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Physical activity and depression: a large cross-sectional, population-based study across 36 low- and middle-income countries

Stubbs B, Koyanagi A, Schuch FB, Firth J, Rosenbaum S, Veronese N, et al.

Acta Psychiatr Scand, 2016 12;134(6):546-556.
PMID: 27704532 DOI: 10.1111/acps.12654

OBJECTIVE: Physical activity (PA) is good for health, yet several small-scale studies have suggested that depression is associated with low PA. A paucity of nationally representative studies investigating this relationship exists, particularly in low- and middle-income countries (LMICs). This study explored the global association of PA with depression and its mediating factors.
METHOD: Participants from 36 LMICs from the World Health Survey were included. Multivariable logistic regression analyses were undertaken exploring the relationship between PA and depression.
RESULTS: Across 178 867 people (mean ± SD age = 36.2 ± 13.5 years; 49.9% male), the prevalence of depression and the prevalence of low PA were 6.6% and 16.8% respectively. The prevalence of low PA was significantly higher among those with depression vs. no depression (26.0% vs. 15.8%, P < 0.0001). In the adjusted model, depression was associated with higher odds for low PA (OR = 1.42; 95% CI = 1.24-1.63). Mediation analyses demonstrated that low PA among people with depression was explained by mobility limitations (40.3%), pain and discomfort (35.8%), disruptions in sleep and energy (25.2%), cognition (19.4%) and vision (10.9%).
CONCLUSION: Individuals with depression engage in lower levels of PA in LMICs. Future longitudinal research is warranted to better understand the relationships observed.
Study name: World Health Survey (Malaysia is a study site)
Depression and physical health multimorbidity: primary data and country-wide meta-analysis of population data from 190 593 people across 43 low- and middle-income countries

Stubbs B, Vancampfort D, Veronese N, Kahl KG, Mitchell AJ, Lin PY, et al.

Psychol Med, 2017 Sep;47(12):2107-2117.
PMID: 28374652 DOI: 10.1017/S0033291717000551

BACKGROUND: Despite the known heightened risk and burden of various somatic diseases in people with depression, very little is known about physical health multimorbidity (i.e. two or more physical health co-morbidities) in individuals with depression. This study explored physical health multimorbidity in people with clinical depression, subsyndromal depression and brief depressive episode across 43 low- and middle-income countries (LMICs).
METHOD: Cross-sectional, community-based data on 190 593 individuals from 43 LMICs recruited via the World Health Survey were analysed. Multivariable logistic regression analysis was done to assess the association between depression and physical multimorbidity.
RESULTS: Overall, two, three and four or more physical health conditions were present in 7.4, 2.4 and 0.9% of non-depressive individuals compared with 17.7, 9.1 and 4.9% among people with any depressive episode, respectively. Compared with those with no depression, subsyndromal depression, brief depressive episode and depressive episode were significantly associated with 2.62, 2.14 and 3.44 times higher odds for multimorbidity, respectively. A significant positive association between multimorbidity and any depression was observed across 42 of the 43 countries, with particularly high odds ratios (ORs) in China (OR 8.84), Laos (OR 5.08), Ethiopia (OR 4.99), the Philippines (OR 4.81) and Malaysia (OR 4.58). The pooled OR for multimorbidity and depression estimated by meta-analysis across 43 countries was 3.26 (95% confident interval 2.98-3.57).
CONCLUSIONS: Our large multinational study demonstrates that physical health multimorbidity is increased across the depression spectrum. Public health interventions are required to address this global health problem.
Study name: World Health Survey (Malaysia is a study site)
Fulltext 2019 revised algorithm for the management of knee osteoarthritis: the Southeast Asian viewpoint

Yeap SS, Tanavalee A, Perez EC, Tan MP, Reyes BHM, Lee JK, et al.

Aging Clin Exp Res, 2021 May;33(5):1149-1156.
PMID: 33774784 DOI: 10.1007/s40520-021-01834-x

BACKGROUND: Since 2014, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) algorithm for the management of knee osteoarthritis (OA) is available worldwide.
AIM: Based on this document, a Southeast Asia Working Group (SEAWG) wished to see how the new ESCEO algorithm developed in 2019 was perceived by Southeast Asian experts and how it was integrated into their clinical practice.
METHODS: A SEAWG was set up between members of the international ESCEO task force and a group of Southeast Asian experts.
RESULTS: Non-pharmacological management should always be combined with pharmacological management. In step 1, symptomatic slow-acting drugs for osteoarthritis are the main background therapy, for which high-quality evidence is available only for the formulations of patented crystalline glucosamine sulfate and chondroitin sulfate. In step 2, oral NSAIDs are a useful option, considering the cardiovascular/renal/gastrointestinal profiles of the individual patient. Intra-articular hyaluronic acid and corticosteroids are a possible alternative to oral NSAIDs, but limited evidence is available. If steps 1 and 2 do not give adequate relief of symptoms, tramadol can be used, but its safety is debated. In general, the indications of the ESCEO algorithm are important in Southeast Asian countries, but the reimbursement criteria of local health systems are an important aspect for adherence to the ESCEO algorithm.
CONCLUSION: This guidance provides evidence-based and easy-to-follow advice on how to establish a treatment algorithm in knee OA, for practical implementation in clinical practice in Southeast Asian countries.
Fulltext Correction to: Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures

Kanis JA, Harvey NC, McCloskey E, Bruyère O, Veronese N, Lorentzon M, et al.

Osteoporos Int, 2020 Apr;31(4):797-798.
PMID: 32065251 DOI: 10.1007/s00198-020-05297-0

The article 'Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures',written by J. A. Kanis, was originally published Online First without Open Access. After publication in volume [#], issue [#] and page [#-#], the author decided to opt for Open Choice and to make the article an Open Access publication.
Fulltext Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures

Kanis JA, Harvey NC, McCloskey E, Bruyère O, Veronese N, Lorentzon M, et al.

Osteoporos Int, 2020 Jan;31(1):1-12.
PMID: 31720707 DOI: 10.1007/s00198-019-05176-3

Guidance is provided in an international setting on the assessment and specific treatment of postmenopausal women at low, high and very high risk of fragility fractures.
INTRODUCTION: The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2019. This manuscript seeks to apply this in an international setting, taking additional account of further categorisation of increased risk of fracture, which may inform choice of therapeutic approach.
METHODS: Clinical perspective and updated literature search.
RESULTS: The following areas are reviewed: categorisation of fracture risk and general pharmacological management of osteoporosis.
CONCLUSIONS: A platform is provided on which specific guidelines can be developed for national use to characterise fracture risk and direct interventions.