Do psychosocial factors predict disability and health at a 3-year follow-up for patients with non-acute musculoskeletal pain? A validation of the Orebro Musculoskeletal Pain Screening Questionnaire.

PURPOSE: Early identification and intervention with those that run the risk of developing long-term disability would offer a great opportunity for reducing costs and personal suffering associated with long-term work absenteeism. The Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) has been used and validated in several studies for participants with mainly acute pain problems. The aim of this study was to validate the OMPSQ for patients with non-acute pain problems (e.g. 1-6 months sick leave) and compare to other relevant questionnaires. METHOD: One hundred and fifty-eight patients with musculoskeletal pain and disability recruited to a multidisciplinary rehabilitation project completed a battery of questionnaires at baseline and at 3-year follow-up visits. The main analysis involved the relationship between risk levels in the questionnaire and sick leave and perceived health after 3 years. RESULTS: The OMSPQ predicted future sick leave and health and was found to have six factors. The function and pain factors were the best predictors of sick leave after 3 years, while the distress factor was the best predictor of perceived mental health and return to work-expectancy was borderline significant. Perceived physical health at 3 years was best predicted by the function and pain factors with the fear-avoidance factor being marginally significant. CONCLUSION: The results demonstrate that psychosocial factors as measured by OMPSQ are related to work disability and perceived health even 3 years after treatment for patients with non-acute pain problems. The OMSPQ was a good predictor of outcome.

Quality of life and maintenance of improvements after early multimodal rehabilitation: a 5-year follow-up.

PURPOSE: There is a paucity of long-term evaluations on rehabilitation of musculoskeletal disorders, e.g., neck, shoulder or back pain. The aim of this study was to assess quality of life and the effect of early multimodal rehabilitation on 91 patients with musculoskeletal pain and disability at a 5-year follow-up. METHOD: The follow-up assessment, which included questions on pain, function, quality of life, perceived health, sick leave and psychosomatic symptoms, was performed 5 years after the assessment of baseline status. RESULTS: Improvements in pain, perceived health and psychosomatic symptoms were maintained at the 5-year follow-up. In addition, improvements in function, quality of life, and level of acceptable pain were significant in comparison to baseline. At the time of the baseline assessment all patients were on sick leave (13% were on partial sick leave). At the 5-year follow-up, 58% of the patients were at work part or full time. The results show that those working differed significantly from those not working at the 5-year follow-up on almost all variables, indicating that those working enjoy better health. The most salient prognostic factors for return to work were perceived health and educational level at the time of the baseline evaluation. CONCLUSIONS: These results show that treatment improved quality of life and the effects were basically maintained at 5 years. Work capacity as reflected in return to work increased greatly (81%) at a 1-year follow-up and was substantial (58%) at the 5-year follow-up. Moreover, perceived health and educational levels were important prognostic factors. Finally, the fact that patients working reported better health underscores the probable importance of return to work. Our results imply that it may be feasible to obtain long-term benefits from such a primary care-based intervention.

Atypical mycobacteria in extrapulmonary disease among children. Incidence in Sweden from 1969 to 1990, related to changing BCG-vaccination coverage.

SETTING: In April 1975, the general BCG vaccination of newborns in Sweden was replaced by selective vaccination of groups at increased risk of tuberculosis. OBJECTIVE: To relate the incidence of atypical mycobacterial disease in children to BCG vaccination. DESIGN: A nationwide survey in Sweden during the period 1969-90 disclosed 390 children under 15 years of age with bacteriologically confirmed atypical mycobacteria from extrapulmonary lesions. RESULTS: The average, annual incidence of atypical mycobacterial disease per 100,000 children under 5 years of age increased from 0.06 during the period 1969-74 to a maximum level of 5.7 during 1981-85. Among the cohorts born in Sweden in the period 1975-85, the cumulative incidence rate before 5 years of age was estimated at 26.8 per 100,000 non-BCG-vaccinated children and at 4.6 among those BCG-vaccinated, ratio 5.9 (95% confidence limits 1.6, 48.5). Mycobacterium avium-intracellulare was found in 83%. Disseminated, fatal disease developed in 3 children. The remaining ones suffered from local infections, most often lymph-node or soft-tissue lesions. The observed incidence of bacteriologically confirmed diagnosis was estimated to represent approximately 40% of the 'true' number, if patients with diagnosis based on histological, clinical and epidemiological findings only were included. CONCLUSION: The present study indicates that BCG vaccination plays a role in protection against localized disease caused by atypical mycobacteria in children.

Infection with Mycobacterium malmoense in Sweden: report of 221 cases.

Mycobacterium malmoense was first described in 1977 and today is second only to the Mycobacterium avium complex as a cause of atypical mycobacterial infection in Sweden. We retrospectively studied the records of 221 patients from whom M. malmoense was isolated during 1968-1989. M. malmoense was recovered from the respiratory tract of 171 patients (170 adults and one child) and from cervical lymph nodes of 36 patients (35 children and one adult). In addition, the organism was isolated from the urine of six patients, one of whom had disseminated disease and two of whom had abscesses caused by M. malmoense. A majority of the patients with pulmonary infection as well as the patient with disseminated disease had other underlying diseases.

Intermittent prophylactic treatment of recurrent vaginal candidiasis by postmenstrual application of a 500 mg clotrimazole vaginal tablet.

The therapeutic efficacy of intermittent, monthly, postmenstrual prophylaxis with a single 500 mg clotrimazole vaginal tablet (n = 33) was compared with placebo tablets (n = 29) in 62 woman (age 28.1, SD 7.2 years) with recurrent vulvovaginal candidiasis. The number of episodes of acute vulvovaginal candidiasis experienced during the year prior to inclusion was 6.3, SD 1.9. The cumulative recurrence frequency after 6 months intermittent prophylaxis with clotrimazole (30.3%) was lower (p less than 0.001) than that recorded for the women who received placebo (79.3%). After an additional 6 months observation period without treatment there was no significant difference in the cumulative recurrence frequency between the groups (clotrimazole 84.9%; placebo 86.2%). The vagina was recolonised with Candida albicans in 70% of the women after 6 months prophylactic treatment with clotrimazole and in 86% of the women who had received placebo. Thus, this study has demonstrated that postmenstrual prophylactic treatment with a single 500 mg clotrimazole vaginal tablet, applied monthly, prevents recurrence of symptoms, although it does not eliminate yeasts from the vagina.

A carrier method for the assessment of the effectiveness of disinfectants against Mycobacterium tuberculosis.

A method for testing the effect of disinfectants against Mycobacterium tuberculosis was developed using glass slide carriers contaminated with Myco. tuberculosis from spleens of guinea-pigs. The method was found to be useful although a greater number of colony forming units, permitting calculation of a reduction factor in the range of 10(5), is desirable. In tests with various disinfectants, alcohols were the most effective agents against Myco. tuberculosis.

Pharmacokinetic studies of 5-fluorouracil after oral and intravenous administration in man.

The pharmacokinetic conditions for oral administration of 5-fluorouracil (5-FU) were investigated in 16 patients with malignant liver tumours. The concentration of 5-FU in portal and systemic blood was determined by a microbiologic method every 10 min. during 2 hours after oral or intravenous administration of a standard dose of 250 mg 5-FU ( approximately 4 mg/kg b. wt.) or 15 mg 5-FU/kg b. wt. The drug was rapidly absorbed after oral administration with peak values within 10-30 min. 25% of the lower and 40% of the higher oral dose reached the systemic circulation. The reduction of systemic bio-availability was partly accomplished by a loss in the gastrointestinal tract and partly by extraction by the liver. The hepatic extraction ratio was calculated to 0.56 and 0.26 after the lower and the higher dose respectively indicating a saturable process. The availability of 5-FU was significantly higher in portal blood than in systemic blood after oral administration. The opposite conditions were found after intravenous administration. Thus, oral administration of 5-FU to patients with malignant liver tumours seems rational.

Chronic papillomatous dermatitis as a peristomal complication in conduit urinary diversion.

In 76 patients with conduit urinary diversion, the skin in the stomal area was studied with regard to complications. No such complications had occurred in 39 cases. Superficial erosive dermatitis was present or had been a transient episode in 27 cases. The immediate peristomal area was found in ten cases to show a different type of complication. This was characterized by hyperplastic, papillomatous skin lesions of a chronic nature. A rubber urinary collecting device for long-term use had been fitted in nine of the ten patients, and none of them had a protruding nipple stoma. The clinical, microbiologic and histologic features of these hyperplastic lesions are described and aetiologic factors are discussed. Change to another type of collecting device was followed within three to six weeks by healing of the lesions.

Absorption of rifampicin in gastrectomized patients. Effect of meals.

Rifampicin absorption was studied in six gastrectomized and six non-gastrectomized tuberculous patients who had been on continuous rifampicin therapy for more than 4 weeks. A dose of 450 mg was given on two occasions, first immediately after breakfast and, 2 days later, 1 h before breakfast. In all the gastrectomized and control patients a serum level well above the MIC for M. tuberculosis (0.2-0.5 microgram/ml) was achieved irrespective of whether rifampicin was administered after the meal or during fasting. Gastrectomized patients tended to have more delayed serum concentration peaks postprandially than when fasting. The differences in absorption were not statistically significant, and the serum concentrations remained above the MIC for M. tuberculosis for similar lenghts of time. Individual serum concentrations varied greatly, and this variation may represent a greater problem in the routine monitoring of rifampicin serum levels than administration of the drug with food.