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Biomedical subjects

H Raspe

Publications and source records attributed to H Raspe.

11 recordsLinked to original sources
PubMed1995

Back pain.

Classification of back pain is a difficult task. Traditional schemes have focused on the small percentage of cases which have specific causes. Structural anomalies observed on X-ray examination explain only a small proportion of back pain cases, and the emphasis placed on these in the traditional schemes is, as Anderson put it, the tail wagging the dog (Anderson, 1977). Many syndrome classifications are based on arbitrary notions of cause, with little empirical justification and no evidence that they can reliably and usefully be applied in practice. More pragmatic approaches start with the separation of the serious from the less serious, and the distinction between spinal pain and pain arising from outside the spine. The classification of the large majority of back pain cases which are 'non-specific' is best approached by grading the severity of the clinical and psychological features of back pain and their disabling consequences. Such grading schemes also provide the most appropriate outcome measures for clinical and epidemiological back pain research.

Back Pain↗
PubMed1995

Fibromyalgia.

The article details the history, concept, definition and assessment of the still enigmatic condition of 'fibrositis' or, as it has more recently been called, 'fibromyalgia'. The concept and diagnosis became popular, especially in North America, in the 1970s, after the seminal publications of Hugh Smythe (1972) and Smythe and Moldofsky (1977). It is noticeable that there does not appear to be an early case report as there is for instance for gout, rheumatoid arthritis or certain vasculitides. This may be one reason why we still lack a commonly shared clinical image of the 'typical' case. After Smythe and coworkers, operational definitions and classification criteria were given by Yunus et al, Lautenschläger et al (both in 1989) and Wolfe et al in 1990. The latter received the endorsement of the American College of Rheumatology and are now the most widely used. They identify fibromyalgia as a musculoskeletal disorder with spontaneous widespread pain and exaggerated tenderness as prominent and distinctive features. The other two criteria sets refer to a different concept of fibromyalgia as a 'functional' or 'dysfunctional' disorder. These and other nosological differences pose problems for clinical as well as epidemiological research. They may be of minor importance if it is accepted that any present definition is arbitrary and that a wide range of possible elements are more relevant to research than a uniform concept of a disease called fibromyalgia.

Fibromyalgia↗
PubMed1995

Survey response rates: national and regional differences in a European multicentre study of vertebral osteoporosis.

STUDY OBJECTIVE: This analysis aimed to compare the response rates of those invited to attend for screening in a multicentre, multinational study within Europe. DESIGN: This was a population survey. SETTING: Thirty four centres in 16 European countries. SUBJECTS: Men and women aged 50 years and over were recruited from population based sampling frames to participate in a prevalence survey of osteoporosis. Subjects were invited by post to attend for radiological screening and interview, and non-responders were followed up by repeat mailing. RESULTS: There was a substantial variation between centres in response rates: the mean was 49% and the range 5-83%. Adjusting for those known to have died or moved house did not affect the overall ranking. The response rates to each mailing also varied between centres: first mailing 45% (range 5-83%) and second mailing mean 10% (range 0-23%). The response rates varied in relation to age and sex and were higher in women than men. Rates fell gradually with age in women but rose in men until the age of 65 years. Response rates varied regionally. These were highest in countries from northern Europe and lowest in southern European countries, but there was wide variation both within regions and within countries. CONCLUSIONS: Multicentre, multinational studies within Europe will probably become increasingly popular. In this study, despite a standardised approach, the range in response rates between centres both within and between countries was substantial. Attempts at cross national standardisation in survey design can have only a limited effect on yielding uniformity in response.

Aged↗
PubMed1995

Fibromyalgia and disability. Report of the Moss International Working Group on medico-legal aspects of chronic widespread musculoskeletal pain complaints and fibromyalgia.

The present article is the result of a working group conference held in Moss, Norway, in June 1993, financed by the Royal Norwegian Ministry of Health and Social Affairs. Its purpose was to review and focus upon problems and needs related to the medico-legal aspects of fibromyalgia and chronic widespread musculoskeletal complaints: thus to define directions for future work on issues which have generally not been addressed within the medical community. Our report describes specific problems in this area in regard to definition, evaluation and recommendation, and in currently available work and disability statistics. We have recommended international efforts to establish research programs through organizations such as the International Social Security Association and the World Health Organization. While our recommendations call for research into medico-legal interactions, causes and pathogenic mechanisms, prevention and treatment are also key and relevant concerns in the medico-legal setting.

Chronic Disease↗
PubMed1995

A database for back (axial skeletal) pain.

Back pain cannot be considered a mere symptom that has as its only function reference to relevant hidden disease. Back pain must be acknowledged as a disorder that requires description and assessment as carefully as any of the well-established clinical entities. This article outlines a clinically useful, descriptive "morphology" or nosography of the various axial skeletal pains stated, and proposes methods for their classification and evaluation.

Back Pain↗
PubMed1994

[Current musculoskeletal symptoms in peri and postmenopausal women: results of a multicenter population epidemiological study. The EVOS Study Group].

Within the European vertebral osteoporosis study four stratified systematic samples of German residents aged 50-79 in Lübeck, Heidelberg, Jena and East Berlin have been drawn. Overall 4628 subjects were included, of whom 4385 were contactable and 3106 (71%) responded to the postal questionnaire enquiring about rheumatic complaints "today". 2348 (54%) followed an invitation to a medical examination in which a specific gynaecological history was taken. The prevalence of current back-, neck- and joint-pain is consistently higher in females than in males in all age groups. Females show a peak prevalence in the age group 55-64. 104/1134 women were pre- or perimenopausal. 1030 women had not had their period for at least 13 months and were classified as "postmenopausal". Neither the menopausal status nor the duration of the postmenopause were statistically significantly associated with the frequency of the three rheumatic complaints.

Aged↗
PubMed1994

Disorders characterised by pain: a methodological review of population surveys.

OBJECTIVE--To review a series of conceptual and methodological problems encountered in surveys primarily devoted to pain disorders. CRITERIA FOR INCLUSION AND EXCLUSION OF ARTICLES--Published reports were systematically collected by electronic database searches (Medline), citations in existing publications, and through personal contacts. Relevant articles from clinical and epidemiological research on pain were included and special attention was given to epidemiological research on back pain. CONCLUSIONS--Surveys of pain disorders should be based on a multidimensional pain model that includes nociceptive input, pain perception, suffering, and pain behaviour as major components. Because of the limited applicability of diagnostic procedures or genuine "non-specificity" of pain states, or both, epidemiological surveys may result in a considerable proportion of cases without an identifiable pathophysiological basis. Staging and grading procedures for pain disorders (as distinguished from classification) may comprise various aspects of pain perception: regional distribution, pain intensity, temporal characteristics, sensory qualities, and dimensions of cognitive-emotional appraisal. Description of temporal development and chronification (staging) should refer to different components of the multidimensional pain model. Explicit a posteriori procedures for grading are preferable to implicit grading based on question wording. Evidence from several sources suggests that localistic concepts of pain may be misleading. Identification of complex pain syndromes should be one primary target for epidemiological pain surveys. Of the many factors that may impair the reliability and validity of data collected in pain surveys, recall biases seem to deserve special attention.

Back Pain↗
PubMed1994

[Guidelines for social medicine assessment and evaluation of primary fibromyalgia].

Primary fibromyalgia belongs to the spectrum of rheumatic soft tissue disorders. It is characterized by wide-spread chronic pain and a low pain threshold. The etiology of the disorders is still unknown. Clinical diagnosis requires examination by a rheumatologically trained physician pathognomonic findings are largely lacking. Classification criteria have been published by Wolfe et al. on behalf of the American College of Rheumatology (ACR). The prognosis of FMA is unfavourable and does hardly, respond to therapy. FMA patients' work capacity cannot be established by mere diagnosis; individual impairments have to be taken into account: Clinical, psychosocial and behavioural dimensions have to be considered. Neither inpatient rehabilitation nor early retirement seem to significantly influence the course of FMA. The patient can usually work fulltime in jobs requiring light activities.

Disability Evaluation↗
PubMed1992

[Rheumatism epidemiology in Europe].

The article describes the present and potential of the epidemiology of the rheumatic diseases in Europe, considering especially rheumatoid arthritis (rA) and fibromyalgia (FMA). This is preceded by a short review of the history of European rheuma-epidemiology within the past 40 years. In rA European rheumatologists and epidemiologists have made important contributions to a differentiated nosology, longterm follow up studies and prognostication, conceptualization and measurement of outcomes and the analysis of a possibly decreasing incidence and severity of the disease. In an own study we were able to use the 1987 revision of the ARA-criteria and to test their stability over time. Among 11,534 German residents of Hannover, aged 25-74 we identified 58 with clinically proven rA or undifferentiated arthritis (uA), resulting in an estimated true prevalence of 0.83% (prevalence according) to Rome-criteria 0.53%, ARA-criteria 1987 0.33%). 39/58 could be reexamined after an average of 29 months. Only 9 of 25 ARA-1987-positive rAs maintained their nosological status. The actual care of the total group seemed widely inadequate. The Concept of FMA has been developed in Canada (H. Smythe) and in Germany/Switzerland (W. Müller) at about the same time, in Europe under the notion of "generalized tendomyopathie". Whereas the credit for developing and defining FMA-criteria goes entirely to rheumatologists from North America, it is an European privilege to provide first epidemiological data. After Jacobsson's work in Malmö/Sweden we studied in Southern Germany 541 German residents of Bad Säckingen, aged 25-74. We eventually identified 10 subjects with a history of widespread pain, 17+ out of 34 tender points and 2 or less out of 10 control points, giving a minimal FMA-prevalence of 1.9% and an estimated true prevalence of 3.0% (95%-Ci 1.6-4.4%). We identified however several nosologic as well as nosographic difficulties, that question the concept of FMA as an exclusively rheumatological disorder within the spectrum of "soft tissue" rheumatism.

Adult↗
PubMedDate not supplied

[Basic principles of community, continuous and cooperative management of patients with chronic rheumatic diseases in Germany].

The lecture presents foundations and results of the work of a commission of the German Rheumatological Association. Based on epidemiological data on the occurrence of selected rheumatic disorders, reference figures for both, in- and outpatient services are developed. There is need of at least one full-time rheumatologist for every 150,000 residents. The commission identifies various actual deficits in the care of rheumatic patients. The most important seems to be the insufficient number and unequal spatial distribution of practicing rheumatologists. Other deficits concern the imperfect integration of preventive, curative and rehabilitative services, of in- and outpatient care and of the work of primary and secondary physicians with various allied health professionals at the community level.

Combined Modality Therapy↗