Objectives. To explore the concept of work instability (WI), a state in which the consequences of a mismatch between an individual's functional abilities and the demands of his or her job could threaten continuing employment if not resolved, in people with rheumatoid arthritis (RA). To develop the Work Instability Scale (WIS). Methods. WI in people with RA was explored through qualitative interviews, which were then used to generate items for the WIS. Results. Through Rasch analysis and validation against a gold standard of expert vocational assessment, a short 23-item, self administered, RA WIS was developed. Conclusion. The WIS can be scored in 3 bands indicating low, medium, and high risk of work disability.

Overall, this instrument has good interobserver reliability for assessing general disease activity. We therefore suggest that this proforma has a place in routine clinical monitoring of patients with BD, as well as assessing outcome in therapeutic trials.

Study objective -To assist a purchasing district in the planning of services for low back pain by assessing the prevalence of symptoms and the current involvement of primary, secondary, and complementary care in the treatment of low back pain. In the light ofthese findings, to assess further the potential impact of a new system of open access to physical therapy, as recommended by the British Clinical Standards Advisory Group (CSAG).Design -A two-stage cross sectional survey approach using postal questionnaires. Subjects -Altogether 1437 men and 1747 women aged 25-64 years, randomly selected from the family health services association register in Bradford. Main results -An annual incidence of4 7% for low back pain was found, with lifetime, 12 month period, and point prevalences of 59%, 39%, and 19% respectively. Over a one year period, 50 3% of episodes were acute (<2 weeks), 21% were subacute (2 weeks-3 months), and 26% were chronic (over 3 months) in duration. Altogether 17*8% of the population in this age range experienced referred pain, numbness, or tingling, and 6-4% took time off work as a result of low back pain. In the same year, 20% of the population in the same age range consulted no-one about their pain, 13-7% were treated at the primary care level, 4% received secondary care, and 3% visited a complementary therapist. One fifth of those who did not consult a professional experienced severe pain during episodes. Prevalence estimates indicate that an emphasis on early intervention and primary care management of simple low back pain as recommended by the CSAG could generate a 131% surge in demand for physical therapy. Conclusions -Local prevalence estimates may allow purchasers to estimate the potential effects of a shift in management policy for low back pain and to highlight areas of unmet need in terms of resources and patient education. (J Epidemiol Community Health 1996;50:347-352) Low back pain (LBP) continues to present a major challenge to industrialised societies. Its associated disability is a problem which some suggest has reached epidemic proportions,' and its effects on industry and health services are increasingly felt. During the past decade, the number of days of certified incapacity due to back pain has tripled to an estimated 106 million,2 and the number of patients referred to hospital has increased fivefold.3 At a total social cost to Britain of nearly 6 billion in 1993, the price of LBP continues to rise by an estimated £500 million each year.3 A recent British report issued by the Clinical Standards Advisory Group (CSAG) has recommended purchaser specific contracts for LBP, with an emphasis on primary care management of the problem. In particular, it recommends that general practitioners have open access to physical therapy.3 However, previous studies have demonstrated that regional differences exist in rates of general practice consultation for LBP.4 If purchasers are to plan effectively and improve standards of care for those with LBP, local baseline estimates ofneed an...

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This paper aimed to discuss functioning, quality of life, (QoL) and lifespan care issues of adolescents and young adults with childhood‐onset physical disability from a clinical, scientific, and personal perspective. We present a résumé of results of recently performed studies in rehabilitation‐based samples of (young) adults with childhood‐onset conditions such as cerebral palsy (CP) and spina bifida (SB), and different models of transition and lifespan care. The studies showed that many young adults with a childhood‐onset disability experience health‐related problems such as functional deterioration, pain or fatigue, and an inactive lifestyle. A significant number are restricted in participation in work, housing, and intimate relationships. They perceive a lower health‐related and global QoL compared with a reference group. In some centres in the UK and the Netherlands specialized outpatient services are available or being developed. In conclusion, transition to adulthood is a critical phase for reaching autonomous participation in adult life. There is an international challenge to incorporate a lifespan perspective in paediatric, transition, and adult health care services for persons with a childhood‐onset disability.

SUMMARY Thirty-two patients with Behcet's syndrome were surveyed clinically, radiologically, and immunologically. HLA antigens were determined in a proportion. The patients were culled from a defined geographical area (Yorkshire) with a population of 5 million. 21 patients satisfied Mason and Barnes's (1969) criteria for major disease. 100 % had mouth ulceration, 91 % genital ulceration, 66 % skin complaints, and 63 % arthritis (of the nonerosive type previously documented). 3 patients had gastrointestinal involvement, one of whom had proven Crohn's disease. One patient had psoriasis. One patient had a popliteal artery aneurysm resected and one has since had surgery after the development of a tracheo-oesophageal fistula. No sacroilititis was found.

The Nurse-WIS is a psychometrically sound method for the early identification of nursing staff experiencing difficulties at work. It offers the prospect of positive proactive management to prevent or minimize sickness absence and potentially prevent loss of nursing staff from the workforce through long-term sickness absence and early retirement.

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