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Background: A recent study of adults aged >or=50 years reporting knee pain found an excess of radiographic knee osteoarthritis (knee ROA) in symptomatic males compared to females. This was independent of age, BMI and other clinical signs and symptoms. Since this finding contradicts many previous studies, our objective was to explore four possible explanations for this gender difference: X-ray views, selection, occupation and non-articular conditions.Methods: A community-based prospective study. 819 adults aged >or=50 years reporting knee pain in the previous 12 months were recruited by postal questionnaires to a research clinic involving plain radiography (weight-bearing posteroanterior semiflexed, supine skyline and lateral views), clinical interview and physical examination. Any knee ROA, ROA severity, tibiofemoral joint osteoarthritis (TJOA) and patellofemoral joint osteoarthritis (PJOA) were defined using all three radiographic views. Occupational class was derived from current or last job title. Proportions of each gender with symptomatic knee ROA were expressed as percentages, stratified by age; differences between genders were expressed as percentage differences with 95% confidence intervals.Results: 745 symptomatic participants were eligible and had complete X-ray data. Males had a higher occurrence (77%) of any knee ROA than females (61%). In 50-64 year olds, the excess in men was mild knee OA (particularly PJOA); in >or=65 year olds, the excess was both mild and moderate/severe knee OA (particularly combined TJOA/PJOA). This male excess persisted when using the posteroanterior view only (64% vs. 52%). The lowest level of participation in the clinic was symptomatic females aged 65+. Within each occupational class there were more males with symptomatic knee ROA than females. In those aged 50-64 years, non-articular conditions were equally common in both genders although, in those aged 65+, they occurred more frequently in symptomatic females (41%) than males (31%).Conclusion: The excess of knee ROA among symptomatic males in this study seems unlikely to be attributable to the use of comprehensive X-ray views. Although prior occupational exposures and the presence of non-articular conditions cannot be fully excluded, selective non-participation bias seems the most likely explanation. This has implications for future study design. [ABSTRACT FROM AUTHOR]

Health literacy (HL), defined as the ability of an individual to understand and appraise health information to make informed decisions on their health, helps maintain and improve one's health and thus reduce the use of healthcare services. There is a recognised global effort to address insufficient HL in early life and understand how HL develops. This study examined the association of a range of factors including educational, speech and language ability, health and healthcare engagement, sleep problems, mental health, demographic, environmental, and maternal factors at different childhood stages (from 5 years to 11 years) with later adult HL at age 25. HL was measured using a HL ordinal score (insufficient, limited, or sufficient) derived from the European Literacy Survey Questionnaire-short version (HLS-EU-Q16) within a large UK based birth cohort (Avon Longitudinal Study of Parents and Children: ALSPAC study). Univariate proportional odds logistic regression models for the probability of having higher levels of HL were developed. Results of analysis of 4248 participants showed that poorer speech and language ability (aged 9 years, OR 0.18 95% CI 0.04 to 0.78), internalising in child (age 11 years, OR 0.62 95% CI 0.5 to 0.78), child depression (age 9 years, OR 0.67 95% CI 0.52 to 0.86), and the presence of maternal depression (child age 5, OR 0.80 95% CI 0.66 to 0.96), reduced the odds of sufficient HL when adult. Our results suggest some useful markers to identify children at potential risk of low HL that could be targeted for research into future interventions within school settings, for example, child's speech and language capability. In addition, this study identified child and maternal mental health as factors associated with later development of limited HL and future research should consider what potential mechanisms might explain this link., Competing Interests: None., (© 2023 The Authors.)

Abstract: A significant proportion of children/adolescents report chronic widespread pain (CWP), but little is known about clinically relevant CWP or what factors lead to onset in this population. Objectives were to report the primary care consultation prevalence of CWP and investigate risk factors associated with onset. A validated algorithm for identifying CWP status from primary care electronic healthcare records was applied to a child or adolescent population (aged 8-18 years). The algorithm records patients who have recurrent pain consultations (axial skeleton and upper or lower limbs) or those with a nonspecific generalised pain disorder (eg, fibromyalgia). Prevalence was described, and a nested case-control study was established to identify risk factors associated with CWP onset using logistic regression producing odds ratios (ORs) and 95% confidence intervals (95% CIs). Two hundred seventy-one children or adolescents were identified with CWP, resulting in a 5-year consultation prevalence of 3.19%. Risk factors significantly associated with CWP onset were as follows: mental health (eg, anxiety/neurosis consultations), neurological (eg, headaches), genitourinary (eg, cystitis), gastrointestinal (eg, abdominal pain), and throat problems (eg, sore throats). Children or adolescents with 1 or 2 risk factors (OR 2.15, 95% CI 1.6-2.9) or 3 or more risk factors (OR 9.17, 95% CI 5.9-14.3) were at significantly increased odds of CWP onset compared with those with none. Findings show a significant proportion of the child or adolescent primary care population has CWP. Most risk factors involved pain-related conditions, suggesting potential pathways of pain development. Further work is now needed to better understand the development of CWP in children and adolescents., (Copyright © 2021 International Association for the Study of Pain.)

Background: The Global Burden of Disease reports indicate that musculoskeletal conditions are important causes of disability worldwide. Such conditions may originate in childhood, but studies investigating changes longitudinally and from childhood to adulthood are infrequent., Methods: Nine birth cohorts of children (starting at ages 7-15 years) were followed. Participants were identified from Consultations in Primary Care Archive, an electronic health record database of 11 English general practices. Musculoskeletal consultation prevalence figures were calculated, and reasons for consultation evaluated., Results: Annual musculoskeletal consultation prevalence was similar across cohorts for each age. Prevalence increased from 6 to 16% between ages 7 and 22 and was higher in males until age 15, after which prevalence was higher in females. Pain was the most common reason for consultation. Back pain consultations increased from 1 consultation/1000 7 year olds to 84 consultations/1000 22 year olds. Lower limb pain consultations increased from 21 consultations/1000 7 year olds to 56 consultations/1000 22 year olds., Conclusions: This study shows that from childhood, individuals are more likely to seek healthcare for musculoskeletal consultations as they age, but rates are not increasing over time. Changes in consultation rates by age, gender and pain region may inform studies on the development of chronic musculoskeletal pain over the life-course., (© The Author(s) 2019. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: People with low health literacy (HL) are at increased risk of poor health outcomes, and receive less benefit from healthcare services. However, healthcare practitioners can effectively adapt healthcare information if they are aware of their patients' HL. Measurements are available to assess HL levels but may not be practical for use within primary care settings. New alternative methods based on demographic indicators have been successfully developed, and we aim to test if such methodology can be applied to routinely collected consultation records., Methods: Secondary analysis was carried out from a recently completed prospective cohort study that investigated a primary care population who had consulted about a musculoskeletal pain problem. Participants completed questionnaires (assessing general health, HL, pain, and demographic information) at baseline and 6 months, with linked data from the participants' consultation records. The Single Item Literacy Screener was used as a benchmark for HL. We tested the performance of an existing demographic assessment of HL, whether this could be refined/improved further (using questionnaire data), and then test the application in primary care consultation data. Tests included accuracy, sensitivity, specificity, and area under the curve (AUC). Finally, the completed model was tested prospectively using logistic regression producing odds ratios (OR) in the prediction of poor health outcomes (physical health and pain intensity)., Results: In total 1501 participants were included within the analysis and 16.1% were categorised as having low HL. Tests for the existing demographic assessment showed poor performance (AUC 0.52), refinement using additional components derived from the questionnaire improved the model (AUC 0.69), and the final model using data only from consultation data remained improved (AUC 0.64). Tests of this final consultation model in the prediction of outcomes showed those with low HL were 5 times more likely to report poor health (OR 5.1) and almost 4 times more likely to report higher pain intensity (OR 3.9)., Conclusions: This study has shown the feasibility of the assessment of HL using primary care consultation data, and that people indicated as having low HL have poorer health outcomes. Further refinement is now required to increase the accuracy of this method.

Musculoskeletal conditions are a major cause of ill health and disability. Inadequate health literacy may partly explain why musculoskeletal self-management programs are not effective for some patients. This study prospectively evaluated the impact of patients' health literacy level on their musculoskeletal pain and physical function (PF) following usual primary care. Primary care patients ( N = 4,720) who had consulted for musculoskeletal pain were mailed a baseline questionnaire; responders were sent a 6-month follow-up questionnaire. The measure of health literacy used was the single-item Literary Screener at baseline, and the outcomes were PF and pain intensity at the 6-months follow-up. Analysis was conducted by linear regression. The number of patients who responded was 1,890 (40%); 17.3% (95% CI [15.6%-19%]) of them had inadequate health literacy. Inadequate health literacy was associated with older age ( p < .05), lower education, mental health, and comorbidities (all p < .001), but not by gender ( p = .642). At the 6-month follow-up stage, patients with inadequate health literacy had lower PF (mean difference -12.2; 95% CI [-16.7, -7.6]) and higher pain intensity (mean difference 1; 95% CI [0.6, 1.4]), which was adjusted for age, gender, education, mental health, and comorbidities. Differences in PF and particularly pain scores between patients with inadequate and adequate health literacy increased over 6 months. Future studies should develop interventions that better support patients who have musculoskeletal pain with inadequate health literacy to successfully manage their pain. [ HLRP: Health Literacy Research and Practice . 2018;2(4):e214-e220.] .

Background: adults aged ≥65 years are often excluded from health research studies. Lack of representation reduces generalisability of treatments for this age group., Objective: to evaluate the effectiveness of strategies that improve recruitment and retention of adults aged ≥65 in observational studies and randomised controlled trials (RCTs)., Methods: searches conducted in 10 databases for RCTs of recruitment and retention strategies in RCTs or observational studies. Two reviewers screened abstracts and full-text articles for eligibility and extracted data. Studies without separate data for adults aged ≥65 were discarded. Risk of bias assessed using the Cochrane Risk of Bias tool. Results were synthesised narratively., Results: thirty-two studies were included in the review (n = 75,444). Twelve studies had low risk of bias, of which 10 had successful strategies including: Opt-out versus opt-in increased recruitment (13.6% (n = 261)-18.7% (n = 36) difference; two studies); Advance notification increased retention (1.6% difference, OR 1.45; 95% CI 1.01, 2.10, one study (n = 2,686); 9.1% difference at 4 months, 1.44; 1.08, 1.92, one study (n = 753)); Hand-delivered versus postal surveys increased response (25.1% difference; X2 = 11.40, P < 0.01; one study (n = 139)); Open randomised design versus blinded RCT increased recruitment (1.56; 1.05, 2.33) and retention (13.9% difference; 3.1%, 24.6%) in one study (n = 538). Risk of bias was high/unclear for studies in which incentives or shorter length questionnaires increased response., Discussion: in low risk of bias studies, few of the strategies that improved participation in older adults had been tested in ≥1 study. Opt-out and advance notification strategies improved recruitment and retention, respectively, although an opt-out approach may have ethical limitations. Evidence from single studies limits the generalisability of other strategies., (© The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: journals.permissions@oup.com)

In older adults, reduced social participation increases the risk of poor health-related quality of life, increased levels of inflammatory markers and cardiovascular disease, and increased mortality. Older adults frequently present to primary care, which offers the potential to deliver interventions at the point of care to increase social participation. The aim of this prospective study was to identify the key modifiable exposures that were associated with reduced social participation in a primary care population of older adults.The study was a population-based prospective cohort study. Participants (n = 1991) were those aged ≥65 years who had completed questionnaires at baseline, and 3 and 6-year follow-ups. Generalized linear mixed modeling framework was used to test for associations between exposures and decreasing social participation over 6 years.At baseline, 44% of participants reported reduced social participation, increasing to 49% and 55% at 3 and 6-year follow-up. Widespread pain and depression had the strongest independent association with reduced social participation over the 6-year follow-up period. The prevalence of reduced social participation for those with widespread pain was 106% (adjusted incidence rate ratio 2.06, 95% confidence interval 1.72, 2.46), higher than for those with no pain. Those with depression had an increased prevalence of 82% (adjusted incidence rate ratio 1.82, 95% confidence interval 1.62, 2.06). These associations persisted in multivariate analysis.Population ageing will be accompanied by increasing numbers of older adults with pain and depression. Future trials should assess whether screening for widespread pain and depression, and targeting appropriate treatment in primary care, increase social participation in older people.

Objective: Most pain in patients aged ≥50 years affects multiple sites and yet the predominant mode of presentation is single-site syndromes. The aim of this study was to investigate if pain sites form clusters in this population and if any such clusters are associated with health factors other than pain., Setting: Six general practices in North Staffordshire, UK., Design: Cross-sectional, postal questionnaire, study., Participants: Community-dwelling adults aged ≥50 years registered at the general practices., Main Outcomes Measures: Number of pain sites was measured by asking participants to shade sites of pain lasting ≥1 day in the past 4 weeks on a blank body manikin. Health factors measured included anxiety and depression (Hospital and Anxiety Depression Scale), cognitive complaint (Sickness Impact Profile) and sleep. Pain site clustering was investigated using latent class analysis. Association of clusters with health factors, adjusted for age, sex, body mass index and morbidities, was analysed using multinomial regression models., Results: 13 986 participants (adjusted response 70.6%) completed a questionnaire, of whom 12 408 provided complete pain data. Four clusters of participants were identified: (1) low number of pain sites (36.6%), (2) medium number of sites with no back pain (31.5%), (3) medium number of sites with back pain (17.9%) and (4) high number of sites (14.1%). Compared to Cluster 1, other clusters were associated with poor health. The strongest associations (relative risk ratios, 95% CI) were with Cluster 4: depression (per unit change in score) 1.11 (1.08 to 1.14); cognitive complaint 2.60 (2.09 to 3.24); non-restorative sleep 4.60 (3.50 to 6.05)., Conclusions: These results indicate that in a general population aged ≥50 years, pain forms four clusters shaped by two dimensions-number of pain sites (low, medium, high) and, within the medium cluster, the absence or presence of back pain. The usefulness of primary care treatment approaches based on this simple classification should be investigated., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Musculoskeletal pain is common and often occurs at multiple sites. Persons with chronic widespread pain (CWP) often report disturbed sleep. Until recently, the relationship between sleep disturbance and CWP has been unclear: does poor sleep increase the risk of developing CWP, do people with CWP develop poor sleep as a consequence of their pain, or is the relationship bi-directional? In this article, we have focused on the relationship between insomnia and CWP. We briefly present descriptive epidemiological data for insomnia and CWP. We then summarise the available evidence which supports the hypothesis that the relationship is bi-directional. Finally, we discuss the clinical management of CWP and insomnia in primary care, where the vast majority of cases of CWP are managed.

Objectives: Number of pain sites (NPS) is a potentially important marker of health-related quality of life (HRQoL) but remains unexplored in older people. This cross-sectional study investigated whether, in older people including the oldest old, NPS was independently associated with poorer mental and physical HRQoL and if the association was moderated by age., Methods: A postal questionnaire sent to a population sample of adults aged ≥50 years in North Staffordshire, UK, included the 12-item Short Form Health Survey (SF-12) mental component summary (MCS) and physical component summary (PCS), a blank body pain manikin, socio-demographic, health behaviour and morbidity questions. Participants shaded sites of pain lasting ≥1 day in the past 4 weeks on the manikin. OA consultation data were obtained for participants consenting to medical records review., Results: A total of 13 986 individuals (adjusted response 70.6%) completed a questionnaire, of which 12 408 provided complete pain data. The median NPS reported was 4 [interquartile range (IQR) 0-8]. General linear models showed that an increasing NPS was significantly associated with poorer MCS (β = -0.43, 95% CI -0.46, -0.40) and PCS (β = -0.87, 95% CI -0.90, -0.84). Adjustment for covariates attenuated the associations but they remained significant (, Mcs: β = -0.28, 95% CI -0.31, -0.24; PCS: β = -0.63, 95% CI -0.66, -0.59). The association between NPS and MCS or PCS was moderated by age, but the strongest associations were not in the oldest old., Conclusion: NPS appears to be a potentially modifiable target for improving physical and mental HRQoL in older people. Future analyses should investigate the influence of NPS on HRQoL over time in older people., (© The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Objective: In older adults, widespread pain (WP) is common, although its etiology is unclear. This study sought to identify factors associated with an increased risk of developing WP in adults age ≥50 years., Methods: A population-based prospective study was conducted. A baseline questionnaire was administered to subjects to collect data on pain, psychological status, lifestyle and health behaviors, and sociodemographic and clinical factors. Participants free of WP (as defined by the American College of Rheumatology 1990 criteria for fibromyalgia) were followed up for 3 years, and those with new-onset WP at followup were identified. Logistic regression analyses were used to test the relationship between baseline factors and new-onset WP. Multiple imputation was used to test the results for sensitivity to missing data., Results: In this population-based study, 4,326 subjects (1,562 reporting no pain at baseline and 2,764 reporting some pain at baseline) participated at followup. Of these participants, 800 (18.5%) reported a status of new WP at followup (of whom, 121 [7.7%] had reported no pain at baseline and 679 [24.6%] had reported some pain at baseline). The majority of the study factors were associated with new-onset WP. However, only a few factors showed a persistent association with new-onset WP in the multivariate analysis, including age (odds ratio [OR] 0.97, 95% confidence interval [95% CI] 0.96-0.99), baseline pain status (OR 1.1, 95% CI 1.08-1.2), anxiety (OR 1.5, 95% CI 1.01-2.1), physical health-related quality of life (OR 1.3, 95% CI 1.1-1.5), cognitive complaint (OR 1.3, 95% CI 1.04-1.6), and nonrestorative sleep (OR 1.9, 95% CI 1.2-2.8). These associations persisted after adjustment for the presence of diffuse osteoarthritis (OA), which led to a modest increase in model fit (C-statistic 0.738, compared with 0.731 in the model excluding diffuse OA). The results were not sensitive to missing data., Conclusion: Of the factors measured in this study, nonrestorative sleep was the strongest independent predictor of new-onset WP., (© 2014 The Authors. Arthritis & Rheumatology is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.)

Attrition is a potential source of bias in cohort studies. Although attrition may be inevitable in cohort studies of older people, there is little empirical evidence as to whether bias due to such attrition is also inevitable. Anonymised primary care data, routinely collected in clinical practice and independent of any cohort research study, represents an ideal unselected comparison dataset with which to compare primary care data from consenting responders to a cohort study. Our objective was to use this method as a novel means to assess if (i) responders at follow-up stages in a cohort study remain representative of responders at baseline and (ii) attrition biases estimates of longitudinal associations. We compared primary care consultation morbidities and prescription prevalences among circa 32,000 patients aged 50+ who contribute to an anonymised general practice database (Consultations in Primary Care Archive (CiPCA)) with those from patients aged 50+ in the North Staffordshire Osteoarthritis Project (NorStOP) cohort, United Kingdom (2002-2008; n=16,159). 8,197 (51%) persons responded to the NorStOP baseline survey and consented to medical record review. 5,121 and 3,311 responded at 3- and 6-year follow-ups. Differences in consulting prevalence of non-musculoskeletal morbidities between NorStOP responders and CiPCA comparison population did not increase over the two follow-up points except for ischaemic heart disease. Differences observed at baseline for osteoarthritis-related consultations were generally unchanged at the two follow-ups (standardised prevalence ratios for osteoarthritis (1.09-1.13) and joint pain (1.12-1.23)). Age and gender adjusted associations between baseline consultation for chronic morbidity and future new osteoarthritis and related consultations were similar in CiPCA (adjusted Hazard Ratio: 1.40; 95% Confidence Interval: 1.34,1.47) and NorStOP 6-year responders (1.32; 1.15,1.51). There was little evidence that responders at follow-ups represented any further selection bias to that present at baseline. Attrition in cohort studies of older people does not inevitably indicate bias.

Background: Chronic pain is the leading cause of disability in developed countries. Prevalence is linked with socio-economic position (SEP), but little is known about the influence of SEP on disabling pain over the life course. We have investigated the influence of different life course trajectories of SEP on disabling pain ('pain interference') in postal surveys of adults aged ≥50 years sampled from the general population of adults registered with three UK general practices., Methods: Current pain interference was measured using the dichotomized 36-item Short-Form (SF-36) health survey. Three recalled SEP measures (age left school, longest job and current/most recent job) were dichotomized into low SEP (left school at or before minimum school leaving age; reported routine or manual occupations) and high SEP, from which eight life course SEP trajectories were constructed. Associations of (i) eight SEP trajectories and (ii) three individual SEP measures adjusted for each other, with pain interference, adjusted for potential confounders, were calculated using logistic regression., Results: A total of 2533 individuals provided data on all three SEP measures. A consistently low life course SEP trajectory was significantly associated with current pain interference compared with a high trajectory [odds ratio (OR) = 2.76, 95% confidence interval (CI): 2.19-3.47], even after adjustment for age and gender. Further adjustment reduced the association but it remained significant (OR = 2.04; 95% CI: 1.55-2.68). In the model with individual measures, low age left school (OR = 1.45; 95% CI: 1.15-1.82) and manual longest job (OR = 1.47; 95% CI: 1.13-1.91) were independently associated with pain interference., Conclusions: Our results highlight the potential for reducing chronic disabling pain in later life by addressing inequalities in both childhood education and adult occupational opportunities.

Background: Since few cohorts encompass the whole life-course, many studies that measure socio-economic position (SEP) across the life-course rely on participant recall of SEP measures from cross-sectional postal or interview surveys. It is also particularly important that SEP measures should be appropriate for the age of the population studied, as the level of missing data has been shown to increase in older people. The aim of this study was to investigate the accuracy of recall of two SEP measures in older adults, age left school and longest job, by examining their validity in a general population postal survey in North Staffordshire, UK., Methods: Sets of questions on education and longest job were included in a questionnaire at different stages of the study. All patients aged 50+ registered with three general practices were sent a baseline Health Questionnaire. 6 years later, 3410 responders were mailed a follow-up Health Questionnaire; a sub-sample of these participants took part in independent qualitative interviews. Validity was assessed by: percentage completion; internal percentage agreement within each set of questions; percentage agreement of qualitative and quantitative data for age left school and longest job; comparing recall of age left school with historical change in legal school leaving age; comparing frequency of pottery job titles with those in 1981 Census data for Stoke-on-Trent., Results: The adjusted response to different stages of the study was 71-85%. Completion of questions was 83-98%. Internal agreement was 84-97% (education) and 95-100% (longest job). Comparison of survey and interview data showed 86% agreement (± 1 year) for age left school and 91% agreement for longest job. The change in age left school data concurred with the historical shift in legal school leaving age. 11% of job titles were pottery in NorStOP data and 15% in Stoke-on-Trent Census data., Conclusions: The results from this study provide evidence for the accuracy of recall of two simple measures of SEP (age left school and longest job) in a postal survey of older adults. Consistency with evidence from external datasets indicated the potential validity of these measures for studying life-course SEP in population surveys.

Aim: To investigate the impact of piecework on musculoskeletal pain and general health, and the influence of perceived workplace psychosocial factors on any such associations, in a general UK population., Methods: A questionnaire was mailed to an age-stratified random sample of 10 000 adults aged 18-75 in North Staffordshire, UK. Respondents reporting a current main job were asked if this job was paid by a piecework system. Health measures were (i) number of pain areas according to a body manikin and (ii) general health (SF-12v2). Other measures included questions on occupational history and psychosocial aspects of the work environment., Results: The adjusted response was 54%. A total of 1193 respondents reported a current main job, of whom 201 (17%) reported piecework. Pieceworkers were more likely to be older (P < 0.05), male (P < 0.001) and in lower socioeconomic groups (P < 0.001) than non-pieceworkers. Piecework was associated with perceptions of a poor psychosocial working environment, more pain areas (P < 0.05), more elbow (P < 0.01), forearm (P < 0.001) and hand pain (P < 0.05), and a lower physical health score (SF-12v2; P < 0.01), but no difference in mental health score (P = 0.60), compared with non-pieceworkers. After controlling for psychosocial factors, and socioeconomic group, the associations between piecework and pain areas, or physical health, were no longer statistically significant., Conclusions: These results show that piecework was associated with poorer self-reported general physical health and more areas of pain, which may be attributed to low socioeconomic group, and workplace perceptions of little job control, high physical demand and little supervisor support.

Background: Work-related neck and upper limb pain has mainly been studied in specific occupational groups, and little is known about its impact in the general population. The objectives of this study were to estimate the prevalence and population impact of work-related neck and upper limb pain., Methods: A cross-sectional survey was conducted of 10,000 adults in North Staffordshire, UK, in which there is a common local manual industry. The primary outcome measure was presence or absence of neck and upper limb pain. Participants were asked to give details of up to five recent jobs, and to report exposure to six work activities involving the neck or upper limbs. Psychosocial measures included job control, demand and support. Odds ratios (ORs) and population attributable fractions were calculated for these risk factors., Results: The age-standardized one-month period prevalence of neck and upper limb pain was 44%. There were significant independent associations between neck and upper limb pain and: repeated lifting of heavy objects (OR = 1.4); prolonged bending of neck (OR = 2.0); working with arms at/above shoulder height (OR = 1.3); little job control (OR = 1.6); and little supervisor support (OR = 1.3). The population attributable fractions were 0.24 (24%) for exposure to work activities and 0.12 (12%) for exposure to psychosocial factors., Conclusion: Neck and upper limb pain is associated with both physical and psychosocial factors in the work environment. Inferences of cause-and-effect from cross-sectional studies must be made with caution; nonetheless, our findings suggest that modification of the work environment might prevent up to one in three of cases of neck and upper limb pain in the general population, depending on current exposures to occupational risk.

Objectives: To investigate the association of occupational factors, both physical and psychosocial, with hand paraesthesia, and whether any such associations differ according to the concurrent presence of neck and upper limb pain (NULP)., Methods: A questionnaire was mailed to an age-stratified random sample of 9596 adults. All subjects were asked about hand paraesthesia in the past 4 weeks. Information was obtained on respondents' main job (the job held for the longest time), whether this job involved any of six neck or upper limb activities on most or all days of the working week, and questions on the psychosocial aspects of the work environment. The questionnaire also asked about NULP according to a preshaded manikin., Results: A total of 5133 people replied to the survey (adjusted response 53.5%). Of these, 1592 reported abnormal feelings in the hands (prevalence of 31.9%). Prolonged gripping, prolonged bending of the neck forwards, working with arms at/above shoulder height, low job control, many changes in tasks and low job support were independently associated with hand paraesthesia. Among responders also reporting NULP, working with arms at/above shoulder height and many changes in tasks were independently associated with hand paraesthesia; prolonged gripping was linked to hand paraesthesia in the absence of NULP., Conclusions: Hand paraesthesia is associated with physical and psychosocial workplace factors, although different work-related factors were associated with hand paraesthesia according to the concurrent presence of NULP, suggesting that these symptoms may not always be mediated in the same way.

Study Design: Study of interrater reliability., Objective: To assess the interrater reliability of data from pain drawings scored by multiple raters and the consistency of the subsequent classification of cases of widespread pain., Summary of Background Data: In large health surveys, pain drawings used to capture self-reported pain, and to classify cases of widespread pain, are often scored by several raters. The reliability of multiple rater scoring of pain drawings has not been investigated., Methods: As part of a postal survey sent to adults 50 years and older, subjects were asked to shade their pain on a blank body manikin. The first 50 pain drawings in which respondents had shaded pain were selected for this study. Eight nonclinical staff were trained to score pain drawings using transparent templates divided into 50 body areas. Interrater reliability was assessed by comparing the scoring of "pain" or "no pain" for all 50 areas of each pain drawing., Results: Complete scoring agreement among all raters was observed for at least 78% of pain drawings across all body areas (kappa > 0.60). The raters had complete agreement in 42 of 50 areas in 90% or more of pain drawings. From the raters' scoring of pain areas, there was complete agreement on the presence or absence of widespread pain for 49 of 50 pain drawings (98% agreement, Kappa = 0.98)., Conclusions: This study shows that multiple raters, with training and guidelines, can reliably score pain drawings, and high consistency in the subsequent classification of cases of widespread pain can be obtained from such data.

Ethical guidelines in the United Kingdom require written consent from participants in epidemiologic studies for follow-up or review of medical records. This may cause bias in samples used for follow-up or medical record review. The authors analyzed data from seven general population surveys conducted in the United Kingdom (1996-2002), to which over 25,000 people responded. Associations of age, gender, and symptom under investigation with consent to follow-up and consent to review of medical records were examined. Consent to follow-up was approximately 75-95% among survey responders under age 50 years but fell among older people, particularly females. Consent to follow-up was also higher among responders who had the symptom under investigation (pooled odds ratio = 1.61, 95% confidence interval: 1.36, 1.92). Consent to review of medical records followed a similar pattern. Patterns of consent were relatively consistent and represented a high proportion of responders. Males, younger people, and subjects reporting the symptom under investigation were more likely to give consent, and these groups may be overrepresented in follow-up samples or reviews of medical records. Although consent is high among responders, the additive effect of nonresponse and nonconsent can substantially reduce sample size and should be taken into account in epidemiologic study planning.

The first use of Kerr gated fluorescence rejection Raman spectroscopy for the analysis of street samples of cocaine in a fluorescing matrix is reported.

Pain drawings can be presented as either a blank or a pre-shaded manikin. This study sought to determine the effect of these two presentations on prevalence estimates of neck and upper limb pain (NULP), and their relationship to patterns of pain report. A postal questionnaire was sent to a stratified random sample of 10000 adults. It contained a blank body manikin and a pre-shaded neck and upper limb manikin screening question. Respondents answering positively to the pre-shaded manikin were asked about pain intensity, affect, disability and duration. Other measures included general health status (SF-12v2) and demographic questions. Adjusted response rate was 53.5%. Age-standardized 1-month period prevalence was 44.0% (crude prevalence 50.5%) for the screening question and 37.3% (crude prevalence 42.1%) for the blank manikin. There was 88% agreement between the pre-shaded manikin and the shading of corresponding areas on the blank manikin (kappa=0.76, 95% CI=0.74, 0.78). Of the 603 disagreements, 509 comprised no shading on the blank manikin but positive response to the pre-shaded manikin; they reported lower pain intensity, fewer days with pain, shorter time since initial onset and less disability than the 2030 reporting NULP on both manikins (P<0.001 in each case). The form of manikin presentation in a postal questionnaire can shift the reported prevalence of pain; a difference of 6.7% in our study. Furthermore, respondents only answering positively to a pre-shaded manikin form a group experiencing less severe NULP and less associated disability.

Methods of detection of amphetamine sulfate using surface enhanced Raman scattering (SERS) from colloidal suspensions and vapour deposited films of both silver and gold are compared. Different aggregating agents are required to produce effective SERS from silver and gold colloidal suspensions. Gold colloid and vapour deposited gold films give weaker scattering than the equivalent silver substrates when high concentrations of drug are analysed but they also give lower detection limits, suggesting a smaller surface enhancement but stronger surface adsorption. A 10(-5) mol dm(-3) solution (the final concentration after addition of colloid was 10(-6) mol dm(-3)) of amphetamine sulfate was detected from gold colloid with an RSD of 5.4%. 25 microl of the same solution could be detected on a roughened gold film. The intensities of the spectra varied across the film surface resulting in relatively high RSDs. The precision was improved by averaging the scattering from several points on the surface. An attempt to improve the detection limit and precision by concentrating a suspension of gold colloid and amphetamine sulfate in aluminium wells did not give effective quantitation. Thus, positive identification and semi-quantitative estimation of amphetamine sulfate can be made quickly and easily using SERS from suspended gold colloid with the appropriate aggregating agents.

Sequences from cDNA molecules encoding alpha 2-adrenoceptor subtype genes were subcloned into prokaryotic vectors and riboprobes generated to hybridise selectively with each of the human alpha 2C2-, alpha 2C4- and alpha 2C10-adrenoceptor subtype mRNA species. The riboprobes were labelled with either 32P or digoxigenin and used to study the expression of alpha 2-adrenoceptor subtypes in sections of human pancreas, in isolated human islets of Langerhans and in clonal HIT-T15 pancreatic beta-cells. Using a ribonuclease protection assay protocol, expression of mRNA species encoding both alpha 2 C2 and alpha 2 C10 was demonstrated in preparations of isolated human islets of Langerhans. mRNA encoding alpha 2C4 was also detected in human islet RNA, using reverse transcription coupled with the polymerase chain reaction. In situ hybridisation was then employed to examine the distribution of each alpha 2-adrenoceptor subtype in sections of human pancreas. All three subtypes of alpha 2-adrenoceptor mRNA were identified in sections of formalin-fixed, paraffin-embedded human pancreas using riboprobes labelled with digoxigenin. Although some labelling of the three alpha 2-adrenoceptor mRNA subtypes was seen in the islets, the labelling was most intense in the exocrine tissue of the pancreas for each receptor subtype. The specificity of the digoxigenin-labelled RNA probes was confirmed in several control tissues and by in situ hybridisation studies using sense probes in the pancreas. The integrity of the pancreas sections was confirmed by in situ hybridisation with an antisense riboprobe derived from human insulin cDNA. The results demonstrate that multiple alpha 2-adrenoceptor subtypes are expressed in human pancreas. Both the exocrine and endocrine cells express more than one receptor subtype, although the islets stain less intensely than the bulk of the tissue suggesting that the islet cells may have lower levels of expression than the acinar tissue. The presence of alpha 2-adrenoceptor subtype mRNA species in pancreatic beta-cells was confirmed by Northern blotting of RNA extracted from the clonal beta-cell line, HIT-T15. Transcripts encoding each of the three cloned alpha 2-adrenoceptor subtypes were detected in HIT-T15 cells. Hybridisation of sections of human pancreas with oligodeoxynucleotide probes designed to hybridise with beta 2-adrenoceptor mRNA revealed expression of this species in islet beta-cells but not in the exocrine tissue of the pancreas.

The effects of the mixed alpha/beta-agonist adrenaline on insulin secretion from isolated human islets of Langerhans were studied. In static incubation experiments, adrenaline (0.1 nmol/l to 10 mumol/l) caused a concentration-dependent inhibition of glucose-induced insulin secretion from isolated human islets. However, perifusion experiments revealed that the time-course of the secretory changes induced by adrenaline was complex. When employed at a high concentration (1 mumol/l), adrenaline caused a sustained inhibition of glucose-induced insulin secretion, which could be relieved by the addition of the alpha 2-antagonist yohimbine (10 mumol/l). By contrast, infusion of adrenaline at a lower concentration (10 nmol/l), produced a large initial potentiation of glucose-induced insulin secretion. This response was, however, short-lived and followed by sustained inhibition of secretion, which could be relieved by yohimbine (10 mumol/l). The initial stimulation of insulin secretion provoked by 10 nmol adrenaline/l was abolished when islets were incubated in the presence of the beta-antagonist, propranolol (1 mumol/l), consistent with activation of beta-adrenoceptors. In support of this, treatment of human islets with the selective beta 2-agonist clenbuterol, was also associated with marked stimulation of insulin secretion. By contrast, each of two selective beta 3-agonists tested failed to alter insulin secretion from human islets. The results indicate that human pancreatic B-cells are equipped with both alpha 2- and beta 2-adrenoceptors which can affect insulin secretion. Adrenaline interacts with both of these but the alpha 2-response is predominant and can overcome the tendency of beta 2-adrenoceptors to potentiate insulin release.

1. In rat isolated islets of Langerhans the selective beta 2-adrenoceptor agonist, clenbuterol (1 to 20 microM), significantly increased the level of adenosine 3':5'-cyclic monophosphate (cyclic AMP) within 2 min of incubation. 2. The cyclic AMP response to clenbuterol was inhibited in the presence of the selective beta 2 adrenoceptor antagonist, ICI 118551 (0.1 or 10 microM) but remained unchanged when the beta 1-antagonist, atenolol (0.1 microM) was administered. 3. Despite causing an elevation in cyclic AMP, clenbuterol (up to 20 microM) failed to influence insulin secretion at any glucose concentration tested, even in the presence of a phosphodiesterase inhibitor. 4. By contrast, clenbuterol elicited a dose-dependent rise in the rate of glucagon secretion; the maximal agonist-induced increase in secretion was two fold, a response equivalent to that observed with 20 mM L-arginine. 5. ICI 118551 significantly inhibited the rise in glucagon secretion induced by clenbuterol (up to 20 microM). 6. The results indicate that the rat islet A cell population is equipped with functional beta 2-adrenoceptors which influence glucagon secretion via the second messenger cyclic AMP, but that the B cells are deficient in functional beta-receptors.

The selective beta 2-adrenergic agonist clenbuterol was ineffective as a stimulus for insulin secretion when isolated rat pancreatic islets were incubated with glucose at concentrations between 4 and 20 mM. Inclusion of the phosphodiesterase inhibitor 3-isobutyl-1-methylxanthine led to potentiation of glucose-induced insulin secretion, but did not facilitate stimulation by clenbuterol. Furthermore, maintenance of isolated rat islets for up to 3 days in tissue culture also failed to result in the appearance of a secretory response to beta-agonists. By contrast, clenbuterol induced a dose-dependent increase in insulin release from isolated human islets incubated with 20 mM glucose. Clenbuterol did not increase the basal rate of insulin secretion (4 mM glucose) in human islets. Under perifusion conditions, the secretory response of human islets to clenbuterol was rapid, of similar magnitude to that seen under static incubation conditions and could be sustained for at least 30 min. The increase in insulin secretion induced by clenbuterol was inhibited by propranolol, indicating that the response was mediated by activation of beta-receptors. In support of this, a similar enhancement of glucose-induced insulin secretion was elicited by a different beta 2-agonist, salbutamol, in human islets. The results indicate that the B cells of isolated rat islets are unresponsive to beta-agonists, whereas those of human islets are equipped with functional beta-receptors which can directly influence the rate of insulin secretion.