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H Raspe

Publications and source records attributed to H Raspe.

At least 91 records · Page 5Linked to original sources
PubMed1996

[Backache in East and West Germany].

On the basis of data of the East German Health Survey (1991/92) and regional studies from West Germany (Bad Säckingen 1990, Lübeck 1991/92, Bad Säkingen 1993/94) results on the prevalence of back pain, other rheumatic complaints and general health problems are compared. East German respondents report on back pain and all other rheumatic complaints definitely less often than West German respondents but suffer equally from general health complaints. Apart from the differences in the prevalence of rheumatic complaints there are remarkable structural analogies between East Germany and the West German cities. In any region, the back is the most often affected part of the body, followed by the neck, the shoulder, and the knee. Beyond that, there are similar age-related and sex-specific differences in prevalence rates of rheumatic complaints. In the groups of elderly people, a pattern of declining or constant prevalence rates can be noticed with many complaints. However, there are differences in pain intensity and functional limitations between East and West. The East German respondents particularly mention mild pain more rarely than respondents of the West German cities. They also report fewer functional limitations. This may indicate that in East Germany people attach less importance to rheumatic pain and deal with it in a different way. Possibly, the differences in prevalence can be explained thereby. To what extent they reflect real differences in morbidity cannot be clarified by the present data.

Activities of Daily Living↗
PubMed1996

[Evidence-based medicine: popular nonsense, old wine in new bottles or current necessity?].

This article is intended to provide a comprehensive overview regarding motives, implications, aims, history, underlying principles, and methods as well as criticism and potential impact of "Evidence Based Medicine" (EBM). The term was defined and the movement initiated by British and Canadian clinicians-epidemiologists. So far, a translation and national adaptation remain to be established. It seems that EBM is suited to compensate for many irrationalities within our clinical practice and health care system. Not only should the underlying principles, aims, methods, and techniques of EBM be considered in clinical practice and primary care in Germany. They should also be emphasized during medical training and postgraduate education and in the needs-oriented distribution of scarcening resources.

Clinical Medicine↗
PubMed1995

Back pain.

Classification of back pain is a difficult task. Traditional schemes have focused on the small percentage of cases which have specific causes. Structural anomalies observed on X-ray examination explain only a small proportion of back pain cases, and the emphasis placed on these in the traditional schemes is, as Anderson put it, the tail wagging the dog (Anderson, 1977). Many syndrome classifications are based on arbitrary notions of cause, with little empirical justification and no evidence that they can reliably and usefully be applied in practice. More pragmatic approaches start with the separation of the serious from the less serious, and the distinction between spinal pain and pain arising from outside the spine. The classification of the large majority of back pain cases which are 'non-specific' is best approached by grading the severity of the clinical and psychological features of back pain and their disabling consequences. Such grading schemes also provide the most appropriate outcome measures for clinical and epidemiological back pain research.

Back Pain↗
PubMed1995

Fibromyalgia.

The article details the history, concept, definition and assessment of the still enigmatic condition of 'fibrositis' or, as it has more recently been called, 'fibromyalgia'. The concept and diagnosis became popular, especially in North America, in the 1970s, after the seminal publications of Hugh Smythe (1972) and Smythe and Moldofsky (1977). It is noticeable that there does not appear to be an early case report as there is for instance for gout, rheumatoid arthritis or certain vasculitides. This may be one reason why we still lack a commonly shared clinical image of the 'typical' case. After Smythe and coworkers, operational definitions and classification criteria were given by Yunus et al, Lautenschläger et al (both in 1989) and Wolfe et al in 1990. The latter received the endorsement of the American College of Rheumatology and are now the most widely used. They identify fibromyalgia as a musculoskeletal disorder with spontaneous widespread pain and exaggerated tenderness as prominent and distinctive features. The other two criteria sets refer to a different concept of fibromyalgia as a 'functional' or 'dysfunctional' disorder. These and other nosological differences pose problems for clinical as well as epidemiological research. They may be of minor importance if it is accepted that any present definition is arbitrary and that a wide range of possible elements are more relevant to research than a uniform concept of a disease called fibromyalgia.

Fibromyalgia↗
PubMed1995

Survey response rates: national and regional differences in a European multicentre study of vertebral osteoporosis.

STUDY OBJECTIVE: This analysis aimed to compare the response rates of those invited to attend for screening in a multicentre, multinational study within Europe. DESIGN: This was a population survey. SETTING: Thirty four centres in 16 European countries. SUBJECTS: Men and women aged 50 years and over were recruited from population based sampling frames to participate in a prevalence survey of osteoporosis. Subjects were invited by post to attend for radiological screening and interview, and non-responders were followed up by repeat mailing. RESULTS: There was a substantial variation between centres in response rates: the mean was 49% and the range 5-83%. Adjusting for those known to have died or moved house did not affect the overall ranking. The response rates to each mailing also varied between centres: first mailing 45% (range 5-83%) and second mailing mean 10% (range 0-23%). The response rates varied in relation to age and sex and were higher in women than men. Rates fell gradually with age in women but rose in men until the age of 65 years. Response rates varied regionally. These were highest in countries from northern Europe and lowest in southern European countries, but there was wide variation both within regions and within countries. CONCLUSIONS: Multicentre, multinational studies within Europe will probably become increasingly popular. In this study, despite a standardised approach, the range in response rates between centres both within and between countries was substantial. Attempts at cross national standardisation in survey design can have only a limited effect on yielding uniformity in response.

Aged↗
PubMed1995

Fibromyalgia and disability. Report of the Moss International Working Group on medico-legal aspects of chronic widespread musculoskeletal pain complaints and fibromyalgia.

The present article is the result of a working group conference held in Moss, Norway, in June 1993, financed by the Royal Norwegian Ministry of Health and Social Affairs. Its purpose was to review and focus upon problems and needs related to the medico-legal aspects of fibromyalgia and chronic widespread musculoskeletal complaints: thus to define directions for future work on issues which have generally not been addressed within the medical community. Our report describes specific problems in this area in regard to definition, evaluation and recommendation, and in currently available work and disability statistics. We have recommended international efforts to establish research programs through organizations such as the International Social Security Association and the World Health Organization. While our recommendations call for research into medico-legal interactions, causes and pathogenic mechanisms, prevention and treatment are also key and relevant concerns in the medico-legal setting.

Chronic Disease↗
PubMed1995

A database for back (axial skeletal) pain.

Back pain cannot be considered a mere symptom that has as its only function reference to relevant hidden disease. Back pain must be acknowledged as a disorder that requires description and assessment as carefully as any of the well-established clinical entities. This article outlines a clinically useful, descriptive "morphology" or nosography of the various axial skeletal pains stated, and proposes methods for their classification and evaluation.

Back Pain↗
PubMed1994

[Current musculoskeletal symptoms in peri and postmenopausal women: results of a multicenter population epidemiological study. The EVOS Study Group].

Within the European vertebral osteoporosis study four stratified systematic samples of German residents aged 50-79 in Lübeck, Heidelberg, Jena and East Berlin have been drawn. Overall 4628 subjects were included, of whom 4385 were contactable and 3106 (71%) responded to the postal questionnaire enquiring about rheumatic complaints "today". 2348 (54%) followed an invitation to a medical examination in which a specific gynaecological history was taken. The prevalence of current back-, neck- and joint-pain is consistently higher in females than in males in all age groups. Females show a peak prevalence in the age group 55-64. 104/1134 women were pre- or perimenopausal. 1030 women had not had their period for at least 13 months and were classified as "postmenopausal". Neither the menopausal status nor the duration of the postmenopause were statistically significantly associated with the frequency of the three rheumatic complaints.

Aged↗
PubMed1994

Reproducibility of a questionnaire on risk factors for osteoporosis in a multicentre prevalence survey: the European Vertebral Osteoporosis Study.

BACKGROUND: The European Vertebral Osteoporosis Study Group (EVOS) developed a questionnaire, back translated into 14 different European languages, for use in a multinational epidemiological study of vertebral osteoporosis. We investigated the reproducibility of this questionnaire in four of the participating study centres. METHODS: In all 151 men and women, aged 50-85 years, from Lubeck (Germany), Malmo (Sweden), Warsaw (Poland) and Oviedo (Northern Spain), were retested with the questionnaire on two occasions using a different observer within a 28-day period. RESULTS: Questions relating to personal or medical history were more reproducible than questions concerning subjective symptoms or aspects of lifestyle. The level of agreement for the non-ordinal categorical variables, as estimated by kappa, varied from 0.38 to 1.00 across the four centres. Agreement for the multicategory ordinal, mainly lifestyle, questions was in general poorer though improved when a weighted analysis was performed. For continuous data the 95% limits of agreement were narrow, and there was no evidence of bias between interviewers. There were no important differences in reproducibility across the four centres for either categorical or continuous data. CONCLUSION: The study indicates that the questionnaire may produce useful and comparable information concerning risk factors for osteoporosis across different countries and in different languages. It also highlights that questionnaire instruments designed for use in multinational population-based studies may provide data of comparable quality across a range of settings.

Aged↗
PubMed1994

Disorders characterised by pain: a methodological review of population surveys.

OBJECTIVE--To review a series of conceptual and methodological problems encountered in surveys primarily devoted to pain disorders. CRITERIA FOR INCLUSION AND EXCLUSION OF ARTICLES--Published reports were systematically collected by electronic database searches (Medline), citations in existing publications, and through personal contacts. Relevant articles from clinical and epidemiological research on pain were included and special attention was given to epidemiological research on back pain. CONCLUSIONS--Surveys of pain disorders should be based on a multidimensional pain model that includes nociceptive input, pain perception, suffering, and pain behaviour as major components. Because of the limited applicability of diagnostic procedures or genuine "non-specificity" of pain states, or both, epidemiological surveys may result in a considerable proportion of cases without an identifiable pathophysiological basis. Staging and grading procedures for pain disorders (as distinguished from classification) may comprise various aspects of pain perception: regional distribution, pain intensity, temporal characteristics, sensory qualities, and dimensions of cognitive-emotional appraisal. Description of temporal development and chronification (staging) should refer to different components of the multidimensional pain model. Explicit a posteriori procedures for grading are preferable to implicit grading based on question wording. Evidence from several sources suggests that localistic concepts of pain may be misleading. Identification of complex pain syndromes should be one primary target for epidemiological pain surveys. Of the many factors that may impair the reliability and validity of data collected in pain surveys, recall biases seem to deserve special attention.

Back Pain↗
PubMed1994

[Guidelines for social medicine assessment and evaluation of primary fibromyalgia].

Primary fibromyalgia belongs to the spectrum of rheumatic soft tissue disorders. It is characterized by wide-spread chronic pain and a low pain threshold. The etiology of the disorders is still unknown. Clinical diagnosis requires examination by a rheumatologically trained physician pathognomonic findings are largely lacking. Classification criteria have been published by Wolfe et al. on behalf of the American College of Rheumatology (ACR). The prognosis of FMA is unfavourable and does hardly, respond to therapy. FMA patients' work capacity cannot be established by mere diagnosis; individual impairments have to be taken into account: Clinical, psychosocial and behavioural dimensions have to be considered. Neither inpatient rehabilitation nor early retirement seem to significantly influence the course of FMA. The patient can usually work fulltime in jobs requiring light activities.

Disability Evaluation↗
PubMed1994

[Work capacity--a central category of practical social medicine].

Gainful employment-related performance capacity is a central but rarely considered category of practical social medicine. Its evaluation belongs to the workday routine of social physicians. Special difficulties arise if chronic pain disorders are to be evaluated, especially in chronic "nonspecific" cases, i.e. in the absence of biomedically relevant signs. Employment-related performance is conceptualised as a multidimensional construct with several latent variables. It integrates and extends the domains of "impairments" and "disabilities" of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) of WHO. Three basic dimensions are distinguished: one comprising biomedical, the other psychological, the third function-related variables. They are specified within a multidimensional model of employment-related performance. This includes different components of the perception and appraisal of pain, concomitant bodily complaints (e.g. vital exhaustion), psychological impairments as helplessness or anxiety, special facets of the pain behaviour, and functional limitations and allows an estimate of the chronification and prognosis of the pain problem. Some diagnostic measures are still inadequate in respect of established clinimetric standards. In particular, assessment of functional limitations requires further development and research.

Activities of Daily Living↗
PubMed1992

[Rheumatism epidemiology in Europe].

The article describes the present and potential of the epidemiology of the rheumatic diseases in Europe, considering especially rheumatoid arthritis (rA) and fibromyalgia (FMA). This is preceded by a short review of the history of European rheuma-epidemiology within the past 40 years. In rA European rheumatologists and epidemiologists have made important contributions to a differentiated nosology, longterm follow up studies and prognostication, conceptualization and measurement of outcomes and the analysis of a possibly decreasing incidence and severity of the disease. In an own study we were able to use the 1987 revision of the ARA-criteria and to test their stability over time. Among 11,534 German residents of Hannover, aged 25-74 we identified 58 with clinically proven rA or undifferentiated arthritis (uA), resulting in an estimated true prevalence of 0.83% (prevalence according) to Rome-criteria 0.53%, ARA-criteria 1987 0.33%). 39/58 could be reexamined after an average of 29 months. Only 9 of 25 ARA-1987-positive rAs maintained their nosological status. The actual care of the total group seemed widely inadequate. The Concept of FMA has been developed in Canada (H. Smythe) and in Germany/Switzerland (W. Müller) at about the same time, in Europe under the notion of "generalized tendomyopathie". Whereas the credit for developing and defining FMA-criteria goes entirely to rheumatologists from North America, it is an European privilege to provide first epidemiological data. After Jacobsson's work in Malmö/Sweden we studied in Southern Germany 541 German residents of Bad Säckingen, aged 25-74. We eventually identified 10 subjects with a history of widespread pain, 17+ out of 34 tender points and 2 or less out of 10 control points, giving a minimal FMA-prevalence of 1.9% and an estimated true prevalence of 3.0% (95%-Ci 1.6-4.4%). We identified however several nosologic as well as nosographic difficulties, that question the concept of FMA as an exclusively rheumatological disorder within the spectrum of "soft tissue" rheumatism.

Adult↗
PubMedDate not supplied

[Physical impairments and comorbidities in a sample of members of a pension fund of blue-collar workers suffering from severe low back pain].

AIM: Idiopathic (unspecific) low back pain is the most common rheumatological complaint. Results of international studies give evidence that in about 80 % of the cases a specific diagnosis is not possible, thus creating an unsatisfactory situation for the orthopaedist. We feel that it is necessary to keep the discussion on the rate of specific causes for low back pain open. METHODS: In the context of a research project on the need for rehabilitation, 335 subjects suffering from severe low back pain were subjected to a physical (orthopaedic-neurological) examination. Also, a questionnaire was distributed assessing psychological status, work situation, comorbid conditions, risk factors, and demography. RESULTS: In more than half of the subjects, clues for a specific cause for the back pain were found; in more than one third of the cases there were one or more neurological signs. CONCLUSION: The data presented demonstrate that specific causes for low back pain might be more common than generally assumed. This leads us to the conclusion that there is a need for more clinically-oriented, population-based (epidemiological) research on possible pathologic causes of low back pain and comorbid conditions.

Adult↗