Manual Professions Research Articles

The journey of pain management for fibromyalgia patients: A ten year experience from Tunisia

IntroductionFibromyalgia often deteriorates the quality of life of patients on physical, emotional, socio-familial, and professional levels. Aim of the workTo describe the characteristics of fibromyalgia patients and to assess the impact of fibromyalgia on their quality of life. Patients and methodsA questionnaire was provided to the fibromyalgia patients at the pain management center of Tunis, during the last ten years and the sociodemographic data, journey characteristics and satisfaction regarding the quality of their care were recorded and the impact of fibromyalgia on the quality of life was assessed using the Fibromyalgia Impact Questionnaire (FIQ). ResultsThe work included 110 patients, 93 females and 13 males (F:M 7.2:1) and a mean age of 52 ± 12 years. 65 % reported an initial pain visual analog scale (VAS) ≥ 7. The mean consultation and diagnostic delays were 75 ± 30 and 44 ± 28 months, respectively. 94 % of patients were initially misdiagnosed, despite consulting more than two different physicians. The mean FIQ total was 77.5 ± 13.Age, female gender, and manual professions were related to a more impaired physical impact of fibromyalgia (p = 0.02; p = 0.01; p = 0.03, respectively). Patients whose fibromyalgia trigger was persistent stress (n = 50) reported more impaired FIQ (p = 0.001). Patients with shorter consultation and diagnostic delays reported more improvement (p = 0.001 and p = 0.01, respectively). Patients treated with tricyclic antidepressants and vitamins felt significantly improved (p = 0.02 and p = 0.002). Non-pharmacological treatments included physical therapy, yoga, acupuncture, and thermal baths. ConclusionsThe quality of life in fibromyalgia patients is frequently impaired, and the journey is complex and ambivalent.

EMPLOYMENT OF FOREIGNERS IN MANUFACTURING AND NON-MANUFACTURING BUSINESSES

In recent years, many manufacturing and non-manufacturing businesses in the Czech Republic as well as elsewhere in the European Union have experienced serious people shortages in manual, technical, and other professions. One possible solution to this personnel issue is the employment of a foreign workforce. Based on a survey of 478 manufacturing and non-manufacturing businesses across the Czech Republic, the paper aims to analyze the experience of surveyed businesses with the employment of foreign workers and propose possible solutions to long-term people shortages. The analysis confirmed that the majority of surveyed businesses need to employ foreign workers to meet present and future labor demands. In addition, dealing with long-term people shortages requires implementing various organizational and technical measures related to working hours, job design, process automation, process outsourcing, and talent development.

Functional Outcome of Uncemented Total Hip Replacement in Low Socioeconomic Group Using Modified Harris Hip Score: A Prospective Midterm Follow-Up Study.

Background Total hip replacement is a safe and effective surgery with excellent outcomes in most patients with hip arthritis. The aim of this study was to evaluate functional outcomes and complications of total hip replacement among patients with low socioeconomic status in India. Methods We assessed 50 patients whose incomes fell below the poverty line and who underwent uncemented total hip replacement. We used a modified Harris Hip Score, replacing two items (one measuring range of motion and one measuring deformity) with two new ones (one related to return to professional activity and another regarding sexual activity). Results At the final follow-up, patients' modified Harris Hip Score improved from a preoperative meanvalueof 13.28 (0-46) to a postoperative meanvalueof 88.52 (64-100), suggesting marked improvement in functional outcome (p<0.001). In total, 32 (64%) patients returned to their original profession, and 12 (24%) switched to alternate work with mild pain. All patients reported satisfaction with their sexual activity at the final follow-up. Conclusions Many patients in India whose income is below the poverty line work in manual labor professions (e.g., farmers, masons, and cobblers) that increase their risk of hip damage. Total hip replacement is beneficial for these patients, offering good personal and professional quality of life after the surgery.

Comparative descriptive analysis of socio-demographic status in immunocompetent and immunocompromised patients with mycoses of the skin, hair and nails

BACKGROUND: Despite the achievements of modern medicine, people's susceptibility to fungal infections is only increasing. In this regard, it is extremely important to understand which social factors are most characteristic of people suffering from mycoses of the skin, hair and nails.&#x0D; AIM: to study the socio-demographic status of immunocompetent and immunocompromised patients with mycoses of skin, hair and nails.&#x0D; MATERIALS AND METHODS: A multicenter prospective cohort observational study of the social and demographic characteristics of immunocompetent and immunocompromised individuals with mycoses of the skin of hair and nails was conducted. Four groups of patients were formed: immunocompetent persons, persons with diabetes mellitus, patients with autoimmune diseases while taking immunosuppressants, patients with infection human immunodeficiency virus (HIV). A total of 646 people were examined. To ensure the quality of research and information processing, questionnaires were developed to be filled in for each examined patient. At the time of inclusion in the study, data concerning the place of residence and living conditions of patients, their lifestyle, marital status, bad habits and profession were entered into the questionnaires.&#x0D; RESULTS: Significant differences (p 0.0001) were revealed between the studied socio- demographic characteristics in the study groups. The age of immunocompetent patients with mycoses of skin, hair and nails was 914 years lower than the age of immunocompromised. Female persons prevailed in the case of autoimmune diseases ― 71.1%. Harmful habits were registered in 60% of patients with superficial mycoses and HIV. 83.33% of autoimmune patients were married. Urban residents prevailed over rural residents in the case of diabetes mellitus and autoimmune pathology. Persons of manual work professions in 48.48% of cases were identified among patients with HIV infection, which was more than in other study groups.&#x0D; CONCLUSION: When studying the socio- demographic characteristics of patients with mycoses of skin, hair and nails, significant differences were revealed in all the factors studied. The obtained results indicate the need to develop a personalized approach to the diagnosis, prevention and treatment of these infections.

Prognostic factors associated with improvements in patient-reported outcomes in idiopathic adhesive capsulitis

The purpose of this study was to identify prognostic factors that are associated with improvements in patient-reported outcomes measures (PROMs) related to upper extremity function and pain in those suffering from idiopathic adhesive capsulitis. All patients treated conservatively for primary idiopathic adhesive capsulitis were identified from our institutional database between 2019 and 2021. Exclusion criteria included any patients treated surgically, follow-up less than one year, or incomplete survey results. PROMs including Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Test Version 2.0 (P-UE), Pain Interference (P-Interference), Pain Intensity (P-Intensity), and visual analog scale (VAS) pain scores. They were obtained at initial consultation and at one year to assess patient-perceived impact of their condition. Multiple linear and multivariable logistic regressions were performed to identify factors associated with improvement in patient-perceived pain and shoulder function using final PROM scores and difference in PROM scores from initial consultation. An independent t-test was used to compare baseline and one-year minimum follow-up PROMs. Odds ratios and their 95% confidence intervals were calculated for each factor; a P value of < .05 was considered statistically significant. A total of 56 patients (40 females and 16 males) were enrolled in the study with an average age of 54.7±7.7 years. A significant improvement (P<.001) was demonstrated at one-year minimum outcomes for P-UE, P-Interference, P-Intensity, and VAS scores. With respect to comorbid conditions, hypothyroidism [P-UE (β: 9.57, P=.006)] was associated with greater improvements in PROMs, while hyperlipidemia [P-UE (β:-4.13, P=.01) and P-Intensity (β: 2.40, P=.02)] and anxiety [P-UE (β:-4.13, P=.03)] were associated with poorer reported changes in PROMs. Female sex [P-UE (β: 4.03, P=.007) and P-Interference (β:-2.65, P=.04)] and employment in manual labor professions [P-Interference (β:-3.07, P=.01), P-Intensity (β:-2.92, P=.006), and VAS (β:-0.66, P=.03)] were associated with significantly better patient-perceived outcomes. Hispanic heritage was associated with higher reported changes of P-Intensity (β: 8.45, P=.004) and VAS (β: 2.65, P=.002). Patient-perceived improvements in PROMIS score during the natural history of adhesive capsulitis are likely multifactorial, with anxiety, hyperlipidemia, increased body mass index, and Hispanic heritage associated with reduced improvement in PROMIS scores.

The Demographic and Social Characteristics of Patients with Ocular Foreign Bodies in a Greek Tertiary Hospital.

PurposeTo present the demographic and social characteristics of patients with ocular foreign bodies (OFB), who visit the Ophthalmological Outpatient Department of a tertiary hospital in Athens, Greece.Patients and MethodsDuring the period January-March 2019, 5181 patients presented to the Ophthalmological Outpatient Department of our hospital, and 543 of them were diagnosed with an ocular foreign body. Moreover, 106 of them were interviewed about their demographic and social factors, regarding among others data about their occupation, level of education, nationality, family, and insurance status.ResultsThe patients with ocular foreign bodies were significantly younger compared to the rest of the examined patients (49.5±13.9 vs 56.3±17 years, p<0.001). Moreover, the ocular foreign bodies were more frequent in men compared to women (15.5% vs 5.0%, p<0.001) and in non-Greek patients (23.7% vs 9.2%, p<0.001). Regarding the social characteristics of the patients with ocular foreign bodies, we found that the majority of them were married, employed, insured, while their educational status was middle and high school. Furthermore, the vast majority of the patients practiced manual professions (73.1% of them).ConclusionWe documented that the introduction of an ocular foreign body is frequently encountered in the Outpatient Department of our tertiary hospital in Athens, Greece. We also demonstrated that these patients are younger, while they are more frequently men, of non-Greek origin, with an educational status of middle and high school, and their occupation is associated with manual labour.

Children's visual impairment and visual care related to socioeconomic status in Catalonia (Spain).

The objective of this study is to assess the prevalence of visual impairment and visual care practices and its association with socioeconomic conditions in the infant population in Catalonia. The Catalan Institute of Statistics provided a random sample of 0 to 14-year-old non-institutionalized children whose parents were interviewed in a continuous health survey from 2011 to 2015 in Catalonia. A multistage stratified and random sampling procedure considering age, sex, county and town was followed. All results have been weighted according to the sample design and are presented as the proportion of the condition with its 95% confidence limits. Chi-square tests were performed to evaluate the association between categorical variables. To study the association of visual care with independent variables, a multiple logistic regression model was used. In 0 to 14-year-old children, a 12.9% (95% confidence interval [CI] [11.8-13.9]) prevalence of correctable visual impairment was observed. The prevalence of non-correctable visual impairment was 0.9% (95% CI [0.6-1.2]). Non-correctable visual impairment was more prevalent in families with lower education levels, manual professions or unemployed. Of children without visual impairment, 13,5% (95% CI:12.3-14.6) visited a visual care professional in the last 12 months while this proportion was 67.4% (95% CI [63.3-71.5]) among those with correctable visual impairment. When parents have a university degree or non-manual professions, a higher level of visual care was observed. In children with correctable visual impairment, visual reviews were more frequent when parents are employed in a non-manual profession. For the first time, indicators related to visual impairment in children in Catalonia have been recorded. There is an association between lower socioeconomic status and having non-correctable visual impairment, and conversely, having correctable visual impairment was significantly associated with employed parents. More visual care is associated with higher socioeconomic status.

Die betriebsärztliche Betreuung von Erwerbstätigen – Ergebnisse der repräsentativen lidA-Studie

Occupational health provision among workers in Germany: results of the representative lidA study Introduction: There is an ongoing debate in Germany as to whether there is a sufficient number of active occupational health physicians (OHPs) to meet the need for occupational health surveillance. In this contribution, the frequency of OHP contact with employees is investigated based on data of a representative sample of older workers in Germany. Methods: The data come from the third wave (2018) of the German lidA study (www.lida-studie.de), a longitudinal study investigating work, age, health and employment among workers born in 1959 or 1965. Data analysis was restricted to those in full-time or part-time employment at the time of the interview (n=3039). The analysis of data is descriptive and specification by occupation required at least 25 cases per occupational group. Results: 62.1 % of all respondents (n=1888) reported that their enterprise had an OHP. 52.1 % of all employees had already had personal contact with him, half of them in the past 12 months. It was not possible to identify a statistically significant correlation with the extent of physical strain at work. Members of the engineering and medical professions and academics reported high OHP contact rates, while low rates were reported by some manual and service professions (e.g. construction and cleaning jobs), administrative professions and retail workers. Discussion: The findings do not point directly to a shortage of OHPs in Germany. However, they do suggest an imbalance in the distribution of OHP resources: some occupations report OHP contacts on a smaller scale than would be expected, whilst the opposite applies to others. Conclusions: There is a need for an in-depth scientific analysis of the current organisation, practice and quality of occupational health surveillance in Germany. Keywords: occupational health surveillance – contact with occupational health physician – lack of occupational health physicians – employees – professional groups – empirical survey

The War on Normal People: The Truth about America's Disappearing Jobs and Why Universal Basic Income Is Our Future by Andrew Yang

in Paris and resuming a normal life had thus become a challenge. Overall, Le Lambeau is a fascinating and often sobering read, one that offers insight into human fragility as well as resilience. One caveat in terms of style: like many French journalists/novelists, Lançon feels the need to insert as many literary references as possible into his narrative, with results that are often more rambling than Proustian . Some judicious editing would have eliminated a few of the unnecessary digressions and provided a sharper, clearer focus. It should be noted that two other survivors of the terrorist attack have published bandes dessinées or graphic albums: Catharsis, by Luz (Futuropolis, 2015), and La légèreté, by Catherine Meurisse (Dargaud, 2016). Edward Ousselin Western Washington University Andrew Yang The War on Normal People: The Truth about America’s Disappearing Jobs and Why Universal Basic Income Is Our Future New York. Hachette. 2018. 284 pages. The case for universal basic income (UBI)—whereby the state makes regular, unconditional income payments to all its working-age citizens—is gaining increasing traction in the United States. Though the concept of UBI is nothing new to American politics, it has acquired renewed relevance in the face of a pressing modern issue: the automation of jobs. Andrew Yang makes one of the more noteworthy arguments in favor of UBI in his urgent new book, The War on Normal People. Yang is clearly a man of action. He is the founder of Venture for America and has recently filed for candidacy in the 2020 US presidential elections. With The War on Normal People, he not only draws attention to current socioeconomic issues but goes on to proposes concrete measures to face them. Yang uses the word “normal ” in the sense of “average” but reminds his readers that the “average” falls lower than they might think. As Yang points out, “the normal American did not graduate from college and doesn’t have an associate ’s degree. He or she perhaps attended college for one year or graduated high school [and] has a net worth of . . . about $6K excluding home and vehicle equity.” It is these “normal” Americans for whom the consequences of shifting from human to machine labor have been and will be most dire. Although “automation [has already] eliminated millions of manufacturing jobs between 2000 and 2015,” Yang believes that the bulk of its impact is yet to come: “I love capitalism[, but] capitalism with the assistance of technology is about to turn on normal people.” However, to think that high-qualification white-collar jobs are immune to this change would be mistaken. The key criterion for the automation of a profession is the extent to which that profession is repetitive or routine, not the extent to which it is manual. Considering that the Federal Reserve classifies almost half of current US jobs as “routine,” Yang contends that the potential impact of continued automation is serious indeed. Yang sees as misguided in the current context the claim that technological revolutions always compensated loss of certain professions by the creation of new fields of employment. A number of specific manual professions becoming obsolete does not compare in quality or impact to any (including any new) routine work being lost to human employment. “History repeats itself until it doesn’t,” he cautions. As a solution to the socioeconomic vulnerability that would result from increasing automation, Yang proposes to pay a universal basic income, whereby each working-age adult is to receive a “Freedom Dividend” of $1,000 a month, which roughly hits the current national poverty line. To gauge the impact of his proposal, he lists a multitude of current and historical UBI experiments (from Alaska and Finland to UBI aid payments in Kenya), which seem to all offer similarly positive conclusions. For instance, in the Canadian town of Dauphin, thirteen thousand people received a four-year UBI, lifting everyone above the poverty line, with researchers finding “minimal effect on work. The only groups who worked substantially less were new mothers and teenagers. . . . Birth rates for women under twenty-five dropped. High school graduation rates went up . . . hospital visits went World Literature in Review 94 WLT NOVEMBER...

Gesture recognition and sensorimotor learning‐by‐doing of motor skills in manual professions: A case study in the wheel‐throwing art of pottery

AbstractThis paper presents a methodological framework for the use of gesture recognition technologies in the learning/mastery of the gestural skills required in wheel‐throwing pottery. In the case of self‐instruction or training, learners face difficulties due to the absence of the teacher/expert and the consequent lack of guidance. Motion capture technologies, machine learning, and gesture recognition may provide a way of overcoming such issues. The proposed methodology is used to record and model expert gestures and then to compare this model in real time with the gestures performed by the learner. Differences in kinematic aspects such as hand distances are detected, and optical/sonic sensorimotor feedback is provided to the learner by the system, alerting him/her when errors occur and guiding him/her to achieve better results. In the case described here, the system was evaluated with 11 learners. With the use of our system, the gestural performance of learners during self‐training has been improved in comparison to cases of self‐training without computer assistance.

Population Reduction, Unification of Curriculum and Diversification of Financial Support of Secondary Education in the Czech Republic: The Situation in the Years 2006 – 2016

Abstract Introduction: The article focuses on the situation in the area of secondary education in the Czech Republic. Its aim is to reflect three topics: population reduction, unification of curriculum and diversification of financial support of secondary education in the Czech Republic in 2006 - 2016. Methods: The results are underlined by available data from the national statistics. The data are collected annually and are accessible on the website of the Ministry of Education, Youth and Sports. They contain the entire population of secondary schools, teachers and pupils. Analysis was provided with the use of SPSS, version 24. Results: There is a reduction of vocational and apprentice schools, but at the same time we are increasing financial support to their fields of study. Under the 2004 law, each school has an individual school educational program, but realistically, we see that the curriculum at secondary school level of education rather standardises. On the labour market, we need graduates of vocational and apprentice schools, but we still strongly support grammar schools and other theoretically oriented schools, whose graduates are not motivated for manual professions. Discussion: Closer analysis focused on reflection of selected trends in the area of secondary education is needed for the purposes of education policy and for planning future research studies in this area. Limitations: Continuous development takes place in the field of education. All comparisons in the years 2006-2016 are therefore limited. The data were used in their original form, in some cases were not available and therefore they could not be included in the analysis. Conclusions: Educational policy is very complicated, because education is difficult to control and it is based on freedom of access. Therefore, the most important target for the future is to stabilize the situation and be able to reflect maximum of factors influencing secondary education in our society. Although current trends clearly support lifelong learning and its unification, we should not forget the specific fields of apprentice and vocational schools, which are needed on the labour market.

Disability in Fibromyalgia Associates with Symptom Severity and Occupation Characteristics

It is intuitive that disability caused by illness should be reflected in illness severity. Because disability rates for fibromyalgia (FM) are high in the developed world, we have examined disease and work characteristics for patients with FM who were working, unemployed, or receiving disability payments for disability as a result of FM. Of the 248 participants in a tertiary care cohort study of patients with FM, 90 were employed, 81 were not employed and not receiving disability payments, and 77 were not working and currently receiving disability payments awarded for disability caused by FM. Demographic, occupation, and disease characteristics were compared among the groups. The prevalence of disability caused by FM was 30.8%. There were no demographic differences among the working, unemployed, or disabled patients. With the exception of measures for anxiety and depression, all measurements for disease severity differed significantly among the groups, with greater severity reported for the disabled group, which used more medications and participated less in physical activity. Disabled patients were more likely previously employed in manual professions or the service industry, whereas employed patients were more commonly working in non-manual jobs that included clerical, managerial, or professional occupations (p = 0.005). The one-third rate of disability for this Canadian cohort of patients with FM is in line with other reports from the western world. Associations of disability compensation were observed for subjective report of symptom severity, increased use of medications, and previous employment in more physically demanding jobs.

Atividade laboral dos pais de estudantes de segundo grau candidatos a Cursos de Graduação em Ciências da Saúde

Modelo do estudo: Estudo baseado em coleta de informações por meio de Questionário Estruturado. Objetivo do estudo: Verificar indicadores da situação econômica e cultural das famílias de alunos do segundo grau que pleiteiam o ingresso em cursos destinados a formar profissionais da saúde. Metodologia: Questionários auto-administrados foram respondidos por 256 estudantes do segundo grau, visitantes de Feira das Profissões da USP (FPUSP-interior). Esses questionários continham perguntas relativas ao tipo de escola que frequentavam e as atividades laborais de seus genitores. Os 108 estudantes de Escolas Públicas constituíram o Grupo 1 e os 148 alunos de Escolas Particulares formaram o Grupo 2. Resultados: A atividade profissional paterna mais frequente no Grupo 1 foi a de “Técnico Manual”(42,15%) e no Grupo 2 a de “Profissional de Nível Universitário” (24,11%). O maior grupo de mães do Grupo 1 foi composto por “Donas de Casa” (22,33%) seguido pelo das que exerciam “Outras Profissões Manuais”( 21,36%). No Grupo 2 a categoria mais frequente para as mães foi “Profissionais de Nível Universitário” (23,18%) seguida por “Professores e Diretores de Escolas” (19,56%). Cinco participantes do Grupo 1 e 27 do Grupo 2 eram filhos de Profissionais da Saúde. Conclusões: Apesar das diferenças das atividades laborais predominantes em cada um dos grupos estudados, os resultados confirmam que aspiração de se tornar um Profissional da Saúde independe da formação ou das profissões dos pais.

THU0317 Disability in Fibromyalgia is Associated with Greater Self-Reported Symptoms and Functional Impairment

BackgroundIt is intuitive that disablement due to illness should be reflected in illness severity. When illness measurement is based on subjective report only, without objective validation, the reliability of symptom...

Access to medical treatments in relation to the social status of the cancer patient cured at the Veneto Oncology Institute of Padua (IOV).

e12028 Background: The NHS in Italy is a public system of universal nature that guarantees health care to all citizens. Few Italian studies relate the therapy received by a cancer patients with their socio-economic status, so we decided to analyze the situation of the IOV. Methods: It is an observational monoinstitutional study conducted on 886 patients (pts) treated at the IOV from May 2006 to December 2011. They were selected from the Onco-AIFA registry which is a national tool used to monitor anticancer high-cost therapies. The socio-demographic data were obtained from medical records.We verified if there are differences in access to treatments (number of diagnostic tests, chemotherapy treatments, specialist and follow visits) in association with the socioeconomic determinants. We analyzed the survival differences in connection with demographic and clinical characteristics.The statistical analysis was performed using the Kruskal-Wallis test and the Cox model. Results: There are 520 pts evaluable of the 886 pts selected: 42% suffering from colorectal cancer, 28% lung cancer and 30% breast cancer. The median age is 63 years (41% male). With regard to the profession the sample is divided as follows: 34% traders/artisans/workers, 25% technical professions/office workers, 14% highly specialized occupations, 25% retired/housewives. The statistical analysis shows no significant differences in the number of exams and medical services in relation to the profession, except one that regards the mean number of chemotherapy infusions (25 manual professions vs. 20 other professions, p = 0.007). The socioeconomic variables do not affect survival, unlike the age (hazard ratio [HR], 1.42, p &lt;.001) and the type of cancer (HR, 0.72, p &lt;.001). The average cost of benefits per pt is about 4.600,00 euro/year, there is a major expense for traders/artisans /workers compared to other professions (+19%). Conclusions: The analysis of the sample of cancer pts did not reveal significant differences if it comes to access to care, so the system does not seem discriminatory. Probably these differences are homogenized by the state of economic well-being enjoyed so far by pts of the IOV.

Authors' reply to the comment by Pazzaglia et al

Since the aetiologies of neuropathic pain are most often degenerative or age related, it is not surprising that these conditions are more common in the elderly (Ahmad and Goucke, 2002; Pickering and Capriz-Ribière, 2008). Neuropathic pain occurs and persists in a heterogeneous group of aetiologically different diseases, with various physio-pathological mechanisms (Cruccu and Truini, 2009; Baron et al., 2012). Patients with neuropathic pain present with various pain-related sensory abnormalities (Baron et al., 2012). Subgrouping patients with neuropathic pain on the basis of individual sensory profiles could guide the choice of pharmacological agents to be proposed to each patient (Bouhassira et al., 2004; Cruccu and Truini, 2009; Baron et al., 2012). We appreciate Pazzaglia et al.'s interest in our study on the characteristics of neuropathic pain in a population of sub-Saharan African elderly, followed for chronic pain of musculoskeletal origin (Lekpa et al., 2013). In this study, we choose to use the neuropathic pain diagnostic questionnaire DN4 (Bouhassira et al., 2005) instead of other validated instruments. Apart from its good discriminative properties for the identification of neuropathic pain, the DN4 questionnaire was easy to use, especially in our sample of elderly patients with a low level of education. Thus, we were able to show through this study that: (1) neuropathic pain existed in African elderly; (2) female gender, low educational status, manual professions, unemployment and diabetes mellitus were significantly associated with the presence of neuropathic pain; (3) chronic spine diseases and painful diabetic peripheral neuropathy are the main causes of neuropathic pain in our sample; and (4) neuropathic pain were neglected by physicians with a low rate of prescription drugs directed against neuropathic pain (Lekpa et al., 2013). In his comments, Pazzaglia et al. presented the methodology and results of a multicentre study they conducted among Italian elderly over 65 years, with peripheral neuropathy (Pazzaglia et al., 2013). The methodology used in our study was different from that used by these authors (musculoskeletal pain vs. peripheral neuropathy). Despite this difference, the results are broadly comparable. Indeed, these authors showed that (Pazzaglia et al., 2013): (1) neuropathic pain are also common in elderly; (2) the aetiologies are numerous; (3) the clinical profile or sensory profile, assessed with the Neuropathic Pain Symptom Inventory (NPSI) (Bouhassira et al., 2004), varies depending on the aetiology; and (4) also the low rate of prescription drugs targeting neuropathic pain. The use of NPSI (Bouhassira et al., 2004) would not have changed the results obtained in our study. However, it would have provided important additional information. We could have had a more accurate assessment of the clinical profile of our patients, differentiating subtypes of neuropathic pain. Indeed, the NPSI was developed and validated for the assessment of different symptoms of neuropathic pain. It is also a simple and easy-to-use instrument for daily practice and clinical studies. The NPSI allows discrimination and quantification of five distinct clinically relevant dimensions of neuropathic pain: burning (superficial) spontaneous pain, pressing (deep) spontaneous pain, paroxysmal pain, evoked pain and paraesthesia/dysaesthesia. One important feature of the NPSI is its sensitivity to treatment effects (Bouhassira et al., 2004). Subgrouping neuropathic pain in our study might have permitted us to make assumptions about the appropriate type of drug to offer to each of our patients, according to the sensory profile of the neuropathic pain presented by each patient, as suggested by Bouhassira et al. (2004), but it remains to be confirmed in controlled studies. Until then, it seems important to recommend the use of the NPSI or other neuropathic pain classification instruments (and the DN4 questionnaire) for the diagnosis and clinical assessment of neuropathic pain, both in daily practice and in further clinical studies.

Socio‐demographic and clinical profile of chronic pain with neuropathic characteristics in sub‐Saharan African elderly

Data on characteristics of neuropathic pain (NP) in sub-Saharan Africa are scarce, especially in the elderly. We conducted this study to appreciate the socio-demographic and clinical profile of chronic pain (CP) with neuropathic characteristics in sub-Saharan African elderly with musculoskeletal pain. From January to December 2011, we performed a cross-sectional study in all Rheumatology outpatients over 60 years at the Center for Gerontology and Geriatrics, Dakar, Senegal. In this study, we included patients who experienced musculoskeletal pain for 3 months or longer (CP) and with a DN4 score ≥ 4 (NP). A complete clinical examination was performed to make the diagnosis of NP 'definite' or 'probable', and to identify the aetiologies of NP. During the study period, 698 outpatients were examined. There were 394 out of the 549 patients over 60 years who reported CP. Among them, 28 patients (7.1%) scored ≥4 on the DN4 questionnaire. Female patients, low educational attainment, manual professions, non-workers and diabetes were associated with NP (p < 0.05). The symptoms described by patients with NP, often intricate, were lumboradiculalgia (n = 9), cervico-brachial neuralgia (n = 3), polyneuropathy (n = 12) and mononeuropathy (n = 6). The presumed aetiologies in patients with NP were: chronic spine diseases (n = 14), painful diabetic peripheral neuropathy (n = 8), Sjögren's syndrome (n = 1), tarsal tunnel syndrome in rheumatoid arthritis (n = 1) and bone metastasis (n = 1). No aetiology was identified among three patients. Chronic spine diseases associated with radiculopathies and diabetic neuropathy are the main causes of NP, well detected by DN4 questionnaire and clinical examination in Senegalese sub-Saharan African elderly.

Hypothesis: Higher prenatal testosterone predisposes ALS patients to improved athletic performance and manual professions

Our objective was to propose a testable hypothesis arising from the recent finding of a low index-to-ring finger ratio (2D:4D ratio) in ALS. The 2D:4D ratio finding suggests that prenatal testosterone exposure may play a role in the development of the disease. Research from other fields is presented to suggest that healthy individuals with low 2D:4D ratio have enhanced sporting prowess, particularly with regard to activities requiring endurance and dependent upon slow-twitch muscles. Although studies are of varying quality, some epidemiological findings in ALS also suggest enhanced sporting prowess, as well as a higher risk of developing the disease among members of certain physically active professions. If the 2D:4D finding survives replication then this might explain the reported elevated risk of ALS among professional athletes, the military, and manual professions. Such a relationship might also explain why ALS patients were more likely to have been elite sportspeople in younger life. This hypothesis may serve as a starting point for debate and discussion over the nature of ALS risk factors, as well as generating a number of specific testable hypotheses that may yield insight into the genesis of the disease.

Employing Migrant Domestic Workers in Urban Yemen: A New Form of Social Distinction

AbstractThis article argues that employing migrant domestic workers has become a new form of social distinction in urban Yemen. The rapid social, economic and political changes of the past forty years have altered Yemen's system of social stratification. Formerly, one's racial descent and economic background determined the work they performed. Manual and service professions had a very low status and were only performed by the lowest social status groups. Nowadays other forms of social distinction have emerged. Although the economic situation in Yemen has deteriorated since the 1990s, the demand for paid domestic labour has increased. Yemeni women are reluctant to take up paid work as domestics, and middle and upper middle class families in urban areas employ migrant and refugee women, in particular from the Horn of Africa.

Prevalence of chronic pain with neuropathic characteristics in the general population

We conducted a large nationwide postal survey to estimate the prevalence of chronic pain with or without neuropathic characteristics in the French general population. A questionnaire aimed at identifying chronic pain (defined as daily pain for at least 3 months), evaluating its intensity, duration and body locations, was sent to a representative sample of 30,155 subjects. The DN4 questionnaire was used to identify neuropathic characteristics. Of the questionnaires, 24,497 (81.2%) were returned and 23,712 (96.8%) could be assessed. Seven thousand five hundred and twenty-two respondents reported chronic pain (prevalence = 31.7%; [95%CI: 31.1–32.3]) and 4709 said the pain intensity was moderate to severe (prevalence = 19.9%; [95%CI: 19.5–20.4]). Neuropathic characteristics were reported by 1631 respondents with chronic pain (prevalence = 6.9%; [95%CI: 6.6–7.2]), which was moderate to severe in 1209 (prevalence = 5.1% [95%CI: 4.8–5.4]). A higher prevalence of chronic pain with neuropathic characteristics was associated with middle age (50–64 years), manual professions and those living in rural areas. It was more frequently located in the lower limbs and its intensity and duration were higher in comparison with chronic pain without neuropathic characteristics. This large national population-based study indicates that a significant proportion of chronic pain patients report neuropathic characteristics. We identified distinctive socio-demographic profile and clinical features indicating that chronic pain with neuropathic characteristics is a specific health problem.