Hoschl, Cyril
    Natl Inst Mental Hlth, Czech Republic.
    Bredicean, Cristina
    Univ Med & Farm Timisoara, Romania.
    Papava, Ion
    Univ Med & Farm Timisoara, Romania.
    Vukovic, Olivera
    Univ Belgrade, Serbia.
    Pejuskovic, Bojana
    Beaumont Hosp, Ireland.
    Russell, Vincent
    Beaumont Hosp, Ireland.
    Athanasiadis, Loukas
    Aristotle Univ Thessaloniki, Greece.
    Konsta, Anastasia
    Aristotle Univ Thessaloniki, Greece.
    Fountoulakis, Nikolaos K.
    Med Univ, Bulgaria.
    Stein, Dan
    Univ Cape Town, South Africa.
    Berk, Michael
    Deakin Univ, Australia; Natl Ctr Excellence Youth Mental Hlth, Australia; Florey Inst Neurosci & Mental Hlth, Australia; Univ Melbourne, Australia.
    Dean, Olivia
    Deakin Univ, Australia; Natl Ctr Excellence Youth Mental Hlth, Australia; Florey Inst Neurosci & Mental Hlth, Australia; Univ Melbourne, Australia.
    Tandon, Rajiv
    Univ Florida, FL USA.
    Kasper, Siegfried
    Med Univ Vienna, Austria.
    De Hert, Marc
    Katholieke Univ Leuven, Belgium; Katholieke Univ Leuven, Belgium; AHLEC Univ, Belgium.
    Gender, age at onset, and duration of being ill as predictors for the long-term course and outcome of schizophrenia: an international multicenter study2022In: CNS Spectrums, ISSN 1092-8529, E-ISSN 2165-6509, Vol. 27, no 6, p. 716-723Article in journal (Refereed)
    Abstract [en]

    Background The aim of the current study was to explore the effect of gender, age at onset, and duration on the long-term course of schizophrenia. Methods Twenty-nine centers from 25 countries representing all continents participated in the study that included 2358 patients aged 37.21 +/- 11.87 years with a DSM-IV or DSM-5 diagnosis of schizophrenia; the Positive and Negative Syndrome Scale as well as relevant clinicodemographic data were gathered. Analysis of variance and analysis of covariance were used, and the methodology corrected for the presence of potentially confounding effects. Results There was a 3-year later age at onset for females (P &lt; .001) and lower rates of negative symptoms (P &lt; .01) and higher depression/anxiety measures (P &lt; .05) at some stages. The age at onset manifested a distribution with a single peak for both genders with a tendency of patients with younger onset having slower advancement through illness stages (P = .001). No significant effects were found concerning duration of illness. Discussion Our results confirmed a later onset and a possibly more benign course and outcome in females. Age at onset manifested a single peak in both genders, and surprisingly, earlier onset was related to a slower progression of the illness. No effect of duration has been detected. These results are partially in accord with the literature, but they also differ as a consequence of the different starting point of our methodology (a novel staging model), which in our opinion precluded the impact of confounding effects. Future research should focus on the therapeutic policy and implications of these results in more representative samples.

  • 47.
    Fountoulakis, Konstantinos N.
    et al.
    Aristotle Univ Thessaloniki, Greece.
    Dragioti, Elena
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Karolinska Huddinge Univ Hosp, Sweden.
    Theofilidis, Antonis T.
    Aristotle Univ Thessaloniki, Greece.
    Wiklund, Tobias
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Karolinska Huddinge Univ Hosp, Sweden.
    Atmatzidis, Xenofon
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Huddinge Univ Hosp, Sweden.
    Nimatoudis, Ioannis
    Aristotle Univ Thessaloniki, Greece.
    Thys, Erik
    Katholieke Univ Leuven, Belgium; KU, Belgium.
    Wampers, Martien
    Katholieke Univ Leuven, Belgium; KU, Belgium.
    Hranov, Luchezar
    Univ Multiprofile Hosp Act Treatment Neurol and Psy, Bulgaria.
    Hristova, Trayana
    Univ Multiprofile Hosp Act Treatment Neurol and Psy, Bulgaria.
    Aptalidis, Daniil
    Univ Multiprofile Hosp Act Treatment Neurol and Psy, Bulgaria.
    Milev, Roumen
    Queens Univ, Canada.
    Iftene, Felicia
    Queens Univ, Canada.
    Spaniel, Filip
    Natl Inst Mental Hlth, Czech Republic.
    Knytl, Pavel
    Natl Inst Mental Hlth, Czech Republic.
    Furstova, Petra
    Natl Inst Mental Hlth, Czech Republic.
    From, Tiina
    Univ Turku, Finland.
    Karlsson, Henry
    Univ Turku, Finland.
    Walta, Maija
    Univ Turku, Finland.
    Salokangas, Raimo K. R.
    Univ Turku, Finland.
    Azorin, Jean-Michel
    St Marguerite Univ Hosp, France; CNRS, France; Aix Marseille Univ, France.
    Bouniard, Justine
    St Marguerite Univ Hosp, France; CNRS, France; Aix Marseille Univ, France.
    Montant, Julie
    St Marguerite Univ Hosp, France; CNRS, France; Aix Marseille Univ, France.
    Juckel, Georg
    Ruhr Univ Bochum, Germany.
    Haussleiter, Ida S.
    Ruhr Univ Bochum, Germany.
    Douzenis, Athanasios
    Univ Athens, Greece.
    Michopoulos, Ioannis
    Univ Athens, Greece.
    Ferentinos, Panagiotis
    Univ Athens, Greece.
    Smyrnis, Nikolaos
    Univ Athens, Greece.
    Mantonakis, Leonidas
    Univ Athens, Greece.
    Nemes, Zsofia
    Nyiro Gyula Hosp, Hungary.
    Gonda, Xenia
    Semmelweis Univ, Hungary.
    Vajda, Dora
    Semmelweis Univ, Hungary.
    Juhasz, Anita
    Semmelweis Univ, Hungary.
    Shrivastava, Amresh
    Western Univ, Canada.
    Waddington, John
    Royal Coll Surgeons Ireland, Ireland.
    Pompili, Maurizio
    Sapienza Univ Rome, Italy.
    Comparelli, Anna
    Sapienza Univ Rome, Italy.
    Corigliano, Valentina
    Sapienza Univ Rome, Italy.
    Rancans, Elmars
    Riga Stradins Univ, Latvia.
    Navickas, Alvydas
    Vilnius Univ, Lithuania; Vilnius Mental Hlth Ctr, Lithuania.
    Hilbig, Jan
    Vilnius Univ, Lithuania; Vilnius Mental Hlth Ctr, Lithuania.
    Bukelskis, Laurynas
    Vilnius Univ, Lithuania; Vilnius Mental Hlth Ctr, Lithuania.
    Stevovic, Lidija Injac
    Clin Ctr Montenegro, Montenegro; Univ Montenegro, Montenegro; Clin Ctr Montenegro, Montenegro.
    Vodopic, Sanja
    Clin Ctr Montenegro, Montenegro; Univ Montenegro, Montenegro; Clin Ctr Montenegro, Montenegro.
    Esan, Oluyomi
    Univ Ibadan, Nigeria.
    Oladele, Oluremi
    Univ Ibadan, Nigeria.
    Osunbote, Christopher
    Univ Ibadan, Nigeria.
    Rybakowski, Janusz K.
    Poznan Univ Med Sci, Poland.
    Wojciak, Pawel
    Poznan Univ Med Sci, Poland.
    Domowicz, Klaudia
    Poznan Univ Med Sci, Poland.
    Figueira, Maria Luisa
    Santa Maria Univ Hosp, Portugal.
    Linhares, Ludgero
    Santa Maria Univ Hosp, Portugal.
    Crawford, Joana
    Santa Maria Univ Hosp, Portugal.
    Panfil, Anca-Livia
    Univ Med and Pharm Targu Mures, Romania.
    Smirnova, Daria
    Samara State Med Univ, Russia.
    Izmailova, Olga
    Samara State Med Univ, Russia.
    Lecic-Tosevski, Dusica
    Inst Mental Hlth, Serbia; Serbian Acad Arts and Sci, Serbia.
    Temmingh, Henk
    Univ Cape Town, South Africa.
    Howells, Fleur
    Univ Cape Town, South Africa.
    Bobes, Julio
    Univ Oviedo, Spain; Ctr Invest Biomed Red Salud Mental CIBERSAM, Spain.
    Garcia-Portilla, Maria Paz
    Univ Oviedo, Spain; Ctr Invest Biomed Red Salud Mental CIBERSAM, Spain.
    Garcia-Alvarez, Leticia
    Univ Oviedo, Spain; Ctr Invest Biomed Red Salud Mental CIBERSAM, Spain.
    Erzin, Gamze
    Diskapi Yildirim Beyazit Training and Res Hosp, Turkey.
    Karadag, Hasan
    Diskapi Yildirim Beyazit Training and Res Hosp, Turkey.
    De Sousa, Avinash
    Lokmanya Tilak Municipal Gen Hosp and Med Coll, India.
    Bendre, Anuja
    Lokmanya Tilak Municipal Gen Hosp and Med Coll, India.
    Hoschl, Cyril
    Natl Inst Mental Hlth, Czech Republic.
    Bredicean, Cristina
    Univ Med and Farm Timisoara, Romania.
    Papava, Ion
    Univ Med and Farm Timisoara, Romania.
    Vukovic, Olivera
    Univ Belgrade, Serbia.
    Pejuskovic, Bojana
    Royal Coll Surgeons Ireland, Ireland.
    Russell, Vincent
    Royal Coll Surgeons Ireland, Ireland.
    Athanasiadis, Loukas
    Aristotle Univ Thessaloniki, Greece.
    Konsta, Anastasia
    Aristotle Univ Thessaloniki, Greece.
    Stein, Dan
    Univ Cape Town, South Africa.
    Berk, Michael
    Deakin Univ, Australia; Orygen, Australia; Univ Melbourne, Australia; Univ Melbourne, Australia; Univ Melbourne, Australia.
    Dean, Olivia
    Deakin Univ, Australia.
    Tandon, Rajiv
    Univ Florida, FL 32611 USA.
    Kasper, Siegfried
    Med Univ Vienna, Austria.
    De Hert, Marc
    Katholieke Univ Leuven, Belgium; KU, Belgium.
    Staging of Schizophrenia With the Use of PANSS: An International Multi-Center Study2019In: International Journal of Neuropsychopharmacology, ISSN 1461-1457, E-ISSN 1469-5111, Vol. 22, no 11, p. 681-697Article in journal (Refereed)
    Abstract [en]

    Introduction

    A specific clinically relevant staging model for schizophrenia has not yet been developed. The aim of the current study was to evaluate the factor structure of the PANSS and develop such a staging method.

    Methods

    Twenty-nine centers from 25 countries contributed 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Analysis of covariance, Exploratory Factor Analysis, Discriminant Function Analysis, and inspection of resultant plots were performed.

    Results

    Exploratory Factor Analysis returned 5 factors explaining 59% of the variance (positive, negative, excitement/hostility, depression/anxiety, and neurocognition). The staging model included 4 main stages with substages that were predominantly characterized by a single domain of symptoms (stage 1: positive; stages 2a and 2b: excitement/hostility; stage 3a and 3b: depression/anxiety; stage 4a and 4b: neurocognition). There were no differences between sexes. The Discriminant Function Analysis developed an algorithm that correctly classified >85% of patients.

    Discussion

    This study elaborates a 5-factor solution and a clinical staging method for patients with schizophrenia. It is the largest study to address these issues among patients who are more likely to remain affiliated with mental health services for prolonged periods of time.

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  • 48.
    Gerdle, Björn
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Fischer, Marcelo Rivano
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Ringqvist, Asa
    Skane Univ Hosp, Sweden.
    Acceptance and Fear-Avoidance Mediate Outcomes of Interdisciplinary Pain Rehabilitation Programs at 12-Month Follow-Up: A Clinical Registry-Based Longitudinal Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)2024In: Journal of Pain Research, E-ISSN 1178-7090, Vol. 17, p. 83-105Article in journal (Refereed)
    Abstract [en]

    Background: Factors that influence outcomes of interdisciplinary pain rehabilitation programs (IPRP) are poorly known. It is unclear how outcomes are influenced by pain intensity, psychological distress, and coping strategies.Aim: This clinical registry-based longitudinal cohort study has three aims: 1) to determine the relative importance of pain intensity, psychological distress, acceptance, and fear-avoidance for changes in three outcomes of IPRP at 12-month follow-up; 2) to investigate whether the effects of pain intensity and psychological distress on the three outcomes are mediated via acceptance and fear-avoidance; and 3) to determine whether sex is a moderator.Methods: This study uses Patient-Reported Outcome Measures (PROMs) from specialist units reporting data (2008-2016) to the Swedish Quality Registry for Pain Rehabilitation (SQRP). Adult chronic pain patients (N = 1991) answered the PROMs (background, pain, psychological distress, coping, participation, and health-related quality of life (HRQoL)). Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to explore the aims.Results: Changes in acceptance (13:0.424-0.553; all P&lt;0.001) were the strongest predictor of the three outcomes (changes in life control, interference, and HRQoL) at 12-month follow-up. The next strongest predictor was baseline acceptance (13: 0.177-0.233; all P&lt;0.001) and changes in fear-avoidance (13: -0.152- -0.186; all P&lt;0.001). Baseline pain intensity and psychological distress showed weak positive associations. Their effects on the three outcomes were mediated via acceptance aspects. Sex was not a moderator.Discussion and Conclusion: Acceptance aspects (baseline and changes) were important predictors of IPRP outcomes. Changes in fear-avoidance were also important although to a lesser degree. Some of the effects of pain intensity and psychological distress on outcomes were mediated via acceptance at baseline. Future PLS-SEM analysis of real-world IPRP should include more potential mediators (eg, catastrophizing and more facets of psychological flexibility and fear-avoidance) and the components of IPRP.

  • 49.
    Gerdle, Björn
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Fischer, Marcelo Rivano
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Ringqvist, Asa
    Skane Univ Hosp, Sweden.
    Pain intensity and psychological distress show different associations with interference and lack of life control: A clinical registry-based cohort study of >40,000 chronic pain patients from SQRP2023In: FRONTIERS IN PAIN RESEARCH, ISSN 2673-561X, Vol. 4, article id 1093002Article in journal (Refereed)
    Abstract [en]

    BackgroundBoth chronic pain and depressive and/or anxiety symptoms are associated with negative impacts on daily living, including interference and lack of life control. However, little is known about how pain and psychological distress affect these impacts.AimThe first aim was to assess how pain intensity, psychological distress, and social support interact with interference and lack of life control. A second aim was to investigate whether the strength of these relationships is moderated by the presence or absence of depression and/or anxiety.Subjects and methodsPatient-Reported Outcome Measures (PROMs), which are available in the Swedish Quality Registry for Pain Rehabilitation (SQRP), were retrieved for patients with chronic pain (N = 40,184). A theoretical model with the constructs/latent variables pain intensity, psychological distress, interference, lack of life control, and social support was proposed and analyzed using Partial Least Squares Structural Equation Modelling (PLS-SEM). Indicators for these constructs were identified from the PROMs of the SQRP. Two models of the total cohort, which differed with respect to the causal relationship between pain intensity and psychological distress, were investigated. The moderating effects of anxiety and/or depression were also analyzed.ResultsRelatively low correlation and explanatory power (R-2 = 0.16) were found for the pain intensity-psychological distress relationship. Pain intensity had a stronger effect on interference than on lack of life control. The reverse was found for psychological distress - i.e., psychological distress seemed to have a higher negative influence on function than on interference. The underlying assumption of the causal relationship between pain intensity and psychological distress determined how strong pain intensity and psychological distress influenced interference and lack of life control. Social support showed very similar absolute significant correlations with interference and lack of life control. Interference and lack of life control showed relatively weak associations. The psychological distress level was a moderating factor for several of the paths investigated.Discussion and conclusionA clinical treatment consequence of the low correlation between pain intensity and psychological distress may be that clinically treating one may not reduce the effect of the other. The relative importance of pain intensity and psychological distress on interference and lack of life control depends on the underlying assumption concerning the pain intensity-psychological distress relationship. Interference and lack of life control showed relatively weak associations, underscoring the need to clinically assess them separately. Social support influenced both impact constructs investigated. The cohort display heterogeneity and thus presence of definite signs of anxiety and/or depression or not was a moderating factor for several of the associations (paths) investigated. The results are important both for the assessments and the design of treatments for patients with chronic pain.

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  • 50.
    Gerdle, Björn
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Rivano Fischer, Marcelo
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Dong, Huan-Ji
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Ringqvist, Asa
    Skane Univ Hosp, Sweden.
    Catastrophizing and acceptance are mediators between insomnia and pain intensity-an SQRP study of more than 6,400 patients with non-malignant chronic pain conditions2023In: FRONTIERS IN PAIN RESEARCH, ISSN 2673-561X, Vol. 4, article id 1244606Article in journal (Refereed)
    Abstract [en]

    BackgroundSleep problems (insomnia) and chronic pain are associated. Chronic pain and insomnia/insufficient sleep quality share similar symptoms and features. Although they have a bidirectional relationship, more research is needed to understand how they interact via mediators and how moderators influence this relationship.AimsIn this large clinical registry-based cohort study (N = 6,497), we investigate important mediators between insomnia and pain intensity in a cross-sectional sample of chronic pain patients using advanced path analysis. In addition, we investigate whether some background variables were moderators of the identified important paths or not and the correlation patterns between insomnia and pain intensity in relation to the mediators.MethodsThis study includes a cohort of adult patients with chronic non-cancer pain from the Swedish Quality Registry for Pain Rehabilitation (SQRP) with data on patient-reported outcome measures (PROMs) (2008-2016). The PROMs cover the background, pain aspects, psychological distress, pain-related cognitions, activity/participation, and health-related quality of life variables of the patients. Partial least squares structural equation modeling was used to explore the direct and indirect (via mediators) relationships between insomnia and pain intensity at baseline.ResultsIn this cohort study, insomnia was prevalent at 62.3%, and both direct and indirect mediating paths were present for the insomnia-pain intensity relationship. All of the mediating effects combined were weaker than the direct effect between insomnia and pain intensity. The mediating effects via catastrophizing and acceptance showed the strongest and equal mediating paths, and mediating effects via fear avoidance were the second strongest. Insomnia showed stronger direct significant correlations with psychological distress, catastrophizing, and acceptance compared with those of pain intensity. Sex, age, education level, spatial extent of pain, or body mass index did not moderate the mediating paths.Discussion and conclusionThis study confirms the existence of significant direct and mediating paths between reported insomnia and pain intensity. Future studies should focus on illuminating how sleep interventions influence pain intensity and other important key factors that contribute to the distress of chronic pain patients.

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