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Dahai Yu,1 Matthew Missen,1 Kelvin P Jordan,1 John J Edwards,1 James Bailey,1 Ross Wilkie,1 Justine Fitzpatrick,2 Nuzhat Ali,2 Paul Niblett,2 George Peat1 1Primary Care Centre versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK; 2Office for Health Improvement and Disparities, Department of Health and Social Care, London, UKCorrespondence: Dahai Yu, Email d.yu@keele.ac.ukPurpose: To compare estimates of annual person-consulting incidence and prevalence of low back pain (LBP) and osteoarthritis for two national English electronic health record databases (Clinical Practice Research Datalink (CPRD) Aurum and CPRD GOLD).Patients and Methods: Retrospective, population-based, longitudinal cohort study. LBP and osteoarthritis cases were defined using established codelists in people aged ≥ 15 and ≥ 45 years, respectively. Incident cases were new recorded cases in a given calendar year with no relevant consultation in the previous 3 years (denominator = exact person-time in the same calendar year for the at-risk population). Prevalent cases were individuals with ≥ 1 consultation for the condition of interest recorded in a given calendar year, irrespective of prior consultations for the same condition (denominator = all patients with complete registration history in the previous 3 years). We estimated age-sex standardised incidence and annual (12-month period) prevalence for both conditions in 2000– 2019, overall, and by sex, age group, and region.Results: Standardised incidence and prevalence of LBP from Aurum were lower than those from GOLD until 2014, after which estimates were similar. Both databases showed recent declines in incidence and prevalence of LBP: declines began earlier in GOLD (after 2012– 2014) than Aurum (after 2014– 2015). Standardised incidence (after 2011) and prevalence of osteoarthritis (after 2003) were higher in Aurum than GOLD and showed different trends: incidence and prevalence were stable or increasing in Aurum, decreasing in GOLD. Stratified estimates in CPRD Aurum suggested consistently higher occurrence among women, older age groups, and those living in the north of England.Conclusion: Comparative analyses of two English databases produced conflicting estimates and trends for two common musculoskeletal conditions. Aurum estimates appeared more consistent with external sources and may be useful for monitoring population musculoskeletal health and healthcare demand, but they remain sensitive to analytic decisions and data quality.Keywords: musculoskeletal, electronic health records, epidemiologic methods, osteoarthritis, low back pain, primary care

The Curry Report (Policy Commission on the Future of Farming and Food, Farming and Food: A Sustainable Future (Curry Report), Cabinet Office, London, 2002) recently recommended that farmers 'reconnect' with their consumers, their markets and the food chain. In terms of livestock production this process of reconnection may not be so straightforward, firstly, because of the productive paradoxes upon which livestock production is built, and secondly, because the nature of people's relationships with livestock is complex, ambiguous and dynamic. This paper uses ethnographic data to illustrate sociologically the paradoxical nature of commercial and hobby livestock production in the context of Northeast Scotland. Producers of livestock have contradictory productive roles: as empathetic carers and economic producers of 'sentient commodities'. The attitudes, feelings and behaviours of those working with livestock cannot be isolated from the position of both humans and animals in the division of labour (breeding, storing and finishing) and the socio-economic context in which commercial and hobby livestock production occurs. For example, those working with breeding animals tend to express varying degrees of emotional attachment whilst those preparing livestock for slaughter express varying degrees of emotional detachment. Any animal, however, that deviates from the routine process of production can stand out from the herd, become individually recognised, have more meaning to the worker, and thus become more than 'just an animal'. I will also draw on the work of Merton (Sociological Ambivalence and Other Essays, The Free Press, New York, 1976), Digard (Relationships between humans and domesticated animals, Interdisciplinary Science Reviews 19(3) (1994) 231) and Kopytoff (The cultural biography of things: commoditisation as process, In: A. Appadurai (Ed.), The Social Life of Things: Commodities in Cultural Perspective, Cambridge University Press, Cambridge, 1986, pp. 64-91) to provide an emerging framework to understand the variable characteristics of people's relationships with their animals, and to account for and capture their contradictory and unstable elements.

Background It is unclear whether seven interventions recommended by Public Health England for preventing and managing common musculoskeletal conditions reduce or widen health inequalities in adults with musculoskeletal conditions. Methods We used citation searches of Web of Science (date of 'parent publication' for each intervention to April 2021) to identify original research articles reporting subgroup or moderator analyses of intervention effects by social stratifiers defined using the PROGRESS-Plus frameworks. Randomized controlled trials, controlled before-after studies, interrupted time series, systematic reviews presenting subgroup/stratified analyses or meta-regressions, individual participant data meta-analyses and modelling studies were eligible. Two reviewers independently assessed the credibility of effect moderation claims using Instrument to assess the Credibility of Effect Moderation Analyses. A narrative approach to synthesis was used (PROSPERO registration number: CRD42019140018). Results Of 1480 potentially relevant studies, seven eligible analyses of single trials and five meta-analyses were included. Among these, we found eight claims of potential differential effectiveness according to social characteristics, but none that were judged to have high credibility. Conclusions In the absence of highly credible evidence of differential effectiveness in different social groups, and given ongoing national implementation, equity concerns may be best served by investing in monitoring and action aimed at ensuring fair access to these interventions. [ABSTRACT FROM AUTHOR]

Background: Recent reviews suggest that the way in which surgeons prepare for a procedure (warm up) can affect performance. Operating lists present a natural experiment to explore this phenomenon. The aim was to use a routinely collected large data set on surgical procedures to understand the relationship between case list order and operative performance. Method: Theatre lists involving the 35 procedures performed most frequently by senior surgeons across 38 private hospitals in the UK over 26 months were examined. A linear mixed‐effects model and matched analysis were used to estimate the impact of list order and the cost of switching between procedures on a list while controlling for key prognosticators. The influence of procedure method (open versus minimally invasive) and complexity was also explored. Results: The linear mixed‐effects model included 255 757 procedures, and the matched analysis 48 632 pairs of procedures. Repeating the same procedure in a list resulted in an overall time saving of 0·98 per cent for each increase in list position. Switching between procedures increased the duration by an average of 6·48 per cent. The overall reduction in operating time from completing the second procedure straight after the first was 6·18 per cent. This pattern of results was consistent across procedure method and complexity. Conclusion: There is a robust relationship between operating list composition and surgical performance (indexed by duration of operation). An evidence‐based approach to structuring a theatre list could reduce the total operating time. [ABSTRACT FROM AUTHOR]

Objective: To examine arthritis impact among US adults with self-reported doctor-diagnosed arthritis using the International Classification of Functioning, Disability and Health (ICF) framework (including the impairments, activity limitations, environmental, and personal factors domains and social participation restriction [SPR] as the outcome) overall and among those with and without SPR, and to identify the correlates of SPR.Methods: Cross-sectional 2009 National Health Interview Survey data were analyzed to examine the distribution of the ICF domain components. Unadjusted and multivariable-adjusted prevalence ratios (PRs) and 95% confidence intervals (95% CIs) were estimated to identify the correlates of SPR. Analyses using SAS, version 9.2 survey procedures accounted for the complex sample design.Results: SPR prevalence was 11% of adults with arthritis (5.7 million). After initial multivariable adjustment by ICF domain, serious psychological distress (impairments domain; PR 2.5 [95% CI 2.0-3.2]), ≥5 medical office visits (environmental domain; PR 3.4 [95% CI 2.5-4.4]), and physical inactivity (personal domain; PR 4.8 [95% CI 3.6-6.4]) were most strongly associated with SPR. A combined measure (key limitations [walking, standing, or carrying]; PR 31.2 [95% CI 22.3-43.5]) represented the activity limitations domain. After final multivariable adjustment incorporating all ICF domains simultaneously, the strongest associations with SPR were key limitations (PR 24.3 [95% CI 16.8-35.1]), ≥9 hours of sleep (PR 1.6 [95% CI 1.3-2.0]), and income-to-poverty ratio <2.00 and severe joint pain (PR 1.4 [95% CI 1.2-1.6] for both).Conclusion: SPR affects 1 of 9 adults with arthritis. This study is the first to use the ICF framework in a population-based sample to identify specific functional activities, pain, sleep, and other areas as priorities for intervention to reduce negative arthritis impacts on disability, including SPR. Increased use of existing clinical and public health interventions is warranted. [ABSTRACT FROM AUTHOR]

Purpose. To investigate the implementation of a web-based survey for involving children in the design of assistive technology devices within the primary school environment. Method. Children were recruited within their normal school environment. They completed tasks within the survey that sought to gather their personal preferences about assistive technology devices. From six primary schools, 257 children (mean age == 9 years and 8 months, SD == 1.51; 123 males, 134 females) including children with cerebral palsy ( N == 11), varying levels of deafness ( N == 7), global developmental delay ( N == 2) and Down's syndrome ( N == 1) participated. Observations were taken whilst the children completed the survey tasks. Results. All children were able to complete the tasks from the survey, although children with disabilities had higher completion times and most required a form of assistance from support assistants and/or sign language interpreters. Conclusions. The use of the web-based survey provided a novel means with which to involve children with and without disabilities in the design of assistive technology devices within a primary school environment. In order for the survey to be utilised more widely, issues that arose when involving children with disabilities need to be addressed. [ABSTRACT FROM AUTHOR]

PURPOSE: To determine whether the extent of multiple-site lower extremity joint pain contributes to disability in middle and old age and describe patterns of severity in site-specific measures amongst those with multiple-site pain. METHOD: Population-based, cross-sectional postal survey. Adults aged 50 years and over registered with three general practices and reporting pain lasting one month or longer in the previous year in at least one hip, knee, or foot were included. Respondents completed a generic measure of physical function and site-specific measures of severity for each relevant joint pain. RESULTS: Of 2429 eligible participants, 1801 reported multiple-site lower limb joint pain. Lower limb joint pain count was independently associated with reduced physical function after adjusting for a range of covariates. The severity of pain and disability attributed to each site increased as the number of painful sites increased. CONCLUSION: Many older people with joint pain in the lower limb have more than one joint affected. Generic and site-specific measures of disability both show the same pattern of reduced physical function. Treatment targeted at a single joint may have only a marginal effect on reducing disability in individuals with multiple joint involvement unless treatment is also conferring benefit at other sites. [ABSTRACT FROM AUTHOR]

Stereopsis and its role in dental practice has been a topic of debate in recent editions of this Journal. These discussions are particularly timely as they come at a point when virtual reality simulators are becoming increasingly popular in the education of tomorrow's dentists. The aim of this article is to discuss the lack of robust empirical evidence to ascertain the relationship (if any) between stereopsis and dentistry and to build a case for the need for further research to build a strong evidence base on the topic. [ABSTRACT FROM AUTHOR]

Abstract Background Participation restriction is defined as "problems an individual may experience in involvement in life situations" and refers to the personal and societal consequences of health conditions. There is a growing interest in participation restriction because (i) problems with work or looking after others may be more concerning to individuals than the signs and symptoms of health conditions and (ii) even when poor health persists, participation may still be maintained. The natural history of participation restriction in the general population is unknown and the aim of this report is to describe change in status of person-perceived participation restriction over three years in community-dwelling adults aged 50 years and over. Method Prospective cohort study (baseline and 3-year follow-up) using postal questionnaires mailed to a population-based sample of older adults. Responders were included in this study if they completed all items of the Keele Assessment of Participation at baseline (n = 6965). Estimates of onset and persistence of person-perceived participation restriction at 3-year follow-up were calculated for any and for each aspect of life in the sample as a whole, and then by age and gender using attrition re-weighted logistic regression to take account of sample attrition. Results In the whole sample of 6965 persons, overall participation status at three years was unchanged in 69%, and changed in 31%. Of 3431 persons with no restriction at baseline, it is estimated that 29.8% (95% confidence interval: 27.6%, 32.0%) would report restriction in at least one aspect of life at 3-year follow-up. Of 3534 persons who had baseline restriction, it is estimated that 68.8% (66.2%, 71.3%) would report continuing restriction in at least one aspect of life after 3 years. Onset and persistence both increased with age, and were most frequently recorded for restricted mobility outside the home. Conclusion Although most older persons do not change their overall participation status during a three-year period, change does occur which implies that population approaches to improving participation can be sought. Both onset and persistence of person-perceived participation restriction are more common the older the age-group.

Abstract Background Selective non-participation at baseline (due to non-response and non-consent) and loss to follow-up are important concerns for longitudinal observational research. We investigated these matters in the context of baseline recruitment and retention at 18 months of participants for a prospective observational cohort study of knee pain and knee osteoarthritis in the general population. Methods Participants were recruited to the Knee Clinical Assessment Study – CAS(K) – by a multi-stage process involving response to two postal questionnaires, consent to further contact and medical record review (optional), and attendance at a research clinic. Follow-up at 18-months was by postal questionnaire. The characteristics of responders/consenters were described for each stage in the recruitment process to identify patterns of selective non-participation and loss to follow-up. The external validity of findings from the clinic attenders was tested by comparing the distribution of WOMAC scores and the association between physical function and obesity with the same parameters measured directly in the target population as whole. Results 3106 adults aged 50 years and over reporting knee pain in the previous 12 months were identified from the first baseline questionnaire. Of these, 819 consented to further contact, responded to the second questionnaire, and attended the research clinics. 776 were successfully followed up at 18 months. There was evidence of selective non-participation during recruitment (aged 80 years and over, lower socioeconomic group, currently in employment, experiencing anxiety or depression, brief episode of knee pain within the previous year). This did not cause significant bias in either the distribution of WOMAC scores or the association between physical function and obesity. Conclusion Despite recruiting a minority of the target population to the research clinics and some evidence of selective non-participation, this appears not to have resulted in significant bias of cross-sectional estimates. The main effect of non-participation in the current cohort is likely to be a loss of precision in stratum-specific estimates e.g. in those aged 80 years and over. The subgroup of individuals who attended the research clinics and who make up the CAS(K) cohort can be used to accurately estimate parameters in the reference population as a whole. The potential for selection bias, however, remains an important consideration in each subsequent analysis.

A pair of monozygotic twins discordant for Wiedemann-Beckwith syndrome is described. The probability of monozygosity is 0.995. This observation suggests that the syndrome is unlikely to be under single gene control and genetic counselling should be based on multifactorial inheritance. [ABSTRACT FROM AUTHOR]

Abstract Background Knee pain affects an estimated 25% of the adult population aged 50 years and over. Osteoarthritis is the most common diagnosis made in older adults consulting with knee pain in primary care. However, the relationship between this diagnosis and both the current disease-based definition of osteoarthritis and the regional pain syndrome of knee pain and disability is unclear. Expert consensus, based on current evidence, views the disease and the syndrome as distinct entities but the clinical usefulness of these two approaches to classifying knee pain in older adults has not been established. We plan to conduct a prospective, population-based, observational cohort study to investigate the relative merits of disease-based and regional pain syndrome-based approaches to classification and prognosis of knee pain in older adults. Methods All patients aged 50 years and over registered with three general practices in North Staffordshire will be invited to take part in a two-stage postal survey. Respondents to this survey phase who indicate that they have experienced knee pain within the previous 12 months will be invited to attend a research clinic for a detailed assessment. This will consist of clinical interview, physical examination, digital photography, plain x-rays, anthropometric measurement and a brief self-complete questionnaire. All consenting clinic attenders will be followed up by (i) general practice medical record review, (ii) repeat postal questionnaire at 18-months.

Abstract Background The clinical syndrome of joint pain and stiffness in older people is the commonest cause of disability and health care consultation in this age group. Yet there have been few prospective studies of its course over time and its impact on personal and social life. We plan a cohort study in the general population aged 50 years and over to determine the course and prognosis of hand, hip, knee and foot pain, and the impact of these syndromes on participation levels and health care use. Methods All patients aged 50 years and over registered with 3 local general practices are to be recruited to a population-based cohort study through the use of a two-stage mailing process. Participants will initially complete a "Health Survey" questionnaire. This will collect information on several areas of life including socio-demographics, general health, physical function, participation, and bodily pain. Those who state that they have experienced any hand problem or any pain in their hands, hips, knees, or feet in the previous 12 months, and also give permission to be re-contacted, will be mailed a "Regional Pains Survey" questionnaire which collects detailed information on the four selected body regions (hand, hips, knees, feet). Follow-up data for the three-year period subsequent to cohort recruitment will be collected through two sources: i) general practice medical records and ii) repeat mailed survey.

Aim: To determine whether outcomes of neonatal mechanical ventilation could be improved by regular pulmonary function testing.Methods: Two hundred and forty five neonates, without immediately life threatening congenital malformations, were mechanically ventilated in the newborn period. Infants were randomly allocated to conventional clinical management (control group) or conventional management supplemented by regular measurements of static respiratory system compliance, using the single breath technique, with standardised management advice based on the results.Results: Fifty five (45%) infants in each group experienced one or more adverse outcomes. The median (quartile) durations of ventilation and oxygen supplementation were 5 (2-12) and 6 (2-34) days for the control group, and 4 (2-9) and 6 (3-36) days for the experimental group (not significant). On post-hoc secondary analysis, control group survivors were ventilated for 1269 days with a median (quartile) of 5 (2-13) days, and experimental group survivors were ventilated for 775 days with a median (quartile) duration of 3 (2-8) days (p = 0.03).Conclusions: Although primary analysis did not show any substantial benefit associated with regular measurement of static respiratory system compliance, this may reflect a type II error, and a moderate benefit has not been excluded. Larger studies are required to establish the value of on-line monitoring techniques now available with neonatal ventilators. [ABSTRACT FROM AUTHOR]

Static respiratory system compliance (Crs) and lecithin/sphingomyelin (L/S) ratios in tracheal aspirates were estimated in two independent groups of mechanically ventilated infants. Crs was measured rapidly at the cotside using a passive expiratory flow technique and L/S ratios were estimated in the laboratory by high performance liquid chromatography. In the reference group of 22 infants, Crs < 1.8 ml/cm H2O/m predicted surfactant deficiency with a positive predictive value of 100% and a negative predictive value of 92%. In the validation group of 23 infants, Crs < 1.8 ml/cm H2O/m predicted surfactant deficiency with a positive predictive value of 94% and a negative predictive value of 83%. Measurement of static Crs is a rapid, non-invasive technique which may usefully supplement current methods of selecting infants at high risk of respiratory distress syndrome. [ABSTRACT FROM AUTHOR]

Static respiratory system compliance (Crs) was measured by a single breath passive expiratory flow technique in 73 newborn infants treated with exogenous surfactant. The first 39 received Curosurf, a natural porcine surfactant. The other 34 received Exosurf Neonatal, a synthetic surfactant. All had a diagnosis of respiratory distress syndrome with an arterial/alveolar oxygen ratio < 0.22. Static Crs and arterial blood gases were measured shortly before, and at three and 12 hours after the first dose of surfactant. In 32 infants treated with Curosurf with initial static Crs < 1.8 ml/cm H2O/m body length, which is consistent with surfactant deficiency, static Crs improved by 18% at three hours and by 39% at 12 hours along with a median reduction in fractional inspired oxygen (FIO2) at three hours by 0.32. In 26 infants treated with Exosurf with initial Crs < 1.8 ml/cm H2O/m, Crs did not improve three and 12 hours after treatment and oxygenation improved less than after Curosurf, with a median reduction in FIO2 at three hours of 0.11. Fifteen of the 73 (21%) infants had initial static Crs of > or = 1.8 ml/cm H2O/m, not consistent with surfactant deficiency. Thirteen of these 15 infants showed a fall in static Crs after surfactant treatment, raising the question whether exogenous surfactant did them more harm than good. Initial static Crs and surfactant type both appear to determine the early response to the first dose of surfactant. Only a considerably larger, randomised study can show which surfactant is more effective in reducing adverse clinical outcome. [ABSTRACT FROM AUTHOR]

Accurate measures of the severity of respiratory disease are important, both clinically and epidemiologically. The apparent prognostic value of static respiratory system compliance (Crs) on the first day and mean appropriate fractional inspired oxygen (FIO2) in the first 12 hours of life were compared in 48 infants who received mechanical ventilation in a regional neonatal unit. Their median (range) gestation was 30 (25-41) weeks and they were representative of all 140 newborn infants born to residents of a geographically defined area who received mechanical ventilation over a 30 month period. Using the best cut off value (< or = 0.6 ml/cm H2O/m corrected for body length), static Crs predicted hospital death with 98% accuracy, 80% sensitivity, and 100% specificity. Using the best cut off value (> 0.60), mean FIO2 in the first 12 hours predicted hospital death with 81% accuracy, 80% sensitivity, and 81% specificity. Static Crs appeared to be a more accurate measure of respiratory function and disease severity than mean FIO2, perhaps because static Crs is less dependent on ventilator management than routine indices based on blood gases. Static Crs now merits wider evaluation, both as an aid to routine clinical management and as a prognostic index in comparative studies. [ABSTRACT FROM AUTHOR]

B Background: b Current approaches to surgical list ordering are driven by a combination of patient characteristics and clinical insight. B Results: b There was a substantial effect of operating list order for single-procedure lists: each increase in position on the list decreased operation time and length of hospital stay (p < 0.0001). [Extracted from the article]