IntroductionCompleteness of Global Burden of Disease (GBD) Study data is acknowledged as a limitation. To date, no study has evaluated this issue for low back pain, a leading contributor to disease burden globally.MethodsWe retrieved reports, in any language, based on citation details from the GBD 2017 study website. Pairs of raters independently extracted the following data: number of prevalence reports tallied across countries, age groups, gender and years from 1987 to 2017. We also considered if studies enrolled a representative sample and/or used an acceptable measure of low back pain.ResultsWe retrieved 488 country-level reports that provide prevalence data for 103 of 204 countries (50.5%), with most prevalence reports (61%) being for high-income countries. Only 16 countries (7.8%) have prevalence reports for each of the three decades of the GBD. Most of the reports (79%) did not use an acceptable measure of low back pain when estimating prevalence.ConclusionWe found incomplete coverage across countries and time, and limitations in the primary prevalence studies included in the GBD 2017 study. This means there is considerable uncertainty about GBD estimates of low back pain prevalence and the disease burden metrics derived from prevalence.

This article reviews the effect of male migration on the spread of HIV infections in mid and far-western Nepal. It explains the link between male mobility and HIV in women and children. Materials were collected by a systematic search of the databases and the websites of national and international agencies. HIV infection amongst male migrants was found to be high. Their risk behaviors such as unprotected sex with multiple partners and sex workers increase the risk of HIV infection. Substance abuse, loneliness, separation from families, peer pressure, long working hours and poor living conditions are factors that promote unsafe sex. Literacy and awareness about HIV is a key measure to decrease the prevalence of the disease and reduce social stigma among people affected. HIV is a major public health issue especially in Nepal with migration playing a major role in its spread. Negligence to sexual health and lack of comprehensive knowledge on the disease among male migrants are the major obstacles that have exacerbated the disease. There is a need for further research on the existing HIV cases affecting women and children of these two regions to get a clear picture of the gravity of the disease.

steoarthritis affects more than 500 million people around the world, and it is a leading cause of disability. 1 Non-pharmacological strategies, such as exercise and maintaining a healthy weight, are recommended for first line management, as are simple analgesics, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen). 2 However, advice on using opioid analgesics to treat the pain of knee and hip osteoarthritis is inconsistent; 3,4 opioids are often prescribed, including for about 40% of people with knee osteoarthritis in the United States. 5 Systematic reviews of placebo-controlled trials of the effectiveness of opioids for treating osteoarthritis pain have been limited in scope. For example, one evaluated only opioid treatments of at least four weeks' duration, 6 while a second was restricted to oral opioid therapy. 7 GRADE ratings were not always reported in the abstract or conclusions, and the validity of opioid dose-response analyses were sometimes unclear. 8 One review excluded tramadol because it had been examined in a separate review. 9 We therefore undertook a systematic review to provide a comprehensive evaluation of the efficacy and safety of opioid analgesic therapy regimens for people with osteoarthritis, and to explore dose-effect relationships. MethodsWe searched MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Allied and Complementary Medicine Database (AMED), the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials (CENTRAL) for eligible randomised controlled trials (RCTs) published in any language in peer-reviewed journals to 31 October 2020 (Supporting Information, table 1). To avoid overestimating treatment effects, 10 we also searched the World Health Organization International Clinical Trials Registry (https://trial search.who.int) for unpublished trials. We screened the reference lists of retrieved publications to identify further RCTs. Our systematic review was prospectively registered with PROSPERO (CRD420191142813; 16 October 2019). Inclusion criteriaWe included RCTs in which the analgesic effect of an opioid was compared with that of placebo in people with osteoarthritis of any type (knee, hip, hand, spine) of any duration. All single ingredient and combination opioid-containing analgesic regimens were included, regardless of opioid dose and administration route. We did not include trials in which the effect of opioid therapy was compared with other treatments but not with placebo. Trials including a range of pain conditions were eligible if data for participants with osteoarthritis could be extracted. Study selectionThree authors (CAS, WA, GZ) independently screened the titles and abstracts and read the full text of potentially eligible publications; disagreements were resolved by consensus.

Aim To compare and contrast the diagnostic codes for spinal causes of low back pain (LBP) in 3 disease classification systems (International Classification of Diseases [ICD]‐10, International Classification of Primary Care [ICPC]‐2 PLUS and Systematized Nomenclature of Medicine Clinical Terms ‐ Australia [SNOMED CT‐AU]) and consider how well they are aligned with the diagnostic approach recommended in contemporary clinical practice guidelines for LBP. Method This was a descriptive study which included 3 disease classification systems: ICD‐10, ICPC‐2 PLUS and SNOMED CT‐AU. Two independent authors extracted relevant LBP codes from each system and mapped the codes to 3 guideline‐endorsed categories of spine‐related diagnoses for LBP (specific spinal pathology, radicular syndromes, and non‐specific LBP) and the various clinical conditions (sub‐categories) within each of the 3 categories. Results ICD‐10, ICPC‐2 PLUS, and SNOMED CT‐AU had 126, 118 and 100 codes for LBP, respectively. All systems provided codes that would cover the 3 guideline‐endorsed categories of spine‐related diagnoses for LBP. On the basis of contemporary guidelines, the authors developed lists of discrete sub‐categories of specific spinal pathology (56 sub‐categories), radicular syndromes (7 sub‐categories), and non‐specific LBP (10 sub‐categories). Each of the classification systems was then mapped against these sub‐categories to tally redundancy and determine exhaustiveness. However, no system covered all 73 sub‐categories of LBP, and within each system, there was substantial redundancy with up to 22 codes for the same clinical condition. Conclusion LBP diagnostic codes used in popular disease classification systems are out of touch with current approaches to diagnosis, as reflected in contemporary LBP guidelines. Our findings suggest these disease classification systems need revision, but precisely how they should be revised is unclear.