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Biomedical subjects

G J Macfarlane

Publications and source records attributed to G J Macfarlane.

At least 73 records · Page 4Linked to original sources
PubMed1998

The occurrence of falls among patients with a new episode of hip pain.

OBJECTIVES: To establish the risk of falling among those who consult their general practitioner with a new episode of hip pain and to discover if risk is altered by age and according to whether, at presentation, signs of osteoarthritis are present on radiography. METHODS: A case-control study was conducted. Cases were all patients who presented with a new episode of hip pain to participating general practices throughout the United Kingdom. All cases had a pelvic radiograph taken on recruitment to the study. Three controls were matched for sex, age, and general practice to each case. A questionnaire was sent by post to all cases and controls. The risk of having fallen in the past 12 months among cases and controls was compared. RESULTS: The study included 111 cases presenting with hip pain and 229 controls who had not consulted with hip pain in the previous 12 months. Women (odds ratio = 3.6, 95% CI 1.9, 6.7) but not men (odds ratio = 0.8, 95% CI 0.3, 2.3) reported an increased risk of falling in the previous 12 months. Similar results were obtained when the previous four months were considered. For all cases, hip pain predated any reported falls. The increased risk in women was found particularly for those aged less than 70. Risk of falling was not altered by the presence of radiological changes of osteoarthritis. CONCLUSIONS: Hip pain, which may be a symptom of osteoarthritis of the hip, increases the risk of falling. This finding has implications for the advice offered by general practitioners to patients who consult with early hip pain.

Accidental Falls↗
PubMed1998

Psychosocial risks for low back pain: are these related to work?

OBJECTIVES: To examine whether psychosocial risks for low back pain, reported in previous studies, are specific to the working population or are more widely relevant. METHODS: A large population-based survey identified subjects free of low back pain, and obtained information on the degree of satisfaction with work (or not working) and the adequacy of income for their family's needs. New episodes of consulting and non-consulting low back pain were identified prospectively over 12 months. The psychosocial risks for developing a new low back pain episode are examined in employed and non-employed groups separately. RESULTS: Dissatisfaction with work status doubled the risk of reporting a new low back pain episode in both the employed (odds ratio 2.0, 95% confidence intervals 1.2, 3.3) and non-employed (OR 2.0, 1.2, 3.1). Those perceiving their income as inadequate were at a threefold risk of consulting for this symptom regardless of their employment status (employed: OR 3.6, 1.8, 7.2; non-employed: OR 3.6, 1.4, 9.0). CONCLUSION: Psychosocial factors pose similar risks for a new low back pain episode in workers and the non-employed. This suggests that such influences may not be related solely to work but be a function of general aspects of life. The economic and individual impact of psychosocial interventions in the workplace, therefore, are likely to be limited unless account is taken of the influence of broader non-work related aspects.

Adult↗
PubMed1998

Validity of a self-completed questionnaire measuring the physical demands of work.

OBJECTIVES: This study determined the accuracy of workers in quantifying occupational physical demands on a self-administered questionnaire. METHODS: First, a self-administered questionnaire on work postures, manual materials-handling, and repetitive upper-limb movements was validated using direct simultaneous observations for 123 randomly selected employees from 6 occupational settings. Second, weight estimation accuracy was assessed on visual analogue scales for 6 manual materials-handling activities using 20 randomly selected employees from 1 occupational setting. RESULTS: At a dichotomous level (ever-never), the accuracy of most of the self-reported physical demands was good (sensitivity 60-100%; specificity 56-100%). A more-detailed analysis of the dimensions studied (frequency, duration and amplitude) also showed that the accuracy of the self-reported estimates was satisfactory. Full agreement between the estimated and observed frequency was >60% for most of the manual materials-handling activities. In addition the average difference between the estimated and observed duration of the physical demands was found to be small. Finally the average difference between the self-reported and actual weights of various loads was found to be modest. CONCLUSIONS: The self-reported questionnaire used in this study would provide a useful instrument for estimating occupational physical demands and the frequency, duration, and amplitude of these demands in future epidemiologic studies associated with musculoskeletal pain.

Adult↗
PubMed1998

Predictors of chronic shoulder pain: a population based prospective study.

OBJECTIVE: To determine the natural history of shoulder pain in the population, and predictors of outcome on the basis of clinical and individual factors. In addition, to determine whether outcome is influenced by the definition of shoulder pain used. METHODS: A prospective cohort study, over a 3 year period, of subjects recruited from a cross sectional population screening study of shoulder pain, conducted in the Greater Manchester area of the UK. RESULTS: Of 92 subjects classified as having shoulder pain in the cross sectional study, 50 (54%) reported shoulder pain at followup about 3 years later. In 90% of cases this was accompanied by some disability specifically relating to the symptoms. Baseline factors that predicted symptoms at followup were: pain (indicated on a manikin) within a more narrowly defined shoulder region, shoulder pain related disability, pain on the day of examination, symptoms lasting more than one year, and a high score on the General Health Questionnaire, a measure of psychological distress. CONCLUSION: Shoulder pain in the population is a longterm disabling symptom, although many subjects do not seek early medical consultation. Disability (independent of whether there was restriction of movement on examination) is a strong predictor of continuing symptoms. The outcome observed in epidemiological studies of shoulder pain will be influenced by the initial definition of symptoms.

Adolescent↗
PubMed1997

Psychosocial factors in the workplace--do they predict new episodes of low back pain? Evidence from the South Manchester Back Pain Study.

STUDY DESIGN: A prospective, population-based cohort study of working adults. OBJECTIVES: To determine whether work-related psychosocial factors and social status predict the occurrence of new episodes of low back pain and influence consultation behavior. SUMMARY AND BACKGROUND DATA: Dissatisfaction with work and social status has been associated with low back pain in several studies; few of these studies have been prospective or population based. METHODS: An initial postal survey was returned by 4,501 (59%) adults (18-75 years old) registered with two primary care practices. From this, a cohort of 1,412 people currently in employment and free of low back pain was identified, and baseline information on work-related psychosocial factors and psychologic distress was obtained. Social class was derived from current occupation using a standardized classification. New episodes of low back pain occurring in the next 12 months were identified by continuous monitoring of primary care consulters and by mailing a second questionnaire a year later to identify occurrences of low back pain for which no consultation was sought. RESULTS: The baseline cross-sectional survey showed modest but significant associations between low back pain and perceived inadequacy of income (risk ratio 1.3), dissatisfaction with work (risk ratio 1.4) and social class IV/V (risk ratio 1.2). In the follow-up year, the risk of reporting low back pain for which no consultation was sought doubled in those dissatisfied with their work. Both perceived inadequacy of income (odds ratio 3.6) and social class IV/V (odds ratio 4.8) were strongly associated with consulting with a new episode of low back pain during the follow-up year, an association more marked in women. The associations with work dissatisfaction and perceived adequacy of income were not explained by general psychologic distress or social status. CONCLUSION: People dissatisfied with work are more likely to report low back pain for which they do not consult a physician, whereas lower social status and perceived inadequacy of income are independent risks for working people to seek consultation because of low back pain.

Adult↗
PubMed1997

Employment and physical work activities as predictors of future low back pain.

STUDY DESIGN: A population-based longitudinal study conducted in northwest England for a 12-month period involving adults aged 18-75 years. OBJECTIVES: To determine physical factors related to employment that predict a new episode of low back pain. SUMMARY OF BACKGROUND DATA: Most epidemiologic studies that have examined the relation between occupation and back pain have been cross-sectional or retrospective in design. Because workers who have experienced low back pain may have changed jobs or work activities, it is important to use longitudinal studies that define "exposures" before the onset of symptoms. METHODS: From adults registered with two general practices in northwest England, 1412 people who were currently in employment and free of low back pain were identified. A lifetime occupational history was recorded for all participants, with details of activities performed in each occupation. Data on consultations for low back pain during the follow-up year were collected through computerized medical records, whereas those who had not consulted with low back pain were sent another questionnaire at the end of the 1-year follow-up. RESULTS: An increased risk of a new episode of low back pain was found in those whose jobs involved lifting/pulling/pushing objects of at least 25 lbs, or whose jobs involved prolonged periods of standing or walking. Risks were, in general, greater in women, for a first ever episode of back pain and for back pain that led to a general practice consultation. No clear relation between years of exposure to such factors and magnitude of risk was evident. CONCLUSIONS: Occupational activities, particularly in women, such as working with heavy weights or lengthy periods of standing or walking, were associated with the occurrence of low back pain. Short-term influences may be more important in the occurrence of new episodes rather than cumulative lifetime exposure, and emphasize that such morbidity may be avoidable.

Adult↗
PubMed1997

Occupational factors related to shoulder pain and disability.

OBJECTIVES: To determine, in a population based study, the influence of occupational factors on the occurrence of shoulder pain and disability. METHODS: A random sample of patients was selected from the register of a general practice in the Greater Manchester area of the United Kingdom. Information was collected by a posted questionnaire with specific enquiries about symptoms in the shoulder region and related disability. A lifetime occupational history was obtained including physical exposures, working conditions, and psychosocial aspects of each workplace. Analysis has been conducted as a case-control study, comparing occupational exposures at the time of onset of symptoms in those with shoulder pain and disability with corresponding occupational exposures in those without shoulder pain and disability. RESULTS: An increased risk of shoulder pain and disability in men was associated with carrying weights on one shoulder (relative risk (RR) 5.5, 95% confidence interval (95% CI) 1.8 to 17), whereas those who reported working with hands above shoulder level, using wrists or arms in a repetitive way, or stretching down to reach below knee level had about twice the risk of shoulder pain and disability. Men working frequently in very cold or damp conditions had a fourfold and sixfold risk respectively of shoulder pain and disability. Reporting of shoulder pain and disability was also more common among men and women who reported that their work caused a lot of stress (RR 1.9, 95% CI 0.9 to 4.1) or was very monotonous (RR 2.7, 95% CI 1.3 to 5.4). The relations between physical exposures, working conditions, and psychosocial factors were independent. CONCLUSIONS: This population based study has shown that physical activities carried out at work, the physical conditions under which the work is conducted, psychosocial aspects of work, or the working environment are all independently related to the occurrence of shoulder symptoms and disability, emphasising the multifactorial nature of this condition.

Activities of Daily Living↗
PubMed1997

Second primary cancers after cancers of the colon and rectum in New South Wales, Australia, 1972-1991.

Data from the New South Wales Central Cancer Registry for the period 1972-1991 were examined to determine the risk of second primary cancers after an initial invasive cancer of the colon (ICD-9 153) or rectum (ICD-9 154). The expected numbers of cancers were obtained by assuming that subjects experienced the same cancer incidence as prevailed in the corresponding general population and by applying sex-, age-, and calendar-specific rates to the appropriate person-years at risk. The relative risk (RR) of a second primary cancer was taken to be the ratio of observed:expected numbers of second cancers. After colon cancer, there was an excess of cancers of the small intestine in both sexes (RRs of 4.5 and 4.4); prostate (RR = 1.4) and kidney (RR = 1.8) in men; and breast (RR = 1.3), body of uterus (RR = 1.9), ovary (RR = 2.8), and thyroid (RR = 2.7) in women. Lung cancer occurred less frequently in men than expected (RR = 0.7). After rectal cancer, men had increased risks of cancers of the colon (RR = 1.5) and prostate (RR = 1.3) and a reduced risk of pancreatic cancer (RR = 0.3). A reciprocal relationship of increased risk was seen between cancers of the proximal (but not the distal) colon and rectum. Shared luminal risk factors for proximal colon cancer and rectal cancer and three syndromes of hereditary predisposition to colon cancer seem to be the major contributors to second primary cancers in patients with an initial colon cancer. Sources of bias have been considered.

Age Factors↗
PubMed1996

Second primary cancers following cancers of the kidney and prostate in New South Wales (Australia), 1972-91.

Data from the New South Wales (NSW) (Australia) Central Cancer Registry for the period 1972-91 were examined to determine the risk of second primary cancers following an initial invasive cancer of the renal parenchyma (ICD-9 code 189.0), renal pelvis (code 189.1), or prostate (code 185). Eligible cases were restricted to those who had survived for at least two months after diagnosis of the first primary cancer. Expected numbers of cancers were obtained by assuming that subjects experienced the same cancer incidence as prevailed in the corresponding general population and applying gender-, age-, and calendar-specific rates to the appropriate person-years at risk. The relative risk (RR) of a second primary cancer was taken to be the ratio of observed to expected numbers of second cancers. Following prostatic cancer, there was an overall deficit of cancers at all sites combined (RR = 0.79, 95 percent confidence interval [CI] = 0.75-0.84), and no site had a significantly raised RR. Taking this into consideration, there appeared to be a reciprocal relationship of increased risk of prostatic cancer (RR = 1.7, CI = 1.2-2.3) following an initial cancer of the renal parenchyma and of renal parenchymal cancer (RR = 1.2, CI = 0.8-1.7) after cancer of the prostate. An increased risk of bladder cancer occurred following renal parenchymal (RR = 3.4, CI = 1.1-8.0, for women only) as well as after renal pelvic cancer (men: RR = 8.7, CI = 5.4-13; women: RR = 39, CI = 26-56). A tobacco-related pattern of excess risk was seen after renal pelvic cancer but not after cancer of the renal parenchyma. These data illustrate that an excess of second primary cancers may reflect shared etiologic factors or increased medical surveillance.

Aged↗
PubMed1996

The relationship between sexual life and urinary condition in the French community.

As part of a large, nationwide community-based study in France on health and urinary condition, involving 2011 men aged between 50 and 80 years, information was collected on sexual life factors (e.g., frequency of sexual desires and sexual relations, and the frequency of having difficulties with erection and ejaculation) in addition to an assessment of overall sexual life satisfaction. Data on sexual life were obtained by means of a self-administered questionnaire, while information on the frequency of urinary symptoms was obtained by a professional interviewer. The median number of sexual relations decreased with age from "once per week" in those aged 50-59 years to "less than once per week" in those aged 60-69 years to "never" in those aged over 70 years, while the percentage reporting difficulty with erection at least some of the time increased from 20 to 38% between 50-59 and 70-79 years, respectively. The number of sexual relations during the past month was by far the most important factor having an influence on overall sexual life satisfaction, with those men reporting relations less than once per week almost 10 times more likely to be dissatisfied. Severity of overall urinary symptoms (as well as many individual symptoms) was also inversely related to sexual life satisfaction, and the association persisted after taking account of the strong influence of age and the frequency of sexual relations. All other factors being equal (age, number of relations, comorbidities, and previous prostate surgery), the likelihood of men being dissatisfied with sexual life increased twofold in men with moderate symptoms and fourfold in those with severe symptoms. The results obtained in the current study should be considered preliminary, given the complexity of the relationship between these two factors and the lack of previously published evidence. They certainly call for further studies, which should include a detailed assessment of sexual function and a clinical assessment of the urinary condition.

Aged↗
PubMed1996

Trends in survival from cancers of the oral cavity and pharynx in Scotland: a clue as to why the disease is becoming more common?

Data were examined to determine trends in survival from cancers of the oral cavity and pharynx in Scotland between 1968 and 1987, and to analyse survival rates and the previously noted increases in the incidence of such cancers according to the level of social deprivation. Incidence data on oral cavity and pharyngeal cancer and survival rates following diagnosis were obtained from the Information and Statistics Division of the Common Services Agency for the National Health Service in Scotland, covering the period 1968-92. It was found that survival rates for cancers of the tongue, mouth and pharynx diagnosed among persons less than 65 years of age decreased between 1968-72 and 1983-87. Five year relative survival rates fell from 47% to 39% over this period, while the equivalent rates among persons older than 65 years have shown a modest improvement from 34% to 38%. When considered by level of social deprivation, survival is lower among persons from the most deprived areas, and it is among such persons that the recent increases in occurrence of cancers of the oral cavity and pharynx have primarily occurred. The poorer survival among those from more socially deprived areas, and the evidence that the largest increase in incidence has occurred in such areas may to some extent explain the non-favourable trends in mortality. More importantly it emphasises the potential benefits of targeting such a population for oral health information. An educational campaign should include both information on the risk factors for developing oral cancer, and also the importance of seeking an early professional consultation in the case of symptoms.

Aged↗
PubMed1996

The frequency of restricted range of movement in individuals with self-reported shoulder pain: results from a population-based survey.

Prevalence studies suggest that shoulder pain is very common (7-20%) in the adult population, though little is known about the severity and impact of such pain. Disability results, in part, from the restriction of movement and we therefore determined the frequency of restricted shoulder movement in individuals in a general population sample reporting shoulder pain and associated disability. In all, 232 individuals were interviewed about shoulder pain and related disability, and their range of shoulder movement in the following planes was measured: elevation, forward flexion, backward flexion, external rotation and internal rotation, together with the minimum difference achieved between the tip of a thumb and the spinous process of C7. In total, 48 (21%) subjects reported current pain and disability in one or both shoulders. Using receiver operating characteristic (ROC) analysis, cut-offs for restricted movements were selected at the point of maximal discrimination between painful and pain-free shoulders. There was considerable overlap in the distribution of range of movement, at all six sites, between these two groups. The highest positive predictive value for pain was observed in restriction of the thumb to cervical spine movement (53%), but this also had the lowest negative predictive value. By contrast, the highest negative predictive value was observed for restriction of external rotation (96%). Restriction in any plane was observed in 77% of those individuals with pain, but was also present in half of those without pain. In summary, most people with self-reported shoulder pain in the community do not have widespread restriction of movement. Reduction in external rotation was the most discriminatory, but it is necessary to examine movement in multiple planes to assess the true burden of shoulder pain in the community.

Adolescent↗
PubMed1996

Interobserver reliability in measuring flexion, internal rotation, and external rotation of the hip using a plurimeter.

OBJECTIVE: To determine reliability of the measurement of hip movements (flexion, internal rotation, and external rotation) between medical practitioners. METHODS: Six clinicians carried out measurements of hip movements on each of six patients with osteoarthritis of one hip, using a specifically designed plurimeter. RESULTS: There was no evidence of any systematic difference between medical practitioners in the measurement of hip flexion, internal rotation, or external rotation. The degree of agreement was greatest for hip flexion. CONCLUSIONS: This study has shown that measurement of range of movement at the hip is repeatable between practitioners using a simple plurimeter and may represent an examination that is suitable for monitoring progress and treatment.

Evaluation Studies as Topic↗
PubMed1996

The influence of alcohol consumption on worldwide trends in mortality from upper aerodigestive tract cancers in men.

STUDY OBJECTIVES: To assess current trends in male mortality from cancers of the oral cavity/pharynx, oesophagus, and larynx (upper aerodigestive tract cancers), and relate these to past national consumption of alcohol and smoking of cigarettes. To assess the impact of current trends in alcohol consumption and tobacco smoking on likely future rates of these cancers. DESIGN: Mortality data for cancers of the oral cavity/pharynx, oesophagus, and larynx were obtained for the years 1955-89 in 25 countries located in North America, Australasia, Europe, and Japan. Information on past and current alcohol consumption was also obtained for these countries, while current national lung cancer rates were used as a proxy measure of past smoking levels. SETTING: The World Health Organization mortality database. MAIN RESULTS: National death rates from cancers of the oral cavity/pharynx, oesophagus, and larynx (considered together) are currently increasing among men and are most strongly associated with the level of per capita consumption of alcohol 20 years previously. They were less strongly associated with the level of alcohol consumption 10 years ago, and only very weakly associated with the current level of lung cancer mortality (a marker of past smoking habits). Regression analysis showed that the national rate of upper aerodigestive tract cancer could be estimated using information on past alcohol consumption and an interaction term between alcohol consumption and current lung cancer rates. Assuming stability in rates of lung cancer, the sizeable increase in alcohol consumption from 5 to 10 litres per capita each year that occurred in some countries during the 1960s and 70s means that increases of around 5 per 100,000 in the death rate from these cancers can be expected in these countries in the next decades. CONCLUSIONS: Previous alcohol consumption in a country is a strong predictor of deaths from cancers of the upper aerodigestive tract in men, and current increases in death rates can probably be related to increases in consumption which took place during the 1960s and 70s. Combined with a reduction in tobacco smoking, which is already taking place in some countries, reversing the trend of increases in consumption of alcohol has the potential for a sizeable impact on the burden of these cancers.

Alcohol Drinking↗
PubMed1995

International patterns in the occurrence of Hodgkin's disease in children and young adult males.

It was reported over 20 years ago that there were distinct age-specific patterns of Hodgkin's disease incidence in countries with different levels of economic development, and that there was an inverse relationship between the incidence of Hodgkin's disease in children and young adults within countries. Such observations were important, leading to hypotheses on the possibly infectious aetiology of the disease. Since the initial report, diverging trends in the incidence of Hodgkin's disease in children and young adults have been observed, and data from a much larger number of countries and cancer registries have become available. This led us to reassess international age-related incidence patterns of Hodgkin's disease occurrence. Recent data show distinct differences in age-specific Hodgkin's disease incidence patterns in different geographic regions. In general, the United States (US) and European countries had the pattern of low childhood rates and high young adulthood rates. However, countries which are not part of the European Union (EU), mainly Baltic states and countries of central and eastern Europe, showed a variant of this pattern: similarly high young adult rates, but rates in children higher than those in the US and EU. Incidence-rate patterns for Latin American countries differed from those previously observed, with a shift towards patterns observed in more economically developed countries. Analysis of incidence data from earlier sources dating back to 1963 confirmed the original finding of an inverse association in incidence rates (c. 1963-1967) using a selected group of cancer registries, but not when all data were considered. This association has become weaker over the past 20 years. Using current incidence rates (1983-1987), no association between Hodgkin's disease rates in children aged 5 to 14 years (as well as 0 to 9 years) and young adults (20 to 34 years) was found.

Age Factors↗
PubMed1995

Alcohol, tobacco, diet and the risk of oral cancer: a pooled analysis of three case-control studies.

This combined analysis of data from three large case-control studies of oral cancer confirms the important effect of tobacco in the aetiology of the disease. The studies have been conducted in the United States, Italy and China and results for risks associated with tobacco smoking were generally consistent across centres, while those for alcohol were not; increased risks amongst alcohol drinkers were evident in two centres but not in the study conducted in Turin, Italy. In addition, the combined analysis had large enough numbers to analyse the risk of tobacco consumption in non-drinkers. In females these showed increased risks while in males the effect of tobacco alone was weaker. Given the popularity of tobacco smoking, and its consequent high attributable risk in terms of oral cancer it is reassuring, in terms of public health, that cessation will result in a substantial reduction in risk; a 30% reduction in risk for those stopping smoking between 1 and 9 years, and a 50% reduction for those stopping more than 9 years. Although encouraging smokers to stop should be the principal aim, decreases in risk for everyone could be achieved by encouraging high fruit and vegetable consumption.

Adult↗
PubMed1995

European School of Oncology Advisory report to the European Commission for the Europe Against Cancer Programme: oral carcinogenesis in Europe.

A European School of Oncology Advisory Group has reviewed current knowledge on the epidemiology, treatment and prevention of cancer of the oral cavity. While the major factors in the aetiology of such cancers are thought to be well understood, i.e. tobacco and alcohol consumption, current increases in the occurrence of the disease, especially in young adults throughout Europe, are cause for concern. The reasons for such increases are not clearly evident and the Advisory Group has suggested further work which is required to be carried out to understand the aetiology. In treatment of the disease there have been no major improvements in survival for patients in recent decades and the importance of examining new radiotherapy modalities and defining the role of chemotherapy is emphasized. Primary prevention of oral cancer could be achieved by stopping smoking tobacco, limiting alcohol consumption to a minimum (2-3 drinks per day) and increasing intake of fruits and vegetables. To supplement these actions, while neither population screening programmes nor screening trials could be recommended by the Advisory Group, initial chemoprevention trials have produced some promising results and this represents an interesting area which is the focus of much current research.

Europe↗