Showing papers by "Cyrus Cooper published in 1995"

Manual handling activities and risk of low back pain in nurses.

Abstract: OBJECTIVE--To investigate the risk factors for low back pain in hospital nurses, with particular emphasis on the role of specific nursing activities. METHODS--A cross sectional survey of 2405 nurses employed by a group of teaching hospitals was carried out. Self administered questionnaires were used to collect information about occupational activities, non-occupational risk factors for back symptoms, and history of low back pain. RESULTS--The overall response rate was 69%. Among 1616 women, the lifetime prevalence of back pain was 60% and the one year period prevalence 45%. 10% had been absent from work because of back pain for a cumulative period exceeding four weeks. Rates in men were generally similar to those in women. In women back pain during the previous 12 months was weakly associated with height, and was significantly more common in those who reported frequent non-musculoskeletal symptoms such as headache and low mood. After adjustment for height and non-musculoskeletal symptoms, significant associations were found with frequency of manually moving patients around on the bed, manually transferring patients between bed and chair, and manually lifting patients from the floor. In contrast, no clear increase in risk was found in relation to transfer of patients with canvas and poles, manually lifting patients in and out of the bath, or lifting patients with mechanical aids. Confirmation of these findings is now being sought in a prospective study of the same population. CONCLUSIONS--This study confirms that low back pain is highly prevalent among nurses and is associated with a high level of sickness absence. People who often report non-musculoskeletal symptoms were significantly more likely to report low back pain. Specific manual handling tasks were associated with an increased risk of back pain; however, no such association was found with mechanised patient transfers.

Rheumatoid arthritis, corticosteroid therapy and hip fracture.

Abstract: OBJECTIVE--To identify the risk of hip fracture in patients with rheumatoid arthritis and those taking corticosteroids METHODS--In a population based case-control study, we compared 300 consecutive patients with hip fracture aged 50 years and over from a defined district and 600 age and sex matched community controls RESULTS--The risk of hip fracture was increased in patients with rheumatoid arthritis (odds ratio (OR) 21; 95% confidence interval (CI) 10 to 47) and those receiving corticosteroids (OR 27; 95% CI 12 to 58) The risk attributable to rheumatoid arthritis was markedly reduced by adjusting for functional impairment, while that for steroid use remained after adjusting for body mass index, smoking, alcohol, and functional status CONCLUSIONS--Hip fracture risk is approximately doubled amongst patients with rheumatoid arthritis and among those taking steroids These risk increases are, to some extent, independent of each other In rheumatoid arthritis, the risk was most closely associated with functional impairment, whereas steroid use did not appear to be confounded by this variable

Vitamin C and risk of death from stroke and coronary heart disease in cohort of elderly people.

Abstract: Objectives: To determine whether vitamin C status, as measured by dietary intake and plasma ascorbic acid concentration, is related to mortality from stroke and coronary heart disease in people aged 65 and over. Design: A 20 year follow up study of a cohort of randomly selected elderly people living in the community who had taken part in the 1973-4 Department of Health and Social Security nutritional survey and for whom dietary and other data had been recorded. Setting: Eight areas in Britain (five in England, two in Scotland, and one in Wales). Subjects: 730 men and women who had completed a seven day dietary record and who had no history or symptoms of stroke, cerebral arteriosclerosis, or coronary heart disease when examined by a geriatrician in 1973-4. Results: Mortality from stroke was highest in those with the lowest vitamin C status. Those in the highest third of the distribution of vitamin C intake had a relative risk of 0.5 (95% confidence interval 0.3 to 0.8) compared with those in the lowest third, after adjustment for age, sex, and established cardiovascular risk factors. The relation between vitamin C intake and stroke was independent of social class and other dietary variables. A similar gradient in risk was present for plasma ascorbic acid concentrations. No association was found between vitamin C status and risk of death from coronary heart disease. Conclusion: In elderly people vitamin C concentration, whether measured by dietary intake or plasma concentration of ascorbic acid, is strongly related to subsequent risk of death from stroke but not from coronary heart disease. Key messages Key messages Vitamin C is the most important dietary antioxidant in terms of intake Both dietary intake of vitamin C and plasma ascorbate concentrations were related to risk of death from stroke (but not from coronary heart disease) in 730 elderly people studied prospectively Vitamin C status was as strong a predictor of death from stroke as diastolic blood pressure Antioxidant vitamins are potentially important in the prevention of cerebrovascular disease

Bone densitometry in clinical practice.

Abstract: Summary points Osteoporosis is a major health problem in the elderly population. It causes more than 150000 fractures each year in the United Kingdom with an estimated cost of pounds sterling742 million Bone mass is a major determinant of risk of fracture and can be assessed by non-invasive techniques such as dual energy x ray absorptiometry Densitometric criteria based on standard deviation scores expressed in relation to reference values in premenopausal women (T scores) provide diagnostic categories from which thresholds for prevention and treatment can be defined on the basis of risk of fracture Population based screening for low bone mass in perimenopausal women cannot at present be justified. In clinical practice, however, bone densitometry has an important role in the diagnosis of osteoporosis in high risk groups and in the monitoring of treatment in some patients For these indications, it is estimated that about 175 bone scans per 100000 population would be needed annually, requiring an annual expenditure for the average health district of pounds sterling25200 At present, bone densitometry resources in the United Kingdom are inadequate to meet these needs. There is an urgent need to improve existing facilities so that effective strategies for the prevention and treatment of osteoporosis in clinical practice can be implemented

Patterns of joint involvement in osteoarthritis of the hand: the Chingford Study.

Abstract: Objective. The hand is the major site of joint involvement in osteoarthritis (OA), but the clustering of this condition at different joint sites within the hand as part of an entity known as generalized OA remains contentious. We examine this issue in a population sample of 967 peri and postmenopausal women. Methods. The pattern of radiographic involvement of hand joints was examined using the Kellgren and Lawrence system in a sample of women aged 45-64 years, selected from the general population in Chingford, East London. Log linear modelling techniques were used to examine clustering of OA in different joint sites and to examine whether this clustering remained significant after age adjustment. Results. There was clear evidence of clustering in joint involvement. Thus 20 women had 4 or more affected joints compared with only 2 expected (X 2 = 72.0, 4df, p<0.001). The risk of multiple distal interphalangeal (DIP)joint involvement, after age adjustment, in a woman with a single affected DIP joint was significantly increased (OR 10.0, 95% CI 7.3-13.7) and was substantially greater than the corresponding risk for proximal interphalangeal joint (OR 3.1, 95% CI 1.4-6.8) involvement. Symmetry was the strongest determinant of pattern with an OR 38.8 (95% CI 14.5-103.5) for corresponding DIP joint involvement in the contralateral hand. Conclusion. These data provide clear evidence for a polyarticular subset of hand OA in women. There are 3 major determinants of the pattern of polyarticular involvement ; symmetry, clustering by row and clustering by ray, in descending order of importance.

Low back pain in Hong Kong: prevalence and characteristics compared with Britain.

Abstract: STUDY OBJECTIVE--To compare the prevalence of low back pain and associated disability in Hong Kong with that in Britain, and to explore whether differences could be explained by certain known risk factors. DESIGN--A cross sectional survey with information collected at interview. Findings were compared with those from an earlier survey in Britain. SETTING--Two housing blocks in Hong Kong. SUBJECTS--Altogether 288 men and 364 women aged 18 years or older, who were resident in the two housing blocks and agreed to interview (response rate = 80%). MAIN RESULTS--Thirty nine per cent (95% confidence interval (CI) 34%, 44%) of interviewees reported having had low back pain at some time, and 21% (95% CI 18%, 25%) had had low back pain in the past 12 months. After standardisation for age and sex, all of the back symptoms examined were substantially less common in Hong Kong than in Britain. The one year period prevalence of low back pain was associated with occupational lifting (in both sexes) and with tall stature (in men only). Subjects tended to carry out less heavy lifting at work and to be shorter than participants in the earlier British study but these differences did not completely explain their lower prevalence of back pain. CONCLUSIONS--The findings indicate a lower prevalence of back symptoms in Hong Kong than Britain that is partly explained by differences in stature and occupational lifting. In addition, Hong Kong people may have a higher threshold for reporting symptoms, or they may differ in their exposure to other, unrecognised risk factors.

Risk Factors for Hip Fracture

Abstract: Hip fractures are among the most important causes of ill health and death among elderly people. Of white North American women 50 years of age, 17.5 percent will have a hip fracture during their remaining lifetime,1 as will 6 percent of white men of similar age. These fractures will contribute substantially to the 2 million person-years of functional impairment and $45 billion in direct medical costs attributable to osteoporosis in the next 10 years.2 In this issue of the Journal, Cummings and colleagues report the results of a large prospective cohort study in which a wide range of risk factors . . .

Occupational activity and the risk of osteoarthritis.

Abstract: Osteoarthritis (OA) is now recognized as a major public health problem. The risk of OA depends upon factors that increase generalized susceptibility to the disorder, as well as biomechanical factors that modify risk at specific joint sites. Occupational physical activity is one of the important influences in this latter category. Epidemiological evidence has begun to mount that occupational physical activity is a determinant of the risk of knee and hip OA. Occupations that involve regular knee bending and heavy lifting confer a greater likelihood of developing knee OA, while there appears to be a particular propensity for hip OA among farmers. Further research into these relationships will have two important consequences: (1) The issue whether industrial recompense is justified for workers in these industries who develop OA will be clarified. (2) A clearer understanding of the pathophysiology of these relationships will lead to more effective preventive strategies.

Epidemiology of the rheumatic diseases.

Abstract: Epidemiologic studies are important for both understanding and defining rheumatology practice. Controversy still exists over whether the incidence of rheumatoid arthritis is declining, and genetic studies indicate a diversity of HLA haplotypes in rheumatoid arthritis. Large longitudinal osteoarthritis studies have helped define diagnostic criteria and the role of obesity in disease progression. The negative association between osteoarthritis and osteoporosis at specific sites continues to be explored, and the value of long-term estrogen therapy in preventing bone loss has been examined. Both retrospective and prospective population studies have been used to describe the relationship between silicone gel breast implants and connective tissue disease. These and other studies have helped to define the important role of epidemiologic research in the understanding of rheumatic diseases.

Domiciliary Oxygen Therapy

Abstract: One of the fundamental problems in chronic obstructive pulmonary disease is the maintenance of adequate oxygenation. Hence it is no surprise that supplementary oxygen therapy in its various forms is an important component in the treatment and rehabilitation of patients with COPD. The effects of supplementary oxygen on gas exchange within the lung are considered elsewhere (Chapter 8) as is its role in the acutely ill COPD patient (Chapter 19). This chapter will consider the physiologic effects and benefits of oxygen treatment on chronic stable COPD patients as well as some of the practical issues involved in the delivery of this important treatment.