Why Is There No Cure for Tinnitus?

Introduction Adolescence is a transformative phase of life, defined broadly as a period spanning from 10 to 19 or 21 years of age. This age group occupies a distinct biopsychosocial developmental stage, and living with chronic health conditions (CHCs) increases the burden of navigating both developmental and condition-related challenges. Globally, it is estimated that 15–20% of children and adolescents have CHCs that impact their lifelong experience. Previous research has highlighted concerns about whether adolescents have sufficient information about their prescribed medicines, which may impact their self-management. To date, no previous review has specifically focused on the medicine information needs of adolescents with CHCs. Aim This review aimed to synthesise the existing evidence on the medicine information needs of adolescents with CHCs and how these have been reported to impact their self-management. Methods The review was undertaken in accordance with the PRISMA 2020 guidelines, employing a comprehensive search strategy. Six electronic databases were searched (Medline, EMBASE, EMCare, CINAHL, PsycINFO, and Epistemonikos) from inception to October 2024. Studies were eligible for inclusion if they reported on the medicine information needs of adolescents aged 10–21 years with CHCs who were on regular medication. Qualitative, quantitative, and mixed-methods designs were included, with no restrictions on language. Exclusions were studies outside this age range, without CHCs or medicine, and non-empirical papers. Two independent reviewers conducted screening using the Rayyan web tool, followed by data extraction and quality assessment with the Mixed Methods Appraisal Tool.[1] Thematic synthesis was conducted using an inductive approach, then informed by a deductive approach using the Individual and Family Self-Management Theory framework.[2] Results Of 5000 records screened, fifteen studies were included (eleven quantitative, four qualitative). In total, 1339 adolescents with different types of CHCs were represented. The included studies were heterogeneous in design, setting, participants, and how results were reported. Themes identified included what information adolescents want, who they perceive needs information related to their medicines, and where they prefer to obtain this information. Across studies, adolescents living with CHCs expressed a need for information about their medicines. The most reported information needed was related to potential side effects, followed by treatment options, benefits, and the use and administration of medicines. Adolescents’ medicine information needs were also influenced by their developmental stage, sex/gender, the complexity of their chronic condition, and the period since diagnosis. However, no study to date has primarily focused on identifying the medicine information needs of adolescents with CHCs from their own perspectives. Conclusion This review synthesises existing evidence on adolescents’ medicine information needs, highlighting key concerns reported in the literature. The findings highlight the need for clinicians and healthcare systems to provide adolescents with information about medicines, particularly about potential side effects and treatment options. Strategies are needed to guide how medicine information is provided to adolescents with CHCs, taking into account their developmental stage and the nature of their condition. Strengths of this review included the comprehensive search strategy and adherence to PRISMA 2020; Heterogeneity across studies limits the comparability and synthesis of findings.

BackgroundChildren with chronic health conditions have better health-related outcomes when their care is managed in a personalised and coordinated way. However, increased demand on Australian ambulatory care hospital services has led to longer waitlist times to access specialists and appropriate intervention services; placing vulnerable children at increased risk of poorer short-term (e.g. social difficulties) and long-term (e.g. convictions) health and social outcomes. Traditional approaches to increasing frequency and service of delivery are expensive and can have minimal impact on caregiver burden. A community based service-integration approach, rather than self-directed care is proposed as increased service linkages are more likely to occur and improve the health outcomes of children with a chronic health condition.MethodsAn open, unblinded, multi-centre randomised controlled trial in two Australian public hospitals. 112 children (0–16 years) fulfilling the inclusion criteria will be randomised to one of two clinical pathways for management of their chronic health condition: (1) integrated children’s care clinic (ICCC) or (2) self-directed care pathway. All children and caregivers will be interviewed at 1 week, and 3, 6 and 12 month time intervals. Primary outcome measures include the Pediatric Quality of Life (PedQOL) questionnaire, Subjective Units of Distress Scale, Child Behaviour Checklist (CBCL) and Rotter’s Locus of Control Scale. Secondary outcome measures include the total number of medical appointments, school days missed and quantity of services accessed. Our main objectives are to determine if the ICCC results in better health and economics outcomes compared to the self-directed care pathway.DiscussionThe success of a health systems approach needs to be balanced against clinical, mortality and cost-effectiveness data for long-term sustainability within a publicly funded health system. A clinical pathway that is sustainable, cost-effective, provides efficient evidence-based care and improves the quality of life outcomes for children with chronic health conditions has the potential to reduce waitlist times, improve access to health services, increase consumer satisfaction; and prevent costs associated with poorly managed chronic health conditions into adulthood. This study will be the first to provide clinical and health economics data on an integrated care pathway for the management of chronic health conditions in children. On a broader scale, results from this study will help guide care coordination frameworks for children with chronic health conditions; particularly with the introduction and implementation of a National Disability Insurance Scheme (NDIS) across Australia.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR) ACTRN12617001188325. Registered: 14th August, 2017.

Tinnitus is the sensation of hearing a "ringing" or "buzzing" in the ears without any external stimuli. Possible causes of tinnitus include hyperactivity in central auditory nuclei, 1 tonotopic reorganization in the auditory cortex, 2 noise exposure, 3 underlying conditions, 4 and use of certain medications. 5 Between 5% and 30% of adults suffer from tinnitus, 6 with about 50% having idiopathic tinnitus. 7www.Shutterstock.com, virtual reality, artificial intelligence, tinnitus.Patients' emotional well-being is affected by tinnitus, 8 including increased anxiety levels. 9 The amygdala and other nonauditory structures in the brain may be involved in tinnitus maintenance by mediating the emotional response in tinnitus patients. 10,11 Novel techniques like the use of vagus nerve implants have been explored for tinnitus mitigation. 12 Although there is no cure for tinnitus yet, effective management techniques include relaxation/mindfulness training, 13 amplification, 14 and sound therapy for both hearing aid users 15 as well as cochlear implant recipients. 16 Sweetow and Sabes 17 evaluated the effects of combining amplification and sound therapy for tinnitus management. The sound therapy included white noise and fractal tones from Widex Zen Therapy. 18 Participants reported a significant reduction in tinnitus annoyance after listening to both sounds but reported feeling more relaxed when hearing the fractal tones. Stress reduction is a significant component in managing chronic health conditions. Distressed patients may turn to social media or mobile applications to explore solutions. 19–22 Techniques for reducing stress can decrease the impact of tinnitus. 23 A randomized controlled trial (RCT) discovered that 16 hours of therapy over two months led to significant reductions in tinnitus measures and reactions to tinnitus. 13 Therapy techniques using virtual reality (VR) have been shown to reduce anxiety in patients with chronic conditions. 24 VR uses specialized equipment that presents visual and auditory information to create specific simulated environments. The use of VR has proven to aid in acute pain management of patients receiving routine and invasive medical procedures. 25 VR also has proven to have significant effects on all affective domains mediated by the limbic system, 26 which is also involved in the perpetuation of tinnitus. 27 Therefore, VR therapy may lessen the engagement of the limbic system in tinnitus perception by delivering relaxation and sound therapy components. The aim of the present study 28 was to explore whether the use of VR combined with conventional sound therapy helped in mitigating tinnitus and reactions to tinnitus as compared to conventional sound therapy alone. STUDY PARTICIPANTS Adults with continuous, chronic, subjective tinnitus were sought as study participants. Adults with hearing aids were recruited if they did not have tinnitus management features programmed into their hearing aids. Twenty adults with both unilateral and bilateral tinnitus (11 males, nine females) between the ages of 18 and 76 years were enrolled in the study. PROCEDURES This study was an RCT with a crossover design. Each participant received two sessions, one week apart. The control intervention provided sound therapy alone, while the experimental intervention provided sound therapy with VR. The sound therapy component used the Zen Aqua program from Widex. The sounds were played for 15 minutes through a computer loudspeaker at a comfortable volume level. The experimental intervention included 15-minute viewings of natural scenes, including flowing streams, lakes, and gorges, presented via VR goggles, while listening to the Zen sounds. Ten participants received the control intervention followed by the experimental intervention and 10 received the experimental intervention followed by the control intervention. Participants' tinnitus loudness, tinnitus functional index (TFI), 29 and minimum masking level (MML) scores were recorded before and after each intervention. RESULTS A multilevel mixed-effects linear regression model accounting for confounding variables revealed that the mean tinnitus loudness and TFI scores reduced significantly (p=0.015 and p=0.043, respectively) after the experimental intervention compared to the control intervention. The MML differences were not statistically significant, but mean values were reduced after the experimental intervention than after the control intervention (p=0.090). DISCUSSION Tinnitus loudness, MMLs, and TFI scores have been used to portray the effectiveness of tinnitus management strategies. 30–32 In the present study, since tinnitus loudness levels and TFI scores improved significantly after receiving the experimental intervention, it can be concluded that these factors are positively affected by combining VR with sound therapy in a controlled setting. While there was no significant improvement in MMLs after the experimental intervention, this could be due to the study procedures causing participants' attention to be focused on their tinnitus. Many tinnitus therapy techniques recommend having an active lifestyle to redirect attention from tinnitus. 33 Previous research has demonstrated that sound therapy, especially fractal tones, can be used to induce relaxation and manage tinnitus. 34,35 In the Sweetow and Sabes study, 17 86% of participants reported feeling relaxed after listening to the wind-chime-like fractal tones. Simonetti et al. 36 discovered a significant reduction in tinnitus handicap inventory (THI) 37 scores after studying the effects of fractal tones on patients with chronic tinnitus. In the present study, participants listened to fractal tones either standalone or with a VR video. Following these interventions, reductions in tinnitus loudness, MMLs, and TFI were present. The emotional and auditory effects of sound therapy can partially explain this trend. For more than two decades, VR has been used to treat conditions such as phobias, 38 anxiety disorders, 24 eating disorders, 39 and intractable pain. 40 A systematic review of 20 studies found VR to be an effective treatment for decreasing acute pain. In 2010, a theoretical framework for the use of VR to manage chronic subjective tinnitus was proposed. 41 Malinvaud et al.42 applied this framework to assess the differences in tinnitus attributes between those receiving VR and those receiving cognitive behavioral therapy (CBT). Without significant differences found between interventions, both interventions showed improvement on THI scores, subjective tinnitus severity scale, and the hospital anxiety and depression scale. 43 The Malinvaud 44 study concluded that VR can be at least as effective as CBT when managing tinnitus. The present study showed significant reductions in tinnitus loudness and TFI for the experimental intervention as compared to the control intervention, supporting these results. LIMITATIONS AND FUTURE DIRECTIONS The present study was conducted in a laboratory setting. Future studies could explore the effects of VR on tinnitus in more natural settings, such as at home. Stimuli can also be presented for a longer duration with more sessions. A longitudinal study would be able to analyze the long-term effects of VR on tinnitus. Future studies could also use a larger participant group. Genetic risk modeling can be used to investigate the biological mechanisms underlying tinnitus. In the present study, participants benefitted from using VR combined with sound therapy for 15 minutes in a laboratory setting. After this intervention, tinnitus loudness levels, MMLs, and TFI scores were reduced when compared to receiving sound therapy alone. Therefore, VR combined with sound therapy is a promising potential technique for managing tinnitus. Future studies could alter the stimuli, mode of delivery, number of sessions, total therapy duration, and number of participants. More trials will be needed before confirming the use of VR and sound therapy to manage tinnitus in a clinical setting.

Each year approximately 20,000 children are admitted to PICUs across the United Kingdom. It is highlighted in several international studies that 40-70% of children admitted to PICUs have at least one chronic health condition that leads to increased length of stay and higher mortality rates. The prevalence of chronic health conditions in children admitted to U.K. PICUs is unknown. The purpose of this study was to use existing clinical data to explore the prevalence and impact of chronic health conditions on length of stay and mortality in a tertiary U.K. PICU. Single-centre retrospective observational cohort study. Single, tertiary referral PICU. One thousand one hundred ninety-seven children 0-18 years old admitted between March 1, 2009, and February 28, 2013. None. Data were derived from the unit's data submitted to the Paediatric Intensive Care Audit Network, the U.K. national PICU dataset. Data included demographics, diagnosis, Pediatric Index of Mortality-2 score, PICU interventions, PICU outcomes, chronic health condition etiologies, admission, and discharge dates and times. In total, 554 of 1,197 (46.3%) had at least one chronic health condition. Of 554, 371 patients (67.1%) presented with a single chronic health condition, 126 (22.6%) with two chronic health conditions, and 57 (10.3%) with at least three chronic health conditions to a maximum of four chronic health conditions. There was a statistically significant difference in length of stay in those with a chronic health condition compared with those without (medians, 4 vs 3 d [interquartile range, 1-7 d]; Mann-Whitney U test, p < 0.001). The length of stay also increased significantly according to the number of chronic health conditions (Kruskal-Wallis test, p < 0.001). Mortality was significantly different between those with and without chronic health conditions (8.8% vs 5.4%; chi-square test, p = 0.024). Having two or at least three chronic health conditions significantly increased mortality compared with no chronic health conditions (odds ratio, 2.3 [CI, 1.2-4.55]; p = 0.013 and 2.95 [CI, 1.28-6.8]; p = 0.011), respectively. The increasing number of chronic healthcare conditions is associated with length of stay and mortality.

It is very important to evaluate the loudness of tinnitus adequately for the appropriate treat ment.The loudness balance test and masking test are commonly used for the evaluation of tinnitus loudness. In this report, the subjective loudness level of tinnitus was compared with the loudness level of tinnitus measured by the above two tests and also with the pure tone threshold in 211 patients with tinnitus.The subjective loudness of tinnitus in these cases was classified into five degrees (very soft (0) to very loud(4)). Thus the subjective loudness level measured by these two tests was expressed by two levels which were the audiometer level and the sensation level.The following results were obtained:1) The tinnitus loudness expressed by the sensation level in these two tests is not useful when the tinnitus loudness is compared in the individual cases. Because the loudness of tinnitus is often estimated much smaller by the influence of recruitment and the technical error of these tests in the 5 dB step measurement method is large.2) The tinnitus loudness expressed by the audiometer level changed almost in parallel with the pure tone threshold. Therefore, it is speculated that the tinnitus loudness, expressed by the audiometer level can not be the true tinnitus loudness level.3) The subjective loudness of the tinnitus seems to be increased with the deterioration of the pure tone threshold.4) From these results, both the loudness balance and masking tests are thought to be unsuitable for evaluating the tinnitus loudness. A more appropriated method should be made to evaluate tinnitus loudess adequately.

BackgroundA chronic health condition (CHC) is a recognized risk factor for experiencing problems in sexual function (PSF). According to the International Classification of Diseases, 11th Revision (ICD-11), the development of severe symptoms of sexual distress is the defining criterion for clinically relevant sexual dysfunction. Data on the contribution of specific CHCs to clinically relevant sexual dysfunction symptoms and related health care needs are limited, hindering targeted interventions.ObjectiveThis study examines the prevalence of PSF, sexual dysfunction, and sexual distress; assesses associations with CHC status; evaluates sexual dysfunction diagnoses; and explores health care preferences.MethodsData collection in this cross-sectional population-based survey study was based on a questionnaire developed with patient and public involvement and administered by YouGov to a representative sample of adults in Germany. Analyses included 1970 women with and without CHCs and different CHC subgroups (mental health–related, gynecological, cardiovascular and metabolic, infectious and inflammatory, cancer, pain-related, and neurological). The outcomes measured were PSF, clinically relevant sexual dysfunction symptoms, sexual distress (Female Sexual Distress Scale-Desire/Arousal/Orgasm [FSDS-DAO]), and self-reported sexual dysfunction diagnoses. Multivariable regression and network analysis explored associations among CHC subgroups, PSF, sexual dysfunction, and FSDS-DAO scores.ResultsAmong 1970 cisgender women (mean age 49.6, SD 16.0 years), 1186 (60.2%) reported CHCs. The 6-month PSF prevalence was 75.2% (820/1090) in women with CHCs and 62.5% (399/638) in women without CHCs. Clinically relevant sexual dysfunction symptoms were less prevalent (CHC: 202/1046, 19.3% vs no CHC: 68/601, 11.3%). Multivariable regression models showed an association between sexual dysfunction and CHCs (odds ratio [OR] 2.56, 95% CI 1.90‐3.49), which was the strongest for women with mental health–related CHCs (OR 2.31, 95% CI 1.70‐3.13) and cancer CHCs (OR 2.00, 95% CI 1.45‐2.78). Being in a relationship was a protective factor for clinically relevant distress among women with CHCs. Network analysis showed positive associations of PSF with gynecological and mental health–related CHCs and of sexual dysfunction with mental health–related, gynecological, and cancer CHCs. Women with sexual dysfunction symptoms reported low rates of sexual dysfunction diagnosis (CHC: 39/200, 19.4% vs no CHC: 6/55, 10.7%) and treatment (CHC: 16/146, 11.0% vs no CHC: 3/40, 7.0%). Gynecologists were the preferred health care providers for sexual dysfunction. The most commonly reported unmet need was a lack of information. Digital solutions, such as apps and websites with exercises, were desired as health care innovations.ConclusionsThe burden of CHCs on women’s sexual health extends beyond functional sexual impairment, with high rates of clinically relevant sexual distress. Cancer and mental health conditions are the strongest predictors of sexual dysfunction. Despite the high prevalence of sexual dysfunction in women with CHCs, access to diagnosis and treatment is limited. Digital offerings could help address these unmet needs.

Health outcomes and costs for injured young people hospitalised with and without chronic health conditions

This study investigated the prevalence and odds of, as well as risk factors for, substance use among Canadian adolescents with chronic health conditions. Adolescents ages 12 to 16 years from the Ontario Child Health Study were analyzed. Prevalence rates of heavy alcohol use, regular smoking, and having tried illicit drugs were 8.0% (N = 55), 11.0% (N = 76), and 13.8% (N = 95), respectively. Odds of ever having tried alcohol were higher among adolescents with chronic health conditions (adjusted odds ratio [AOR] = 2.24 [1.18, 4.25]). No associations were found with other forms of substance use. Among adolescents with chronic health conditions, those who were older and exhibited symptoms of mental health problems were at increased odds of reporting lifetime heavy alcohol use. Coordinated prevention strategies within the primary health care and educational systems are needed.

Over 4 million children in the United States suffer from chronic health conditions, including cancer, sickle cell disease, and diabetes. Because of major advances in the early identification and treatment of these conditions, survival rates for these children continue to rise, and the majority now lives into adulthood. However, increases in survival have come with costs related to long-term effects of disease processes and treatments. Foremost among these consequences is impairment in brain development and neurocognitive function that may affect a substantial portion of children with chronic health conditions and follow many into adulthood. Impaired cognitive function may contribute to impairment in educational and occupational attainment, mental health, and quality of life for children with chronic conditions. Despite the significance and scope of this problem, advances in the identification and understanding of neurocognitive problems and the delivery of effective clinical care have been hindered in part because research has been "siloed"-conducted on each chronic condition in isolation. This review examines, for the first time, neurocognitive problems in a selected set of 6 chronic pediatric health conditions-leukemia, brain tumors, sickle cell disease, congenital heart disease, Type 1 diabetes, and traumatic brain injury-to define the magnitude of the problem and identify directions for future research and clinical care. Psychologists from many areas of specialization, including pediatric psychology, educational and school psychology, neuropsychology, behavioral medicine, and adult primary care, are uniquely positioned to contribute to every phase of this work, including research, identification, and intervention. (PsycINFO Database Record

Impact of COVID-19 on services for people with disabilities and chronic health conditions

Objectives: Acoustic stimulation or sound therapy is proposed as a main treatment option for chronic subjective tinnitus. To further probe the field of acoustic stimulations for tinnitus therapy, this exploratory study compared 10 Hz amplitude modulated (AM) sounds (two pure tones, noise, music, and frequency modulated (FM) sounds) and unmodulated sounds (pure tone, noise) regarding their temporary suppression of tinnitus loudness. First, it was hypothesized that modulated sounds elicit larger temporary loudness suppression (residual inhibition) than unmodulated sounds. Second, with manipulation of stimulus loudness and duration of the modulated sounds weaker or stronger effects of loudness suppression were expected, respectively.Methods: We recruited 29 participants with chronic tonal tinnitus from the multidisciplinary Tinnitus Clinic of the University of Regensburg. Participants underwent audiometric, psychometric and tinnitus pitch matching assessments followed by an acoustic stimulation experiment with a tinnitus loudness growth paradigm. In a first block participants were stimulated with all of the sounds for 3 min each and rated their subjective tinnitus loudness to the pre-stimulus loudness every 30 s after stimulus offset. The same procedure was deployed in the second block with the pure tone AM stimuli matched to the tinnitus frequency, manipulated in length (6 min), and loudness (reduced by 30 dB and linear fade out). Repeated measures mixed model analyses of variance (ANOVA) were calculated to assess differences in loudness growth between the stimuli for each block separately.Results: First, we found that all sounds elicit a short-term suppression of tinnitus loudness (seconds to minutes) with strongest suppression right after stimulus offset [F(6, 1331) = 3.74, p < 0.01]. Second, similar to previous findings we found that AM sounds near the tinnitus frequency produce significantly stronger tinnitus loudness suppression than noise [vs. Pink noise: t(27) = −4.22, p < 0.0001]. Finally, variants of the AM sound matched to the tinnitus frequency reduced in sound level resulted in less suppression while there was no significant difference observed for a longer stimulation duration. Moreover, feasibility of the overall procedure could be confirmed as scores of both tinnitus loudness and questionnaires were lower after the experiment [tinnitus loudness: t(27) = 2.77, p < 0.01; Tinnitus Questionnaire: t(27) = 2.06, p < 0.05; Tinnitus Handicap Inventory: t(27) = 1.92, p = 0.065].Conclusion: Taken together, these results imply that AM sounds, especially in or around the tinnitus frequency, may induce larger suppression than unmodulated sounds. Future studies should thus evaluate this approach in longitudinal studies and real life settings. Furthermore, the putative neural relation of these sound stimuli with a modulation rate in the EEG α band to the observed tinnitus suppression should be probed with respective neurophysiological methods.

ABSTRACTObjectivesThe goal of this cross‐sectional study was to characterize stress, injury, and chronic health conditions among agricultural producers in Illinois. The objectives were to: (1) describe the prevalence and nature of work‐related injuries; (2) describe chronic health conditions, stress, and symptoms of mental health conditions; and (3) explore relationships between work‐related injuries and stress, mental health, and health conditions.MethodsA cross‐sectional survey was conducted using a modified Dillman approach. Agricultural producers received mailed questionnaires assessing demographics, farm characteristics, chronic health conditions, stress (using the PSS questionnaire), anxiety (GAD‐7), depression (PHQ‐9), and work‐related injuries. Descriptive statistics describe the population, farm characteristics, injuries, symptoms of mental health, and chronic health conditions. Chi‐squared tests describe associations between variables.ResultsAgricultural injuries were reported by 8.01% of respondents, and were primarily minor or moderate. Nearly half (49.07%) reported moderate to high stress, and 10.83% had symptoms of moderate to severe anxiety. No significant associations were found between injury and stress, anxiety, or depression.ConclusionsThese findings highlight the complex interplay between health, stress, and safety in agricultural workers. Longitudinal and qualitative approaches are needed to better understand how stress and chronic conditions may relate to agricultural injuries.

Primary Subject area Mental Health Background Chronic childhood health conditions are known to have an impact on the well-being of family members. Parental caregivers face well-defined adverse health outcomes, though less is known about the health impacts on siblings. Objectives To assess clinical health outcomes in siblings of children with chronic health condition(s) compared to siblings of healthy children or normative data. Design/Methods We searched Ovid MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, PsycInfo, and CINAHL through June 4, 2020. We included English-language studies that: (1) reported clinically diagnosable mental or physical health outcomes of siblings of children (0-18 years old) diagnosed with any childhood chronic health condition; (2) included a comparison group; and (3) used an experimental or observational study design. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results We included 28 studies of the 9053 screened, comprising 10 cohort studies and 18 cross-sectional studies. Studies from 11 different countries reported most commonly on siblings of children with disabilities (12 studies), cancer (8 studies), or psychiatric disorders (4 studies). Siblings of children with chronic conditions had greater depression rating scale scores than their comparison groups (standardized mean difference 0.49; 95% CI 0.33-0.65; P &amp;lt; .001 [5 studies]) (Fig. 1), whereas anxiety scores did not differ significantly (standardized mean difference 0.24; 95% CI -0.03-0.52; P = .08 [6 studies]) (Fig. 2). Studies that reported on prevalence of psychiatric diagnoses, rather than rating scale scores, had mixed results, either indicating increased risk (3 studies) or no increased risk (4 studies) among exposed siblings. We did not meta-analyze effects for mortality (3 studies) or physical health outcomes (dental caries [1 study], traumatic brain injury [1 study], sexually transmitted infection [1 study], overweightness/obesity [1 study]) given the limited number of studies and between-study heterogeneity. Included studies were rated as high quality (12 studies) or of moderate quality (16 studies). Conclusion Siblings of children with chronic health conditions may be at an increased risk of depression. Our findings suggest the need for targeted interventions to support the psychological well-being of siblings of children with chronic health conditions.

Screening for Unhealthy Alcohol Use Among Patients With Multiple Chronic Conditions in Primary Care

The aim of this study was to determine the influence of work conditions, psychosocial factors and perceived health on the association between the presence of a chronic health condition and (single-item) work ability among workers aged 45years and older. In addition, we aimed to examine variables associated with work ability for workers with and without a chronic health condition separately. The data of this cross-sectional study were obtained from 5,247 workers aged 45years and older in five different work sectors. Work ability was assessed with the first item of the Work Ability Index. The presence of a chronic health condition was assessed by self-report. Independent variables in the multivariable linear regression analysis were work conditions, psychosocial factors and perceived health status. The presence of a chronic health condition was negatively associated with work ability (B=-0.848). The strength of this association slightly attenuated after subsequently adding individual characteristics (B=-0.824), work conditions (B=-0.805) and more so after adding psychosocial factors (B=-0.704) and especially perceived health variables (B=-0.049) to the model. Variables associated with work ability for workers with and without a chronic health condition were similar. Perceived health and psychosocial factors, rather than work conditions, explained the association between the presence of a chronic health condition and work ability. Substantial differences in variables associated with work ability for workers with and without a chronic health condition were not found. Based on the lower mean scores for workers with a chronic health condition and work ability as well for predictors, these workers might have the most benefit by a policy focussing on enhancing these associated variables.