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Biomedical subjects

G J MacFarlane

Publications and source records attributed to G J MacFarlane.

7 recordsLinked to original sources
PubMed2006

The role of psychosocial factors in predicting the onset of chronic widespread pain: results from a prospective population-based study.

OBJECTIVE: Chronic widespread pain (CWP) is strongly associated with psychosocial distress both in a clinical setting and in the community. The aim of this study was to determine the contribution of measures of psychosocial distress, health-seeking behaviour, sleep problems and traumatic life events to the development of new cases of CWP in the community. METHODS: In a population-based prospective study, 3171 adults aged 25-65 yrs free of CWP were followed-up 15 months later to identify those with new CWP. Baseline data were available on their scores from a number of psychological scales including Illness Attitude Scales (IAS), Somatic Symptom Checklist (SSC), Hospital Anxiety & Depression Scale, Sleep Problems Scale, and Life Events Inventory. RESULTS: 324 subjects [10%, 95% confidence interval (CI) 9.2, 11.3] developed new CWP at follow-up. After adjustment for age and sex, three factors independently predicted the development of CWP: scoring three or more on the SSC [odds ratio (OR) 1.8, 95% CI 1.1, 3.1], scoring eight or more on the Illness Behaviour subscale of the IAS (OR 3.3, 95% CI 2.3, 4.8), and nine or more on the Sleep Problem Scale (OR 2.7, 95% CI 1.6, 3.2). Subjects exposed to all three factors were at 12 times the odds of new CWP than those with low scores on all scales. CONCLUSION: Subjects are at substantial increased odds of developing CWP if they display features of somatization, health-seeking behaviour and poor sleep. Psychosocial distress has a strong aetiological influence on CWP.

Adult↗
PubMed1996

The natural history of chronic pain in the community: a better prognosis than in the clinic?

OBJECTIVE: To evaluate the predictors of improvement at 2 years in subjects with chronic widespread pain ascertained from a community survey. METHODS: As part of a community based epidemiological survey on the occurrence of pain, 141 subjects (age range 24-74 years; 44 men, 97 women) were selected for more detailed assessment. Followup information on pain experience was collected at a median of 27 months (range 15-35). Subjects were categorized according to whether they had no pain, chronic widespread pain (according to the American College of Rheumatology criteria), or regional pain, both at initial assessment and followup. In addition, subjects were examined at both time periods for tender points. RESULTS: Of those with chronic widespread pain at initial assessment, 35% still had chronic widespread pain at followup, 50% regional pain, and 15% no pain. Of those originally with regional pain, 65% still had regional pain, 19% chronic widespread pain, and 16% no pain at followup. Logistic regression analysis was conducted to examine factors among those with chronic widespread pain associated with still having these symptoms at followup. Female sex, older age, leaving school at a young age, high tender point count, high levels of fatigue, or additional physical or psychological symptoms were all associated with symptoms being less likely to resolve. CONCLUSION: Chronic widespread pain in the community has a generally good prognosis. However, those with additional symptoms associated with the fibromyalgia syndrome were more likely still to have chronic widespread pain 2 years later.

Adult↗
PubMed1996

Widespread pain: is an improved classification possible?

OBJECTIVE: The classification of widespread pain, proposed by the American College of Rheumatology (ACR) for use in the clinic as a screen for fibromyalgia, as described, does not require truly widespread pain. Studies considering the epidemiology of widespread pain per se may therefore require a definition with greater face validity, which might also show enhanced associations with other physical and psychological measures. We aimed to develop a more coherent definition of widespread pain for use in epidemiological studies and to compare performance in identifying individuals with significant morbidity. METHODS: A group of 172 subjects who had participated in a community based study on the occurrence of pain were identified and categorized by their pain experience as indicated on line drawings of the body according to ACR definition and to a new, more stringent definition that required the presence of more diffuse limb pain. A number of other clinical and psychological measures were recorded for these individuals and the association between their pain status measures and these other variables was assessed and compared. RESULTS: Persons satisfying the newly proposed definition for chronic widespread pain, in comparison with those who satisfied only the present ACR definition, had a significantly higher score on the General Health Questionnaire [median difference (MD) 7.95% CI 1.13], a higher score on the Health and Fatigue Questionnaire (MD 10.95% CI 0.15), and greater problems with sleep (sleep problem score MD 4.95% CI 0.9). Those satisfying the new definition also had a greater number of tender points on examination (MD 3.95% CI -1.7). The morbidity of those satisfying only the present ACR definition was closer to persons who had regional pain. CONCLUSION: A redefinition of widespread pain has produced a group of subjects whose pain is (a) likely to be more "widespread" and (b) is associated more strongly with factors such as psychological disturbance, fatigue, sleep problems, and tender points, and may be more appropriate in epidemiological studies.

Adolescent↗
PubMed1993

The descriptive epidemiology of pharyngeal cancer in Scotland.

There have been recent reports of substantial increases occurring in the incidence of and/or mortality from tongue and mouth cancers in several countries. In this paper using data from Scotland (1960-89) we report on time trends in pharyngeal cancer. Similar increases in rates are evident for cancers of the oropharynx and hypopharynx while there has been little change in the occurrence of nasopharyngeal cancer (which has distinct aetiological factors). It therefore seems that reported changes in the incidence of and mortality from oral cancer may be real, and in Scotland, this is most probably due to changes in alcohol consumption.

Adult↗
PubMed1993

The epidemiology of thyroid carcinoma.

Thyroid cancer is one of the rarest forms of cancer, yet there are wide variations in the degree of malignancy, ranging from the most rapidly fatal to the relatively benign. This is almost entirely dependent on the histological type. Generally speaking, data available on changing trends of incidence and mortality are subject to reservation, dependent on the degree to which they have been influenced by changing diagnostic criteria and the precision of histopathological description. Nevertheless, there is evidence that mortality is slowly decreasing, while incidence is slowly increasing. The purpose of this review is to try to interpret the temporal trends of incidence and mortality rates for thyroid carcinoma in the last 3 decades in light of the problems arising from changes in diagnostic standards and histological classification regarding thyroid neoplasms. Attention is also drawn to the implications, from a public health viewpoint, of the present intensive detection and treatment of occult thyroid carcinomas.

Causality↗
PubMed1986

Prognostic factors in thyroid tumours.

Using Cox's Proportional Hazard Model, we have demonstrated the influence of age, sex, microscopic tumour type, extent of primary tumour, nodal status and the presence of metastases on prognosis, in our population of 441 patients with thyroid carcinoma. The TNM classification contributes significantly to survival, but does not include other contributory prognostic variables, whereas the prognostic index developed by the EORTC thyroid study group, which takes account of age and histology, proved a reliable predictor of survival for our patient group.

Age Factors↗