: Although studies from many countries have estimated the impact of ambient temperature on mortality, few have compared the relative impacts of heat and cold on health, especially in basin climate ...cities. We aimed to quantify the impact of ambient temperature on mortality, and to compare the contributions of heat and cold in a large basin climate city, i.e., Chengdu (Sichuan Province, China);
: We estimated the temperature-mortality association with a distributed lag non-linear model (DLNM) with a maximum lag-time of 21 days while controlling for long time trends and day of week. We calculated the mortality risk attributable to heat and cold, which were defined as temperatures above and below an "optimum temperature" that corresponded to the point of minimum mortality. In addition, we explored effects of individual characteristics;
: The analysis provides estimates of the overall mortality burden attributable to temperature, and then computes the components attributable to heat and cold. Overall, the total fraction of deaths caused by both heat and cold was 10.93% (95%CI: 7.99%-13.65%). Taken separately, cold was responsible for most of the burden (estimate 9.96%, 95%CI: 6.90%-12.81%), while the fraction attributable to heat was relatively small (estimate 0.97%, 95%CI: 0.46%-2.35%). The attributable risk (AR) of respiratory diseases was higher (19.69%, 95%CI: 14.45%-24.24%) than that of cardiovascular diseases (11.40%, 95%CI: 6.29%-16.01%);
: In Chengdu, temperature was responsible for a substantial fraction of deaths, with cold responsible for a higher proportion of deaths than heat. Respiratory diseases exert a larger effect on death than other diseases especially on cold days. There is potential to reduce respiratory-associated mortality especially among the aged population in basin climate cities when the temperature deviates beneath the optimum. The result may help to comprehensively assess the impact of ambient temperature in basin cities, and further facilitate an appropriate estimate of the health consequences of various climate-change scenarios.
This is a cross-national comparison of workers' compensation claims for back pain in Japan and the United States (US).
The main objective is to juxtapose rates of back pain claims in Japan and ...Washington state. Because the Washington state rate closely matches rates for other US states as well as the rate for the US as a whole, it is used to represent the US rate. A puzzle is to be framed: Why are back pain claim rates in Japan and the United States so disparate?
Occupational back pain is common among workers in both Japan and the United States. Wage compensation for time off work is also substantial in both countries and potentially induces time off work at least as much in Japan as in the United States. Accordingly, back pain claim rates in Japan seemingly would be on the same order of magnitude as rates in the United States.
Washington state rates are based on data from its state fund. Both Japan and Washington state rates are composed of the number of workers eligible to file worker compensation claims in a given year (denominator) and the number of back pain claims accepted during that year (numerator). Because rates may fluctuate from year-to-year, 5 years of data on rates are presented, 1995-1999. Central to the comparison are Japanese and Washington state rates of workers' compensation claims for back pain with more than 3 days compensated time loss from work.
The back pain claim rate in 1999 was 60 times higher in Washington state than in Japan. The disparity in rates for the other years in the study (1995-1998) was similar.
Back pain is common among workers both in Japan and the United States, but there is no simple or necessary relationship between that symptom and how it manifests itself in one country or another. Rather, the symptom is protean in its social manifestations. As for what shapes those manifestations-or, more specifically, what causes the startling disparity in back pain claim rates between Japan and the United States-that is a puzzle. Various solutions to the puzzle are discussed, but it remains essentially unsolved.
Objective
Although the usefulness of an additional forearm tourniquet to conventional intravenous regional anesthesia (IVRA) has been reported, the forearm cuff may disturb the surgical field to some ...degree, especially in wrist surgery. In the present study, we assessed the clinical efficacy of a temporary additional forearm rubber tourniquet to the conventional upper arm tourniquet on the quality of IVRA.
Methods
The study included 32 ASA physical status I and II adult patients undergoing elective hand surgery who were randomly allocated to either an additional forearm tourniquet group (Group F) or to a conventional upper arm tourniquet group (Group C). Upper arm tourniquet IVRA was established using 40 mL of 0.5 % lidocaine in Group C. Hypothetically enhanced forearm tourniquet IVRA was established using 10 mL of 0.5 % lidocaine with an additional forearm rubber tourniquet and then administering 30 mL of 0.25 % lidocaine after removing the forearm tourniquet in Group F. The sensory and motor block onset and recovery times, onset time of tourniquet pain, intraoperative fentanyl consumption, and incidence of local anesthetic toxicity were recorded. The numerical rating score (NRS) of perioperative and postoperative pain and quality of anesthesia were also assessed.
Results
Although the total dose of lidocaine in Group F was less and the sensory and motor block onset times were significantly shorter in Group F than those in Group C (
P
< 0.05), there was no difference regarding sensory and motor block recovery times, onset time of tourniquet pain, intraoperative fentanyl consumption, NRS of perioperative and postoperative pain, and the quality of anesthesia in the two groups (
P
> 0.05). Compared with Group C, the incidence of local anesthetic toxicity (i.e., dizziness, 43.8 vs 6.2 %,
P
= 0.02) was significantly decreased in Group F.
Conclusions
The combination of the additional forearm and upper arm tourniquets with a smaller amount of local anesthetic achieved more rapid onset of sensory and motor block, a similar quality of anesthesia and a lower incidence of local anesthetic toxicity compared with the conventional technique.
Objective. Chinese is the most commonly spoken language in the world, and back pain is as prevalent in China as it is elsewhere. Nevertheless, there is a paucity of measures in Chinese to evaluate ...back pain treatment. We assemble a set of Chinese measures to evaluate outcomes in diverse domains. A set of measures is necessary, because measures in one domain may vary independently from measures in another. Chinese measures are in four domains: pain intensity, global rating of improvement, physical disability, and emotional functioning. The Oswestry Disability Index (ODI) represents the domain of physical disability, and both the World Health Organization Five‐Item Well‐being Index (WHO‐5) and the Center for Epidemiological Studies‐Depression Scale (CES‐D depression scale) represent the domain of emotional functioning.
Design. Measures were cross‐culturally adapted into Chinese. The development of Chinese versions of the ODI, the WHO‐5, and the CES‐D entailed psychometric evaluation. Additionally, we administered the previously validated Chinese SF‐36 to evaluate the validity of measures in our set.
Setting. The western‐style Pain Clinic and the Acupuncture Clinic of West China Hospital (Chengdu, Sichuan Province).
Patients. Eighty‐six patients with nonspecific back pain.
Results. We found no significant differences between patients from the Pain Clinic and those from the Acupuncture Clinic. For the ODI, the CES‐D, and the WHO‐5, we evaluated the psychometric properties of reliability, validity, and ceiling and floor effects. We found these properties to be good to excellent.
Conclusions. In the Appendix (available online, in supplemental materials for this article), we present the West China Hospital set of measures in Chinese to evaluate back pain treatment.
Chronic back pain (CBP) is a common symptom throughout the world, and those undergoing it often experience a profound degradation of life. Despite extensive research, it remains an elusive symptom. ...In most cases, CBP is "non-specific," since bio-mechanisms examined in the clinic do not account for it; another way of saying this is that it is "of obscure origins." This paper re-directs attention towards origins that are distal and usually out of sight from the vantage point of the clinic. CBP as considered here is non-specific, persists ≥ 3 months, and, additionally, interferes with activities of daily life, such as family interaction or work. A theory proposed in the paper draws upon Durkheim's
to explain
exposures in the distal social contexts of family and workplace are fundamentally implicated in CBP. The theory is formed out of previously published studies on family and workplace social contexts of CBP and, in effect, provides a theoretical framework with which to review them. After treatment of CBP in the clinic, patients return to family and workplace contexts. Unless exposures in these contexts are addressed, they serve as continually renewing sources of CBP that remain unabated regardless of mechanism-based treatment in the clinic.
A criteria-based review of the literature.
The literature on the epidemiology of low back pain is accumulating, but for the most part studies are restricted to high-income countries, which comprise ...less than 15% of the world's population. Little is known about the epidemiology of low back pain in the rest of the world.
To address the imbalance in the literature and to review the relatively few studies on the epidemiology of low back pain in low- and middle-income countries. Rates from these studies are contrasted with rates from selected high-income countries. In reviewing the literature, a hypothesis is tested: low back pain rates are higher in low-income countries than in high-income countries, not only because hard physical labor is more prevalent in low-income countries, but also because, unlike high-income countries, hard physical labor for older workers in low-income countries often is unavoidable.
Among other sources, articles for the review come from a search of the MEDLINE bibliographic database, with "back pain" and individual low- and middle-income countries entered as key words. To avoid recall biases, findings specifically on point prevalence are reviewed.
Within the categories of low-income and high-income countries, low back pain rates vary twofold or more. In comparisons between these categories of countries, rates on the whole are higher among the general populations of selected high-income countries than among rural low-income populations; specifically, rates are 2-4 times higher among Swedish, German, and Belgium general populations than among Nigerian, southern Chinese, Indonesian, and Filipino farmers. Within low income countries, rates are higher among urban populations than among rural populations and still higher among workers in particular worksites, referred to as "enclosed workshops."
The disparity in low back pain rates within categories of countries, high-income and low-income, calls attention to the high proportion of studies on the epidemiology of low back pain that are methodologically questionable. Recommendations are offered to improve the methodologic quality of this type of study. Conclusions may be drawn from comparisons between studies, although, in the absence of set methodologic standards, they are tentative. The considerably lower rates among populations of low-income farmers compared with rates of the affluent populations of selected northern European countries indicate that, contrary to the hypothesis proposed here, hard physical labor itself is not necessarily related to low back pain. The higher rates in urban low-income populations as compared with rates in rural low-income populations and the sharply higher rates among workers in enclosed workshops of low-income countries suggest a disturbing trend: low back pain prevalence may be on the rise among vast numbers of workers as urbanization and rapid industrialization proceed.
Although information exists on the cost of workers' compensation low back pain (LBP), there is limited information on the duration of lost work time as well as the association between cost and ...duration. For this study, cost and duration of lost work time information were derived from a large workers' compensation company's database for 1992 LBP claim (h = 106,961). The distribution of cost was skewed, with an average cost of a claim being 20 times higher than its median. A disproportionately small percentage of the costliest LBP claims (10%) were responsib for a large percentage of the total cost (86%). The distribution of length of disability (LOD) was also skewed, with an average of 102 days and a median of zero. The average and median LOD for those claims with at least one day of compensable disability was 303 and 39 days, respectively. As a "rule of thumb, " it was found that of those claimants who remain on disability at the end ofn weeks, approximately 50% wil be off disability at the end of 6n weeks. Additionally, the 7% of the claims with an LOD greater than one year accounted for 75.1% of the cost and 84.2% of the total disability days. Disability days that were accrued after one year of disability accounted for 59.3% of the total number of disability days. This result suggests that other LOD estimation techniques, which may not account for disability days beyond one calendar year (eg, the Bureau of Labor Statistics Annual Survey of Occupational Injuries and Illnesses), may result in a marked underestimation of LOD.
Outcomes of opioid therapy for noncancer pain remain to be more fully explored. Loss of work is among these outcomes. Especially when work loss becomes "chronic" (persists >or=90 days), it has ...profound psycho-social repercussions that compound suffering of those already in pain. Furthermore, costs escalate as work loss persists. We thus explored associations between opioid therapy for back pain and chronic work loss. Data consisted of workers compensation claims for nonspecific low back pain. We used multivariate analyses to control for diverse covariates. Workers with no opioid prescriptions constituted the reference group. Findings included the following: compared with the (no opioid) reference group, odds of chronic work loss were six times greater for claimants with schedule II ("strong") opioids; compared with the reference group, odds of chronic work loss were 11-14 times greater for claimants with opioid prescriptions of any type during a period of >or=90 days; and three years after injury, costs of claimants with schedule II opioids averaged $19,453 higher than costs of claimants in the reference group. Our analysis was not designed to ascertain antecedent causes, or why chronic work loss occurred in the first place. Rather, we focused on an ensuing consequence of opioid therapy, i.e., the outcome of chronic work loss, which occurred far removed in time (>or=90 days) after the worker's recorded date of back injury. The strong associations observed suggest that for most workers opioid therapy did not arrest the cycle of work loss and pain.
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