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PubMed2004

[Developments in chromate allergy in the German construction industry].

For decades potassium dichromate has been the most important allergen in the construction industry. In Scandinavian countries the prevalence of potassium dichromate sensitization declined following the introduction of low-chromate cement. In contrast, analysis of our register in Northern Bavaria and the data of workers compensation board show no significant decline in potassium dichromate sensitization in the German construction industry during the 1990s. In 1993, German legislation provided an Approved Code of Practice and the cement manufacturers committed themselves to reduce the level of water-soluble chromates to less than 2 ppm in bag cement. Since 2000 this agreement has also included ready-mixed concrete. It remains to be seen, if sensitization against potassium dichromate will decline in the upcoming years. Based on our data, it would be desirable if only low-chromate cement was used in the construction industry in Germany as in Scandinavia.

Adolescent↗
PubMed2000

[Comparison of the annual data of 2 stroke units in neurological clinics of acute hospitals].

The Stroke Unit concept of the German Neurological Society differs from its precedents in Scandinavia or the United Kingdom. Hallmarks of the German concept are very early onset of diagnosis and treatment, continuous surveillance of vital functions by bedside monitors and specialized care by a multiprofessional team. This comparison of two Stroke Units in Minden and Munich-Harlaching, working according to the new German concept, shows broad similarities in admission intervals, diagnostic procedures, treatment modalities and short term prognosis, with an exceedingly low in-hospital mortality of 3.4-5.6% and a high proportion of patients (64-69%) leaving the hospital with Barthel scores above 70. Ongoing studies will show how this kind of Stroke Unit treatment compares to general wards.

Aged↗
PubMed2006

[Questionnaire on crossover renal transplantations in Germany].

Due to increasingly better long-term survival rates with dialysis the number of patients with renal failure constantly increases by 4% annually worldwide. Despite great progress in operative and perioperative management as well as improved immunosuppressive drugs, kidney transplantation still faces two major problems. First of all there is a huge deficit of donor organs and secondly the long-term results of the kidney grafts must be improved. One way to relieve this tense situation may be live kidney donation. In many countries not participating in Eurotransplant, especially the United States and Scandinavia, live kidney donation is performed more often than kidney transplantation from deceased donors. Germany implemented a transplantation law in December 1997. This law also regulates living donation, with exclusion of crossover transplantations. Cross-over transplantation is a special variation of live donation for couples who cannot donate/receive in their respective couple constellation. Therefore, the donor of the one couple donates his/her kidney to the recipient of the other couple and vice versa. According to German legislation this is illegal. We performed a study in order to evaluate the opinions of the German kidney transplant centers on crossover kidney transplantations. The majority of the German transplantation centers believe that crossover transplantation is acceptable with regard to ethical and medical concerns. To enable this kind of kidney transplantation the transplantation law would have to be changed. Nevertheless, nationwide polls show that live kidney donation represents only a very small portion of all transplantations taking place. Live kidney donation should be granted higher priority as dialysis triggers psychological and physical damage, especially in children. For many patients live kidney donation is the only chance for early transplantation with an excellent long-lasting kidney graft function.

Attitude of Health Personnel↗
PubMed1995

Variation by age group and seasonality at diagnosis of childhood IDDM in Europe. The EURODIAB ACE Study Group.

Recent data provided by the EURODIAB ACE study group have confirmed wide variation in the incidence of insulin-dependent diabetes mellitus (IDDM) across Europe. The aim of this report is to compare age-specific incidence and seasonality at clinical onset of IDDM between study regions. Using a uniform methodology, the EURODIAB ACE framework ascertained 3,168 newly-diagnosed cases of IDDM in children under the age of 15 years during 1989-1990. Eighteen percent of the cases were age 0-4 years at diagnosis, 34% were age 5-9 years and 48% were age 10-14 years. Poisson regression analysis suggested that there were highly significant statistical differences in incidence between the three age groups and between the 24 regions. Although incidence rates in the 0-4 year and 5-9 year age groups varied from region to region in a similar fashion, the pattern of variation in the older age group was different. Seasonality of diagnosis conformed to a sinusoidal model with a peak occurring in winter, a feature which was consistently observed in both sexes and in all age groups. However, a statistically significant heterogeneity in the seasonal distribution was present among regions, those in Scandinavia showing the smallest relative amplitude. The first insulin injection was given the same day or the day after diagnosis in 93% of the cases for whom data were available.

Adolescent↗
PubMed2001

[Development of rheumatoid arthritis orthopedics in German-speaking countries].

In the realization that the cause of and thus an appropriate curative systemic therapy for rheumatoid arthritis did not and does not exist, surgical treatment of this usually destructive disease emerged as a major field in orthopedics in collaboration with internists specialized in rheumatology. The establishment of working groups within the scientific society initiated by the German Association for Orthopedics and Traumatology (DGOT) in 1971 to improve efficiency was a decisive factor for the further development in the German-speaking countries. A significant role was played by the fact that the Swiss N. Gschwend from Zurich was entrusted with the formation of the working group. This ensured that other German-speaking colleagues in Austria as well as Scandinavia also had the opportunity to add their input and influence rheumatoid orthopedics to a large extent. The DGOT also supported the creation of the ARO, which was founded as an independent association within the DGOT in 1992. The growth of rheumatoid orthopedics received considerable impetus from the fact that it was recognized in 1981 as the only subspecialty of orthopedics granted equal footing, as was the case for rheumatology in internal medicine. At the start of the 1970s, interest was focused on synovectomy for joint preservation, also with regard to its techniques and the possibility for preventive indications. Influenced by the experience gained from the development of endoprosthetic replacements, arthrodeses for rheumatic patients, e.g., in the region of the shoulder and knee joints, were almost completely ignored. The special field of reconstructive surgery on the hand and wrist employing implantation of finger joints and limited arthrodeses yielded impressive subjective and partially functional improvement for the patients. New impulses in the surgical treatment of foot deformities with joint-saving techniques for toe joints and endoprosthetic reconstruction of the ankle have brought about new trends in rheumatoid orthopedics in the past 10 years. Operative stabilization of cervical instabilities represents a special aspect in the development of rheumatoid orthopedics. Both the differential indication and the surgical technique have changed. The development of magnet resonance tomography and new implants for the cervical spine has played a significant role. Rheumatoid arthritis surgery has shown preference to integrating physical measures including in particular ergotherapy and special hand therapy into local surgical interventions. Functional treatment measures, care of braces and aids, and training in joint protection have become a firm part of the therapeutic concept. It is significant that in the German-speaking countries a treatment plan focused solely on the joints has thus far not gained general acceptance as is the case in Anglo-American countries. Preference is given to working as a team with subspecialties for upper and lower extremities and the spinal column. This guarantees that the priorities of the patients who usually present with multiple joint alterations can be dealt with by one group.

Arthritis, Rheumatoid↗
PubMed1998

Information in the ICU: are we being honest with our patients? The results of a European questionnaire.

BACKGROUND: We were interested in determining the current practices and views of European intensive care doctors regarding communication with patients and informed consent for interventions. METHODS: A questionnaire was sent to the 1272 western European doctor members of the European Society of Intensive Care Medicine. All questionnaires were anonymous. Five hundred four completed questionnaires from 16 western European countries were analyzed. RESULTS: Of the respondents, 25 % said they would always give complete information to a patient, although 35 % felt they should. Thirty-two percent would give complete details of an iatrogenic incident, but 70% felt they should. There were significant differences in these attitudes between doctors from different countries, with doctors from the Netherlands more likely to give complete information, and doctors from Greece, Spain and Italy less likely. Fifty percent of the respondents required written consent for surgery, but for insertion of an arterial catheter oral consent was more widely accepted. The Netherlands and Scandinavia generally accepted oral requests for procedures, while Germany and the United Kingdom preferred written requests. Doctors of all countries were generally happy with their current practice concerning informed consent. Seventy-five percent would accept the right of a patient to refuse treatment, but 19% would carry out the procedure against the patient's wishes. CONCLUSIONS: Doctors are often not completely honest with their patients regarding their diagnosis or prognosis, or in the event of an iatrogenic incident. However, most doctors will respect a patient's right to refuse treatment. Informed consent practices vary substantially and are largely determined by locally accepted policy and accepted by doctors working in those areas.

Adult↗
PubMed2000

Different diagnostic approaches to adult candidates for cadaveric kidney transplantation in Europe.

We investigated which diagnostic procedures are mandatory for all transplant candidates irrespective of their individual situation in European transplant centres, how homogeneously these are applied and what centre characteristics determine differences in the diagnostic approach. A questionnaire was sent to European renal transplant centres asking which of 45 listed diagnostic procedures are mandatory for every transplant candidate. The 154 participating centres require 15.6 +/- 5.6 (4-33) mandatory tests, with significantly less mandatory diagnostics in centres in the UK (8.5 +/- 3.9) and Scandinavia (9.8 +/- 2.3). Geographic location is the single significant factor in multifactorial analysis of possibly related factors. Detailed analysis revealed 16 tests that are required significantly less often in the north of Europe. There are significant differences in the evaluation of renal transplant candidates across Europe. In some parts of Europe transplant candidates are either investigated more discriminately or less comprehensively than in other regions.

Adult↗
PubMed2002

Do neighboring lakes share common taxa of bacterioplankton? Comparison of 16S rDNA fingerprints and sequences from three geographic regions.

Bacterioplankton community composition was studied in 12 lakes in three different geographic regions in Scandinavia using denaturing gradient gel electrophoresis (DGGE) and sequencing of 16S rDNA. Area-specific abundant taxa were found in the lakes in two of the regions. In the region of Uppland the lakes had an alpha-proteobacterium, belonging to the subgroup Alpha V in common. The Alpha V bacteria appeared to be favored by neutral or higher pH values. The lakes in Lappland were found to harbor Actinobacteria, which appeared to be favored in bog lakes. No abundant taxon was found to be in common for the lakes in Svalbard, the third region studied.

Actinobacteria↗
PubMedDate not supplied

Psychosocial impact of cosmetic rhinoplasty.

The psychosocial impact of cosmetic rhinoplasty in Scandinavia is poorly investigated. Therefore a study was undertaken utilizing a mailed audit covering self-percepted experiences before, during, and after surgery. A total of 67 of 80 patients responded to the questionnaire (84%), on average 18 months after surgery. The mean age was 31 years (range, 16-63 years) and the M/F ratio was 20/44 among the 64 patients analyzed, half of whom were of foreign extraction. The self-report disclosed that a majority of the patients had been preoccupied with their noses since puberty and that the mental awareness of nasal stigmatization was given mainly by the mirror (58%), not by others. Despite the early exclusion of patients with possible body dysmorphic disorder, almost one-fourth had a severe complex, and one-third felt socially inhibited by their noses and avoided being looked at from certain angles. Surgery was not a significant problem even though it was performed under local anesthesia and i.v. sedation. The great majority (91%) were satisfied with the result and 89% would recommend the procedure to others. More than 60% felt more self-confident and perceived life as being easier. To conclude, successful rhinoplasty may change preoccupied patients' lives, because the majority simply stopped thinking about their noses.

Adolescent↗
PubMed1997

ENVIRONMENTAL AUDITING: Exceedance of Critical Loads for Lakes inFinland, Norway, and Sweden: Reduction Requirements for AcidifyingNitrogen and Sulfur Deposition

/ The main objectives of this study were to identify the regions inFennoscandia where the critical loads of sulfur (S) and acidifying nitrogen(N) for lakes are exceeded and to investigate the consequences for depositionreductions, with special emphasis on the possible trade-offs between S and Ndeposition in order to achieve nonexceedance. In the steady-state model forcalculating critical loads and their exceedances, all relevant processesacting assinks for N and S are considered. The critical loads of N and S areinterrelated (defining the so-called critical load function), and therefore asingle critical load for one pollutant cannot be defined without makingassumptions about the other. Comparing the present N and S deposition withthe critical load function for each lake allows determination of thepercentage of lakes in the different regions of Fennoscandia where: (1) Sreductions alone can achieve nonexceedance, (2) N reductions alone aresufficient, and (3) both N and S reductions are required but to a certaindegree interchangeable. Secondly, deposition reduction requirements wereassessed by fixing the N deposition to the present level, in this wayanalyzing the reductions required for S, and by computing the percentage oflakes exceeded in Finland, Norway and Sweden for every possible percentdeposition reduction in S and N, in this way showing the (relative)effectiveness of reducing S and/or N deposition. The results showed clearregional patterns in the S and N reduction requirements. In practically thewhole of Finland and the northern parts of Scandinavia man-made acidificationof surface waters could be avoided by reducing S deposition alone. In thesouthern parts of Sweden some reductions in N deposition are clearly neededin addition to those for S. In southern Norway strong reductions are requiredfor both N and S deposition.KEY WORDS: Acidification; Critical load; Exceedance; Sulfur; Nitrogen;Deposition; Lake

Journal Article↗
PubMed2005

Evaluation of dysplastic features in myelodysplastic syndromes: experience from the morphology group of the European Working Group of MDS in Childhood (EWOG-MDS).

In the absence of genetic abnormalities, the diagnoses of myelodysplastic syndromes (MDS) is primarily based on the presence of dysplasia in blood and marrow cells. Currently, there is no standardized approach to evaluate dysplasia. International cooperative study groups like the European Working Group on MDS in Childhood (EWOG-MDS) depend, however, on a concordance in diagnoses by their national reference centres for morphology. In EWOG-MDS, the morphological diagnoses of all cases enrolled from Scandinavia, the Netherlands, Germany, the Czech Republic, Austria and Italy are established by five experienced pathologists or hematologists cooperating in a morphology board. To study their concordance in evaluating myelodysplastic disorders, members of the morphology board initiated blinded reviews of smears of blood and bone marrow aspirates of known cases. Four features of dysplasia in granulopoiesis, erythropoiesis and megakaryopoiesis were assessed on May-Grünwald-Giemsa stained smears. In a final review of six blinded cases, good concordance for these features was achieved among the five observers. Accurately defined and restrictively applied cellular features of dysplasia are an important tool to improve and ensure the concordance in the diagnosis of MDS among investigators. For cooperative groups, agreement on the evaluation of the morphological assessment of dysplasia is a prerequisite.

Adult↗
PubMed2000

Recessively inherited amyotrophic lateral sclerosis: a Germany family with the D90A CuZn-SOD mutation.

Mutations of the SOD1 gene encoding the free radical scavenging enzyme copper-zinc superoxide dismutase (CuZn-SOD) occur in patients with familial amyotrophic lateral sclerosis (ALS). Recent reports have shown homozygosity for a CuZn-SOD mutation in exon 4, the D90A (Asp90A1a) mutation. Other mutations described to date show an autosomal dominant pattern of inheritance. This is the first description of autosomal recessively inherited ALS in an out-bred population in central Europe. This study confirms the earlier described characteristic phenotype reported in D90A homozygous ALS patients in Scandinavia and supports the theory of the existence of a strong modifying factor in some cases of ALS associated with mutations in the CuZn-SOD gene.

Adult↗
PubMed2005

Incidence and outcomes of uveitis in juvenile rheumatoid arthritis, a synthesis of the literature.

BACKGROUND: Juvenile rheumatoid arthritis (JRA) is the most common systemic cause of pediatric uveitis in Europe and North America. Uveitis is commonly perceived as a frequent sequela of JRA and JRA-associated uveitis is commonly considered to have a complicated course with frequent adverse visual outcomes. METHODS: We performed a systematic literature search for series of consecutive patients with JRA (as defined by the American College of Rheumatology criteria) reporting on the frequency of uveitis and/or complications of uveitis, published between January 1980 and December 2004. The main outcome measures were: the cumulative incidence of uveitis in JRA, the cumulative incidence of adverse visual outcome and that of complications in JRA-associated uveitis. Additionally, the influence of gender, presence of antinuclear antibody (ANA) and disease onset subtype to the likelihood of developing uveitis were examined. RESULTS: Analysis of pooled data from the 26 eligible series suggested a cumulative incidence of uveitis in JRA of 8.3% [95% confidence intervals (CI), 7.5-9.1%]. The cumulative incidence of uveitis varied according to geographic location, being highest in Scandinavia, then the US, then Asia and lowest in India. JRA-associated uveitis was more common in pauciarticular than polyarticular onset patients [odds ratio (OR) = 3.2, 95% CI, 2.33-4.36] and in ANA-positive than ANA-negative patients (OR = 3.18, 95% CI, 2.22-4.54). Female gender was only a weak risk factor for the development of uveitis in JRA patients (OR = 1.69, 95% CI 1.09-2.62) and was not statistically significant after considering disease onset subtypes. In JRA-associated uveitis the cumulative incidence of cumulative incidence of adverse outcome (visual acuity < 20/40 OU) was 9.2% (95% CI: 4.7-15.8) of cataracts 20.5% (95% CI: 15.5-26.3), of glaucoma 18.9% (95% CI: 14.4-24.2) and of band keratopathy 15.7% (95% CI: 10.9-21.7). CONCLUSION: The cumulative incidence of uveitis in JRA varies according to geographic location, presence of ANA, type of JRA onset and gender. Uveitis, adverse visual outcome, and complications in JRA are less frequent than commonly accepted.

Adolescent↗
PubMed2005

Integration of Anopheles beklemishevi (Diptera: Culicidae) in a PCR assay diagnostic for palaearctic Anopheles maculipennis sibling species.

A few years ago a PCR-based assay for a quick and reliable identification of six palaearctic sibling species of the Anopheles maculipennis complex was presented making use of differences in the nucleotide sequence of the ITS2 ribosomal mosquito DNA. An. beklemishevi, which is distributed in Scandinavia and Russia only, has now been integrated into this test after analysis of its ITS2 region which turned out to be much longer than those of the other sibling species. Three oligonucleotides putatively specific for An. beklemishevi were constructed and tested in combination with a universal genus-specific primer for the amplification of an An. beklemishevi-specific ITS2 DNA-fragment. Two of the three oligos generated accurate and specific PCR products, even when used in a multiplex PCR together with the specific primers for the other six sibling species. Cross-hybridization of the primers to heterologous culicid DNA was never observed. The amplicons that identify An. beklemishevi consist of 554 and 735 bp, respectively, and are easily distinguished from those specific for the other sibling species after gel electrophoresis.

Animals↗
PubMed2003

High level of male-biased Scandinavian admixture in Greenlandic Inuit shown by Y-chromosomal analysis.

We have used binary markers and microsatellites on the Y chromosome to analyse diversity in a sample of Greenlandic Inuit males. This sample contains Y chromosomes typical of those found in European populations. Because the Y chromosome has a unique and robust phylogeny of a time depth that precedes the split between European and Native American populations, it is possible to assign chromosomes in an admixed population to either continental source. On this basis, 58+/-6% of these Y chromosomes have been assigned to a European origin. The high proportion of European Y chromosomes contrasts with a complete absence of European mitochondrial DNA and indicates strongly male-biased European admixture into Inuit. Comparison of the European component of Inuit Y chromosomes with European population data suggests that they have their origins in Scandinavia. There are two potential source populations: Norse settlers from Iceland, who may have been assimilated 500 years ago, and the Danish-Norwegian colonists of the eighteenth century. Insufficient differentiation between modern Icelandic and Danish Y chromosomes means that a choice between these cannot be made on the basis of diversity analysis. However, the extreme sex bias in the admixture makes the later event more likely as the source.

Asian People↗
PubMed2004

The origin of the isolated population of the Faroe Islands investigated using Y chromosomal markers.

Historical, archaeological and linguistic sources suggest that the ancestors of the present day population in the Faroe Islands may have their origin in several different regions surrounding the North Atlantic Ocean. In this study we use binary and microsatellite markers of the Y chromosome to analyse genetic diversity in the Faroese population and to compare this with the distribution of genotypes in the putative ancestral populations. Using a combination of genetic distance measures, assignment and phylogenetic analyses, we find a high degree of similarity between the Faroese Y chromosomes and the Norwegian, Swedish and Icelandic Y chromosomes but also some similarity with the Scottish and Irish Y chromosomes. Diversity measures and estimates of effective population sizes also suggest that the original gene pool of the settlers have been influenced by random genetic drift, thus complicating direct comparisons with other populations. No extensive immigration from Iceland to the Faroe Islands can be documented in the historical record. We therefore hypothesise that the high degree of Y chromosome similarity between the two populations arose because they were colonised at approximately the same time by males originating from the same regions of Scandinavia and, to a lesser extent, from the British Isles.

Atlantic Islands↗
PubMed2006

Diabetes and myocarditis in voles and lemmings at cyclic peak densities--induced by Ljungan virus?

Although it is well-documented from theoretical studies that pathogens have the capacity to generate cycles, the occurrence and role of pathogens and disease have been poorly empirically studied in cyclic voles and lemmings. In screening for the occurrence of disease in cyclic vole and lemming populations, we found that a high proportion of live-trapped Clethrionomys glareolus, C. rufocanus, Microtus agrestis and Lemmus lemmus at high collective peak density, shortly before the decline, suffered from diabetes or myocarditis in northern Scandinavia. A high frequency of animals had abnormal blood glucose (BG) levels at the time of trapping (5-33%). In contrast, C. rufocanus individuals tested at a much lower overall density, and at an earlier stage relative to the decline in the following cycle, showed normal BG concentrations. However, a high proportion (43%) of a sample of these individuals kept in captivity developed clinical diabetes within five weeks, as determined by BG levels and a glucose tolerance test performed at that later time. A new picornavirus isolated from the rodents, Ljungan virus (LV), was assumed to cause the diseases, as LV-induced diabetes and myocarditis, as well as encephalitis and fetal deaths, were observed in laboratory mice. We hypothesize that LV infection significantly affects morbidity and mortality rates in the wild, either directly or indirectly, by predisposing the rodents to predation, and is at least involved in causing the regular, rapid population declines of these cyclic voles and lemmings. Increased stress at peak densities is thought to be an important trigger for the development of disease, as the occurrence of disease in laboratory mice has been found to be triggered by introducing stress to LV-infected animals.

Animals↗
PubMed1996

[Multidisciplinary treatment program for chronic low back pain, part 1. Overview].

UNLABELLED: A multimodal treatment program is presented in cases of functional restoration for chronic low back pain. The study comprises four parts. Part I gives an overview of the different results of the study. Part II focuses on the medical and functional examination in comparison with persons who do not suffer from back pain. Part III describes psychosocial aspects (depression, complaints, ways of coping, disability) and psychotherapy. In part IV prognostic factors and their reliability for predicting treatment outcome (return to work, pain intensity, self-assessment of success by patients) are examined. In addition the relevant effects of the program on social and health care systems are also addressed. PROBLEM: The incidence of low back pain is continuously increasing, causing tremendous costs for the health insurance system. Therefore effective treatment methods are needed that take into account somatic, psychological and social factors. Chronic low back pain is conceptualized as a complex phenomenon including biological, social and psychological aspects, all of which should be addressed in a treatment program. A multimodal treatment program for chronic low back pain is presented, in which physical activity and cooperation of the patient are the primary targets. Therapeutic aims focus less on pain reduction and emphasize instead pain control, individual responsibility of the patient, and early reintegration into the working environment. The specific goals of the program are to increase the physical abilities of the patients (i. e., flexibility, strength and endurance), to increase patients' knowledge and the use of body mechanics and back protection techniques, to decrease medication-intake, to decrease dependency on the medical community, to improve patients' own positive coping skills and levels of emotional control, to increase the patient's activity level at home and to facilitate a return to work. METHODS: A total of 90 disabled patients with chronic low back pain were admitted to an 8-week program of functional restoration and behavioral support. The program consisted of a pre-program (3 weeks: education, stretching and calisthenic exercises) and an intensive treatment period (aerobics, functional strength and endurance exercises, back exercises, cognitive behavioral group therapy, relaxation training, socioeconomic and vocational counseling) which took place for 5 weeks, 7 h a day, on an outpatient basis. Apart from a medical examination and a personal interview, the patients' physical impairment, pain descriptions, and psychological distress (according to different criteria for evaluation) were also measured. This includes variables such as depression, psychovegetative complaints, quality of life and workplace satisfaction, disability, and coping with disease. Measurements were repeated at the end of the 8-week program, and after 6 and 12 months. RESULTS: In total 84 patients (94 %) were examined following treatment. There was a statistically significant improvement in flexibility, strength, lifting capacity, and endurance measurements ( p < 0.001) at the end of the treatment. In addition, significant reductions in pain, disability, depression, and psychovegetative signs were demonstrated ( p < 0.001). There was a decreased use of medical treatment for back pain following the program, with 42 % of the patients refraining from the intake of analgesics, followed by a significant reduction in physiotherapy and the consultation of physicians. Assessment of the patients' reported increased activity levels at home also supported findings that statistical improvements were significant. Sixty-three percent of the patients were found to have returned to active, productive work following discharge from the program. Most of the improvements remained stable at the 6- and 12-month follow-up examinations. CONCLUSION: The results demonstrate the effectiveness of the multimodal program of functional restoration, not only concerning positive changes in somatic, psychological and physical variables, but also with respect to the number of patients who returned to work. Our methods are also compared with the discrepant results of multimodal treatment in the United States and Scandinavia.

English Abstract↗