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Biomedical subjects

G J Macfarlane

Publications and source records attributed to G J Macfarlane.

At least 37 records · Page 2Linked to original sources
PubMed2003

Effects of psychosocial and individual psychological factors on the onset of musculoskeletal pain: common and site-specific effects.

OBJECTIVE: To determine whether adverse psychosocial and individual psychological factors increase the risk of pain across regional sites. METHODS: A prospective study was conducted of newly employed workers from 12 diverse occupational groups. Near to the beginning of subjects' employment, details of work related psychosocial factors and individual psychological distress were obtained by means of a self completed questionnaire. Questionnaire follow up after 12 months provided data on these same exposures and ascertained pain at any of four anatomical sites: the low back, shoulder, wrist/forearm, and knee. RESULTS: Of the original 1081 subjects, 829 (77%) provided full details at the one year follow up. Psychosocial work demands and high levels of individual psychological distress were found to have a common effect across sites. Psychological distress was associated with a doubling of the risk of reported pain (odds ratio = 2.1, 95% confidence interval 1.6 to 2.7), while aspects of job demand, poor support from colleagues, and work dissatisfaction were all associated with increased odds of reported pain onset of between 1.4 and 1.7. These effects were almost all common across the four regional pain sites. CONCLUSIONS: In cohorts of newly employed workers, certain work related psychosocial factors and individual psychological distress are associated with the subsequent reporting of musculoskeletal pain, and generally this effect is common across anatomical sites.

Adult↗
PubMed2003

Mechanical and psychosocial factors predict new onset shoulder pain: a prospective cohort study of newly employed workers.

AIM: To test the hypothesis that work related mechanical and psychosocial factors predict new onset shoulder pain in newly employed workers. METHODS: Two year prospective study of newly employed workers from 12 diverse occupational settings. At baseline, 1081 subjects provided information on work related mechanical and psychosocial risk factors, and current pain status. RESULTS: In all, 803 (74%) subjects were free from shoulder pain at baseline. Of those, 638 (79%) responded at 12 months and 476 (88%) at 24 months. New onset shoulder pain was reported by 93 (15%) and 73 (15%) subjects respectively. An increased risk of symptom onset was found in subjects reporting mechanical exposures involving heavy weights including lifting with one or two hands, carrying on one shoulder, lifting at or above shoulder level, and pushing or pulling. Working with hands above shoulder level was also predictive of new onset shoulder pain. Of the psychosocial factors examined, the strongest predictor was monotonous work. Those individuals with any other previous pain also had an increased risk of new onset shoulder pain at follow up. In multivariate analysis, lifting heavy weights with one or two hands, pushing or pulling heavy weights, working with hands above shoulder level, and monotonous work were independently associated with new onset shoulder pain. CONCLUSIONS: This study supports the hypothesised relation between mechanical risk factors and shoulder pain. In general, work related psychosocial factors were modestly associated with new onset shoulder pain. However, monotonous work was a strong risk factor for new onset shoulder pain.

Adult↗
PubMed2002

Sex hormonal factors and chronic widespread pain: a population study among women.

OBJECTIVE: The observation of higher rates of chronic widespread pain, the cardinal feature of fibromyalgia, in women has led to hypotheses about the role of sex hormonal factors in the aetiology of symptoms. There is little available evidence from epidemiological studies on their importance or role. METHODS: A population postal survey was carried out involving 1178 female participants living in south-east Cheshire in the north-west of England. RESULTS: Amongst pre- and peri-menopausal women, the risk of chronic widespread pain was unrelated either to the length of the menstrual cycle or the usual length of period reported by participants. Risk was similar in current users and non-users of the oral contraceptive pill, and amongst users there was no relationship with duration of use. However, the reporting of chronic widespread pain showed a relationship with total score on a premenstrual symptom questionnaire. However, this relationship was explained by pain symptoms. Amongst post-menopausal women, reporting chronic widespread pain was not related to age at menopause. An increased (but non-significant) risk of chronic widespread pain was associated with current hormone replacement therapy (HRT), which may be a consequence of HRT being prescribed for menopausal symptoms. CONCLUSION: This study, conducted on a large unselected population, has not demonstrated an association between sex hormonal factors and chronic widespread pain.

Adolescent↗
PubMed2002

Chronic widespread pain in the population: a seven year follow up study.

OBJECTIVES: To document the natural course of chronic widespread pain (CWP) in a general population sample over a seven year period and to identify comorbidities which predict persistence. METHODS: A mailed survey questionnaire returned by 2334 adults registered with two general practices was used to obtain information on pain status (no pain, regional pain, or CWP) and other health and pain symptoms. Seven years later a second questionnaire was sent to responders who were still registered with the same general practice, asking about their current pain status. RESULTS: Information was obtained for 1386 adults (an adjusted response of 93%). The prevalence of CWP was similar for both surveys at 11% and 10% respectively. Of those with CWP initially, a third recorded CWP on the second survey and 15% were pain free. Only 2% of subjects with no initial pain had developed CWP at follow up. Of subjects with CWP on the initial survey who were aged over 50 years and reported dry eyes or mouth and daytime tiredness, 77% reported CWP seven years later. This contrasts with a persistence of only 9% for those aged under 50 and with neither symptom recorded at initial survey. CONCLUSION: The proportion of subjects from a general population sample changing from CWP to no pain, or vice versa, over a seven year period was very low. This suggests that pain, once established, is likely to persist (or recur) especially if accompanied by other somatic symptoms and older age.

Adult↗
PubMed2002

Mortality among US and UK veterans of the Persian Gulf War: a review.

Mortality data on Gulf War veterans was reviewed as a means of evaluating the long term consequences of the war. Studies were located from searches of Medline, Proceedings of the Conference on Federally Sponsored Gulf War Veterans' Illnesses Research, Proceedings of the American Public Health Association Annual Meetings, Annual Reports to Congress, and personal contacts with knowledgeable investigators. Data on study design, methods, and results were obtained from published studies of both US and UK veterans who served in the Persian Gulf. The methodology and results of studies are summarised and evaluated. Additional research recommendations based on reviewed studies are presented. It is concluded that in both US and UK studies, mortality from external causes was higher, while mortality from all illnesses was lower among Gulf War veterans in comparison to those of non-Gulf War veterans. Increased mortality from external causes is consistent with patterns of postwar mortality observed in veterans of previous wars. Further follow up of Gulf War veterans and their controls is warranted for evaluating the mortality risk from diseases with longer latency periods.

Accidents, Traffic↗
PubMed2001

Widespread body pain and mortality: prospective population based study.

OBJECTIVE: To determine whether there is excess mortality in groups of people who report widespread body pain, and if so to establish the nature and extent of any excess. DESIGN: Prospective follow up study over eight years. Mortality rate ratios were adjusted for age group, sex, and study location. SETTING: North west England. PARTICIPANTS: 6569 people who took part in two pain surveys during 1991-2. MAIN OUTCOME MEASURES: Pain status at baseline and subsequent mortality. RESULTS: 1005 (15%) participants had widespread pain, 3176 (48%) had regional pain, and 2388 (36%) had no pain. During follow up mortality was higher in people with regional pain (mortality rate ratio 1.21, 95% confidence interval 1.01 to 1.44) and widespread pain (1.31, 1.05 to 1.65) than in those who reported no pain. The excess mortality among people with regional and widespread pain was almost entirely related to deaths from cancer (1.55 (1.09 to 2.19) for regional pain and 2.07 (1.37 to 3.13) for widespread pain). The excess cancer mortality remained after exclusion of people in whom cancer had been diagnosed before the original survey and after adjustment for potential confounding factors. There were also more deaths from causes other than disease (for example, accidents, suicide, violence) among people with widespread pain (5.21, 0.94 to 28.78). CONCLUSION: There is an intriguing association between the report of widespread pain and subsequent death from cancer in the medium and long term. This may have implications for the long term follow up of patients with "unexplained" widespread pain symptoms, such as those with fibromyalgia.

Adult↗
PubMed2001

Features of somatization predict the onset of chronic widespread pain: results of a large population-based study.

OBJECTIVE: Chronic widespread pain, the clinical hallmark of the fibromyalgia syndrome, is associated with other physical and psychological symptoms both in patients studied in a clinical setting and in those identified in the community. The present study was undertaken to examine the hypothesis that psychological and physical indicators of the process of somatization predict the development of new chronic widespread pain. METHODS: In this population-based prospective study, 1,658 adults ages 18-65 years completed a detailed pain questionnaire, which included a pain drawing. They also completed the following psychosocial instruments: General Health Questionnaire, Somatic Symptom Checklist, Fatigue Questionnaire, and Illness Attitude Scales. Individuals were followed up at 12 months, at which time 1,480 (93% of subjects still living at their baseline address) provided data on pain status, using the same instruments. RESULTS: At baseline, 825 subjects were classified as pain free and 833 as having pain not satisfying criteria for chronic widespread pain. Of those, 18 (2%) and 63 (8%), respectively, were classified as having chronic widespread pain at followup. After adjustment for age and sex, there were strong relationships between baseline test scores and subsequent risk of chronic widespread pain (odds ratio for the Somatic Symptom Checklist 3.3; odds ratio for the Illness Behavior subscale of the Illness Attitude Scales 9.0). All 95% confidence intervals excluded unity. These associations were independent of baseline pain status. CONCLUSION: Subjects who are free of chronic widespread pain are at increased future risk of its development if they display other aspects of the process of somatization. Data from this population-based prospective study lend powerful support to the hypothesis that chronic widespread pain can be one manifestation of the somatization of distress.

Adolescent↗
PubMed2001

Risk factors for persistent chronic widespread pain: a community-based study.

BACKGROUND: Chronic widespread pain is the cardinal clinical feature of the fibromyalgia syndrome, which, in the majority of clinic patients, is persistent. By contrast, in community-derived patients, pain is persistent in only half of the affected individuals, particularly those with psychological distress. Whether such distress is a consequence of the pain or a manifestation of a wider process of somatization which is associated with the persistence of pain is unclear. OBJECTIVES: We tested in a large, prospective, population-based study the hypothesis that features of somatization predict the persistence of chronic widespread pain. METHODS: In all, 252 (13%) of 1953 adult subjects selected from a population register were classified as having chronic widespread pain based on a detailed questionnaire which included a pain drawing. The patients also completed a number of psychosocial instruments which measure features known to be associated with somatization. Two hundred and twenty-five (91%) of the patients were successfully followed up after 12 months and provided data on pain status using the same instruments. RESULTS: In all, 126 (56%) patients reported chronic widespread pain at follow-up, 74 (33%) reported other pain and 25 (11%) reported no pain. Persistent chronic widespread pain was strongly associated with baseline test scores for high psychological distress and fatigue. In addition, these subjects were more likely to display a pattern of illness behaviour characterized by frequent visits to medical practitioners for symptoms which disrupt daily activities. The prevalence of persistent pain increased with the number of risk factors the subjects were exposed to. CONCLUSIONS: Although almost half of the cases of chronic widespread pain resolved within 1 yr, this study has demonstrated for the first time that those subjects who display features of somatization are more likely to have widespread pain which persists. These findings have implications for the identification and treatment of persons with persistent chronic widespread pain.

Adolescent↗
PubMed2001

Health and exposures of United Kingdom Gulf war veterans. Part I: The pattern and extent of ill health.

OBJECTIVES: To assess the health of United Kingdom Gulf war veterans, to compare their health to that of similar personnel not deployed, to describe patterns of ill health in both groups, and to estimate their extent. METHODS: Main Gulf (n=4795) and validation Gulf (n=4793) cohorts were randomly selected within strata from the population deployed to the Gulf and a non-Gulf cohort (n=4790) from those who were not sent. Seven years after the war subjects completed a questionnaire about their health in the past month, including 95 symptom questions and two manikins on which to shade areas of pain or numbness and tingling. Responses were subjected to a principal component analysis with rotation and to a cluster analysis within each cohort. Mean symptom score was used as a measure of severity. Areas shaded on the manikins were coded to indicate widespread pain and possible toxic neuropathy. RESULTS: A response of 85.5% was achieved. Those who had been to the Gulf were more troubled by every symptom with a mean severity score (3.0) substantially greater than in the non-Gulf cohort (1.7). Seven factors were extracted accounting for 48% of the variance. The scores on five factors (labelled psychological, peripheral, respiratory, gastrointestinal, and concentration) were significantly worse in those who had been to the Gulf. Symptoms suggestive of peripheral neuropathy were found more often (12.5%) in the Gulf than the non-Gulf (6.8%) cohorts. Widespread pain was also found more often (12.2% Gulf; 6.5% non-Gulf). Those who had been to the Gulf were found disproportionately (23.8%) in three clusters with high mean severity scores; only 9.8% of non-Gulf respondents were in these clusters. There was no evidence of an important excess in the use of alcohol, tobacco, or referral to hospital specialists by those who had been to the Gulf. For the same level of reported ill health those who had been to the Gulf were less likely to be referred to specialists than non-Gulf veterans. CONCLUSION: 7 Years after the war, the Gulf war veterans were more troubled about their health than those who had not been sent, with a substantial subgroup reporting a pattern of symptoms suggestive of a significant decline in health.

Adult↗
PubMed2001

Health and exposures of United Kingdom Gulf war veterans. Part II: The relation of health to exposure.

OBJECTIVES: To investigate whether, in personnel who served with the United Kingdom forces in the Gulf war, self reported exposures were related to symptoms in a way that was consistent, specific, and credible. METHODS: Responses to symptom and exposure questionnaires, completed 7 or more years after the war, were collected from 7971 subjects deployed in the Gulf, from two exposed cohorts, in a study with an overall response rate of 85.5%. Exposures were considered in three groups, those outside the control of the subjects, the use of prophylaxis, and indicators of susceptibility. Health indices derived from symptom questionnaires were related to reports of 14 exposures in these three groups in a series of multiple regression analyses to allow for confounding. The relation of exposure to complaints of widespread pain and to symptoms suggesting peripheral neuropathy were examined by logistic regression. RESULTS: Consistent but weak correlations between exposures and with health effects were found in independent analyses of the two (main and validation) cohorts. Three exposures outside the control of the subject, the number of inoculations, the number of days handling pesticides, and the days exposed to smoke from oil fires, were consistently and independently related to severity. The number of inoculations was also associated with higher scores on a factor weighted on symptoms associated with skin and musculoskeletal complaints. The number of days handling pesticides related particularly to scores on a neurological factor and to symptoms consistent with toxic neuropathy. CONCLUSION: The relations between exposures and ill health were generally weak. Consistent, specific, and credible relations, warranting further investigation, were found between health indices and two exposures, the reported number of inoculations and days handling pesticides.

Adult↗
PubMed2001

Short term influence of mechanical factors on regional musculoskeletal pain: a study of new workers from 12 occupational groups.

OBJECTIVES: To determine the influence of short term exposure to mechanical factors on regional musculoskeletal pain. METHODS: Full time newly employed workers were recruited from 12 occupational groups and information collected by questionnaire. Subjects indicated on a blank body manikin any low back, shoulder, wrist or forearm or both, or knee pain which had occurred during the past month and had lasted more than 1 day. Data were also collected with a previously validated questionnaire on working postures, manual handling activities, and repetitive movements of the upper limb. The relations between mechanical factors and each area of pain were calculated as odds ratios (ORs) with 95% confidence intervals (95% CIs). Adjustment was made for age and sex. RESULTS: 1081 subjects (median age 23; interquartile range 20--27) were recruited to the study (a participation rate of 91%). 261 (24%) reported low back pain, 221 (20%) shoulder pain, 93 (9%) wrist or forearm pain, and 222 (21%) knee pain. Several specific manual handling activities were found to be associated with low back, shoulder, and knee pain. Carrying weights of more than 50 lbs (23 kg) on one shoulder was the factor which was most strongly associated with low back pain (OR 2.4 (95% CI 1.5 to 3.8)), shoulder pain (OR 3.1 (95% CI 1.9 to 4.8)), and knee pain (OR 3.5 (95% CI 2.2 to 5.5)), whereas forearm pain was most strongly associated with repetitive movements of the wrists (OR 1.8 (95% CI 1.04 to 3.1)). By contrast very few postures were associated with regional pain, although bending forwards in an uncomfortable position for at least 15 minutes was associated with shoulder pain (OR 1.6 (95% CI 1.2 to 2.2)) and kneeling for at least 15 minutes was associated with knee pain (OR 1.8 (95% CI 1.2 to 2.6)). Exposure to mechanical factors was most strongly associated with pain at multiple sites rather than with pains in individual regions. CONCLUSIONS: Even among workers with only short term exposure to mechanical factors, musculoskeletal pain is increased.

Adult↗
PubMed2001

The grading of hallux valgus. The Manchester Scale.

This article describes a new, noninvasive method of assessing the severity of hallux valgus deformity by means of a set of standardized photographs. Six podiatrists were independently asked to grade the level of deformity of 13 subjects (26 feet) on a scale of 1 (no deformity) to 4 (severe deformity). The reliability of the four-point scale for the severity of hallux valgus was investigated by means of kappa-type statistics for more than two raters. The results showed that the grading method had excellent interobserver repeatability with a combined kappa-type statistic of 0.86, making it a suitable instrument for clinical and research purposes.

Foot↗
PubMed2001

The influence of work related psychosocial factors and psychological distress on regional musculoskeletal pain: a study of newly employed workers.

OBJECTIVE: To determine the influence of short term work related psychosocial factors (work demands, job control, and social support) and psychological distress on regional pain syndromes. METHODS: Newly employed workers were recruited from 12 occupational groups and information collected by questionnaire. Subjects indicated on a blank body manikin any low back, shoulder, wrist/forearm, or knee pain that had occurred during the past month and lasted more than one day. Data were also collected on work related psychosocial factors and on levels of psychological distress [using the General Health Questionnaire (GHQ)]. The relationships between psychosocial factors and psychological distress and each area of pain were calculated as odds ratios with 95% confidence intervals. Adjustment was made for age, sex, and occupational group. RESULTS: 1081 subjects (median age 23; interquartile range 20-27) were recruited to the study shortly after commencing employment: 261 (24%) reported low back pain, 221 (20%) reported shoulder pain, 93 (9%) reported wrist/forearm pain, and 222 (21%) reported knee pain. High levels of psychological distress were associated with increased likelihood of pain, with a trend observed between scores on the GHQ and the odds of pain in each of the 4 sites. Those who perceived their work as stressful most of the time were more likely to report back (OR 1.8, 95% CI 1.01-3.1) or shoulder pain (OR 1.9, 95% CI 1.02-3.4) than those who considered their work seldom stressful. Pace of work or job autonomy was less markedly related to pain at individual sites. Strong relationships were observed between psychological distress, job demands (stressful work, hectic work), low job control, and pain at multiple sites. CONCLUSION: The study has shown that adverse work related psychosocial factors, in particular aspects of job demand and control, influence the reporting of regional musculoskeletal pain. This occurs even after only short term exposure. The odds of reporting these adverse exposures are increased when pain is reported at multiple sites.

Adult↗
PubMed2001

Association of occupational physical demands and psychosocial working environment with disabling shoulder pain.

OBJECTIVE: To estimate the individual and combined associations of physical and psychosocial working environment with disabling shoulder pain and to identify groups at "high risk" for shoulder pain. METHODS: A cross sectional survey was conducted at five manual occupational settings in south Manchester, United Kingdom (n=775, 83%). RESULTS: Both the duration of occupational physical demands (working postures, manual handling activities, and repetitive arm movements) and psychosocial working environment (psychological demands and lack of opportunity to learn new skills) were found to be significantly associated with shoulder pain. Three occupational factors identified a high risk group for shoulder pain: duration of lifting with one hand (prevalence rate ratio (PRR) (highest third) 2.0, 95% confidence interval (CI) 1.4 to 2.8), duration of working above shoulder level (PRR (highest third) 2.2, 95% CI 1.5 to 3.3), and whether employees found their work stressful (PRR (highest third) 1.4, 95% CI 1.0 to 2.1). In addition, a measure of psychological distress (General Health Questionnaire (GHQ) score) was found to identify a group at high risk for shoulder pain (PRR (highest third) 1.9, 95% CI 1.3 to 2.9). In employees exposed to three or more of these factors, 79% (23/29) reported shoulder pain compared with only 16% (56/353) of those not exposed to any. CONCLUSION: This study has identified a variety of occupational physical demands and psychosocial factors associated with shoulder pain. It has also identified groups of employees at a "high risk" for shoulder pain by their exposure to both physical and psychosocial factors.

Adolescent↗
PubMed2001

Associations between adverse events in childhood and chronic widespread pain in adulthood: are they explained by differential recall?

OBJECTIVE: Clinic based studies suggest that adverse events in childhood may predispose to chronic pain in adult life. These have been conducted on highly selected groups, and it is unknown whether these relationships hold in the general population and to what extent the increased rate of adverse childhood events in persons with pain is an artefact of differential reporting. We examined the hypothesis that chronic widespread pain was associated with reports of adverse experiences in childhood and whether any observed relationships could be explained by differential recall. METHODS: A cross sectional population based screening survey was conducted. Subjects completed a questionnaire that included assessments of pain and psychological state. In total, 296 subjects who had demonstrated psychological distress were randomly selected and had a detailed interview, which included an assessment of 14 adverse childhood experiences. Medical records relating to childhood were also examined for those subjects. RESULTS: The prevalence of self-reported adverse childhood experiences was greatest in adult subjects with current chronic widespread pain. Exposure to illness in family members, parental loss, operations, and abuse were all associated with increased, but nonsignificant, odds of having chronic widespread pain versus those without such exposures. However the only statistically significant association was with childhood hospitalizations. From medical record information the associations of hospitalizations (OR 5.1, 95% CI 2.0-13.0) and operations (OR 3.0, 95% CI 1.2-7.2) with pain previously noted were partly explained by differential recall between subjects with and without pain: hospitalizations, OR 2.2, 95% CI 0.9-5.5; operations, OR 1.2, 95% CI 0.5-3.4. CONCLUSION: Although several reported adverse events in childhood were observed to be associated with chronic widespread pain in adulthood, only reports of hospitalizations were significantly associated. Validation of self-reported exposures suggests that there was differential recall of past events among those with and without pain, and this differential recall explained the association between hospitalizations and current chronic pain. Such differential recall may explain other observations of an association between reports of adverse childhood events and chronic pain in adulthood.

Adult↗