Search PubMed⌕ Search

Biomedical subjects

N M Hadler

Publications and source records attributed to N M Hadler.

At least 37 records · Page 2Linked to original sources
PubMed1997

Fibromyalgia, chronic fatigue, and other iatrogenic diagnostic algorithms. Do some labels escalate illness in vulnerable patients?

Contemporary medicine has the sophistication to identify the clinical settings in which the hunt for a diagnosis can be harmful to a patient's health. Which patients are best served by a prolonged search for a cause? Why has the disease-illness paradigm backfired for so many patients? Dr Hadler challenges readers to look at the difficult questions linked with diagnostic labels that might teach patients to stay sick.

Colonic Diseases, Functional↗
PubMed1996

Acute severe low back pain. A population-based study of prevalence and care-seeking.

STUDY DESIGN: Telephone interviews were conducted with a random sample of adults in 4437 North Carolina households. The response rate was 79%. OBJECTIVE: The prevalence of low back pain and the correlates of care-seeking in a defined population were examined. SUMMARY OF BACKGROUND DATA: Previous research on low back pain has used varying definitions of the illness of low back pain, and has admixed patients with acute and chronic low back pain. Acute low back pain was examined in this study as a distinct phenomenon separate from chronic low back pain. METHODS: Respondents completed a detailed interview regarding the occurrence of and care sought for back pain in 1991. Acute back pain was defined as functionally limiting pain lasting less than 3 months. RESULTS: From this sample, 485 individuals had at least one occurrence of acute severe low back pain in 1991, representing 7.6% of the adult population. Symptoms were reported less commonly in individuals older than age 60 years (5% vs. 8.5%) and in nonwhites compared with whites (5% vs. 8.5%). Thirty-nine percent of those with back pain sought medical care; 24% sought care initially from an allopathic physician, 13% from a chiropractor, and 2% from other providers. More prolonged pain, more severe pain, and sciatica were associated with care-seeking. Gender, income, age, rural residence, and health insurance status did not correlate with the decision to seek medical care. Younger age, male gender, and nonjob-related pain did correlate with the decision to seek care from a chiropractor. CONCLUSIONS: Acute back pain is common. Care is often sought regardless of income and insurance status. Seeing a health care provider for acute back pain may not be discretionary from the perspective of the patient.

Acute Disease↗
PubMed1995

The influence of indemnification by workers' compensation insurance on recovery from acute backache. North Carolina Back Pain Project.

STUDY DESIGN: A prospective observational cohort was recruited from 208 randomly selected North Carolina practices. OBJECTIVE: To compare the course of compensation claimants with gainfully employed patients not so insured from the time when they first sought care for acute back pain. SUMMARY OF BACKGROUND DATA: The human and financial cost attributable to disabling chronic low back pain identified by worker's compensation programs continues to escalate. We explored the antecedents to this phenomenon. METHOD: Consecutive patients with acute low back pain were interviewed by telephone within 1 week of first seeking care and in follow-up calls after 2, 4, 8, 12, and 24 weeks to monitor functional and work status. RESULTS: Of the 1633 patients enrolled, 505 were insured by workers' compensation. These were compared with 861 who had been employed on any job for pay within 3 months of the onset of their backache but whose care was not so underwritten. Those with compensable back pain were more likely to categorize their tasks as physically demanding and had taken more time off work in the month before the baseline interview (P = 0.02). Recovery of the sense of wellness they enjoyed before this episode of back pain was delayed (Cox Model: Hazard Ratio = 0.822; P < 0.001; confidence interval: 0.733, 0.923), but recovery of function or return to work was not. This delay was independent of type of health care and perception of task demand and beyond that which could be ascribed to the quality of back pain. CONCLUSION: Each of these associations is a reproach to the fashion in which workers' compensation insurance for regional back pain serves the ethic that is its raison d'être.

Adult↗
PubMed1995

Controversy. Low back school. Education or exercise?

Few interventions have conclusively changed the natural history of low back pain with respect to recovery once an episode has begun, or have prevented future recurrence. Variations of the low back school, an educational approach, have become increasingly popular but their efficacy remains controversial. Dr. Hall is emphatic that patient education is a less than perfect but nonetheless an important approach. Dr. Hadler believes that these programs re-enforce the misconception that low back pain is an injury rather than a commonly occurring life event, such as the flu, and should be handled but not overtreated. He offers a more tempered opinion.

Exercise Therapy↗
PubMed1994

Backache and work incapacity in Japan.

No one is spared a regional backache. Some episodes will compromise function to the extent of work incapacity. Throughout the industrialized world, workers' compensation insurance programs provide recourse for the segment of people whose incapacitating backache is held to have arisen out of and in the course of employment. Most programs have evolved from the Prussian paradigm introduced a century ago. That evolution represents country specific, de facto experiments in health policy. In the case of Japan, the Prussian paradigm was imposed on a very distinctive tradition at the end of World War II. Therein lies one of the more dramatic experiments of health policy. This essay attempts to document the process that resulted. To gain such insight, relevant physicians and bureaucrats in Japan were interviewed and government documents reviewed. This information was supplemented by nonsystematic culling of relevant reflections of scholars also pursuing the heuristic method but with different, usually nonclinical, tempering. It is clear that Japan has evolved an approach to the worker with an incapacitating backache that favors options other than recourse in workers' compensation for redress.

Back Pain↗