1. Spine (Phila Pa 1976). 2009 Apr 1;34(7):706-12.

Aging of the cervical spine in healthy volunteers: a 10-year longitudinal

magnetic resonance imaging study.

Okada E, Matsumoto M, Ichihara D, Chiba K, Toyama Y, Fujiwara H, Momoshima S, Nishiwaki Y, Hashimoto T, Ogawa
J, Watanabe M, Takahata T.

Department of Orthopaedic Surgery, Advanced Therapy for Spine and Spinal Cord Diseases, Keio University,
Shinanomachi 35, Shinjuku-ku, Tokyo, Japan.

Abstract

STUDY DESIGN: Prospective longitudinal study, mean follow-up period; 11.7 +/- 0.8
years was conducted from 1995 to 2007.

OBJECTIVE: To clarify normal aging process of cervical spine and correlation

between progression of disc degeneration and development of clinical symptoms.

SUMMARY OF BACKGROUND DATA: Aging of the cervical spine can inevitably occur
in anyone. Long-term longitudinal studies following the same individuals are
necessary to elucidate the accurate aging processes of the cervical spine.

METHODS: Two hundred twenty-three subjects of 497 original cohorts (123 men,
100 women, mean age: 39.0 +/- 15.0, follow-up rate: 44.9%). Subjects, who
underwent MRI 10 years ago, underwent another MRI, neurologic examination, and
questionnaire survey regarding symptoms related to cervical spine and life style.
Following 5 MR findings representing intervertebral disc degeneration were
evaluated: (1) decrease in signal intensity of disc, (2) anterior compression of dura
and spinal cord, (3) posterior disc protrusion (PDP), (4) disc space narrowing (DSN),
and (5) foraminal stenosis (FS).

RESULTS: Progression of degenerative findings was observed in 189 subjects

(81.1%). Progression of decrease in signal intensity of disc was observed in 59.6%,
anterior compression of dura and spinal cord in 61.4%, PDP in 70.0%, DSN in 26.9%,
and FS in 9.0%. Logistic regression analysis revealed that incidence of progression
of PDP, DSN, FS was higher in elderly subjects. There were no correlations between
any degenerative MR findings and sex, smoking, alcohol, sport, or body mass index.
Neck pain, shoulder stiffness, and numbness in upper extremities were recognized
in 9.9%, 30.0%, and 4.0% of subjects, and 1 or more clinical symptoms have
developed in 34.1% during 10 years.
CONCLUSION: Progression of degeneration of cervical spine on MRI was frequently
observed during 10-year period, with development of symptoms in 34% of subjects.
No factor related to progression of degeneration of cervical spine was identified
except for age.

http://www.ncbi.nlm.nih.gov/pubmed

----------------------------------------------------------------------------------------------------------

Arch Ophthalmol. 1993 May;111(5):680-5.

2.Vision change and quality of life in the elderly. Response to cataract surgery and
treatment of other chronic ocular conditions.

Brenner MH, Curbow B, Javitt JC, Legro MW, Sommer A.

http://www.ncbi.nlm.nih.gov/pubmed

School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Md.

Abstract

OBJECTIVE: Evaluation of health care in older populations has increasingly focused

on quality of life as a critical outcome of treatment. Vision is assumed to be central
to functioning. Data suggest that aging, in itself, is associated with a decline in
visual functioning, which, in turn, is related to a decline in physical and mental
functioning. Other studies indicate that cataract surgery is followed by significant
improvement in vision and visual function. Our objective was to test these
assumptions.

DESIGN: Prospective study of 1021 patients, consecutively drawn from 76 randomly

selected ophthalmologists' offices in three cities. Structured interviews were
completed at baseline, 2 months, and 1 year after entry.

PATIENTS: Six hundred thirteen patients with cataracts and 408 other ophthalmic
patients drawn from the same offices but treated for other chronic ocular disorders.
All received refractive services as needed.
SETTING: Patients from three cities (Baltimore, Md, St Louis, Mo, and San Diego,
Calif) were interviewed once in their homes and twice by telephone.

INTERVENTIONS: The study involved the measurement of the effects of usual

treatment for cataracts and other degenerative eye diseases.

MAJOR OUTCOME MEASURES: Visual, social, and psychological functioning.

RESULTS: Within 1 year of treatment, change in visual function was accompanied by

significant changes, in the same direction, in quality of life functions: night-time
driving, daytime driving, community activities, home activities, mental health, and
life satisfaction. In addition, the patients with cataracts showed significantly greater
improvement in measures of vision than did the noncataract group.

CONCLUSIONS: Regardless of treatment, improvement across quality of life

functions occurred when visual function improved. Thus, many types of functional
degeneration observed in older populations, attributed to a decline in vision, can be
slowed, or even reversed, when visual function is improved. Cataract surgery was
effective in improving vision and quality of life functions.

---------------------------------------------------------------------------------------------------------

Ann Rheum Dis. 1998 Feb;57(2):94-9.

3. Allelic variation in the vitamin D receptor, lifestyle factors and lumbar spinal
degenerative disease.

Jones G, White C, Sambrook P, Eisman J.

Menzies Centre for Population Health Research, Hobart, Tasmania, Australia.

Abstract

OBJECTIVE: To describe the relation between spinal degenerative disease, allelic

variation in the vitamin D receptor gene, and lifestyle factors in a population-based
association study.
METHODS: Random population-based sample of 110 men and 172 women over 60
years of age participating in the Dubbo Osteoporosis Epidemiology Study who had
spinal radiographs (performed according to a standardised approach), assessment
of lifestyle factors, bone densitometry as well as blood taken for genotyping.

RESULTS: Spinal degenerative disease of varying severity was common in this

sample. Multivariate analysis of genetic and lifestyle factors simultaneously
strengthened the statistical significance of each indicating the presence of additive
gene environment interaction. Allelic variation in the vitamin D receptor gene was
associated with severity of osteophytosis (adjusted OR "TT" v "tt" 0.41, 95% CI 0.17,
0.97), presence of disc narrowing (adjusted OR "TT" v "tt" 0.45, 95% CI 0.20, 0.99)
and weakly with presence of osteophytosis (adjusted OR "TT" v "tt" 0.47, 95% CI
0.19, 1.16) but not with severity of disc narrowing (OR "TT" v "tt" 1.05, 95% CI 0.40,
2.72) or apophyseal arthritis (OR "TT" v "tt" 0.63, 95% CI 0.24, 1.59). Adjustment for
femoral neck bone density did not change these findings suggesting that the
association is not mediated through bone density. Presence and severity of spinal
degenerative disease increased with age at all sites. Current smoking increased
both the presence (adjusted OR 9.70, 95% CI 2.08, 45.1) and severity (adjusted OR
2.91, 95% CI 1.16, 9.03) of spinal osteophytosis with intermediate values for past
smokers. Severity of osteophytosis was also independently associated with body
mass index and quadriceps strength consistent with a contributory effect of physical
loading.

CONCLUSIONS: In this elderly sample, both genetic and lifestyle factors were
associated with the presence and severity of spinal degenerative disease. There
were site specific differences in associations at the spine, which may be because of
misclassification of disease status or may indicate possible environmental and
genetic differences in the pathophysiology of spinal degenerative disease. Further
studies are required to confirm these findings in different population samples and to
further explore potential aetiological mechanisms particularly gene environment
interaction.

-----------------------------------------------------------------------------------------------------

4. Epidemiology of chronic disc degeneration and osteoarthritis of the lumbar spine

in Britain and Japan: a comparative study.

Yoshimura N, Dennison E, Wilman C, Hashimoto T, Cooper C.

2000

Department of Public Health, Wakayama Medical College, City, Japan.

Abstract

OBJECTIVE: To compare the prevalence of spinal osteoarthritis (OA) in Britain and

Japan.

METHODS: A total of 206 men and 188 women living in Hertfordshire, UK, and a
total of 100 men and 100 women living in Miyama, Japan, aged 60-79 years were
studied. Participants completed a lifestyle questionnaire, and anteroposterior and
lateral radiographs of the thoracic and lumbar spine were obtained under
standardized conditions. Each lumbar radiograph was graded for osteoarthritic
changes according to the overall Kellgren-Lawrence (K-L) score. Gradings were also
recorded separately for disc narrowing and osteophyte formation.

RESULTS: British subjects were much more likely to have lumbar spine radiographs
graded as K-L grade 4 severity (p = 0.05 in men, p < 0.001 in women). British men
displayed a greater prevalence of disc narrowing (p = 0.08), but less severe
osteophytosis (p = 0.06) than their Japanese counterparts. British women displayed
more severe disc narrowing (p < 0.001) and osteophyte formation (p < 0.001). On
multiple regression analysis, a higher body mass index (BMI) was associated with
excess risk in the British population (OR 1.84, 95% CI 1.12-3.02), but not in the
Japanese population. Differences between countries in K-L severity persisted after
allowing for age and BMI, suggesting that differences in body build could not fully
explain differences in lumbar spine OA in the 2 countries.

CONCLUSION: We found that severe lumbar degenerative disease is more common

in the UK than in a mountain village in Japan, and that differences exist in the
prevalence of both osteophytosis and disc degeneration between the 2 countries.

---------------------------------------------------------------------------------------------------------------

Br J Sports Med. 2001 Feb;35(1):38-42.

5.Influence of rugby injuries on players' subsequent health and lifestyle: beginning a

long term follow up.

Lee AJ, Garraway WM, Hepburn W, Laidlaw R.

Medical Statistics Unit, Public Health Sciences, University of Edinburgh, Scotland,
UK. Mandy.Lee@ed.ac.uk

Abstract

OBJECTIVES: To describe the current rugby playing status of a cohort of 1,169 men
who had previously participated in an epidemiological survey of rugby injuries
during the 1993-1994 season, and assess the consequences of rugby injuries
sustained.

METHODS: In May 1998, 911 (78%) men completed a questionnaire reporting their
current involvement in rugby and the influence that the 324 (71%) injuries they had
sustained four years earlier had since had on their health and wellbeing.

RESULTS: The most common reasons given by the 390 (43%) ex-players for ceasing
to play rugby were family (10%), employment (25%), and an injury sustained while
playing rugby (26%), 80% of which were dislocations, strains, and sprains, mainly to
the knee (35%), back (14%), and shoulder (9%). A significantly (chi2 test 21.7, df =
1, p<0.001) higher proportion of current players (90%) undertook (non-rugby)
sporting activities compared with ex-players (78%). Few ex-players undertook
coaching (12%) and refereeing (2%). Only 22 (9%) men reported significant
negative effects to employment, family life, and health up to mid-1998 from injuries
that occurred during the 1993-1994 season, although the impact on their lifestyle
had been substantial in some cases.

CONCLUSIONS: With the recent increase in the incidence of dislocation, strain, and
sprain injuries in rugby football, the findings of this follow up could have a great
impact on the game in the future. Although this survey has shown that, so far, only
a small proportion of players suffer significant effects of rugby injuries, four years is
not long enough to assess the long term effects. This cohort of rugby players need
to be followed up for at least a further 20 years to determine whether there is a
higher incidence of subsequent degenerative joint disease or other long term
sequelae to injuries sustained while playing rugby.

------------------------------------------------------------------------------------------------------------------

Rheumatology (Oxford). 2002 Jan;41(1):27-30.

6.Risk factors for diffuse idiopathic skeletal hyperostosis: a case-control study.

Kiss C, Szilágyi M, Paksy A, Poór G.

National Institute of Rheumatology and Physiotherapy, Frankel Leó str. 38-40,

Budapest, Hungary.

Abstract

OBJECTIVE: Diffuse idiopathic skeletal hyperostosis (DISH) is a skeletal disease

characterized by ligamentous ossification of the anterolateral side of the spine. The
aim of this study was to characterize risk factors associated with DISH.

METHODS: Subjects were recruited for participation in a screening survey of

vertebral osteoporosis. The cases were 69 men and 62 women with DISH and the
controls were 69 men and 62 women with spondylosis over the age of 50 yr. Cases
and controls were matched for age and sex. Radiographs were taken according to a
standardized protocol and DISH was classified using the Resnick criteria. Laboratory
parameters and an interviewer-administered questionnaire were used to obtain
data about exposure.

RESULTS: The mean ages of the populations with DISH and spondylosis were
65.2+/-8.8 and 65.0+/-9.1 yr respectively. Compared with controls, patients with
DISH had a greater body mass index (27.8 vs 26.0 kg/m(2), P<0.05) and a higher
serum level of uric acid (308 vs 288 micromol/l, P<0.05) and were more likely to
have had diabetes mellitus (19.8 vs 9.1%, P<0.05).

CONCLUSION: DISH is clearly a distinct disorder with risk factors that distinguish it
from other spinal degenerative diseases.

-----------------------------------------------------------------------------------------------------------------

Pharmacoeconomics. 2002;20(6):367-87.

7.Cost effectiveness of treatments for amyotrophic lateral sclerosis: a review of the

literature.

Ginsberg G, Lowe S.

Department of Medical Technology Assessment, Ministry of Health, Jerusalem,

Israel.
objectives:to know the treatment for ALS.

Pharmacoeconomics. 2002;20(6):389-91.

Abstract

Amyotrophic lateral sclerosis (ALS) is a difficult to diagnose, fatal, progressive

degenerative disease with an average survival time of 2 to 5 years. Percutaneous
endoscopic gastrotomy (PEG) and bi-level intermittent positive pressure (BIPAP)
ventilation may be the major interventions leading to longer survival of patients
with ALS. Riluzole has been shown to have modest effects on survival (as opposed
to functional) gains and is currently the only drug approved for the treatment of
ALS. There is conflicting evidence with regard to the ability of recombinant human
insulin-like growth factor (rhIGF-I) to retard ALS progression. Mechanical ventilation
(via a tracheostomy tube) is expensive, but is widely used in later stage patients
with ALS in the US. A review of nine cost-effectiveness studies of riluzole and one of
rhIGF-I found the following: drug costs and survival gains are the major drivers of
cost effectiveness; survival gains are estimated from truncated databases with a
high degree of uncertainty; more accurate stage-specific utility weights based on
patients who agreed to treatment are needed; case incidence-based evaluations
should be carried out; cost-effectiveness ratios are insensitive to discount rates;
employment and caregiver issues or externalities have been widely ignored;
threshold acceptance cost-effectiveness values are ill-defined and evaluations are
not generalisable to other countries because of cost and treatment style
differences. On account of the high degree of uncertainty pertaining to survival
gains and the relatively high costs per life years or quality-adjusted life-years
gained, and while acknowledging that not every therapy has to be cost effective
(e.g. orphan drugs), it is still inconclusive as to whether or not riluzole or rhIGF-1
can be considered as cost-effective therapies for ALS.

-------------------------------------------------------------------------------------------------

Biol Psychiatry. 2009 Jun 1;65(11):918-26. Epub 2008 Oct 11.

8. Chronic psychosocial stress exacerbates impairment of cognition and

long-term potentiation in beta-amyloid rat model of Alzheimer's disease.

Srivareerat M, Tran TT, Alzoubi KH, Alkadhi KA.

Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston,
Texas 77204-5037, USA.

Comment in:

Biol Psychiatry. 2009 Jun 1;65(11):916-7.

objectives: This study investigated the effect of chronic psychosocial stress in Abeta
rat model of Alzheimer's Disease.

Abstract

BACKGROUND: Alzheimer's disease (AD) is a degenerative disorder that leads to

progressive cognitive decline. Alzheimer's disease develops as a result of over-
production and aggregation of beta-amyloid (Abeta) peptides in the brain. The
reason for variation in the gravity of symptoms among AD patients is unknown and
might result from patient-related factors including lifestyle. Individuals suffering
from chronic stress are at an increased risk for developing AD. This study
investigated the effect of chronic psychosocial stress in Abeta rat model of AD.

METHODS: Psychosocial stress was induced with a rat intruder model. The rat model
of AD was induced by 14-day osmotic pump infusion of a mixture of 300 pmol/day
Abeta(1-40)/Abeta(1-42). The effect of chronic stress on the severity of Abeta-
induced spatial learning and memory impairment was tested by three approaches:
behavioral testing in the radial arm water maze, in vivo electrophysiological
recording in anesthetized rat, and immunoblot analysis to determine protein levels
of learning- and memory-related molecules.

RESULTS: A marked impairment of learning and memory developed when stress

was combined with Abeta, more so than that caused by Abeta alone. Additionally,
there was a significantly greater impairment of early-phase long-term potentiation
(E-LTP) in chronically stressed/Abeta-treated rats than in either the stressed or
Abeta-treated rats. This might be a manifestation of the reduction in protein levels
of calcium/calmodulin-dependent protein kinase II (CaMKII) and the abnormal
increase in calcineurin levels.

CONCLUSIONS: Chronic stress significantly intensified Abeta-induced deficits of

short-term memory and E-LTP by a mechanism involving decreased CaMKII
activation along with increased calcineurin levels.

----------------------------------------------------------------------------------------------

BMC Health Serv Res. 2008 Oct 9;8:209.

9.Costs and quality of life for prehabilitation and early rehabilitation after
surgery of the lumbar spine.
Nielsen PR, Andreasen J, Asmussen M, Tønnesen H.

Centre of Head and Orthopaedics, Department of Anaesthesiology, Rigshospitalet, University of Copenhagen,

Denmark. rotboell@rh.dk

objectives: to assess the quality of life and to estimate the cost-effectiveness of

standard care versus an integrated programme including prehabilitation and early
rehabilitation.

Abstract

During the recent years improved operation techniques and administrative

procedures have been developed for early rehabilitation. At the same time
preoperative lifestyle intervention (prehabilitation) has revealed a large potential for
additional risk reduction. The aim was to assess the quality of life and to estimate
the cost-effectiveness of standard care versus an integrated programme including
prehabilitation and early rehabilitation.

METHODS: The analyses were based on the results from 60 patients undergoing
lumbar fusion for degenerative lumbar disease; 28 patients were randomised to the
integrated programme and 32 to the standard care programme. Data on cost and
health related quality of life was collected preoperatively, during hospitalisation and
postoperatively. The cost was estimated from multiplication of the resource
consumption and price per unit.

RESULTS: Overall there was no difference in health related quality of life scores. The
patients from the integrated programme obtained their postoperative milestones
sooner, returned to work and soaked less primary care after discharge. The
integrated programme was 1,625 euros (direct costs 494 euros + indirect costs
1,131 euros) less costly per patient compared to the standard care programme.

CONCLUSION: The integrated programme of prehabilitation and early rehabilitation

in spine surgery is more cost-effective compared to standard care programme
alone.

-----------------------------------------------------------------------------------------------------------------

Health Technol Assess. 2008 May;12(13):iii-iv, ix-139.

10.Stepped treatment of older adults on laxatives. The STOOL trial.

Mihaylov S, Stark C, McColl E, Steen N, Vanoli A, Rubin G, Curless R, Barton R, Bond J.

Clinical Trials Unit, Institute of Health and Society, Newcastle University, UK.

Abstract

OBJECTIVES: To investigate the clinical effectiveness and cost-effectiveness of bulk-

forming, stimulant and osmotic laxatives, and also of adding a second type of
laxative agent in the treatment of patients whose constipation is not resolved by a
single agent. Additionally, to define the meaning of constipation in older people
from the perspective of GPs and older patients, and to investigate the use of
prescribed and non-prescribed treatments for constipation in older people together
with their adherence to prescribed treatments.

DESIGN: A multicentre pragmatic, factorial randomised controlled trial with

economic evaluation and qualitative study using in-depth interviews and focus
groups with older people, GPs and community nurses.

SETTING: General practices in north-east England.

PARTICIPANTS: People aged 55 years or over with chronic constipation living in

private households.

INTERVENTIONS: Six stepped-treatment strategies using three classes of laxatives:

bulk, stimulant and osmotic preparations, singly and in combination.

MAIN OUTCOME MEASURES: The primary outcome was the constipation-specific

Patient Assessment of Constipation--Symptoms/Patient Assessment of
Constipation--Quality of Life. Secondary outcomes included EuroQoL 5 Dimensions,
reported number of bowel movements per week, the presence/absence of the other
Rome II criteria for constipation, adverse effects of treatment and relapse rates.

RESULTS: Recruitment to the trial was difficult and the trial was closed after
recruiting 19 participants. GP participants provided patient-centred definitions that
focused on the idea of a change from the norm as defined by the individual patient
and 'textbook definitions' that focused on reduced frequency of defecation
associated with a range of unpleasant sensations and other clinical symptoms.
Nurses' definitions of constipation included both a patient-centred perspective and
the description of particular symptoms associated with constipation. Older
participants defined constipation in terms of frequency of bowel movements and
changes in normal bowel routine. Older participants perceived constipation as
follows: linked to specific diseases, medical conditions or health problems; caused
by the consumption of specific medications or surgical procedures; caused by diet
or eating habits; part of the ageing process; due to not going to the toilet when
having the urge to defecate; hereditary; caused by stress or worry; and caused by
environmental exposure. GP participants suggested that constipation is due to
changes in diet and lifestyle; the physiology and degenerative processes of ageing;
and the iatrogenic impact of opiate medications. Nurse participants identified that
constipation is linked to decreased mobility, decreased food intake, decreased fluid
intake and consumption of certain medications. For many older people their
constipation emerged as a problem over a period of time; for some the 'condition'
had existed for many years. Self-management of constipation had typically been
their first response to the symptoms and continued once professional help had been
sought. Older participants had a wide experience of different management
strategies and treatments for constipation, and at the time of the study had firm
preferences about the laxatives they would use. GP participants recognised the
experience and use of laxatives of their patients. They exhibited strong personal
preferences for different laxatives, often prescribing them in combination. Nurses
were more likely than GPs to treat and prevent constipation using non-laxative
measures; these included providing advice on appropriate dietary changes,
increasing fluid intake and, if possible, encouraging exercise and mobility.

CONCLUSIONS: There is little shared understanding between patients and

professionals about 'normal' bowel function with little consensus in general practice
of the optimum management strategies for chronic constipation and the most
effective strategies to use. Chronic constipation is seen as less important than other
conditions prevalent in general practice (e.g. diabetes) because it is not an agreed
management target within national frameworks. Consequently, practitioners had
little interest in constipation as a research topic. Patient preferences and the
absence of patient equipoise formed an enormous barrier to the recruitment of
patients in the implementation of this trial. Studies are needed to investigate
different methods of recruitment within the constraints of current ethical guidelines
on 'opting in' and to identify barriers and facilitators to recruitment to complex trials
in general. Patient preference trials and natural cohort observational studies are
also needed to investigate the effectiveness or cost-effectiveness of different
laxatives and treatment strategies in the management of chronic constipation.
---------------------------------------------------------------------------------------

BMC Musculoskelet Disord. 2008 Apr 16;9:51.

11.Are the determinants of vertebral endplate changes and severe disc

degeneration in the lumbar spine the same? A magnetic resonance
imaging study in middle-aged male workers.

Kuisma M, Karppinen J, Haapea M, Niinimäki J, Ojala R, Heliövaara M, Korpelainen R, Kaikkonen K, Taimela S, Natri
A, Tervonen O.

Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland. mari.kuisma@fimnet.fi

objectives: To evaluate the determinants of vertebral endplate (Modic) changes,

and whether they are similar for Modic changes and severe disc degeneration
focusing on L5-S1 level.

Abstract

BACKGROUND: Modic changes are bone marrow lesions visible in magnetic

resonance imaging (MRI), and they are assumed to be associated with symptomatic
intervertebral disc disease, especially changes located at L5-S1. Only limited
information exists about the determinants of Modic changes. The objective of this
study was to evaluate the determinants of vertebral endplate (Modic) changes, and
whether they are similar for Modic changes and severe disc degeneration focusing
on L5-S1 level.

METHODS: 228 middle-aged male workers (159 train engineers and 69 sedentary
factory workers) from northern Finland underwent sagittal T1- and T2-weighted MRI.
Modic changes and disc degeneration were analyzed from the scans. The
participants responded to a questionnaire including items of occupational history
and lifestyle factors. Logistic regression analysis was used to evaluate the
associations between selected determinants (age, lifetime exercise, weight-related
factors, fat percentage, smoking, alcohol use, lifetime whole-body vibration) and
Modic type I and II changes, and severe disc degeneration (= grade V on
Pfirrmann's classification).

RESULTS: The prevalences of the Modic changes and severe disc degeneration were
similar in the occupational groups. Age was significantly associated with all
degenerative changes. In the age-adjusted analyses, only weight-related
determinants (BMI, waist circumference) were associated with type II changes.
Exposure to whole-body vibration, besides age, was the only significant determinant
for severe disc degeneration. In the multivariate model, BMI was associated with
type II changes at L5-S1 (OR 2.75 per one SD = 3 unit increment in BMI), and
vibration exposure with severe disc degeneration at L5-S1 (OR 1.08 per one SD =
11-year increment in vibration exposure).

CONCLUSION: Besides age, weight-related factors seem important in the

pathogenesis of Modic changes, whereas whole-body vibration was the only
significant determinant of severe disc degeneration.

--------------------------------------------------------------------------------------

Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S75-82.

12.Course and prognostic factors for neck pain in the general population:
results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain
and Its Associated Disorders.

Carroll LJ, Hogg-Johnson S, van der Velde G, Haldeman S, Holm LW, Carragee EJ, Hurwitz EL, Côté P, Nordin M,
Peloso PM, Guzman J, Cassidy JD; Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated
Disorders.

Department of Public Health Sciences, School of Public Health, University of Alberta, Alberta, Canada.
lcarroll@ualberta.ca

Republished in:

J Manipulative Physiol Ther. 2009 Feb;32(2 Suppl):S87-96.

Abstract

STUDY DESIGN: Best evidence synthesis.

OBJECTIVE: To undertake a best evidence synthesis on course and prognosis of neck

pain and its associated disorders in the general population.

SUMMARY OF BACKGROUND DATA: Knowing the course of neck pain guides

expectations for recovery. Identifying prognostic factors assists in planning public
policies, formulating interventions, and promoting lifestyle changes to decrease the
burden of neck pain.

METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its
Associated Disorders (Neck Pain Task Force) conducted a critical review of literature
published between 1980 and 2006 to assemble the best evidence on neck pain.
Findings from studies meeting criteria for scientific validity were abstracted into
evidence tables and included in a best evidence synthesis.

RESULTS: We found 226 articles on the course and prognostic factors in neck pain
and its associated disorders. After critical review, 70 (31%) of these were accepted
on scientific merit. Six studies related to course and 7 to prognostic factors in the
general population. Between half and three quarters of persons in these populations
with current neck pain will report neck pain again 1 to 5 years later. Younger age
predicted better outcome. General exercise was unassociated with outcome,
although regular bicycling predicted poor outcome in 1 study. Psychosocial factors,
including psychologic health, coping patterns, and need to socialize, were the
strongest prognostic factors. Several potential prognostic factors have not been well
studied, including degenerative changes, genetic factors, and compensation
policies.

CONCLUSION: The Neck Pain Task Force undertook a best evidence synthesis to
establish a baseline of the current best evidence on the course and prognosis for
this symptom. General exercise was not prognostic of better outcome; however,
several psychosocial factors were prognostic of outcome.

-----------------------------------------------------------------------------------------------------

BMC Musculoskelet Disord. 2006 Jun 2;7:48.

13.Problems and needs for improving primary care of osteoarthritis

patients: the views of patients, general practitioners and practice nurses.

Rosemann T, Wensing M, Joest K, Backenstrass M, Mahler C, Szecsenyi J.

Department of General Practice and Health Services Research, University of

Heidelberg, Vossstr, 2, 69115 Heidelberg, Germany. thomas_rosemann@med.uni-
heidelberg.de

objectives: to identify health care needs of patients with OA and to reveal possible
obstacles for improvements in primary care management of OA patients.
Abstract

BACKGROUND: Osteoarthritis (OA) is highly prevalent and has substantial impact on

quality of life as well as on healthcare costs. The general practitioner (GP) often is
the first care provider for patients with this chronic disease. The aim of this study
was to identify health care needs of patients with OA and to reveal possible
obstacles for improvements in primary care management of OA patients.

METHODS: We performed semi-structured interviews with a stratified sample of 20

patients, 20 GPs and 20 practice nurses.

RESULTS: Diagnosing OA posed no major problem, but during the course of OA, GPs
found it difficult to distinguish between complaints resulting from the affection of
the joints and complaints related to a concomitant depression. Patients felt to be
well informed about the degenerative nature of the disease and possible side
effects of medications, but they lacked information on individual consequences of
the disease. Therefore, the most important concerns of many patients were pain
and fear of disability which they felt to be addressed by GPs only marginally.
Regarding pain treatment, physicians and patients had an ambivalent attitude
towards NSAIDs and opiates. Therefore, pain treatment was not performed
according to prevailing guidelines. GPs felt frustrated about the impact of
counselling regarding life style changes but on the other hand admitted to have no
systematic approach to it. Patients stated to be aware of the impact of life style on
OA but lacked detailed information e.g. on how to exercise. Several suggestions
were made concerning improvement.

CONCLUSION: GPs should focus more on disability and pain and on giving
information about treatment since these topics are inadequately addressed.
Advanced approaches are needed to increase GPs impact on patients' life style.
Being aware of the problem of labelling patients as chronically ill, a more proactive,
patient-centred care is needed.

--------------------------------------------------------------------------------------------

J Affect Disord. 2003 May;74(3):237-46.

14.Psychosocial and vascular risk factors of depression in later life.

Oldehinkel AJ, Ormel J, Brilman EI, van den Berg MD.

Department of Psychiatry and Graduate School of Behavioural and Cognitive Neurosciences, University of
Groningen, Groningen, Netherlands. a.j.oldehinkel@med.rug.nl

Abstract
BACKGROUND: Research on the aetiology of late-life depression has typically
focused on either risk factors from the psychosocial stress-vulnerability domain or
degenerative biological changes (for instance, vascular disease). We examined
whether vascular risk factors could be interpreted within the stress-vulnerability
model of depression.

METHODS: The data came from a case-control design, nested in a community

survey of elderly people. We compared 83 persons with a recently started episode
of major or minor depression with 83 controls, with respect to the occurrence of
stressful life events, long-term difficulties, neuroticism, and vascular risk factors
(hypertension, heart disease, stroke).

RESULTS: The (non-significant) association of vascular risk factors and onset of

depressive episodes was not modified by neuroticism or the presence of long-term
difficulties. Quite unexpectedly, vascular risk factors seemed to neutralize the
depressogenic effect of stressful life events. The effect of vascular risk was
significantly stronger in depressive episodes not preceded by a life event than in
onsets following an event.

CONCLUSIONS: Vascular risk factors cannot be interpreted within the stress-

vulnerability model, but represent another pathway to depression. Why vascular
risk factors reduce the depressogenic effect of stressful life events is not clear.
Replication is critical to exclude the possibility of a chance finding.

--------------------------------------------------------------------------------------------

15.

J Clin Nurs. 2007 Mar;16(3A):35-43.

Non-finite loss and emotional labour: family caregivers' experiences of living with
motor neurone disease.

Ray RA, Street AF.

School of Nursing & Midwifery, La Trobe University, Melbourne, Australia. r.ray@latrobe.edu.au

Abstract
AIM AND OBJECTIVES: This paper aims to add to nurses' knowledge concerning the losses and emotional labour
family caregivers face caring for people living with neurodegenerative, life-limiting illnesses such as motor neurone
disease.
BACKGROUND: Motor neurone disease is a relentless, progressive illness resulting in progressive loss of voluntary
muscle mass and function. Previous caregiver research presents the salient losses such as social, financial and
relationship loss. However, the non-finite, unpredictable losses faced every day by caregivers and the emotional
labour experienced are not effectively represented and have not been explored for caregivers of adult patients with
life-limiting, degenerative, illness.
DESIGN/METHODS: Semi-structured interviews, ecomaps of social support networks and field notes were used to
collect data for this ethnographic case study. Data were attained at three time points over a 10-month period from 18
primary caregivers and once from six peripheral caregivers.
RESULTS: Data revealed new information about the psychosocial and emotional losses experienced daily, when
living with motor neurone disease. The impact of the constancy of voluntary muscle degeneration and the uncertainty
of the illness progression in terms of available time and functional loss, threatened people's understanding and
expectations of life, their relationships, their personal identity and their future. Managing their relationship with the
patient and their reactions to the devastation of motor neurone disease is consistent with the concept of emotional
labour.
CONCLUSIONS: Family caregivers living with relentless, life-limiting illness experience non-finite losses and
emotional labour on a daily basis. While each individual's experience of loss is unique, nurses need to include
caregivers as well as patients, in their spectrum of supportive care.
RELEVANCE TO CLINICAL PRACTICE: Nurses can be independent confidants who share the emotional labour
and work with caregivers to develop interventions to assist them to manage their losses and their changing needs for
psychological and emotional support.

16

Rev Chir Orthop Reparatrice Appar Mot. 2005 Oct;91(6):502-7.

[Shoulder function and scores in 180 asymptomatic individuals aged over 75

years]

[Article in French]

Scarlat M, Florescu A.

Département de Chirurgie Orthopédique et Traumatologique, Clinique Chirurgicale Saint-Michel, Toulon.

mscarlat@wanadoo.fr

Abstract
PURPOSE OF THE STUDY: The purpose of this study was to define the normal shoulder in patients aged over 75
years and to look for correlations between general health, mental status and shoulder function.
MATERIALS AND METHODS: Shoulder motion, rotator cuff strength and abnormal movements were evaluated in
180 subjects over 75 without surgical history involving the shoulder. Body mass index (BMI) was determined for each
subject. The Simple Shoulder Test (SST) was performed and the Constant and Murley score was calculated for each
shoulder. The Beck test was used to assess depression. When joint function was impaired, supplementary x-ray and
ultrasound examinations were performed.
RESULTS: Asymptomatic pathological features (rotator cuff tears, stiffness, degenerative joint disease) were
identified in 56% of the shoulders. Only 44% of the shoulders were free of pathological features. 56.4% of rotator cuff
tears were found in the dominant shoulder; 13.9% of subjects had bilateral degenerative joint disease; 23.3% had
bilateral stiffness. There were many associated conditions: cardiovascular (33%), pulmonary (28%), gastrointestinal
(25.6%), diabetes (12.2%), tumors (10.6%). 18.3% of the subjects were depressive and 14.4% were taking treatment
for depression. Shoulder motion and strength were correlated with BMI and nutritional status. Thin subjects (BMI <
20) had more rotator cuff tears. Obese subjects (BMI > 29.9) had more degenerative joint disease and joint stiffness.
Demand for treatment and examinations were greater among depressed subjects.
DISCUSSION AND CONCLUSION: Shoulder function is compatible with normal lifestyle in subjects over 75,
corresponding to their desires and expectations. Shoulder function is correlated with body mass index and mental
status. We should carefully assess shoulders in elderly subjects because good shoulder function, even if impaired, is
often compatible with moderate stiffness, mild osteoarthritis, and rotator cuff tears, with no particular need for surgery.

Cancer. 2002 Dec 1;95(11):2390-6.

Food groups and the risk of colorectal carcinoma in an Asian population.

Seow A, Quah SR, Nyam D, Straughan PT, Chua T, Aw TC.

Department of Community, Occupational, and Family Medicine, National University of Singapore, Singapore.
cofseowa@nus.edu.sg

Abstract
BACKGROUND: Singapore Chinese have experienced a rapid transition toward a pattern of disease in which
lifestyle-related, chronic, degenerative diseases are major public health concerns. The rates of colorectal carcinoma
have increased 2-fold over the last 3 decades. It has long been known that dietary factors play a role in the risk of this
disease, although studies in Asian populations, with their unique dietary intake, have been few.
METHODS: The authors conducted a population-based case-control study that included 121 Chinese patients with
colorectal carcinoma and 222 healthy control participants who provided information on usual intake of major food
groups in the preceding 3 years, physical activity, family history of colorectal carcinoma, and demographic variables
through an in-person questionnaire.
RESULTS: High intake of red meat, but not other meats, indicated a predisposition to risk of colorectal carcinoma
(adjusted odds ratio [OR] for the highest tertile vs. the lowest tertile, 2.2; 95% confidence interval [95%CI], 1.1-4.2). A
low vegetable intake also was associated with a higher risk, and the combined effect appeared to be additive. Those
in the highest tertile of meat intake and the lowest quartile of vegetable intake had an OR of 2.6 (95%CI, 1.0-6.7). The
authors observed a slight, albeit nonsignificant, positive association with foods high in refined sugars. There was no
association observed with fruit or soy-legume intake in this study. Among nondietary variables, a family history of
colorectal carcinoma conferred a significant increase in risk (OR, 6.7; 95% CI 2.4-18.7).
CONCLUSIONS: Meat intake and vegetable intake were associated significantly with risk of colorectal carcinoma in
this Asian population, and further studies on the effects of changes in these specific types of food may shed light on
how best to reduce the rapid increase in rates in similar populations.