Background-Epidemiologically-based rheumatology healthcare needs assessment requires an understanding of the incidence and prevalence of musculoskeletal disorders in the community, of the reasons why people consult in primary care, and of the proportion of people who would benefit from referral to secondary care and paramedical services. This paper reports the first phase of such a needs assessment exercise. Specific objective-To estimate the relative frequency of musculoskeletal pain in diVerent, and multiple, anatomical sites in the adult population. Setting-Three general practices in the former Tameside and Glossop Health Authority, Greater Manchester, UK, a predominantly urban area. Design-Population survey. Methods-An age and sex stratified sample of 6000 adults from the three practices was mailed a questionnaire that sought data on demographic factors, musculoskeletal symptoms (pain in the past month lasting for more than a week), and physical disability (using the modified Health Assessment QuestionnairemHAQ). The areas of pain covered were neck, back, shoulder, elbow, hand, hip, knee, and multiple joints. The Carstairs index was used as a measure of social deprivation of the postcode sector in which the person lived. Results-The response rate after two reminders was 78.5%. Non-responders were more likely to live in areas of high social deprivation. People who lived in more deprived areas were also more likely to report musculoskeletal pain, especially backpain. After adjusting for social deprivation the rates of musculoskeletal pain did not diVer between the practices and so their results were combined. After adjustment for social deprivation, the most common site of pain was back (23%; 95% CI 21, 25) followed by knee (19%; 95% CI 18, 21), and shoulder (16%; 95% CI 14, 17). The majority of subjects who reported pain had pain in more than one site. The prevalence of physical disability in the community rose with age. It was highest in those with multiple joint problems but was also high in those with isolated back or knee pain. Conclusion-Musculoskeletalpain is common in the community. People who live in socially deprived areas have more musculoskeletal symptoms. Estimates of the overall burden of musculoskeletal pain that combine the results of site specific surveys will be too high, those that do not adjust for socioeconomic factors will be too low. (Ann Rheum Dis 1998;57:649-655) It is well recognised that musculoskeletal symptoms are common in the adult community. Disorders of the musculoskeletal system were the most frequent self reported longstanding illness in the 1995 General Household Survey, with a rate of 159 per 1000 adult women and 143 per 1000 adult men.1 The frequency of these disorders, and the prevalence of physical disability, increase with age. 2Almost one third of people aged over 75 have a significant musculoskeletal problem, and the prevalence of locomotor disability rises from 3.1% in those aged less than 60 to almost 50% in those aged more than 75.3 Musculoskeletal compl...

No abstract

In recent years international bioethics bodies have made prominent declarations about the uses of donated tissue and related information in genetic research 1. Following the 'legislative' mode of bioethics 2 , these organisations have put forward a number of general principles with a view to promoting the fair and equitable use of donated tissue in such research. However, government policies in this field are shaped differently in different national regimes. In this paper, I use recent debates in the UK about a national genetic 'biobank' to illustrate how the shape and texture of policy discussions surrounding the use of donated blood for genetic research have been built upon a prior national consensus that regarded blood as a public good.

No abstract

The clinical use of blood has a long history, but its apparent stability belies the complexity of contemporary practices in this field. In this article, we explore how the production, supply and deployment of blood products are socially mediated, drawing on theoretical perspectives from recent work on ‘tissue economies’. We highlight the ways in which safety threats in the form of infections that might be transmitted through blood and plasma impact on this tissue economy and how these have led to a revaluation of donor bodies and restructuring of blood economies. Specifically, we consider these themes in relation to the management of recent threats to blood safety in the United Kingdom. We show that the tension between securing the supply of blood and its products and ensuring its safety may give rise to ethical concerns and reshape relations between donor and recipient bodies.