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Alif SM, Benke GP, Kromhout H, Vermeulen R, Tran C, Ronaldson K, Walker-Bone K, Woods R, Beilin L, Tonkin A, Owen AJ, McNeil JJ. Long-term occupational exposures on disability-free survival and mortality in older adults. Occup Med (Lond) 2023; 73:492-499. [PMID: 37948123 PMCID: PMC10756660 DOI: 10.1093/occmed/kqad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The impact of long-term occupational exposures on health in older adults is increasingly relevant as populations age. To date, no studies have reported their impact on survival free of disability in older adults. AIMS We aimed to investigate the association between long-term occupational exposure and disability-free survival (DFS), all-cause mortality and cause-specific mortality in initially healthy older adults. METHODS We analysed data from 12 215 healthy participants in the ASPirin in Reducing Events in the Elderly (ASPREE) study whose mean age was 75 years. Their work history was collated with the 'ALOHA-plus JEM' (Job Exposure Matrix) to assign occupational exposures. The primary endpoint, DFS, was a composite measure of death, dementia or persistent physical disability. The secondary endpoint, mortality, was classified according to the underlying cause. Cox proportional hazard models were used to calculate hazard ratios and 95% confidence intervals, adjusted for confounders. RESULTS A total of 1835 individuals reached the DFS endpoint during the median 4.7 years follow-up period. Both ever-high and cumulative exposure to all dusts and all pesticides during a person's working years were associated with reduced DFS. Compared to no exposure, men with high exposure to dusts and pesticides had a reduced DFS. Neither of these exposures were significantly associated with all-cause mortality. Men with high occupational exposure to solvents and women exposed to dusts experienced higher all-cause and cancer-related mortality. CONCLUSIONS Long-term occupational exposure to all dusts and pesticides was associated with a reduced DFS and increased mortality in community-dwelling healthy older adults.
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Affiliation(s)
- S M Alif
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- School of Health Sciences, The University of Melbourne, Melbourne, Victoria 3000, Australia
- Institute of Health and Wellbeing, Federation University Australia, Berwick, Victoria 3806, Australia
| | - G P Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - H Kromhout
- Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - R Vermeulen
- Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - C Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - K Ronaldson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - K Walker-Bone
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - R Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - L Beilin
- School of Medicine, The University of Western Australia, Perth, Western Australia 6009, Australia
| | - A Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - A J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - J J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
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Walker-Bone K, Macfarlane GJ, Burton K, McConnachie AM, Zhang R, Jones GT. Advice to remain active with arm pain reduces disability. Occup Med (Lond) 2023; 73:268-274. [PMID: 37261458 PMCID: PMC10292681 DOI: 10.1093/occmed/kqad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Arm pain is common amongst working-aged adults and causes substantial work disability. The results of a population-based randomized controlled trial (the ARM trial) suggested that advice to remain active reduced disability after 6 months. AIMS To verify ARM trial results amongst people in paid employment. METHODS The ARM trial recruited adults with distal arm pain referred for physiotherapy and randomized equally to three groups: wait-listed for physiotherapy (advised to rest); wait-listed for physiotherapy (advised to remain active) or early physiotherapy. The primary outcome was absence of disability at 26 weeks. Secondary analyses were undertaken amongst participants in paid employment. RESULTS Amongst 538 trial participants, 347 (64%) were in paid employment, mean age 46.1 years and 47% in manual work. Employed participants were randomized equally to the three arms. Amongst the 271 (78% workers with 26-week data), 43% of those advised to remain active were free from disability, as compared with 37% of those advised to rest. Forty per cent of those who waited for physiotherapy were disability-free as compared with 35% of those treated rapidly. Advice to rest was associated with lower chances of recovery amongst workers who lift/carry weights and those who believed work had caused their symptoms (P = 0.023). CONCLUSIONS Although not powered as a trial for workers only, our findings suggest that advising activity was as beneficial for people currently in paid work and may be superior to advice to rest in reducing disability. Addressing harmful beliefs about causation of symptoms has the potential to reduce disability.
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Affiliation(s)
- K Walker-Bone
- Monash Centre for Occupational and Environmental Health, University of Monash, Melbourne, Victoria, Australia
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - G J Macfarlane
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - K Burton
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - A M McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - R Zhang
- Medical and Scientific Affairs, Astrazeneca UK Limited, 2 Pancras Square, 8th floor, London N1C 4AG, UK
| | - G T Jones
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Walker-Bone K, D’Angelo S, Linaker CH, Stevens MJ, Ntani G, Cooper C, Syddall HE. Morbidities among older workers and work exit: the HEAF cohort. Occup Med (Lond) 2022; 72:470-477. [PMID: 35904117 PMCID: PMC9578672 DOI: 10.1093/occmed/kqac068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Governments need people to work to older ages, but the prevalence of chronic disease and comorbidity increases with age and impacts work ability. AIMS To investigate the effects of objective health diagnoses on exit from paid work amongst older workers. METHODS Health and Employment After Fifty (HEAF) is a population cohort of adults aged 50-64 years recruited from English GP practices which contribute to the Clinical Practice Research Datalink (CPRD). Participants have completed questionnaires about health and work at baseline and annually for 2 years: their responses were linked with their objective health diagnoses from the CPRD and data analysed using Cox regression. RESULTS Of 4888 HEAF participants ever in paid work, 580 (25%) men and 642 (25%) women exited employment, 277 of them mainly or partly for a health reason (health-related job loss (HRJL)). Amongst HEAF participants who remained in work (n = 3666) or who exited work but not for health reasons (n = 945), there was a similar prevalence of background health conditions. In men and women, HRJL was associated with inflammatory arthritis, sleep disorders, common mental health conditions and musculoskeletal pain. There were however gender differences: widespread pain and lower limb osteoarthritis were associated with HRJL in women but hypertension and cardiovascular disease in men. CONCLUSIONS Improved diagnosis and management of common conditions might be expected to increase working lives. Workplace well-being interventions targeting obesity and increasing mobility might contribute to extended working lives. Employers of predominantly female, as compared with male workforces may need different strategies to retain older workers.
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Affiliation(s)
- K Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton SO16 6YD, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- Monash Centre for Occupational and Environmental Health, Monash University, Melbourne, Australia
| | - S D’Angelo
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton SO16 6YD, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - C H Linaker
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton SO16 6YD, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - M J Stevens
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton SO16 6YD, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - G Ntani
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton SO16 6YD, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - C Cooper
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton SO16 6YD, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford OX3 7LD, UK
- National Institute for Health Research Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - H E Syddall
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton SO16 6YD, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
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Parsons V, Juszczyk D, Gilworth G, Ntani G, Henderson M, Smedley J, McCrone P, Hatch SL, Shannon R, Coggon D, Molokhia M, Griffiths A, Walker-Bone K, Madan I. Developing and testing a case-management intervention to support the return to work of health care workers with common mental health disorders. J Public Health (Oxf) 2022:6594717. [PMID: 35640243 DOI: 10.1093/pubmed/fdac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 03/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To assess the feasibility and acceptability of conducting a trial of the clinical effectiveness and cost-effectiveness of a new case-management intervention to facilitate the return to work of health care workers, on sick leave, having a common mental disorder (CMD). METHODS A mixed methods feasibility study. RESULTS Systematic review examined 40 articles and 2 guidelines. Forty-nine National Health Service Occupational Health (OH) providers completed a usual care survey. We trained six OH nurses as case managers and established six recruitment sites. Forty-two out of 1938 staff on sick leave with a CMD were screened for eligibility, and 24 participants were recruited. Out of them, 94% were female. Eleven participants received the intervention and 13 received usual care. Engagement with most intervention components was excellent. Return-to-work self-efficacy improved more in the intervention group than in the usual care group. Qualitative feedback showed the intervention was acceptable. CONCLUSIONS The intervention was acceptable, feasible and low cost to deliver, but it was not considered feasible to recommend a large-scale effectiveness trial unless an effective method could be devised to improve the early OH referral of staff sick with CMD. Alternatively, the intervention could be trialled as a new stand-alone OH intervention initiated at the time of usual OH referral.
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Affiliation(s)
- V Parsons
- Occupational Health Service, Guy's & St Thomas' NHS Foundation Trust, London SE1 7NJ, UK.,Faculty of Life Sciences & Medicine, King's College London, London SE1 9NH, UK
| | - D Juszczyk
- Occupational Health Service, Guy's & St Thomas' NHS Foundation Trust, London SE1 7NJ, UK
| | - G Gilworth
- Occupational Health Service, Guy's & St Thomas' NHS Foundation Trust, London SE1 7NJ, UK
| | - G Ntani
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton SO16 6YD, UK
| | - M Henderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - J Smedley
- Occupational Health, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - P McCrone
- King's Health Economics, King's College London, London SE1 9NH, UK.,Faculty of Education, Health & Human Sciences School of Health Sciences University of Greenwich, King's College London, London SE19NH, UK
| | - S L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London SE5 8AF, UK
| | - R Shannon
- School of Health Sciences, University of Southampton, Southampton SO14 0YN, UK
| | - D Coggon
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - M Molokhia
- Department of Population Health Sciences, School of Life Course and Population Sciences, Population Health Sciences, King's College London, London SE1 1UL, UK
| | - A Griffiths
- Mental Health & Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham NG7 2UH(UK), UK
| | - K Walker-Bone
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton SO16 6YD, UK
| | - I Madan
- Occupational Health Service, Guy's & St Thomas' NHS Foundation Trust, London SE1 7NJ, UK.,Faculty of Life Sciences & Medicine, King's College London, London SE1 9NH, UK
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Jobanputra D, Cherry L, Walker-Bone K, Price C, D’angelo S, Ntani G. OP0007-HPR AN EPIDEMIOLOGICAL STUDY OF FOOT AND ANKLE PAIN AND HEALTH-RELATED JOB LOSS IN ADULTS OVER 50: CROSS-SECTIONAL FINDINGS FROM THE HEAF COHORT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundFoot and ankle pain (FAP), particularly that of musculoskeletal origin, is increasingly prevalent in our aging populations1. Moreover, governments need people to work to older ages to reduce the costs of pensions and welfare benefits. It is not currently known however whether people with FAP are able to keep working or to what extent it pushes people out of work. We investigated this question in older working adults.ObjectivesTo determine whether FAP is associated with HRJL amongst older working adults.MethodsHealth And Employment After Fifty2 is a longitudinal population-based cohort incepted 2013 to investigate health and retirement. At follow-up two years later, people were asked to complete a full-body mannequin which included the ankles/feet. Mannequins were coded: foot/ankle pain (FAP) with pain at other sites; pain elsewhere but not FAP; and no pain. Two years later, participants were asked whether they had left paid work entirely or partly because of health (Health-related job loss (HRJL). A Cox proportional hazards model was used to explore associations between health-related job loss, FAP, and other potential risk factors (such as age, mental health, BMI, and finances). A sensitivity analysis was carried out to determine which occupational activities were significantly associated with health-related job loss due to FAP.ResultsAt 2 years, 4050 participants completed a pain mannequin, amongst whom 3762 were in paid work. Over 2 further years of follow-up, there were 235 incident HRJLs. Amongst those with HRJL, 73 had no pain, 54 had pain involving FAP, 108 had pain not involving FAP. After adjusting for age and sex, people with FAP had 83% increased risk of HRJL compared to people with no pain (HR=1.83, 95% CI 1.29-2.61), whilst those with pain NOT involving FAP had 34% increased risk (HR1.34, 95% CI 1.00 – 1.80). FAP remained a significant predictor of HRJL within a fully adjusted model (HR=1.65, 95% CI 1.15-2.36). Sensitivity analyses confirmed that doing jobs which involved climbing more than 30 flights of stairs was associated with increased risk of HRJL amongst people with FAP (HR=1.96, 95% CI 1.00-3.80).ConclusionFAP is a risk factor for HRJL amongst older working adults, particularly if their job involves stair climbing. Potentially, modification of duties to reduce stair climbing could mitigate job loss amongst people with FAP.References[1]Executive HaS. Work-related ill health and occupational disease. https://www.hse.gov.uk/statistics/causdis/; 2020.[2]Keith T. Palmer KW-B, E. Clare Harris, Cathy Linaker, Stefania D’ANgelo, Avan Aihi Sayer, Catharine R. Gale, Maria Evandrou, Tjeerd van Staa, Cyrus Cooper, David Coggon. Health and Employment after Fifty (HEAF): a new prospective cohort study. BMC Public Health 2015.Disclosure of InterestsNone declared.
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Zaballa E, Ntani G, Harris E, Arden N, Cooper C, Walker-Bone K. Returning to and staying in work after knee replacement. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bevilacqua G, D'Angelo S, Ntani G, Stevens M, Linaker CH, Walker-Bone K. Shift work amongst older UK workers and job exit. Occup Med (Lond) 2021; 71:429-438. [PMID: 34693446 DOI: 10.1093/occmed/kqab131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Night/shift work may be increasing but there are few data about the prevalence amongst older workers. With governments encouraging people to work to older ages, it is important to know how feasible night/shift work is for them and whether there are any adverse health consequences. AIMS Amongst current older workers (aged 50-64 years), to explore the prevalence of night/shift working and evaluate its health impacts and sustainability over 4 years of follow-up. METHODS Data from the Health and Employment After Fifty cohort were used to describe the demographic, job and health characteristics of men and women undertaking night/shift work. Longitudinal data were used to examine the number and nature of exits annually thereafter. RESULTS Amongst the 5409 working at baseline, 32% reported night/shift work in sectors which differed by sex. Night/shift workers were more likely to be: current smokers; doing physically demanding work; struggling to cope at work; dissatisfied with their hours; depressed; sleeping poorly; rating their health poorly. Women whose job involves night work were more likely to exit the workforce over 4 years. CONCLUSIONS Almost one in three contemporary UK older workers report night/shift work. We found some evidence of adverse impacts on health, sleep and well-being and higher rates of job exit amongst women. More research is needed but night/shift work may be challenging to sustain for older workers and could have health consequences.
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Affiliation(s)
- G Bevilacqua
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton SO16 6YD, UK.,MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - S D'Angelo
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton SO16 6YD, UK.,MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - G Ntani
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton SO16 6YD, UK.,MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - M Stevens
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton SO16 6YD, UK.,MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - C H Linaker
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton SO16 6YD, UK.,MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - K Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton SO16 6YD, UK.,MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
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Bradshaw A, Bosworth A, Walker-Bone K, Lunt L, Verstappen S. SAT0072 THE IMPACT OF COMORBIDITIES ON ABSENTEEISM, PRESENTEEISM AND EMPLOYMENT STATUS IN PEOPLE LIVING WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Many people with rheumatoid arthritis (RA) have comorbidities. However, there is limited research on the impact of multimorbidity on absenteeism (e.g. sick leave) and presenteeism (i.e. reduced productivity while at work due to ill health) in people with RA.Objectives:i) to explore the impact of comorbidities on absenteeism and presenteeism in patients with RA and ii) to evaluate the association between multimorbidity and employment status.Methods:A cross-sectional survey was conducted by the National Rheumatoid Arthritis Society (NRAS), UK, collecting information on: demographics, education, employment status (i.e. employed (Empl), stopped/retired early because of RA (Stop_RA), stopped/retired early because of other health issues (Stop_Health)), and disease related variables (e.g. symptom duration, rheumatoid arthritis impact of disease (RAID) questionnaire). Participants were asked to report whether they had or were treated for any of 15 predefined comorbidities (categorised into 0, 1, 2, 3, or ≥4 (Table)). Percentage of number of hours missed due RA (i.e. absenteeism) and presenteeism (10-point Likert scale) were assessed using the Work Productivity and Activity Impairment Questionnaire (WPAI-RA). For the purpose of this study both absenteeism and presenteeism outcomes were dichotomized (no presenteeism/absenteeism versus any) and only patients aged <65yrs were included. Logistic regression analysis were applied to assess the association between number of comorbidities and absenteeism/presenteeism, adjusting for the categorical variables age, gender and education. Chi2-square test was applied to assess frequencies of individual comorbidities between the three employment status groups.Results:868 participants were included; 91.7% women with a median symptom duration of 8.3 years [IQR 4.4-13.7]. The average RAID score was 5.2 (SD 2.2). 80.4% were in paid employment, including those currently on sick leave, 16.9% stopped early because of their RA and 2.7% reported stopping early because of other health reasons. In those employed most commonly occurring comorbidities were: back pain (28.8%%), osteoarthritis (21.5%), depression (26.3%) and anxiety (22.6%). Compared to people with RA with no comorbidities, the odds associated with time off work due to RA increased from 1.7 up to 3.4 with increasing number of comorbidities (Table). Although a similar trend was observed for presenteeism, the effect sizes were smaller. Significant differences (p<0.05) in frequencies of the following comorbidities were observed between the three employment status groups (Empl, Stop_RA, Stop_Health, respectively): heart disease (3.9%, 7.9%, 20.0%), blood pressure (18.0%, 29.5%, 36.7%), lung disease (5.7%, 16.3%, 26.7%), diabetes (4.4%, 4.2%, 26.7%), ulcer (6.1%, 11.1%, 13.3%), cancer (3.3%, 2.6%, 13.3%), depression (26.3%, 33.6%, 50.0%), OA (21.5%, 44.7%, 63.33%), and back pain (28.8%, 48.4%, 60.0%).Absenteeism (yes/no)Presenteeism (yes/no)Number of comorbiditiesNOR95%CIOR95%CI0206Ref.Ref.11741.701.06-2.711.661.00-2.7321361.771.08-2.921.991.13-2.863851.751.00-3.081.530.82-2.864-15max863.381.98-5.782.641.28-5.44OR=odds ratio; 95%CI=95% confidence interval; Comorbidities included: heart disease, blood pressure, lung disease, diabetes, ulcer or stomach disease, kidney disease, liver disease, anaemia or other blood disease, cancer, depression, anxiety, OA, back pain, osteoporosis and Sjögren. Bold figuresP<0.05.Conclusion:Although the study is cross-sectional and no temporal association can be determined, this study shows that not only personal and work related contextual factors should be considered when preventing worker productivity loss, but also other comorbidities.Disclosure of Interests:A. Bradshaw: None declared, Ailsa Bosworth Speakers bureau: a number of pharmaceutical companies for reasons of inhouse training, advisory boards etc., K. Walker-Bone: None declared, Laura Lunt: None declared, Suzanne Verstappen Grant/research support from: BMS, Consultant of: Celltrion, Speakers bureau: Pfizer
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Stevens MJ, Walker-Bone K, Culliford DJ, Alcacer-Pitarch B, Blake A, Hopkinson N, Teh LS, Vital EM, Edwards CJ, Williams AE, Cherry L. Work participation, mobility and foot symptoms in people with systemic lupus erythematosus: findings of a UK national survey. J Foot Ankle Res 2019; 12:26. [PMID: 31164925 PMCID: PMC6489339 DOI: 10.1186/s13047-019-0335-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/11/2019] [Indexed: 11/12/2022] Open
Abstract
Objective The aim of this study was to investigate whether foot and lower limb related symptoms were associated with work participation and poor mobility in people with Systemic Lupus Erythematosus (SLE). Method A quantitative, cross-sectional, self-reported survey design was utilised. People with SLE from six United Kingdom (UK) treatment centres and a national register were invited to complete a survey about lower limb and foot health, work participation and mobility. Data collected included work status and the prevalence of foot symptoms. The focus of the analyses was to explore potential associations between poor foot health work non-participation. Results In total, 182 useable surveys were returned. Seventy-nine respondents reported themselves as employed and 32 reported work non-participation. The remaining were retired due to age or reported work non-participation for other reasons. Work non-participation due to foot symptoms was significantly associated with difficulty walking (p = 0.024), past episodes of foot swelling (p = 0.041), and past episodes of foot ulceration (p = 0.018). There was a significant increase in foot disability scores amongst those not working (mean 18.13, 95% CI: 14.85–21.41) compared to those employed (mean 10.16, 95% CI: 8.11–12.21). Conclusions Twenty-nine% of people with SLE reported work non-participation because of lower limb or foot problems. Our results suggest that foot health and mobility may be important contributors to a persons’ ability to remain in work and should be considered as part of a clinical assessment.
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Affiliation(s)
- M J Stevens
- 1MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, Southampton, UK
| | - K Walker-Bone
- 1MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, Southampton, UK
| | - D J Culliford
- 3Methodological Hub, NIHR Collaboration for Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - B Alcacer-Pitarch
- 4NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - A Blake
- Private podiatrist, Verwood, Dorset UK
| | - N Hopkinson
- 6Department of Rheumatology, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - L S Teh
- 7Department of Rheumatology, Royal Blackburn Teaching Hospital, East Lancashire Hospital NHS Trust, Blackburn, UK.,8Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Preston, UK
| | - E M Vital
- 4NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - C J Edwards
- 9NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A E Williams
- 10Directorate of prosthetics, orthotics and Podiatry, University of Salford, Salford, UK
| | - L Cherry
- 11School of Health Sciences, Faculty of Health Sciences, University of Southampton, Building 45, Burgess Road, Southampton, SO17 1BJ UK.,12Department of Podiatry, Solent NHS Trust, Southampton, UK
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10
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Paccou J, D'Angelo S, Rhodes A, Curtis EM, Raisi-Estabragh Z, Edwards M, Walker-Bone K, Cooper C, Petersen SE, Harvey NC. Prior fragility fracture and risk of incident ischaemic cardiovascular events: results from UK Biobank. Osteoporos Int 2018; 29:1321-1328. [PMID: 29479646 PMCID: PMC6015763 DOI: 10.1007/s00198-018-4426-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/06/2018] [Indexed: 11/25/2022]
Abstract
UNLABELLED In the large UK Biobank population-based cohort, we found that amongst men, but not women, prior fragility fracture was associated with increased risk of admission with ischaemic heart disease. INTRODUCTION We aimed to investigate the relationship between prior fracture and risk of incident ischaemic cardiovascular events in a UK population-based cohort. METHODS UK Biobank is a large prospective cohort comprising 502,637 men and women aged 40-69 years, with detailed baseline assessment. History of fracture was self-reported, and details of hospital admissions for ischaemic heart disease (IHD) (ICD-10:I20-I25) were obtained through linkage to UK Hospital Episode Statistics. Cox proportional hazards models were used to investigate the prospective relationships between prior fracture and hospital admission for men and women, controlling for age, BMI, smoking, alcohol, educational level, physical activity, systolic blood pressure, calcium and vitamin D use, ankle spacing-width, heel BUA and HRT use (women). RESULTS Amongst men, a fragility fracture (hip, spine, wrist or arm fracture resulting from a simple fall) within the previous 5 years was associated with a 35% increased risk of IHD admission (fully adjusted HR 1.35; 95%CI 1.00, 1.82; p = 0.047), with the relationship predominantly driven by wrist fractures. Associations with hospitalisation for angina in men were similar in age-adjusted models [HR1.54; 95%CI: 1.03, 2.30), p = 0.037], but did not remain statistical significant after full adjustment [HR 1.64; 95%CI: 0.88, 3.07); p = 0.121]. HRs for admission with angina were lower in women, and neither age- nor fully adjusted relationships attained statistical significance. CONCLUSIONS Prior fragility fracture is an independent risk factor for incident ischaemic cardiovascular events in men. Further work may clarify whether this association is causal or represents shared risk factors, but these findings are likely to be of value in risk assessment of both osteoporosis and cardiovascular disease.
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Affiliation(s)
- J Paccou
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- Université Lille Nord-de-France, Lille, France
| | - S D'Angelo
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - A Rhodes
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - E M Curtis
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - Z Raisi-Estabragh
- NIHR Barts Biomedical Research Centre, Barts Health NHS Trust and Queen Mary University of London, London, UK
| | - M Edwards
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - K Walker-Bone
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
| | - S E Petersen
- NIHR Barts Biomedical Research Centre, Barts Health NHS Trust and Queen Mary University of London, London, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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11
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Walker-Bone K, Linaker CH. Prediction of prognosis for people off sick with upper extremity musculoskeletal disorders. Occup Environ Med 2016; 73:805-806. [PMID: 27558704 DOI: 10.1136/oemed-2016-103884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/27/2016] [Indexed: 02/06/2023]
Affiliation(s)
- K Walker-Bone
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - C H Linaker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
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12
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Edwards MH, Robinson DE, Ward KA, Javaid MK, Walker-Bone K, Cooper C, Dennison EM. Cluster analysis of bone microarchitecture from high resolution peripheral quantitative computed tomography demonstrates two separate phenotypes associated with high fracture risk in men and women. Bone 2016; 88:131-137. [PMID: 27130873 PMCID: PMC4913839 DOI: 10.1016/j.bone.2016.04.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 04/21/2016] [Accepted: 04/25/2016] [Indexed: 12/28/2022]
Abstract
Osteoporosis is a major healthcare problem which is conventionally assessed by dual energy X-ray absorptiometry (DXA). New technologies such as high resolution peripheral quantitative computed tomography (HRpQCT) also predict fracture risk. HRpQCT measures a number of bone characteristics that may inform specific patterns of bone deficits. We used cluster analysis to define different bone phenotypes and their relationships to fracture prevalence and areal bone mineral density (BMD). 177 men and 159 women, in whom fracture history was determined by self-report and vertebral fracture assessment, underwent HRpQCT of the distal radius and femoral neck DXA. Five clusters were derived with two clusters associated with elevated fracture risk. "Cluster 1" contained 26 women (50.0% fractured) and 30 men (50.0% fractured) with a lower mean cortical thickness and cortical volumetric BMD, and in men only, a mean total and trabecular area more than the sex-specific cohort mean. "Cluster 2" contained 20 women (50.0% fractured) and 14 men (35.7% fractured) with a lower mean trabecular density and trabecular number than the sex-specific cohort mean. Logistic regression showed fracture rates in these clusters to be significantly higher than the lowest fracture risk cluster [5] (p<0.05). Mean femoral neck areal BMD was significantly lower than cluster 5 in women in cluster 1 and 2 (p<0.001 for both), and in men, in cluster 2 (p<0.001) but not 1 (p=0.220). In conclusion, this study demonstrates two distinct high risk clusters in both men and women which may differ in etiology and response to treatment. As cluster 1 in men does not have low areal BMD, these men may not be identified as high risk by conventional DXA alone.
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Affiliation(s)
- M H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom
| | - D E Robinson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom
| | - K A Ward
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, United Kingdom
| | - M K Javaid
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 5UG, United Kingdom
| | - K Walker-Bone
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom; NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 5UG, United Kingdom; NIHR Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, United Kingdom.
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom; Victoria University, Wellington, New Zealand
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13
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Walker-Bone K, D'Angelo S, Syddall HE, Palmer KT, Cooper C, Coggon D, Sayer AA. Heavy manual work throughout the working lifetime and muscle strength among men at retirement age. Occup Environ Med 2016; 73:284-6. [PMID: 26896253 PMCID: PMC4817232 DOI: 10.1136/oemed-2015-103293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 02/05/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Reductions in heavy manual work as a consequence of mechanisation might adversely impact muscle strength at older ages. We investigated the association between grip strength at retirement age and lifetime occupational exposure to physically demanding activities. Grip strength is an important predictor of long-term health and physical function in older people. METHODS Grip strength (maximum of three readings in each hand) was measured in men from the Hertfordshire Cohort Study at a single examination when their mean age was 65.8 (SD 2.9) years. Associations with lifetime occupational exposure (ascertained by questionnaire) to three activities (standing/walking ≥ 4 h/day; lifting ≥ 25 kg; and energetic work sufficient to induce sweating) were assessed by multivariable linear regression with adjustment for various potential confounders. RESULTS Complete data were available from 1418 men who had worked for at least 20 years. After adjustment for age, height and weight, those with longer exposures to walking/standing and heavy lifting had lower grip strength, but the relationship disappeared after further adjustment for confounders. Working at physical intensity sufficient to induce sweating was not significantly associated with grip strength. CONCLUSIONS We found no evidence that physically demanding occupational activities increase hand grip strength at normal retirement age. Any advantages of regular physical occupational activity may have been obscured by unmeasured socioeconomic confounders.
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Affiliation(s)
- K Walker-Bone
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - S D'Angelo
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - H E Syddall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - K T Palmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Southampton, UK
| | - D Coggon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - A A Sayer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK NIHR Collaboration for Leadership in Applied Health Research and Care, Wessex, UK Newcastle University Institute for Ageing and Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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D’Angelo S, Syddall H, Coggon D, Palmer KT, Cooper C, Sayer AA, Walker-Bone K. OP05 Association between lifetime occupational physical activities and grip strength at retirement age: findings from the hertfordshire cohort study. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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15
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Walker-Bone K, D'Angelo S, Syddall HE, Palmer KT, Cooper C, Coggon D, Dennison EM. Exposure to heavy physical occupational activities during working life and bone mineral density at the hip at retirement age. Occup Environ Med 2014; 71:329-31. [PMID: 24619156 DOI: 10.1136/oemed-2013-101967] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND People in sedentary occupations are at increased risk of hip fracture. Hip fracture is significantly associated with low bone mineral density (BMD) measured at the hip. Physical activity is important in the development and maintenance of BMD, but the effects of occupational physical activity on bone health are unclear. We investigated the influence of lifetime physical activity on BMD at the hip. METHODS This was a cross-sectional epidemiological study of the associations between total hip BMD measured by dual-energy X-ray absorptiometry at retirement age and lifetime exposure to occupational physical workload (standing/walking ≥4 h/day; lifting ≥25 kg; energetic work sufficient to induce sweating and manual work). RESULTS Complete data on occupational exposures were available for 860 adults (488 men and 372 women) who had worked ≥20 years. Their mean age was 65 years, and many reported heavy physical workplace activities over prolonged durations. There were no statistically significant associations between total hip BMD and any of these measures of lifetime occupational physical activity in men or women. CONCLUSIONS Lifetime cumulative occupational activity was not associated with hip BMD at retirement age. Our findings suggest that, if sedentary work conveys an increased risk of hip fracture, it is unlikely that the mechanism is through reductions in BMD at the hip and may relate to other physical effects, such as falls risk. Further studies will be needed to test this hypothesis.
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Affiliation(s)
- K Walker-Bone
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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Abstract
A multitude of rheumatologic manifestations have been associated with HIV infection and protease inhibitors use. We describe two cases that display a temporal relationship between initiating Kaletra and developing Achilles tendinopathy. Immediate and dramatic resolution of symptoms occurred on switching from Kaletra to an alternative agent. Clinicians may want to consider a trial of an alternative agent in individuals on Kaletra who experience Achilles tendinopathy. Adverse events must be formally reported so that our understanding of antiretrovirals may continually evolve and aid decisions about antiretroviral prescribing.
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Affiliation(s)
- F V Cresswell
- Lawson Unit, Brighton and Sussex University Hospital, Brighton, UK
| | - J Tomlins
- Lawson Unit, Brighton and Sussex University Hospital, Brighton, UK
| | - D R Churchill
- Lawson Unit, Brighton and Sussex University Hospital, Brighton, UK
| | - K Walker-Bone
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - D Richardson
- Lawson Unit, Brighton and Sussex University Hospital, Brighton, UK
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Abstract
BACKGROUND Musculoskeletal disorders (MSDs) are a common cause of disability in the workplace. Despite this, there is known to be a wide variation in the assessment of MSDs by UK occupational health (OH) professionals. Therefore we developed a workshop, supported by a bespoke, on-line video, focussing on the assessment and management of MSDs. AIMS To assess the impact of the training package on the knowledge, confidence and reported behaviour of attendees. METHODS Workshops were held in two regional centres in England. Delegates completed a questionnaire on arrival to establish their baseline knowledge and confidence and again at the end of the training. A third questionnaire, with one reminder, was e-mailed to delegates 4 months following the workshops. RESULTS Ninety-two OH professionals (77 nurses, 10 doctors and 5 'others') attended and more than 80% reported that they had no previous training in examining the upper or lower limb or in distinguishing specific from non-specific MSDs. Confidence among delegates in examination, diagnosis and management of MSDs improved after the workshop and these changes were sustained and remained statistically significant from baseline 4 months afterwards. Following the training, 79% (50) of delegates reported that they had shared the knowledge and skills acquired with their colleagues and 71% reported that they had used the examination techniques in their day-to-day practice. CONCLUSIONS We have developed a training package which resulted in improved knowledge among attendees and gave them confidence to use their skills in practice.
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Affiliation(s)
- I Madan
- Department of Occupational Health, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
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Heathfield S, Parker B, Zeef L, Bruce I, Alexander Y, Collins F, Stone M, Wang E, Williams AS, Wright HL, Thomas HB, Moots RJ, Edwards SW, Bullock C, Chapman V, Walsh DA, Mobasheri A, Kendall D, Kelly S, Bayley R, Buckley CD, Young SP, Rump-Goodrich L, Middleton J, Chen L, Fisher R, Kollnberger S, Shastri N, Kessler BM, Bowness P, Nazeer Moideen A, Evans L, Osgood L, Williams AS, Jones SA, Nowell MA, Mahadik Y, Young S, Morgan M, Gordon C, Harper L, Giles JL, Paul Morgan B, Harris CL, Rysnik OJ, McHugh K, Kollnberger S, Payeli S, Marroquin O, Shaw J, Renner C, Bowness P, Nayar S, Cloake T, Bombardieri M, Pitzalis C, Buckley C, Barone F, Barone F, Nayar S, Cloake T, Lane P, Coles M, Buckley C, Williams EL, Edwards CJ, Cooper C, Oreffo RO, Dunn S, Crawford A, Wilkinson M, Le Maitre C, Bunning R, Daniels J, Phillips KLE, Chiverton N, Le Maitre CL, Kollnberger S, Shaw J, Ridley A, Wong-Baeza I, McHugh K, Keidel S, Chan A, Bowness P, Gullick NJ, Abozaid HS, Jayaraj DM, Evans HG, Scott DL, Choy EH, Taams LS, Hickling M, Golor G, Jullion A, Shaw S, Kretsos K, Bari SF, Rhys-Dillon B, Amos N, Siebert S, Phillips KLE, Chiverton N, Bunning RD, Haddock G, Cross AK, Le Maitre CL, Kate I, Phillips E, Cross A, Chiverton N, Haddock G, Bunning RAD, Le Maitre CL, Ceeraz S, Spencer J, Choy E, Corrigall V, Crilly A, Palmer H, Lockhart J, Plevin R, Ferrell WR, McInnes I, Hutchinson D, Perry L, DiCicco M, Humby F, Kelly S, Hands R, Buckley C, McInnes I, Taylor P, Bombardieri M, Pitzalis C, Mehta P, Mitchell A, Tysoe C, Caswell R, Owens M, Vincent T, Hashmi TM, Price-Forbes A, Sharp CA, Murphy H, Wood EF, Doherty T, Sheldon J, Sofat N, Goff I, Platt PN, Abdulkader R, Clunie G, Ismajli M, Nikiphorou E, Young A, Tugnet N, Dixey J, Banik S, Alcorn D, Hunter J, Win Maw W, Patil P, Hayes F, Main Wong W, Borg FA, Dasgupta B, Malaviya AP, Ostor AJ, Chana JK, Ahmed AA, Edmonds S, Hayes F, Coward L, Borg F, Heaney J, Amft N, Simpson J, Dhillon V, Ayalew Y, Khattak F, Gayed M, Amarasena RI, McKenna F, Amarasena RI, McKenna F, Mc Laughlin M, Baburaj K, Fattah Z, Ng N, Wilson J, Colaco B, Williams MR, Adizie T, Dasgupta B, Casey M, Lip S, Tan S, Anderson D, Robertson C, Devanny I, Field M, Walker D, Robinson S, Ryan S, Hassell A, Bateman J, Allen M, Davies D, Crouch C, Walker-Bone K, Gainsborough N, Gullick NJ, Lutalo PM, Davies UM, Walker-Bone K, Mckew JR, Millar AM, Wright SA, Bell AL, Thapper M, Roussou T, Cumming J, Hull RG, Thapper M, Roussou T, McKeogh J, O'Connor MB, Hassan AI, Bond U, Swan J, Phelan MJ, Coady D, Kumar N, Farrow L, Bukhari M, Oldroyd AG, Greenbank C, McBeth J, Duncan R, Brown D, Horan M, Pendleton N, Littlewood A, Cordingley L, Mulvey M, Curtis EM, Cole ZA, Crozier SR, Georgia N, Robinson SM, Godfrey KM, Sayer AA, Inskip HM, Cooper C, Harvey NC, Davies R, Mercer L, Galloway J, Low A, Watson K, Lunt M, Symmons D, Hyrich K, Chitale S, Estrach C, Moots RJ, Goodson NJ, Rankin E, Jiang CQ, Cheng KK, Lam TH, Adab P, Ling S, Chitale S, Moots RJ, Estrach C, Goodson NJ, Humphreys J, Ellis C, Bunn D, Verstappen SM, Symmons D, Fluess E, Macfarlane GJ, Bond C, Jones GT, Scott IC, Steer S, Lewis CM, Cope A, Mulvey MR, Macfarlane GJ, Symmons D, Lovell K, Keeley P, Woby S, Beasley M, McBeth J, Viatte S, Plant D, Lunt M, Fu B, Parker B, Galloway J, Solymossy C, Worthington J, Symmons D, Dixey J, Young A, Barton A, Williams FM, Osei-Bordom DC, Popham M, MacGregor A, Spector T, Little J, Herrick A, Pushpakom S, Ennis H, McBurney H, Worthington J, Newman W, Ibrahim I, Plant D, Hyrich K, Morgan A, Wilson A, Isaacs J, Barton A, Sanderson T, Hewlett S, Calnan M, Morris M, Raza K, Kumar K, Cardy CM, Pauling JD, Jenkins J, Brown SJ, McHugh N, Nikiphorou E, Mugford M, Davies C, Cooper N, Brooksby A, Bunn D, Symmons D, MacGregor A, Dures E, Ambler N, Fletcher D, Pope D, Robinson F, Rooke R, Hewlett S, Gorman CL, Reynolds P, Hakim AJ, Bosworth A, Weaver D, Kiely PD, Skeoch S, Jani M, Amarasena R, Rao C, Macphie E, McLoughlin Y, Shah P, Else S, Semenova O, Thompson H, Ogunbambi O, Kallankara S, Patel Y, Baguley E, Jani M, Halsey J, Severn A, Bukhari M, Selvan S, Price E, Husain MJ, Brophy S, Phillips CJ, Cooksey R, Irvine E, Siebert S, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Griffiths B, Foggo H, Edgar S, Vadivelu S, Coady D, McHugh N, Ng WF, Dasgupta B, Taylor P, Iqbal I, Heron L, Pilling C, Marks J, Hull R, Ledingham J, Han C, Gathany T, Tandon N, Hsia E, Taylor P, Strand V, Sensky T, Harta N, Fleming S, Kay L, Rutherford M, Nicholl K, Kay L, Rutherford M, Nicholl K, Eyre T, Wilson G, Johnson P, Russell M, Timoshanko J, Duncan G, Spandley A, Roskell S, Coady D, West L, Adshead R, Donnelly SP, Ashton S, Tahir H, Patel D, Darroch J, Goodson NJ, Boulton J, Ellis B, Finlay R, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Vadivelu S, Coady D, McHugh N, Griffiths B, Foggo H, Edgar S, Ng WF, Murray-Brown W, Priori R, Tappuni T, Vartoukian S, Seoudi N, Picarelli G, Fortune F, Valesini G, Pitzalis C, Bombardieri M, Ball E, Rooney M, Bell A, Merida AA, Isenberg D, Tarelli E, Axford J, Giles I, Pericleous C, Pierangeli SS, Ioannou J, Rahman A, Alavi A, Hughes M, Evans B, Bukhari M, Parker B, Zaki A, Alexander Y, Bruce I, Hui M, Garner R, Rees F, Bavakunji R, Daniel P, Varughese S, Srikanth A, Andres M, Pearce F, Leung J, Lim K, Regan M, Lanyon P, Oomatia A, Petri M, Fang H, Birnbaum J, Amissah-Arthur M, Gayed M, Stewart K, Jennens H, Braude S, Gordon C, Sutton EJ, Watson KD, Gordon C, Yee CS, Lanyon P, Jayne D, Isenberg D, Rahman A, Akil M, McHugh N, Ahmad Y, Amft N, D'Cruz D, Edwards CJ, Griffiths B, Khamashta M, Teh LS, Zoma A, Bruce I, Dey ID, Kenu E, Isenberg D, Pericleous C, Garza-Garcia A, Murfitt L, Driscoll PC, Isenberg D, Pierangeli S, Giles I, Ioannou Y, Rahman A, Reynolds JA, Ray DW, O'Neill T, Alexander Y, Bruce I, Segeda I, Shevchuk S, Kuvikova I, Brown N, Bruce I, Venning M, Mehta P, Dhanjal M, Mason J, Nelson-Piercy C, Basu N, Paudyal P, Stockton M, Lawton S, Dent C, Kindness K, Meldrum G, John E, Arthur C, West L, Macfarlane MV, Reid DM, Jones GT, Macfarlane GJ, Yates M, Loke Y, Watts R, MacGregor A, Adizie T, Christidis D, Dasgupta B, Williams M, Sivakumar R, Misra R, Danda D, Mahendranath KM, Bacon PA, Mackie SL, Pease CT. Basic science * 232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Campbell R, Hofmann D, Hatch S, Gordon P, Lempp H, Das L, Blumbergs P, Limaye V, Vermaak E, McHugh N, Edwards MH, Jameson K, Sayer AA, Dennison E, Cooper C, Salvador FB, Huertas C, Isenberg D, Jackson EJ, Middleton A, Churchill D, Walker-Bone K, Worsley PR, Mottram S, Warner M, Morrissey D, Gadola S, Carr A, Cooper C, Stokes M, Srivastava RN, Sanghi D, Srivastava RN, Sanghi D, Elbaz A, Mor A, Segal G, Drexler M, Norman D, Peled E, Rozen N, Goryachev Y, Debbi EM, Haim A, Rozen N, Wolf A, Debi R, Mor A, Segal G, Debbi EM, Cohen MS, Igolnikov I, Bar Ziv Y, Benkovich V, Bernfeld B, Rozen N, Elbaz A, Collins J, Moots RJ, Clegg PD, Milner PI, Ejtehadi HD, Nelson PN, Wenham C, Balamoody S, Hodgson R, Conaghan P, Wilkie R, Blagojevic M, Jordan KP, Mcbeth J, Peffers MJ, Beynon RJ, Thornton DJ, Clegg PD, Chapman R, Chapman V, Walsh D, Kelly S, Hui M, Zhang W, Doherty S, Rees F, Muir K, Maciewicz R, Doherty M, Snelling S, Davidson RK, Swingler T, Price A, Clark I, Stockley E, Hathway G, Faas H, Auer D, Chapman V, Hirsch G, Hale E, Kitas G, Klocke R, Abraham A, Pearce MS, Mann KD, Francis RM, Birrell F, Tucker M, Mellon SJ, Jones L, Price AJ, Dieppe PA, Gill HS, Ashraf S, Chapman V, Walsh DA, McCollum D, McCabe C, Grieve S, Shipley J, Gorodkin R, Oldroyd AG, Evans B, Greenbank C, Bukhari M, Rajak R, Bennett C, Williams A, Martin JC, Abdulkader R, MacNicol C, Brixey K, Stephenson S, Clunie G, Andrews RN, Oldroyd AG, Evans B, Greenbank C, Bukhari M, Clark EM, Gould VC, Carter L, Morrison L, Tobias JH, Pye SR, Vanderschueren D, O'Neill TW, Lee DM, Jans I, Billen J, Gielen E, Laurent M, Claessens F, Adams JE, Ward KA, Bartfai G, Casanueva F, Finn JD, Forti G, Giwercman A, Han TS, Huhtaniemi I, Kula K, Lean ME, Pendleton N, Punab M, Wu FC, Boonen S, Mercieca C, Webb J, Shipley J, Bhalla A, Fairbanks S, Moss KE, Collins C, Sedgwick P, Clark EM, Gould VC, Morrison L, Tobias JH, Parker J, Greenbank C, Evans B, Oldroyd AG, Bukhari M, Harvey NC, Cole ZA, Crozier SR, Ntani G, Mahon PA, Robinson SM, Inskip HM, Godfrey KM, Dennison EM, Cooper C, Bridges M, Ruddick S, Holroyd CR, Mahon P, Crozier SR, Godfrey K, Inskip HM, Cooper C, Harvey NC, Bridges M, Ruddick S, McNeilly T, McNally C, Beringer T, Finch M, Coda A, Davidson J, Walsh J, Fowlie P, Carline T, Santos D, Patil P, Rawcliffe C, Olaleye A, Moore S, Fox A, Sen D, Ioannou Y, Nisar S, Rankin K, Birch M, Finnegan S, Rooney M, Gibson DS, Malviya A, Ferris CM, Rushton SP, Foster HE, Hanson H, Muthumayandi K, Deehan DJ, Birt L, Poland F, MacGregor A, Armon K, Pfeil M, McErlane F, Beresford MW, Baildam EM, Thomson W, Hyrich K, Chieng A, Davidson J, Foster HE, Gardner-Medwin J, Lunt M, Wedderburn L, Gibson DS, Finnegan S, Newell K, Evans A, Manning G, Scaife C, McAllister C, Pennington SR, Duncan M, Moore T, Rooney M, Pericleous C, Croca SC, Giles I, Alber K, Yong H, Isenberg D, Midgely A, Beresford MW, Rahman A, Ioannou Y, Rzewuska M, Mallen C, Strauss VY, Belcher J, Peat G, Byng-Maddick R, Wijendra M, Penn H, Roddy E, Muller S, Hayward R, Mallen C, Kamlow F, Pakozdi A, Jawad A, Green DJ, Muller S, Mallen C, Hider SL, Singh Bawa S, Bawa S, Turton A, Palmer M, Grieve S, Lewis J, Moss T, McCabe C, Goodchild CE, Tang N, Scott D, Salkovskis P, Selvan S, Williamson L, Selvan S, Williamson L, Thalayasingam N, Higgins M, Saravanan V, Rynne M, Hamilton JD, Heycock C, Kelly C, Norton S, Sacker A, Done J, Young A, Smolen JS, Fleischmann RM, Emery P, van Vollenhoven RF, Guerette B, Santra S, Kupper H, Redden L, Kavanaugh A, Keystone EC, van der Heijde D, Weinblatt ME, Mozaffarian N, Guerette B, Kupper H, Liu S, Kavanaugh A, Zhang N, Wilkinson S, Riaz M, Ostor AJ, Nisar MK, Burmester G, Mariette X, Navarro-Blasco F, Oezer U, Kary S, Unnebrink K, Kupper H, Jobanputra P, Maggs F, Deeming A, Carruthers D, Rankin E, Jordan A, Faizal A, Goddard C, Pugh M, Bowman S, Brailsford S, Nightingale P, Tugnet N, Cooper SC, Douglas KM, Edwin Lim CS, Bee Lian Low S, Joy C, Hill L, Davies P, Mukherjee S, Cornell P, Westlake SL, Richards S, Rahmeh F, Thompson PW, Breedveld F, Keystone E, van der Heijde D, Landewe R, Smolen JS, Guerette B, McIlraith M, Kupper H, Liu S, Kavanaugh A, Byng-Maddick R, Penn H, Abdulkader R, Dharmapalaiah C, Shand L, Rose G, Clunie G, Watts R, Eldashan A, Dasgupta B, Borg FA, Bell GM, Anderson AE, Harry RA, Stoop JN, Hilkens CM, Isaacs J, Dickinson A, McColl E, Banik S, Smith L, France J, Bawa S, Rutherford A, Scott Russell A, Smith J, Jassim I, Withrington R, Bacon P, De Lord D, McGregor L, Morrison I, Stirling A, Porter DR, Saunders SA, Else S, Semenova O, Thompson H, Ogunbambi O, Kallankara S, Baguley E, Patel Y, Alzabin S, Abraham S, Taher TE, Palfeeman A, Hull D, McNamee K, Jawad A, Pathan E, Kinderlerer A, Taylor P, Williams RO, Mageed RA, Iaremenko O, Mikitenko G, Ferrari M, Kamalati T, Pitzalis C, Tugnet N, Pearce F, Tosounidou S, Obrenovic K, Erb N, Packham J, Sandhu R, White C, Cardy CM, Justice E, Frank M, Li L, Lloyd M, Ahmed A, Readhead S, Ala A, Fittall M, Manson J, Ioannou Y, Sibilia J, Marc Flipo R, Combe B, Gaillez C, Le Bars M, Poncet C, Elegbe A, Westhovens R, Hassanzadeh R, Mangan C, France J, Bawa S, Weinblatt ME, Fleischmann R, van Vollenhoven R, Emery P, Huizinga TWJ, Goldermann R, Duncan B, Timoshanko J, Luijtens K, Davies O, Dougados M, Hewitt J, Owlia M, Dougados M, Gaillez C, Le Bars M, Poncet C, Elegbe A, Schiff M, Alten R, Kaine JL, Keystone E, Nash PT, Delaet I, Qi K, Genovese MC, Clark J, Kardash S, Wong E, Hull R, McCrae F, Shaban R, Thomas L, Young-Min S, Ledingham J, Genovese MC, Covarrubias Cobos A, Leon G, Mysler EF, Keiserman MW, Valente RM, Nash PT, Abraham Simon Campos J, Porawska W, Box JH, Legerton CW, Nasonov EL, Durez P, Pappu R, Delaet I, Teng J, Alten R, Edwards CJ, Arden N, Campbell J, van Staa T, Housden C, Sargeant I, Edwards CJ, Arden N, Campbell J, van Staa T, Housden C, Sargeant I, Choy E, McAuliffe S, Roberts K, Sargeant I, Emery P, Sarzi-Puttini P, Moots RJ, Andrianakos A, Sheeran TP, Choquette D, Finckh A, Desjuzeur ML, Gemmen EK, Mpofu C, Gottenberg JE, Bukhari M, Shah P, Kitas G, Cox M, Nye A, O'Brien A, Jones P, Sargeant I, Jones GT, Paudyal P, MacPherson H, Sim J, Doherty M, Ernst E, Fisken M, Lewith G, Tadman J, Macfarlane GJ, Mariette X, Bertin P, Arendt C, Terpstra I, VanLunen B, de Longueville M, Zhou H, Cai A, Lacy E, Kay J, Keystone E, Matteson E, Hu C, Hsia E, Doyle M, Rahman M, Shealy D, Scott DL, Ibrahim F, Abozaid H, Choy E, Hassell A, Plant M, Richards S, Walker D, Simpson G, Kowalczyk A, Prouse P, Brown A, George M, Kumar N, Mackay K, Marshall S, Nash PT, Ludivico CL, Delaet I, Qi K, Murthy B, Corbo M, Kaine JL, Emery P, Smolen JS, Samborski W, Berenbaum F, Davies O, Ambrugeat J, Bennett B, Burkhardt H, Prouse P, Brown A, George M, Kumar N, Mackay K, Marshall S, Bykerk V, Ostor AJ, Roman Ivorra J, Wollenhaupt J, Stancati A, Bernasconi C, Sibilia J, Scott DGI, Claydon P, Ellis C, Buchan S, Pope J, Fleischmann R, Dougados M, Bingham CO, Massarotti EM, Wollenhaupt J, Duncan B, Coteur G, Weinblatt M, Hull D, Ball C, Abraham S, Ainsworth T, Kermik J, Woodham J, Haq I, Quesada-Masachs E, Carolina Diaz A, Avila G, Acosta I, Sans X, Alegre C, Marsal S, McWilliams D, Kiely PD, Young A, Walsh DA, Fleischmann R, Bolce R, Wang J, Ingham M, Dehoratius R, Decktor D, Rao V, Pavlov A, Klearman M, Musselman D, Giles J, Bathon J, Sattar N, Lee J, Baxter D, McLaren JS, Gordon MM, Thant KZ, Williams EL, Earl S, White P, Williams J, Westlake SL, Ledingham J, Jan AK, Bhatti AI, Stafford C, Carolan M, Ramakrishnan SA. Muscle disorders * 111. The impact of fatigue in patients with idiopathic inflammatory myopathy: a mixed method study. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Otter SJ, Lucas K, Springett K, Moore A, Davies K, Young A, Walker-Bone K. Identifying patient-reported outcomes in rheumatoid arthritis: the impact of foot symptoms on self-perceived quality of life. Musculoskeletal Care 2012; 10:65-75. [PMID: 22337478 DOI: 10.1002/msc.1001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The importance of patient-reported outcome measures in healthcare is increasingly recognized but these need to be patient generated. Given that foot symptoms are very common in rheumatoid arthritis (RA), we chose a patient-centred model with which to investigate the patients' perspective on how their foot symptoms affected them as individuals and impacted on their self-perceived quality of life, rather than using the traditional approaches of clinical examination (e.g. prevalence of deformities) or radiological assessments. METHODS A 33-item self-administered postal questionnaire was sent to all people with RA attending outpatient clinics in three hospitals over the course of one month (n=390). The questionnaire used both quantitative and qualitative approaches to enquire about the nature and extent of foot complaints and how respondents believed this affected their quality of life. RESULTS In total, 190 usable replies were received (49%). Nearly all respondents (n=177; 93.2%) reported that their quality of life was adversely affected by their foot complaint(s), with over half describing their quality of life as being badly or very badly affected. When asked to rate how severely foot complaints affected their quality of life using a 10 cm visual analogue scale, the mean score was 5.36 (range 0-10 ± SD 3), indicating that foot complaints have a moderate-to-severe effect on quality of life. Those aspects of daily living most significantly affected were: the ability to walk and the ability to wear a variety of shoes. CONCLUSION This study demonstrated that people with RA focus on different aspects of the impact of their disease to doctors. Rather than foot deformity or ulceration, disease activity score or health assessment questionnaire score, patients were easily able to pinpoint the key negativities of living with RA in their feet and indicated choice of footwear and ability to walk as crucial. This study and similar ones are key to identifying appropriate patient-reported outcome measures.
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Affiliation(s)
- S J Otter
- School of Health Professions, University of Brighton, Brighton, UK.
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Vagadia V, Bartholomew P, Kelly M, Handley G, Kelly C, Bridges M, Ruddick S, Malik R, Gilleece Y, Fisher M, Walker-Bone K, Selvan S, Collins DA, Meryon I, Pattle J, Scurr C, Davies G, Callan M, Mercieca C, Down M, Webb J, Shipley J, Bhalla AK, Poole KE, Treece GM, Ridgway GR, Mayhew PM, Borggrefe J, Gee AH, Mehta P, Nelson M, Boag F, Oldroyd AG, Halsey J, Goodson NJ, Greenbank C, Evans B, Bukhari M, Azagra R, Roca G, Encabo G, Aguye A, Zwart M, Casado E, Iglesias M, Puchol N, Sola S, Guell S, Harvey NC, Garrett E, Sheppard A, McLean C, Lillycrop K, Burdge G, Slater-Jefferies J, Rodford J, Crozier S, Inskip H, Starling Emerald B, Gale C, Hanson M, Gluckman P, Godfrey K, Cooper C, Edwards MH, Jameson K, Denison H, Aihie Sayer A, Cooper C, Dennison E, Cole Z, Harvey NC, Kim M, Robinson S, Inskip H, Godfrey KM, Cooper C, Dennison E, Clark EM, Morrison L, Gould V, Cuming M, Tobias J. Osteoporosis and metabolic bone disease: 73. Do Low Vitamin D Levels Predict Osteoporosis? Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Castillo-Gallego C, de Miguel Mendieta E, Garcia-Arias M, Plasencia-Rodriguez C, Lojo-Oliveira L, Martin-Mola E, Tillett W, Cavill C, Korendowych E, McHugh N, Coates L, Bhalla AK, Creamer P, Packham J, Hailwood S, Taylor G, Hamilton L, Brooksby A, Leeder J, Gaffney K, Malipeddi AS, Neame R, Francis J, Hassan W, Mease P, Olds M, Kary S, Kupper H, Bell C, Peffers G, Rees F, Lanyon P, Obrenovic K, Sandhu R, Packham J, Erb N, Coates LC, Conaghan P, Emery P, Green M, Ibrahim G, MakIver H, Helliwell P, Giles JL, McHugh K, DiGleria K, Shaw J, Kollnberger S, Maenaka K, Marroquin O, Renner C, Bowness P, Landewe R, Ritchlin C, Olds M, Guerette B, Lavie F, Kavanaugh A, McInnes I, Krueger GG, Gladman D, Zrubek J, Goldstein N, Xu S, Mudivarthy S, Mack M, Prevosto C, McDonald S, De Riva A, Goodman R, Key T, Hill Gaston JS, Deery MJ, Busch R, Fischer R, Wright C, Kessler B, Bowness P, Sheehy C, Jois RN, Leeder J, Kerrigan N, Mills KS, Somerville M, Scott DG, Gaffney K, Kavanaugh A, van der Heijde D, Chattopadhyay C, Gladman D, Mease P, McInnes I, Krueger GG, Xu W, Rahman MU, Zrubek J, Baratelle A, Beutler A, Stober CB, Benham HJ, Goodall JC, Hill Gaston JS, Sanyal K, Walker-Bone K, Coates LC, Conaghan P, Emery P, Green M, Ibrahim G, MakIver H, Helliwell PS, Vastesaeger N, Wang Y, Inman R, Deodhar A, Hsu B, Rahman MU, Dijkmans B, Braun J, Geusens P, Sieper J, van der Heijde D, El Miedany Y, Palmer D, McHugh K, Giles JL, Shaw J, Kollnberger S, Payeli S, Utriainen L, Milling S, Renner C, Bowness P. Spondylarthropathies (including psoriatic arthritis): 244. Validity of Colour Doppler and Spectral Doppler Ultrasound of Sacroilicac Joints Againts Physical Examination as Gold Standard. Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kober C, Richardson D, Bell C, Walker-Bone K. Acute seronegative polyarthritis associated with lymphogranuloma venereum infection in a patient with prevalent HIV infection. Int J STD AIDS 2011; 22:59-60. [DOI: 10.1258/ijsa.2010.010262] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 44-year-old man who has sex with men presented with a three-month asymmetrical polyarthropathy. He had a positive HIV-1 antibody test consistent with infection acquired more than six months previously. Lymphogranuloma venereum (LGV)-associated DNA was detected from a rectal swab. Following successful treatment for LGV his arthritis resolved completely. Infection with HIV-1 has been hypothesized to cause reactive arthritis but this has been disputed. The most likely diagnosis in this patient was sexually acquired reactive arthritis secondary to LGV infection. As LGV can be asymptomatic and treatment differs from that of the other serovars, screening should be considered in all men who have sex with men (MSM) presenting with acute arthritis, particularly if they are HIV infected.
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Affiliation(s)
- C Kober
- Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton
| | - D Richardson
- Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton
| | - C Bell
- Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton
| | - K Walker-Bone
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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Abstract
BACKGROUND Upper limb pain is common among working-aged adults and a frequent cause of absenteeism. AIMS To systematically review the evidence for workplace interventions in four common upper limb disorders. METHODS Systematic review of English articles using Medline, Embase, Cinahl, AMED, Physiotherapy Evidence Database PEDro (carpal tunnel syndrome and non-specific arm pain only) and Cochrane Library. Study inclusion criteria were randomized controlled trials, cohort studies or systematic reviews employing any workplace intervention for workers with carpal tunnel syndrome, non-specific arm pain, extensor tenosynovitis or lateral epicondylitis. Papers were selected by a single reviewer and appraised by two reviewers independently using methods based on Scottish Intercollegiate Guidelines Network (SIGN) methodology. RESULTS 1532 abstracts were identified, 28 papers critically appraised and four papers met the minimum quality standard (SIGN grading + or ++) for inclusion. There was limited evidence that computer keyboards with altered force displacement characteristics or altered geometry were effective in reducing carpal tunnel syndrome symptoms. There was limited, but high quality, evidence that multi-disciplinary rehabilitation for non-specific musculoskeletal arm pain was beneficial for those workers absent from work for at least four weeks. In adults with tenosynovitis there was limited evidence that modified computer keyboards were effective in reducing symptoms. There was a lack of high quality evidence to inform workplace management of lateral epicondylitis. CONCLUSIONS Further research is needed focusing on occupational management of upper limb disorders. Where evidence exists, workplace outcomes (e.g. successful return to pre-morbid employment; lost working days) are rarely addressed.
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Affiliation(s)
- F D Dick
- Environmental and Occupational Medicine, Population Health Section, Division of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill Road, Aberdeen AB25 2ZP, UK.
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Wincup CJ, Evans D, Walker-Bone K, Mohammed S, Lunniss PJ, Zarate N, Aziz Q, Scott SM. Biology of Bone, Cartilage and Connective Tissue Disease [1-2]: 1. Effect of Corticosteroid on Tenocytes: Should Steroids be used as a Treatment for Tendonopathies? Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Evans S, Otter S, Walker-Bone K, Prada A, Isasi C, Campos J, Oton T, Polo J, Garcia B, Mulero J, Gadallah NA, El-Hefnawy HE, El-Arousy NH, El-Hefnawy NG, Abdou TA, El Shafie EA, El Zohiery AK, Hider SL, Whitehurst DG, Thomas E, Foster NE, Devany AJ, Musonda P, Blake JC. Soft Tissue and Regional Musculoskeletal Disease, Fibromyalgia [114-118]: 114. Foot and Ankle Injuries in Footballers: A Pilot Epidemiological Study. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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El Miedany Y, El Gaafary M, Youssef S, Toth M, Weightman J, Kelly M, Johnston E, Stone A, Harrison P, Bartholomew P, Kelly C, Vagadia V, Tuck S, Al-Shakarchi I, Louise Dolan A, Bridges MJ, Ruddick S, Bracewell C, Wright D, Aspray T, Hynes GM, Jameson K, Aihie Sayer A, Cooper C, Dennison E, Robinson S, Tull TJ, Fisher BA, Jenabzadeh R, Cobb JP, Abraham S, Hynes GM, Jameson K, Harvey N, Aihie Sayer A, Cooper C, Dennison E, Cheah J, Stacpoole S, Heaney D, Duncan J, Roshandel D, Holliday K, Pye SR, Boonen S, Borghs H, Vanderschueren D, Adams JE, Ward KA, Finn JD, Huhtaniemi IT, Silman AJ, Wu FC, Thomson W, O'Neill TW, White S, Shaw S, Short C, Gilleece Y, Fisher M, Walker-Bone K, Narshi CB, Martin R, Mitchell K, Keen R, Bridges MJ, Ruddick S, El Miedany Y, Toth M, Youssef S, El Gaafary M, Alhambra DP, Azagra R, Duro GE, Aguye A, Zwart M, Javaid KM. Osteoporosis and Metabolic Bone Disease [127-142]: 127. Osteoporosis, Falls and Fractures: Three Confounders in One Equation. Development and Validity of a New form for Assessment of Patients Referred for Dxa Scanning. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Samarawickrama A, Malik R, Fisher M, Gilleece Y, Walker-Bone K. Rates of bone fractures in a cohort of HIV-infected adults in the UK. J Int AIDS Soc 2010. [PMCID: PMC3112874 DOI: 10.1186/1758-2652-13-s4-p100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lawson E, Bond K, Churchill D, Walker-Bone K. A case of immune reconstitution syndrome: adult-onset Still's disease in a patient with HIV infection. Rheumatology (Oxford) 2009; 48:446-7. [DOI: 10.1093/rheumatology/ken514] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wall E, Walker-Bone K. Use of bisphosphonates and dual-energy X-ray absorptiometry scans in the prevention and treatment of glucocorticoid-induced osteoporosis in rheumatology. QJM 2008; 101:317-23. [PMID: 18270228 DOI: 10.1093/qjmed/hcm126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients treated with steroids are at risk of glucocorticoid-induced osteoporosis. Appropriate investigations and therapeutic agents can decrease rate of bone loss and fracture. AIM To review adherence to current UK guidelines for the prevention of glucocorticoid-induced osteoporosis in rheumatology outpatient clinics. DESIGN Retrospective case note review. METHODS The management of patients taking glucocorticoids who attended outpatient rheumatology clinics at a Teaching Hospital NHS Trust over a 4-week period was reviewed against current UK recommendations for prevention and treatment of osteoporosis (Bone and Tooth Society, National Osteoporosis Society, Royal College of Physicians. Glucocorticoid-induced osteoporosis: guidelines for prevention and treatment. London: Royal College Physicians, 2002). RESULTS Over the study period, 519 patients attended rheumatology outpatient clinics, amongst whom 104 were current glucocorticoid users. Most patients had been taking oral steroids for over 12 months (n = 79, 76%). The majority had also received steroids by at least one other route (n = 67, 64.4%). According to the guidelines, 51 patients, at relatively low risk of osteoporosis (<65 years, no previous fragility fracture) should have been referred for bone density assessment; of these, 27 (53%) had received a DEXA scan. In total, 58 subjects fulfilled criteria for bisphosphonates (>65 years, fragility fracture, T-score <-1.5) and, of these, 51 (87.9%) were appropriately treated. In 21 cases, a DEXA scan had been performed when guidelines recommended that treatment could commence without further assessment. DISCUSSION The findings indicate a high level of awareness of glucocorticoid-induced osteoporosis amongst UK rheumatologists. Most patients identified to be at high risk of bone loss were offered treatment. Although encouraging, current practice could potentially be improved, particularly through more targeted use of DEXA scanning.
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Affiliation(s)
- E Wall
- Brighton & Sussex Medical School, Education Centre, Princess Royal Hospital, Lewes Road, Haywards Heath, West Sussex, RH16 4EX, UK
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Ye S, Patodi N, Walker-Bone K, Reading I, Cooper C, Dennison E. Variation in the matrix metalloproteinase-3, -7, -12 and -13 genes is associated with functional status in rheumatoid arthritis. Int J Immunogenet 2007; 34:81-5. [PMID: 17373931 DOI: 10.1111/j.1744-313x.2007.00664.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
As matrix metalloproteinases (MMPs) play an important role in rheumatoid arthritis, we investigated whether variation in MMP genes was associated with functional disability in rheumatoid arthritis patients. A cohort of patients with seropositive rheumatoid arthritis were recruited and genotyped for the MMP1-1607 1G > 2G, MMP3-1612 5A > 6A, MMP7-153C > T, MMP7-181G > A, MMP12-82A > G and MMP13-77A > G polymorphisms. Genotypes were then analysed in relation to functional disability assessed by Steinbrocker index and Health Assessment Questionnaire (HAQ) score. We detected an association between the MMP13-77 A > G polymorphism and Steinbrocker index, with patients of the A/A genotype having higher score than patients of the A/G or G/G genotype (P = 0.005), and the association remained significant after adjusting for age, sex, erythrocyte sedimentation rate, presence of erosive disease, Ritchie score, prednisolone therapy and years of diagnosis (P = 0.003). We also observed a relationship of Steinbrocker index with the MMP3-1612 5A > 6A, MMP7-181 A > G and MMP12-82A > G polymorphisms (P = 0.082, P = 0.037 and P = 0.045). No association was detected between the MMP1-1607 1G > 2G and MMP7-153C > T polymorphisms and either Steinbrocker index or HAQ score. These results suggest that MMP3, MMP7, MMP12 and MMP13 genotypes may play a role in determining functional status of rheumatoid arthritis.
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Affiliation(s)
- S Ye
- Human Genetics Division, School of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK.
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Walker-Bone K, Cooper C. Hard work never hurt anyone: or did it? A review of occupational associations with soft tissue musculoskeletal disorders of the neck and upper limb. Ann Rheum Dis 2005; 64:1391-6. [PMID: 16162900 PMCID: PMC1755253 DOI: 10.1136/ard.2003.020016] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Pain in the neck and upper limb is common and contributes considerably to absence from work due to sickness. Evidence suggest that prolonged abnormal posture and repetition contribute to such conditions. Psychosocial risk factors may also play a part in the aetiology of upper limb disorders.
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Affiliation(s)
- K Walker-Bone
- Brighton and Sussex Medical School, Mayfield House, University of Brighton, Falmer, Brighton, East Sussex BN1 9PH, UK.
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Walker-Bone K, Cooper C. Hard work never hurt anyone--or did it? A review of occupational associations with soft tissue musculoskeletal disorders of the neck and upper limb. Ann Rheum Dis 2005; 64:1112-7. [PMID: 15829576 PMCID: PMC1755625 DOI: 10.1136/ard.2004.026484] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Pain in the neck and upper limb is common and contributes greatly to absence due to sickness. Evidence is accumulating that factors such as prolonged abnormal posture and repetition contribute to these conditions. Psychosocial factors may also play a part and the relative importance of these is not yet known. Primary and secondary prevention trials are needed.
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Affiliation(s)
- K Walker-Bone
- Brighton and Sussex Medical School, Mayfield House, University of Brighton, Falmer, Brighton, East Sussex BN1 9PH, UK.
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Abstract
BACKGROUND Indo-Asian immigrants are known to be at high risk of metabolic bone disease, but the prevalence of osteoporosis in this population is unknown. AIM To compare the bone mineral at the lumbar spine and femoral neck of Indo-Asian immigrant women with that of age-matched Caucasian women. DESIGN Retrospective analysis. METHODS Women of Indo-Asian origin referred for bone density scans in the last five years were identified. The skeletal status of each was compared with an age-matched Caucasian control for bone mineral content (BMC), bone mineral density (BMD) and bone mineral apparent density (BMAD) at the lumbar spine and femoral neck, and hip axis length was measured. RESULTS At the lumbar spine, Indo-Asians had a significantly lower BMD than Caucasians (0.834 vs. 0.913, p = 0.008), but there was no significant difference when BMAD values were calculated (0.123 vs. 0.122). At the femoral neck, there was no difference in BMD (0.728 vs. 0.712, p = 0.5), and BMAD values were significantly higher among Indo-Asians than Caucasians (0.393 vs. 0.319, p = 0.022). Hip axis length was significantly shorter among Indo-Asian women (10.3 vs. 10.7, p = 0.009). DISCUSSION Although Indo-Asian women appear to have lower spinal BMD than Caucasians, these differences disappear when BMAD values are calculated. While BMD is an areal density, not taking into account the 'depth' of the bone, BMAD is an estimation of volumetric density. Hence lower BMD values in Asians may be a size-related artefact. Longitudinal studies may be required to evaluate the use of BMD as a marker for fracture risk in this population.
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Affiliation(s)
- G Mehta
- Department of Rheumatology, Charing Cross Hospital, London
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Mitchell S, Reading I, Walker-Bone K, Palmer K, Cooper C, Coggon D. Pain tolerance in upper limb disorders: findings from a community survey. Occup Environ Med 2003; 60:217-21. [PMID: 12598671 PMCID: PMC1740489 DOI: 10.1136/oem.60.3.217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To test the hypothesis that non-specific upper limb pain arises from altered pain perception with reduced tolerance of sensory stimuli. METHODS Subjects undergoing clinical examination as part of a community based survey of upper limb disorders were invited to return for an assessment of pain tolerance. A standardised algorithm was used to classify the 94 participants according to whether they had specific upper limb disorders (n = 22), non-specific arm pain (n = 15), or no arm pain (n = 57). Pain tolerance was assessed at three anatomical sites in each arm in response to electrocutaneous stimulation with alternating currents up to a maximum of 10 mA at three frequencies (5, 250, and 2,000 Hz). A proportional odds model was used to compare pain tolerance thresholds according to sex, age, and diagnosis. RESULTS Women were less tolerant of pain than men (OR 0.13) and tolerance also declined with age (OR for one year increase in age 0.97). After allowance for sex and age, there was no indication that pain tolerance was lower in subjects with non-specific arm pain than in those with specific upper limb disorders or those who had no arm pain. CONCLUSIONS The study hypothesis was not supported. However, before the hypothesis is dismissed, it should be tested further in patients with more severe and disabling arm pain.
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Affiliation(s)
- S Mitchell
- MRC Environmental Epidemiology Unit, University of Southampton, UK
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Abstract
Farming is a physically arduous occupation and this places farm workers at potential risk of musculoskeletal disorders such as osteoarthritis (OA) of the hip and knee, low back pain (LBP), neck and upper limb complaints, and hand-arm vibration syndrome (HAVS). This review considers the epidemiological evidence concerning such risks. The strongest evidence relates to OA of the hip, for which the public health impact is likely to be considerable. There is also weaker, but suggestive evidence that farmers more often have knee OA and LBP than workers in occupations with fewer physical demands. Tractor drivers, in particular, seem to have more LBP. Relatively little information exists on the risks of soft tissue rheumatism in the limbs and neck. For some outcomes, the link with occupational risk factors (such as heavy loading of joints and whole-body vibration) is sufficient to suggest the course that future prevention should take, but for several outcomes more research is first needed.
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Affiliation(s)
- K Walker-Bone
- MRC Environmental Epidemiology Unit, Community Clinical Sciences, University of Southampton, Southampton, UK
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Walker-Bone K, Byng P, Linaker C, Reading I, Coggon D, Palmer KT, Cooper C. Reliability of the Southampton examination schedule for the diagnosis of upper limb disorders in the general population. Ann Rheum Dis 2002; 61:1103-6. [PMID: 12429544 PMCID: PMC1753973 DOI: 10.1136/ard.61.12.1103] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Epidemiological research in the field of soft tissue neck and upper limb disorders has been hampered by the lack of an agreed system of diagnostic classification. In 1997, a United Kingdom workshop agreed consensus definitions for nine of these conditions. From these criteria, an examination schedule was developed and validated in a hospital setting. OBJECTIVE To investigate the reliability of this schedule in the general population. METHODS Ninety seven adults of working age reporting recent neck or upper limb symptoms were invited to attend for clinical examination consisting of inspection and palpation of the upper limbs, measurement of active and passive ranges of motion, and clinical provocation tests. A doctor and a trained research nurse examined each patient separately, in random order and blinded to each other's findings. RESULTS Between observer repeatability of the schedule was generally good, with a median kappa coefficient of 0.66 (range 0.21 to 0.93) for each of the specific diagnoses considered. CONCLUSION As expected, the repeatability of tests is poorer in the general population than in the hospital clinic, but the Southampton examination schedule is sufficiently reproducible for epidemiological research in the general population.
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Affiliation(s)
- K Walker-Bone
- MRC Environmental Epidemiology Unit, University of Southampton, UK
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Affiliation(s)
- C Cooper
- MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, England.
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Godfrey K, Walker-Bone K, Robinson S, Taylor P, Shore S, Wheeler T, Cooper C. Neonatal bone mass: influence of parental birthweight, maternal smoking, body composition, and activity during pregnancy. J Bone Miner Res 2001; 16:1694-703. [PMID: 11547840 DOI: 10.1359/jbmr.2001.16.9.1694] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Evidence is accumulating that intrauterine growth and development may influence an individual's risk of osteoporosis in later adult life. To examine maternal and paternal influences on intrauterine skeletal growth, we used dual-energy X-ray absorptiometry to measure the neonatal bone mineral content (BMC) and bone mineral density (BMD) of 145 infants born at term. Independently of the infant's duration of gestation at birth, the birthweights of both parents and the height of the father were positively correlated with neonatal whole body BMC. Women who smoked during pregnancy had infants with a lower whole body BMC and BMD; overall, there was a 7.1-g (11%) average difference between whole body BMC of infants whose mothers did and did not smoke during pregnancy (p = 0.005). Women with thinner triceps skinfold thicknesses (reflecting lower fat stores) and those who reported a faster walking pace and more frequent vigorous activity in late pregnancy also tended to have infants with a lower BMC and BMD (p values for BMC; 0.02, 0.03, and 0.05, respectively). Maternal thinness and faster walking pace but not maternal smoking or parental birthweight also were associated with lower bone mineral apparent density (BMAD). The influences on skeletal growth and mineralization were independent of placental weight, a marker of the placental capacity to deliver nutrients to the fetus. These observations point to a combination of genetic and intrauterine environmental influences on prenatal skeletal development and suggest that environmental modulation, even at this early stage of life, may reduce the risk of osteoporosis in adulthood.
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Affiliation(s)
- K Godfrey
- MRC Environmental Epidemiology Unit, University of Southampton, United Kingdom
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Palmer KT, Cooper C, Walker-Bone K, Syddall H, Coggon D. Use of keyboards and symptoms in the neck and arm: evidence from a national survey. Occup Med (Lond) 2001; 51:392-5. [PMID: 11584118 DOI: 10.1093/occmed/51.6.392] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to examine the relationship between upper limb symptoms and keyboard use in a population survey. A questionnaire was mailed to 21,201 subjects aged 16-64 years, selected at random from the registers of 34 British general practices. Information was collected on occupation and on regular use of keyboards (for >4 h in an average working day), pain in the upper limbs and neck, numbness or tingling in the upper limbs, headaches, and feelings of tiredness or stress. Associations were explored by logistic regression, with the resultant odds ratios converted into prevalence ratios (PRs). Among 12,262 respondents, 4899 held non-manual occupations. These included 1871 regular users of keyboards (e.g. computer operators, data processors, clerks, administrators, secretaries and typists). Pain in the neck or upper limbs and sensory symptoms were common in the non-manual workers overall (with 1 week period prevalences of 30 and 15%, respectively), and were associated with older age, smoking, headaches and tiredness or stress. After adjustment for these factors, regular keyboard use was significantly associated with pain in the past week in the shoulders (PRs 1.2-1.4) and the wrists or hands (PR 1.4), but not with elbow pain or sensory symptoms over the same period, or with neck or upper limb pain that prevented normal activities in the past year. Disabling symptoms were somewhat less prevalent among symptomatic keyboard users than among other symptomatic workers. We conclude that use of keyboards was associated with discomfort at the shoulder and wrist or hand, but risk estimates were lower than generally reported in workplace surveys. Previous estimates of risk in the occupational setting may have been biased by shared expectations, concerns, or other aspects of illness behaviour.
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Affiliation(s)
- K T Palmer
- MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
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Walker-Bone K, Javid K, Arden N, Cooper C. Glucosamine and chondroitin may help in osteoarthritis. BMJ 2001; 322:673. [PMID: 11250841 PMCID: PMC1119856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Palmer KT, Walker-Bone K, Griffin MJ, Syddall H, Pannett B, Coggon D, Cooper C. Prevalence and occupational associations of neck pain in the British population. Scand J Work Environ Health 2001; 27:49-56. [PMID: 11266146 DOI: 10.5271/sjweh.586] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This study determined the prevalence of neck pain and its relation to occupation and occupational activities in the general population. METHODS A questionnaire was mailed to 21 201 subjects aged 16-64 years, randomly selected from the patient registers of general practices in England, Scotland, and Wales, and to 993 subjects randomly selected from pay records of the armed services. Information was collected on occupation, workplace physical activities, neck pain in the past week and year, headaches, and feelings of tiredness or stress. Associations were explored by logistic regression, the resultant odds ratios being converted to prevalence ratios (PR). RESULTS Among 12907 respondents, 4348 and 2528 reported neck pain in past year (1421 with pain interfering with normal activities) and week, respectively. Symptoms were the most prevalent among male construction workers [past week and year 24% and 38% (pain interfering with activities 11%), respectively], followed by nurses, armed services members, and the unemployed. Generally the age-standardized prevalence of neck pain varied little by occupation. Work with arms above the shoulders for >1 hours/day was associated with a significant excess of symptoms [PR 1.3-1.7 (women) and 1.2-1.4 (men)], but no associations existed for typing, lifting, vibratory tool use, or professional driving. Stronger neck-pain associations were found with frequent headaches (PR 2.3-2.8) and frequent tiredness or stress (PR 2.2-2.5) than with occupational activities. CONCLUSIONS The data provide evidence against a strong association between neck pain and the examined occupational physical activities. They suggest that psychosocial factors may be more important.
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Affiliation(s)
- K T Palmer
- Environmental Epidemiology Unit, Medical Research Council (MRC), University of Southampton, England.
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Abstract
This review has shown that osteoporosis is a major public health problem because of its association with fracture. It is now possible to predict future risk of fracture by measuring BMD with noninvasive techniques. The relation between BMD and fracture is comparable to that between blood pressure and stroke such that fracture risk can be assessed from a definition of osteoporosis using bone mass and past history of fracture. Because some of the risk factors for peak bone mass, involutional bone loss, and fracture are now characterized, coupled with innovative agents capable of retarding bone loss, it is becoming possible to generate preventive strategies, for the entire population as well as for those at highest risk.
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Affiliation(s)
- K Walker-Bone
- Medical Research Council Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
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Cooper C, Walker-Bone K, Arden N, Dennison E. Novel insights into the pathogenesis of osteoporosis: the role of intrauterine programming. Rheumatology (Oxford) 2000; 39:1312-5. [PMID: 11136871 DOI: 10.1093/rheumatology/39.12.1312] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- K Walker-Bone
- MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD
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Abstract
Classification of the inflammatory rheumatic disorders is challenging. They represent a heterogeneous group of conditions, mostly of unknown aetiology. However, a uniform language is essential in facilitating clinical and epidemiological research and, therefore, several different approaches have evolved by which we can classify these diseases. One way in which inflammatory arthropathies are frequently distinguished is by the number of joints affected at presentation. Therefore, this chapter will discuss the differential diagnosis of a monoarthropathy and polyarthropathy. The epidemiology of many of the less common inflammatory disorders is poorly elucidated, but the current knowledge, together with its strengths and weaknesses, will be discussed. Finally, we will describe the overall burden of the musculoskeletal disorders in the community, and then highlight the role of the rheumatologist in the management of these disabling conditions.
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Affiliation(s)
- K Walker-Bone
- MRC Environmental Epidemiology Unit, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
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Palmer K, Walker-Bone K, Linaker C, Reading I, Kellingray S, Coggon D, Cooper C. The Southampton examination schedule for the diagnosis of musculoskeletal disorders of the upper limb. Ann Rheum Dis 2000; 59:5-11. [PMID: 10627419 PMCID: PMC1752977 DOI: 10.1136/ard.59.1.5] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Following a consensus statement from a multidisciplinary UK workshop, a structured examination schedule was developed for the diagnosis and classification of musculoskeletal disorders of the upper limb. The aim of this study was to test the repeatability and the validity of the newly developed schedule in a hospital setting. METHOD 43 consecutive referrals to a soft tissue rheumatism clinic (group 1) and 45 subjects with one of a list of specific upper limb disorders (including shoulder capsulitis, rotator cuff tendinitis, lateral epicondylitis and tenosynovitis) (group 2), were recruited from hospital rheumatology and orthopaedic outpatient clinics. All 88 subjects were examined by a research nurse (blinded to diagnosis), and everyone from group 1 was independently examined by a rheumatologist. Between observer agreement was assessed among subjects from group 1 by calculating Cohen's kappa for dichotomous physical signs, and mean differences with limits of agreement for measured ranges of joint movement. To assess the validity of the examination, a pre-defined algorithm was applied to the nurse's examination findings in patients from both groups, and the sensitivity and specificity of the derived diagnoses were determined in comparison with the clinic's independent diagnosis as the reference standard. RESULTS The between observer repeatability of physical signs varied from good to excellent, with kappa coefficients of 0.66 to 1.00 for most categorical observations, and mean absolute differences of 1.4 degrees -11.9 degrees for measurements of shoulder movement. The sensitivity of the schedule in comparison with the reference standard varied between diagnoses from 58%-100%, while the specificities ranged from 84%-100%. The nurse and the clinic physician generally agreed in their diagnoses, but in the presence of shoulder capsulitis the nurse usually also diagnosed shoulder tendinitis, whereas the clinic physician did not. CONCLUSION The new examination protocol is repeatable and gives acceptable diagnostic accuracy in a hospital setting. Examination can feasibly be delegated to a trained nurse, and the protocol has the benefit of face and construct validity as well as consensus backing. Its performance in the community, where disease is less clear cut, merits separate evaluation, and further refinement is needed to discriminate between discrete pathologies at the shoulder.
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Affiliation(s)
- K Palmer
- The MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD
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Abstract
Regional musculoskeletal disorders are a major cause of morbidity both in the community and in the workplace. They comprise a heterogeneous group of conditions that are, for the most part, poorly characterized. Consequently, agreed diagnostic criteria have not existed for many of these disorders, and epidemiological investigations have used varied or ill-defined approaches to case definition. This chapter describes our current understanding of the epidemiology of regional pain disorders and details the strengths and weaknesses of the available data. Pain syndromes can be divided anatomically into those which cause generalized pain, such as fibromyalgia syndrome and myofascial pain syndromes, and those which are confined to one regional anatomical area. The latter group comprise those of the neck, shoulder, elbow, wrist/hand, hip, knee and ankle/foot. Current information is considered on the known risk factors for disorders at these sites, in addition to their impact upon both the individual and society.
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Affiliation(s)
- C H Linaker
- Southampton General Hospital, Southampton, Hants S016 6YD, UK
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