[The semiotics of fibromyalgia and related somatoform disorders].
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Biomedical subjects
Publications and source records attributed to N M Hadler.
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The chiropractic is a health care profession that offers and purveys a distinctive treatment act. When reduced to its methodology, the chiropractic is hard pressed to demonstrate effectiveness. But as a treatment act, it has gained wide acceptance. The challenge raised in this discussion relates to the "moral hazard" of including the chiropractic treatment act in more general health insurance policies.
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Regional arm pain is a ubiquitous, remittent, and intermittent predicament of life. There is no evidence that arm use in a fashion that is familiar and usually comfortable, inside or outside the workplace, increases the incidence of regional arm pain. Therefore, coping with this morbidity, not avoiding it, is prerequisite to healthfulness. When one systematically examines the reasons a worker may find coping prohibitive, task demands are not the common denominator. Psychosocial factors such as work organization and interpersonal relationships predominate.
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In spite of more than 50 years of concerted effort to diminish task demand, the incidence of compensable back injuries has not wavered. Before we persist for another 50 years in the quest for the "right way to lift," we should consider recent multivariate clinical investigations that suggest alternative approaches. Because task context is at least as important as task content in this regard, it follows that including regional backache under the rubric of "compensable injury" demands reconsideration. Likewise, rather than pursuing the "right way to lift," the more reasonable and humane quest might be for workplaces that are comfortable when we are well and accommodating when we are ill.
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Disabling back pain plagues industrialized societies. Generally redress adheres to a Prussian paradigm that those injured at work are more deserving than those who have worked but can no longer do so because of diseases not related to work. Those who never have worked are least entitled. A comparison of the way the Prussian paradigm behaves in different cultures is instructive and daunting; no generalizable solution has emerged. It is time to cast off the Prussian paradigm. It is clinically unsound and, judging from the experience of the past century, ethically flawed.
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