PubMed Health⌕ Search

Biomedical subjects

G J Macfarlane

Publications and source records attributed to G J Macfarlane.

At least 55 records · Page 3Linked to original sources
PubMed2000

Risk of malignancy among patients with rheumatic conditions.

Previous studies have described an increased risk of malignancy in subjects diagnosed with rheumatic conditions, most notably rheumatoid arthritis (RA). Our aim was to quantify and compare risks for site-specific malignancy among hospitalized patients with RA, osteoarthritis (OA) and other rheumatic conditions in a nationwide, population-based cohort. Subjects were identified from Scottish hospital in-patient records from 1981 to 1996 and followed up by computer linkage of the Scottish Cancer Registry and the national registry of deaths. Expected cancer incidence was calculated from national cancer rates and related to the observed incidence by the standardized incidence ratio (SIR). Among RA patients, there was an increased risk for hematopoietic [males SIR= 2.13, 95% confidence interval (CI) 1.7-2.7; females SIR = 1.76, 95% CI 1.5-2.1], lung (males SIR = 1.32, 95% CI 1.2-1.5; females SIR = 1.44, 95% CI 1.3-1.6) and prostate (SIR = 1.26, 95% CI 1.0-1.6) cancers. Reduced risk were seen for colorectal cancer (males SIR = 0.87, 95% CI 0.7-1.1; females SIR = 0.71, 95% CI 0.6-0.9) and, among females, stomach cancer (SIR = 0.70, 95% CI 0.5-1.0). The excess risk for hematopoietic cancer and the reduced risk for colorectal and stomach cancers were sustained over 10 years of follow-up. An overall decreased risk of cancer was observed for patients with OA; the greatest reductions were observed for colorectal (males SIR = 0.88, 95% CI 0.8-1.0; females SIR = 0.84, 95% CI 0.8-0.9), stomach (males SIR = 0.79, 95% CI 0.7-0.9; females SIR = 0.66, 95% CI 0.6-0.8) and lung (males SIR = 0.72, 95% CI 0.7-0.8; females SIR = 0.84, 95% CI 0.8-0.9) malignancies, with decreased risks generally still evident at 10 years of follow-up. Our results support several previous findings regarding the incidence of hematopoietic and colorectal malignancies in RA patients. In addition, we have shown a large decrease in stomach cancer among patients with OA and females with RA that warrants further investigation since it may provide clues to possible prevention strategies. To further our knowledge about the underlying mechanisms of altered risk in cancer patients with rheumatic conditions, population studies requiring primary data collection are required.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

Role of mechanical and psychosocial factors in the onset of forearm pain: prospective population based study.

OBJECTIVE: To determine the aetiology of forearm pain. In particular to determine the relative contribution of (a) psychological factors, features of somatisation, and health anxiety and behaviour, (b) work related mechanical factors, and (c) work related psychosocial factors in the onset of forearm pain. DESIGN: 2 year prospective population based cohort study, with retrospective assessment of exposures at work. SETTING: Altrincham, Greater Manchester. PARTICIPANTS: 1953 individuals aged 18-65 years. OUTCOME MEASURES: Forearm pain of new onset. RESULTS: At follow up, 105 (8.3%) participants reported forearm pain of new onset lasting at least one day in the past month. Among these, 67% also reported shoulder pain, 65% back pain, and 45% chronic widespread pain. Increased risks of onset were associated with high levels of psychological distress (relative risk 2.4, 95% confidence interval 1.5 to 3.8), reporting at least two other somatic symptoms (1.7, 0.95 to 3.0), and high scores on the illness behaviour subscale of the illness attitude scales. The two work related mechanical exposures associated with the highest risk of forearm pain in the future were repetitive movements of the arm (4.1, 1.7 to 10) or wrists (3.4, 1.3 to 8.7), whereas the strongest work related psychosocial risk was dissatisfaction with support from colleagues or supervisors (4.7, 2. 2 to 10). CONCLUSIONS: Psychological distress, aspects of illness behaviour, and other somatic symptoms are important predictors of onset of forearm pain in addition to work related psychosocial and mechanical factors. Misleading terms such as "cumulative trauma disorder" or "repetitive strain injury," implying a single uniform aetiology, should be avoided.

Adult↗
PubMed2000

Mortality among UK Gulf War veterans.

BACKGROUND: Armed forces personnel who served in the Gulf War report more current ill-health than those who were not deployed. There has been concern expressed that they may also experience higher mortality rates. METHODS: A retrospective cohort study was done including all 53462 UK Gulf War veterans (Gulf cohort) and a comparison group equivalent in size of personnel who were not deployed but matched for age, sex, rank, service, and level of fitness (Era cohort). Individuals were identified on central registers of the Office for National Statistics and information on death among cohort subjects, including cause of death, obtained. Follow-up extended from April 1, 1991 (the end of the Gulf War) until March 31, 1999. FINDINGS: There were 395 deaths among the Gulf cohort and 378 deaths amongst the Era cohort (mortality rate ratio [MRR] 1.05, 95% CI 0.91-1.21). Mortality from "external" causes was higher in the Gulf cohort (Gulf 254, Era 216; MRR 1.18 [0.98-1.42] while mortality from "disease-related" causes was lower (Gulf 122, Era 141; 0.87 [0.67-1.11]). The higher mortality rate from "external" causes in the Gulf cohort was principally due to higher mortality rates from accidents. There was, however, no excess of deaths recorded as suicide in the Gulf cohort. INTERPRETATION: This follow-up of veterans of the Gulf war has shown, 8 years after the end of the conflict, that although they have experienced higher mortality rates than a comparison cohort, the excess mortality rate is very small and does not approach statistical significance. The excess is related mainly to accidents rather than disease, a pattern that is consistent both with US veterans of the Gulf war and veterans from other conflicts.

Adult↗
PubMed2000

The association between chronic widespread pain and mental disorder: a population-based study.

OBJECTIVE: Patients with chronic widespread pain (CWP) have been reported to have a greater prevalence of mental disorders and somatization than that found in the general population, but the true association between CWP and mental disorders is unknown. In this study, we investigated whether there is an increased prevalence of mental disorder in people with CWP from the general population. We also describe the psychiatric diagnoses associated with CWP. METHODS: In a population-based case-control study, 1,953 subjects (75% of a random sample of individuals age 18-65 years) completed a questionnaire that included a pain assessment and the 12-item General Health Questionnaire (GHQ-12). Of 710 subjects scoring >1 on the GHQ-12, 301 were assessed further using a structured psychiatric interview and detailed assessment of medical records to identify cases of mental disorder, in accordance with criteria of the 10th edition of the International Classification of Diseases. The association between CWP and mental disorder was modeled using logistic regression, adjusting for possible confounders including age, sex, and nonresponders. RESULTS: We estimated the overall population prevalence of mental illness to be 11.9%. The odds of having a mental disorder for subjects with versus those without CWP were 3.18 (95% confidence interval 1.97-5.11). Most subjects with mental disorders were diagnosed as having mood and anxiety disorders. Only 3 cases of somatoform disorders were identified, and all were associated with pain. CONCLUSION: This study, although unable to demonstrate a cause-and-effect relationship, showed that 16.9% of those with CWP were estimated to have a psychiatric diagnosis, suggesting that these disorders should be identified and treated.

Adolescent↗
PubMed2000

Development and validation of a questionnaire to assess disabling foot pain.

This study outlines the design and validation of a new self-administered instrument for assessing foot pain and disability. The 19-item questionnaire was tested on 45 rheumatology patients, 33 patients who had attended their general practitioner with a foot-related problem and 1000 responders to a population survey of foot disorders. Levels of reported disability were found to be greatest for rheumatology patients and least for community subjects. In addition, the instrument was able to detect differences in disability levels reported by community subjects who did and did not consult with a health care professional and those who did and did not have a history of past and current foot pain. A good level of agreement was found when items on the questionnaire were compared with similar items on the ambulation sub-scale of the Functional Limitation Profile questionnaire. A Cronbach's alpha value of 0.99 and item-total correlation values between 0.25 and 0.62 confirmed the internal consistency of the instrument. Finally the results of a principal components analysis identified three constructs that reflected disabilities that are associated with foot pain: functional limitation, pain intensity and personal appearance. The design of the foot disability questionnaire makes it a suitable instrument for assessing the impact of painful foot conditions in both community and clinical populations.

Adult↗
PubMed2000

Increasing incidence of oral cancer amongst young persons: what is the aetiology?

The reasons for an increasing incidence of oral cancer, particularly amongst younger persons is unclear. It has been hypothesised either to be a result of an increase in exposure to known risk factors amongst certain groups in the community, or to be due to new aetiological agents. Prior to conducting large expensive population-based studies, it seems appropriate to conduct initial smaller-scale surveys to assess evidence for each of these two hypotheses. This survey of young persons with oral cancer suggest that most are exposed to traditional risk factors of tobacco smoking, drinking alcohol and a low consumption of fruit and vegetables.

Adolescent↗
PubMed2000

Radiographic change is common in new presenters in primary care with hip pain. PCR Hip Study Group.

OBJECTIVE: To determine the prevalence of radiographic osteoarthritis in subjects with hip pain newly presenting to primary care. METHODS: The study was cross-sectional in design, set in 35 general practices across the UK. It included 195 men and women aged 40 yr and over (median 63 yr) presenting with a new episode of hip pain. Hip radiographs were scored for minimum joint space (MJS) and overall-Croft's modification of the Kellgren and Lawrence (Croft)-grade of osteoarthritis. RESULTS: In all, definite evidence of radiographic change in the painful joint was common: Croft grade > or =2 in 44%, > or =3 in 34%. MJS of 2.5 mm or less was seen in 30% of whom half were below 1.5 mm. There were no significant gender differences in radiographic severity. CONCLUSIONS: Radiographic change is common in patients newly presenting with hip pain and many already have advanced disease.

Adult↗
PubMed2000

Occupational risk factors for shoulder pain: a systematic review.

OBJECTIVES: To systematically evaluate the available evidence on occupational risk factors of shoulder pain. METHODS: Relevant reports were identified by a systematic search of Medline, Embase, Psychlit, Cinahl, and Current Contents. The quality of the methods of all selected publications was assessed by two independent reviewers using a standardised checklist. Details were extracted on the study population, exposures (physical load and psychosocial work environment), and results for the association between exposure variables and shoulder pain. RESULTS: 29 Studies were included in the review; three case-control studies and 26 cross sectional designs. The median method score was 60% of the maximum attainable score. Potential risk factors related to physical load and included heavy work load, awkward postures, repetitive movements, vibration, and duration of employment. Consistent findings were found for repetitive movements, vibration, and duration of employment (odds ratio (OR) 1.4-46 in studies with method scores >/= 60%). Nearly all studies that assessed psychosocial risk factors reported at least one positive association with shoulder pain, but the results were not consistent across studies for either high psychological demands, poor control at work, poor social support, or job dissatisfaction. Studies with a method score >/=60% reported ORs between 1.3 and 4.0. Substantial heterogeneity across studies for methods used for exposure assessment and data analysis impeded statistical pooling of results. CONCLUSIONS: It seems likely that shoulder pain is the result of many factors, including physical load and the psychosocial work environment. The available evidence was not consistent across studies, however, and the associations were generally not strong. Future longitudinal research should evaluate the relative importance of each individual risk factor and the role of potential confounding variables-such as exposure during leisure time-to set priorities for the prevention of shoulder pain in occupational settings.

Bias↗
PubMed1999

Short-term physical risk factors for new episodes of low back pain. Prospective evidence from the South Manchester Back Pain Study.

STUDY DESIGN: A prospective population-based cohort study performed in South Manchester, United Kingdom. OBJECTIVES: To determine whether nonoccupational physical activity and indicators of physical stress on the spine predict low back pain in the short term. SUMMARY OF BACKGROUND DATA: There is evidence that physical activity outside the workplace helps to protect against low back pain in the long term. However, such activity may injure or stress the spine in the short term. METHODS: A baseline survey questionnaire identified 2715 adults, aged 18-75 years, with no low back pain at the time of the survey. Information on potential predictors of low back pain also was obtained. New episodes of back pain were identified during the subsequent year. RESULTS: A new low back pain episode occurred in 34% of men and 37% of women. Poor general health at baseline was the strongest predictor of a new episode of pain (men: relative risk (RR) 1.5, 95% confidence intervals (CI) 0.8, 2.7; women: RR 2.2, 95% CI 1.2, 4.0). High weight was associated with subsequent low back pain in women (RR 1.4; 95% CI 1.0, 2.0), but neither height nor weight predicted low back pain in men. A self-rated low level of physical activity was not consistently linked with subsequent low back pain, nor were specific nonoccupational physical activities, apart from home-improvement work in men and regular sports in women. CONCLUSION: Although some specific activities may be hazardous to the back, physical activity outside the workplace does not increase the short-term risk of low back pain overall. Leisure-time physical activity is not a hazard to the back, whereas poor physical health in both genders and heavier weight in women do increase the risk of new low back pain episodes in the short term.

Adult↗
PubMed1999

Predicting who develops chronic low back pain in primary care: a prospective study.

OBJECTIVES: To quantify the relative contribution of premorbid and episode specific factors in determining the long term persistence of disabling symptoms of low back pain. DESIGN: Prospective cohort study. SETTING: Two general practices in the south Manchester area. PARTICIPANTS: 180 patients, who previously participated in a cross sectional population survey, who consulted because of low back pain during the study period. They were followed at 1 week and 3 and 12 months after consultation. MAIN OUTCOME MEASURE: Persistent disabling low back pain in the 12 months after the consultation. RESULTS: Disabling low back pain persisted in one third of participants after consultation and was more common with increasing age, among those with a history of low back pain, and in women. Persistence of symptoms was associated with "premorbid" factors (high levels of psychological distress (odds ratio 3.3; 95% confidence interval 1.5 to 7.2), poor self rated health (3.6; 1.9 to 6.8), low levels of physical activity (2.8; 1.4 to 5.6), smoking (2. 1; 1.0 to 4.3), dissatisfaction with employment (2.4; 1.3 to 4.5)) and factors related to the episode of low back pain (duration of symptoms, pain radiating to the leg (2.6; 1.3 to 5.1), widespread pain (6.4; 2.7 to 15), and restriction in spinal mobility). A multivariate model based on six factors identified groups whose likelihood of persistent symptoms ranged from 6% to 70%. CONCLUSIONS: The presence of persistent low back pain is determined not only by clinical factors associated with pain but also by the premorbid state.

Adolescent↗
PubMed1999

The association between tender points, psychological distress, and adverse childhood experiences: a community-based study.

OBJECTIVE: To examine the hypothesis that characteristics of somatization and illness behavior, and their childhood antecedents, are associated with the presence of multiple tender points. METHODS: Two hundred eighty-nine subjects who had demonstrated psychological distress (General Health Questionnaire score > or =2) had a tender point examination and in-depth psychological evaluation. In addition, subjects were interviewed about a number of adverse childhood experiences. The 99 subjects with 5 or more tender points were compared with the remaining 190 subjects. RESULTS: A high tender point count (> or =5) was associated with low levels of self-care (odds ratio [OR] 2.4, 95% confidence interval [95% CI] 1.1-5.0), reports of a greater number of somatic symptoms (OR 2.2, 95% CI 1.0-4.9), high levels of fatigue (OR 3.3, 95% CI 1.7-6.3), and a pattern of illness behavior characterized by increased medical care usage (OR 4.2, 95% CI 2.1-8.4). Those with high tender point counts were substantially more likely to report adverse childhood experiences, including loss of parents (OR 2.1, 95% CI 1.1-3.9) and abuse (OR 6.9, 95% CI 2.0-24.6). These results were not explained by the presence of chronic pain. CONCLUSION: These data add further weight to the hypothesis that tender points, as part of the fibromyalgia syndrome, are strongly associated with specific components of psychological distress as well as characteristics of somatization and its antecedents. It is possible that these features contribute to the development of the syndrome of fibromyalgia.

Adolescent↗
PubMed1999

Predictors of early improvement in low back pain amongst consulters to general practice: the influence of pre-morbid and episode-related factors.

Low back pain symptoms are extremely common. affecting as many as 80% of the population at some time in their lives. However, the majority of the medical costs arise from the minority of patients whose symptoms become chronic. The authors propose a model in which chronicity is determined not only by factors related to the episode of low back pain, but also factors prior to the onset of symptoms (pre-morbid factors). No previous study has collected information on predictors of low back pain chronicity prior to the onset of symptoms. Participants in the South Manchester Low Back Pain Study, recruited by means of a cross-sectional population survey were followed prospectively over 18 months to identify those who consulted their general practitioner with a new episode of low back pain. At interview, 1-2 weeks post-consultation, it was determined whether or not subjects' symptoms had improved. In males, low levels of psychological distress, a higher than average reported level of physical activity, being in employment, and being satisfied with current work status were associated with a quick improvement in symptoms. In addition factors related to the episode, namely a short duration before consultation and symptoms with a sudden onset and confined to the lower back area, also strongly predicted a good early outcome. Using information on both pre-morbid and episode related factors, groups of male patients were identified whose probability of an early resolution of symptoms ranged between 0.25 and 1. Few factors, either pre-morbid or episode-related, were strongly associated with outcome amongst females. This large population-based study has shown, despite the known heterogeneity in the origin of low back pain and the pathologies associated with symptoms, an early improvement in symptoms amongst male attenders at general practice can be predicted on the basis of a small number of variables.

Adolescent↗
PubMed1999

Generalized pain, fibromyalgia and regional pain: an epidemiological view.

Generalized pain, which is one component of the fibromyalgia syndrome, is a common and disabling problem in the general population. Pain at individual sites, such as the lower back and shoulder, has traditionally been considered distinct from generalized pain and studied separately. This chapter considers first the basic definition and distribution of widespread pain in the population, and second examines the evidence as to whether widespread and regional pain are truly or usefully distinguished.

Chronic Disease↗
PubMed1999

The prevalence and associated features of chronic widespread pain in the community using the 'Manchester' definition of chronic widespread pain.

OBJECTIVE: We examine the descriptive epidemiology of chronic widespread pain using the 'Manchester' definition [CWP(M)] and assess psychosocial and other features which characterize subjects with such pain according to these more stringent criteria. METHODS: A population postal survey of 3004 subjects was conducted in the Greater Manchester area of the UK. RESULTS: The point prevalence of Manchester-defined chronic widespread pain was 4.7%. CWP(M) was associated with psychological disturbance [risk ratio (RR) = 2.2, 95% confidence interval (CI) (1.4-3.5)], fatigue [RR = 3.8, 95% CI (2.3-6.1)], low levels of self-care [RR = 2.2, 95% CI (1.4-3.6)] and with the reporting of other somatic symptoms [RR = 2.0, 95% CI (1.3-3.1)]. Hypochondriacal beliefs and a preoccupation with bodily symptoms were also associated with the presence of CWP(M). CONCLUSION: This definition of chronic widespread pain is more precise in identifying subjects with truly widespread pain and its associated adverse psychosocial factors. Clear associations with other 'non-pain' somatic symptoms were identified, which further supports the hypothesis that chronic widespread pain is one feature of somatization.

Adolescent↗
PubMed1999

Chronic widespread pain in the community: the influence of psychological symptoms and mental disorder on healthcare seeking behavior.

OBJECTIVE: To determine whether psychological symptoms and mental disorder are an intrinsic part of the chronic widespread pain syndrome or whether they have been observed in clinic attenders primarily because of their influence on the decision to seek a medical consultation. METHODS: A population survey of 1953 subjects was conducted in the Greater Manchester area of the United Kingdom. The survey included a postal questionnaire, and in a subgroup of respondents with high levels of distress, the presence of mental disorder was assessed by a semistructured standardized interview. Subjects with chronic widespread pain were classified according to whether they had sought a medical consultation for the reported pain ("consulters") or not ("nonconsulters"). RESULTS: In all, 252 subjects (13%) satisfied American College of Rheumatology criteria for chronic widespread pain, and of these 72% reported having consulted a general practitioner about this pain. There was a clear difference in levels of psychological distress, measured by the General Health Questionnaire (GHQ), between consulters, nonconsulters, and those with no pain. Consulters did not differ from nonconsulters in terms of levels of fatigue, social dysfunction, or number of somatic symptoms reported. Although consulters (among whom one in 4 had a mental disorder) were more likely to have a mental disorder than subjects without pain [OR = 4.9, 95% CI (2.6, 9.5)] the increase in risk comparing consulters to nonconsulters [OR = 2.1, 95% CI (0.7, 5.9)] and nonconsulters to subjects without pain [OR = 1.4, 95% CI (0.7, 2.6)] was not significant. CONCLUSION: The results suggest that psychological distress is associated with chronic widespread pain in addition to any effect on whether consultation is sought for symptoms. The finding that one-quarter of consulters to primary care with chronic widespread pain have a mental disorder should alert primary care physicians and rheumatologists to screen for mental disorder in this group.

Adolescent↗
PubMed1998

Outcome of low back pain in general practice: a prospective study.

OBJECTIVES: To investigate the claim that 90% of episodes of low back pain that present to general practice have resolved within one month. DESIGN: Prospective study of all adults consulting in general practice because of low back pain over 12 months with follow up at 1 week, 3 months, and 12 months after consultation. SETTING: Two general practices in south Manchester. 490 subjects (203 men, 287 women) aged 18-75 years. MAIN OUTCOME MEASURES: Proportion of patients who have ceased to consult with low back pain after 3 months; proportion of patients who are free of pain and back related disability at 3 and 12 months. RESULTS: Annual cumulative consultation rate among adults in the practices was 6.4%. Of the 463 patients who consulted with a new episode of low back pain, 275 (59%) had only a single consultation, and 150 (32%) had repeat consultations confined to the 3 months after initial consultation. However, of those interviewed at 3 and 12 months follow up, only 39/188 (21%) and 42/170 (25%) respectively had completely recovered in terms of pain and disability. CONCLUSIONS: The results are consistent with the interpretation that 90% of patients with low back pain in primary care will have stopped consulting with symptoms within three months. However most will still be experiencing low back pain and related disability one year after consultation.

Adolescent↗
PubMed1998

Association between measures of spinal mobility and low back pain. An analysis of new attenders in primary care.

STUDY DESIGN: Comparison of spinal movements in new attenders to primary care with an episode of low back pain with a sample with no recalled history of ever having had low back pain. OBJECTIVES: To examine the association between restriction of spinal movement and the presence of low back pain in primary care. SUMMARY OF BACKGROUND DATA: The presence of restriction in spinal mobility has frequently been investigated by specialists in the clinical setting. What is not known, however, is whether an association exists between pain and restriction in those newly presenting to primary care and whether these measurements can be used to discriminate between those with and without back pain. METHODS: The study participants consisted of 344 consulters to two general practices, prospectively ascertained in the South Manchester Back Pain Study, who were compared with 118 individuals from the same practices who denied ever having back pain. The two groups were compared for right and left lateral flexion, standing extension, modified Schober's test, finger-to-floor distance, and right and left knee extension. RESULTS: There was a statistically significant reduction in all planes in those with low back pain. Modified Schober's, standing extension, and left knee extension were the most discriminatory, with likelihood ratios of approximately 5 for the optimal cutoff. Restriction of three or more of these seven movements was observed in 50% of the low back pain cases and in less than 5% of the pain-free participants. Stratification by presence or absence of radiation of pain to the legs did not alter these findings. CONCLUSIONS: Measures of spinal mobility are restricted to varying extents in a community-based sample of subjects with low back pain. Maximal discrimination was observed when restriction was present in three or more planes. The utility of these measures in predicting outcome remains to be assessed.

Adult↗