Although epidural injections of methylprednisolone may afford short-term improvement in leg pain and sensory deficits in patients with sciatica due to a herniated nucleus pulposus, this treatment offers no significant functional benefit, nor does it reduce the need for surgery.

Objective. To compare the efficacy of a single intraarticular corticosteroid injection, a supervised physiotherapy program, a combination of the two, and placebo in the treatment of adhesive capsulitis of the shoulder.Methods. Ninety-three subjects with adhesive capsulitis of <1 year's duration were randomized to 1 of 4 treatment groups: group 1, corticosteroid injection (triamcinolone hexacetonide 40 mg) performed under fluoroscopic guidance followed by 12 sessions of supervised physiotherapy; group 2, corticosteroid injection alone; group 3, saline injection followed by supervised physiotherapy; or group 4, saline injection alone (placebo group). All subjects were taught a simple home exercise program. Subjects were reassessed after 6 weeks, 3 months, 6 months, and 1 year. The primary outcome measure was improvement in the Shoulder Pain and Disability Index (SPADI) score.Results. At 6 weeks, the total SPADI scores had improved significantly more in groups 1 and 2 compared with groups 3 and 4 (P ‫؍‬ 0.0004). The total range of active and passive motion increased in all groups, with group 1 having significantly greater improvement than the other 3 groups. At 3 months, groups 1 and 2 still showed significantly greater improvement in SPADI scores than group 4. There was no difference between groups 3 and 4 at any of the followup assessments except for greater improvement in the range of shoulder flexion in group 3 at 3 months. At 12 months, all groups had improved to a similar degree with respect to all outcome measures.Conclusion. A single intraarticular injection of corticosteroid administered under fluoroscopy combined with a simple home exercise program is effective in improving shoulder pain and disability in patients with adhesive capsulitis. Adding supervised physiotherapy provides faster improvement in shoulder range of motion. When used alone, supervised physiotherapy is of limited efficacy in the management of adhesive capsulitis.Adhesive capsulitis is a common cause of shoulder pain and disability. It is characterized by spontaneous onset of shoulder pain accompanied by progressive limitation of both active and passive glenohumeral movement (1). The pathophysiology of idiopathic adheSupported by a grant from the Arthritis Society of Canada.

H erpes zoster, which is characterized by dermatomal pain and vesicular rash, 1,2 results from reactivation of the varicella-zoster virus. 3,4 The average lifetime risk of herpes zoster in developed countries is estimated to be about 30% [5][6][7] and increases with increasing life expectancy. The most common complication of herpes zoster, and one of the most challenging to treat, is post herpetic neuralgia, a painful condition often defined as pain persisting for more than 90 days after rash onset.8 According to this definition, postherpetic neuralgia is estimated to occur in 8%-27% of people with herpes zoster overall.9-14 The risk of postherpetic neuralgia increases markedly with age. 15The Shingles Prevention Study, a randomized doubleblind placebo-controlled trial, showed that a live-attenuated varicella-zoster virus vaccine was safe and effective in preventing herpes zoster and postherpetic neuralgia among people 60 years of age and older.13 Given these promising results, policy-makers and clinicians are being asked to make recommendations regarding the use and funding of the herpes zoster vaccine. To do this, evidence on the burden of herpes zoster from the patient's perspective is required. The only data available on the impact of herpes zoster on health-related quality of life comes from two short-term studies.16,17 Clinical reports and cross-sectional surveys [18][19][20] have also suggested that post herpetic neuralgia can profoundly impair quality of life. However, no study followed a cohort of patients with newly diagnosed herpes zoster for a sufficient period to assess postherpetic neuralgia and describe the associated impact on quality of life.We undertook a multicentre prospective study to describe the impact of herpes zoster and postherpetic neuralgia on health-related quality of life.

No abstract

Among these white-collar workers, exposure to cumulative job strain had a modest but significant effect on systolic blood pressure among men. The risk was of comparable magnitude to that observed for age and sedentary behavior. Men and women with low levels of social support at work appeared to be at higher risk for increases in blood pressure.

IntroductionMatrix metalloproteinase (MMP)-2 is very active at degrading extracellular matrix. It is under the influence of an activator, membrane type 1 MMP (MMP-14), and the tissue inhibitor of metalloproteases (TIMP)-2. We hypothesized that the individual expression of these three markers or their balance may help to predict breast cancer prognosis.MethodsMMP-2, MMP-14 and TIMP-2 expression has been evaluated by 35S mRNA in situ hybridization on paraffin material of 539 breast cancers without distant metastasis at diagnosis and with a median follow-up of 9.2 years.ResultsMMP-2 and MMP-14 mRNA was detected primarily in reactive stromal cells whereas TIMP-2 mRNA was expressed by both stromal and cancer cells. Of the three molecules, an adjusted Cox model revealed that high MMP-14 mRNA (≥ 10% cells) alone predicted a significantly shorter overall survival (p = 0.031) when adjusted for clinical factors (tumor size and number of involved lymph nodes). Prognostic significance was lost when further adjusted for Her-2/neu and urokinase-type plasminogen activator (p = 0.284). Furthermore, when all three components were analyzed together, the survival was worst for patients with high MMP-2/high MMP-14/low TIMP-2 (5 year survival = 60%) and best with low MMP-2/low MMP-14/high TIMP-2 (5 year survival = 74%), but the difference did not reach statistical significance (p = 0.3285).ConclusionOf the MMP-14/TIMP-2/MMP-2 complex, MMP-14 was the factor most significantly associated with the outcome of breast cancer and was an independent factor of poor overall survival when adjusted for clinical prognostic factors, but not for certain ancillary markers.

BACKGROUND The goal of this study was to assess variations with age in the management of breast carcinoma and to identify determinants of care received. METHODS A stratified random sample was selected among women age ≥ 50 newly diagnosed with lymph node negative breast carcinoma in Québec in 1988, 1991, and 1993. Information was abstracted from medical charts. Predictors of definitive locoregional treatment (total mastectomy with lymph node dissection or breast‐conserving surgery with both axillary lymph node dissection and radiation therapy) were identified by multiple logistic regression analysis. RESULTS Overall, 1174 patients age ≥ 50 years with breast carcinoma were included. Women age ≥ 70 years were much less likely to receive definitive locoregional treatment compared with women ages 50–69 years (48.7% vs. 83.5%; P < 0.0001). Older women were less likely to undergo surgery with breast preservation (76.7% vs. 86.3%; P < 0.0001), radiation therapy (54.7% vs. 90.5%; P < 0.0001), dissection of the axillary lymph nodes (55.6% vs. 86.3%; P < 0.0001), or chemotherapy (1.2% vs. 13.9%; P < 0.0001), but not treatment with tamoxifen (66.4% vs. 64.7%; P = 0.41). Adjusting for comorbidity and other characteristics related to the disease, the hospital, and the attending physician, age remained a strong determinant of the probability of receiving definitive locoregional treatment (odds ratio [OR], 0.14; 95% confidence interval [95% CI], 0.12–0.18 for women age ≥ 70 years vs. women ages 50–69 years). The same association was observed when women who did not undergo lymph node dissection but who received systemic adjuvant treatment were considered to have received definitive therapy (OR, 0.13; 95% CI, 0.10–0.17) for women age ≥ 70 years vs. women ages 50–69 years). CONCLUSIONS Less aggressive patterns of care are provided to elderly breast carcinoma patients, independent of comorbidity. This could explain, at least in part, the sustained breast carcinoma mortality in this population. Cancer 1999;85:1104–13. © 1999 American Cancer Society.

The study aimed to determine whether the incidence and duration of certified sick leave (CSL) among nurses had increased during major restructuring of the health care system in the province of Québec, and to determine whether nurses exposed to adverse psychosocial factors at work showed an increased incidence of CSL. It involved nurses working in 13 health facilities. Sickness absence data were retrieved from administrative files (n = 1454). Incidence of CSL for all diagnoses and for mental health problems was examined. Telephone interviews were conducted to measure psychosocial factors at work with validated instruments. There was an increase in CSL among nurses during the restructuring, particularly for mental health problems. Modifiable adverse psychosocial work factors were identified and provide basis for interventions. Since human resources are the mainstay and primary resource of the health network, it is essential that people be able to perform their work under optimal conditions.La plupart des pays industrialisés connaissent une augmentation importante des absences du travail pour des problèmes de santé mentale. Le tiers de ces absences serait relié au travail et aux conditions dans lesquelles il s’exerce. De plus, les effets du travail sur la santé des personnes, notamment la santé mentale, seraient grandement sous-estimés et si un renversement des tendances (dans les conditions d’exécution du travail) ne survient pas, dans un délai raisonnable, les coûts économiques et sociaux de ce dérapage deviendront insupportables, tant pour les travailleurs que pour les entreprises et pour les caisses d’assurance privées ou publiques.Certains facteurs psychosociaux au travail sont reconnus pour leur contribution potentielle à la survenue des problèmes de santé mentale chez les travailleurs et travailleuses. Les deux modèles les mieux documentés dans ce domaine sont ceux de la demande psychologique, la latitude décisionnelle et le soutien social de Karasek, Theorell et Jonhson et celui du déséquilibre entre les efforts et la reconnaissance de Siegrist. Une combinaison de ces modèles théoriques permet de faire un diagnostic des facteurs particulièrement nocifs pour la santé et offre aux gestionnaires un cadre de référence stimulant susceptible de soutenir l’action.Le contexte. La dernière décennie a connu d’importantes réformes dans le réseau québécois de la santé dans un souci d’améliorer l’efficacité du système et d’en réduire les coûts. De façon générale, l’environnement psychosocial du travail s’est détérioré pendant la transformation du réseau.Les objectifs. Un premier objectif de cette étude visait à déterminer si l’incidence et la durée des absences pour maladie certifiées (AMS) chez les infirmières avaient augmenté pendant la transformation du réseau de la santé. À cette fin, les absences pour maladie tous diagnostics et pour un problème de santé mentale ont été examinées selon les différentes périodes caractérisant la transformation. Un deuxième objectif visait à déterminer si les infirmières exposées à des...