Respiratory alkalinization and posterior cerebral artery dilatation predict acute mountain sickness severity during 10 h normobaric hypoxia.

NEW FINDINGS: What is the central question of this study? The pathophysiology of acute mountain sickness (AMS), involving the respiratory, renal and cerebrovascular systems, remains poorly understood. How do the early adaptations in these systems during a simulated altitude of 5000 m relate to AMS risk? What is the main finding and its importance? The rate of blood alkalosis and cerebral artery dilatation predict AMS severity during the first 10 h of exposure to a simulated altitude of 5000 m. Slow metabolic compensation by the kidneys of respiratory alkalosis attributable to a brisk breathing response together with excessive brain blood vessel dilatation might be involved in early development of AMS. ABSTRACT: The complex pathophysiology of acute mountain sickness (AMS) remains poorly understood and is likely to involve maladaptive responses of the respiratory, renal and cerebrovascular systems to hypoxia. Using stepwise linear regression, we tested the hypothesis that exacerbated respiratory alkalosis, as a result of a brisk ventilatory response, sluggish renal compensation in acute hypoxia and dysregulation of cerebral perfusion predict AMS severity. We assessed the Lake Louise score (LLS, an index of AMS severity), fluid balance, ventilation, venous pH, bicarbonate, sodium and creatinine concentrations, body weight, urinary pH and cerebral blood flow [internal carotid artery (ICA) and vertebral artery (VA) blood flow and diameter], in 27 healthy individuals (13 women) throughout 10 h exposures to normobaric normoxia (fraction of inspired O2 = 0.21) and normobaric hypoxia (fraction of inspired O2 = 0.117, simulated 5000 m) in a randomized, single-blinded manner. In comparison to normoxia, hypoxia increased the LLS, ventilation, venous and urinary pH, and blood flow and diameter in the ICA and VA, while venous concentrations of both bicarbonate and creatinine were decreased (P < 0.001 for all). There were significant correlations between AMS severity and the rates of change in blood pH, sodium concentration and VA diameter and more positive fluid balance (P < 0.05). Stepwise regression found increased blood pH [beta coefficient (ß) = 0.589, P < 0.001] and VA diameter (ß = 0.418, P = 0.008) to be significant predictors of AMS severity in our cohort [F(2, 20) = 16.1, R2  = 0.617, P < 0.001, n = 24], accounting for 62% of the variance in peak LLS. Using classic regression variable selection, our data implicate the degree of respiratory alkalosis and cerebrovascular dilatation in the early stages of AMS development.

Age-Related Differences in Perceived Exertion While Walking and Running Near the Preferred Transition Speed.

PURPOSE: To investigate whether youth and adults can perceive differences in exertion between walking and running at speeds near the preferred transition speed (PTS) and if there are age-related differences in these perceptions. METHODS: A total of 49 youth (10-12 y, n = 21; 13-14 y, n = 10; 15-17 y, n = 18) and 13 adults (19-29 y) completed a walk-to-run transition protocol to determine PTS and peak oxygen uptake. The participants walked and ran on a treadmill at 5 speeds (PTS-0.28 m·s-1, PTS-0.14 m·s-1, PTS, PTS+0.14 m·s-1, PTS+0.28 m·s-1) and rated perceived exertion using the OMNI Perceived Exertion (OMNI-RPE) scale. Oxygen consumption was measured during the walk-to-run transition protocol to obtain the relative intensity (percentage of peak oxygen uptake) at PTS. OMNI-RPE scores at all speeds and percentage of peak oxygen uptake at PTS were compared between age groups. RESULTS: The 10- to 12-year-olds transitioned at a higher percentage of peak oxygen uptake than adults (64.54 [10.18] vs 52.22 [11.40], respectively; P = .035). The 10- to 14-year-olds generally reported higher OMNI-RPE scores than the 15- to 17-year-olds and adults (P < .050). In addition, the 10- to 14-year-olds failed to distinguish differences in OMNI-RPE between walking and running at PTS and PTS+0.14 m·s-1. CONCLUSIONS: Children aged 10-14 years are less able to distinguish whether walking or running requires less effort at speeds near the PTS compared with adults. The inability to judge which gait mode is less demanding could hinder the ability to minimize locomotive demands.

Tertiary education in ergonomics and human factors: quo vadis?

In 2019, the Human Factors and Ergonomics (HFE) discipline turned 70; to celebrate, an international group of academics and educators have reflected on the status of HFE tertiary education across the globe. This paper draws on presentations and discussions from the 20th Triennial International Ergonomics Association (IEA) conference and considers the implications for HFE education programmes. Past, current, and future challenges are outlined and discussed with examples from different countries and programmes. This paper builds on 2012 strategy proposed by Dul and colleagues, to strengthen the demand, and application, of the HFE discipline and profession. It provides a considered set of reflections, noting the range of structural issues and financial pressures within the tertiary education system that create challenges for the viability of specialist programmes such as HFE. A need exists for the broader profession to collaborate and share innovations in HFE programme development, to ensure sustainable HFE education programmes. Practitioner summary: A range of structural issues and financial pressures exist within the tertiary education system that creates challenges for the viability of specialist programmes such as HFE. A need exists for the broader profession to collaborate and share innovations in HFE programme development, to ensure sustainable HFE education programmes. Abbreviation: HFE: Human Factors and Ergonomics; IEA: International Ergonomics Association; CIEHF: Chartered Institute of Ergonomics & Human Factors; UX: User Experience; CREE: Centre for Registration of European Ergonomist; BRICSplus: Brazil, Russia, India, China and South Africa; MOOCS: Massive Open Online Courses; STST: socio technical systems theory; LMIC: low and middle-income countries.

Age-dependent variability in spatiotemporal gait parameters and the walk-to-run transition.

Adolescents tend to exhibit more variability in their gait patterns than adults, suggesting a lack of gait maturity during this period of ongoing musculoskeletal growth and development. However, there is a lack of consensus over the age at which mature gait patterns are achieved and the factors contributing to gait maturation. Therefore, the purpose of this study was to investigate gait control and maturity in adolescents by determining if differences existed between adolescents and adults in a) the amount of spatiotemporal variability of walking and running patterns across a range of speeds, and b) how swiftly gait patterns are adapted to increasing gait speed during the walk-to-run transition. Forty-six adolescents (10-12-year-olds, n = 17; 13-14-year-olds, n = 12; and 15-17-year-olds, n = 17) and 12 young adults completed an incrementally ramped treadmill test (+0.2 km·h-1 every 30 s) to determine the preferred transition speed (PTS) during a walk-to-run transition. Age-related differences in the variability of stride lengths and stride durations were assessed across 4 speeds (self-selected walking speed, PTS - 0.06 m·s-1, PTS + 0.06 m·s-1, PTS + 0.83 m·s-1). Repeated measures ANOVAs (p < 0.05) compared coefficients of variation for these spatiotemporal parameters, while a one-way ANOVA compared the numbers of gait transitions and speed increments used to identify PTS between the adolescent groups and young adults. Compared to adults, 10-12yo exhibited more spatiotemporal variability during all gait conditions, while 13-17yo only exhibited more variability at PTS + 0.06 m·s-1. No age-dependent pattern was observed in PTS values, but 10-12yo completed more gait transitions over more speed increments than 15-17yo and adults. The development of mature gait patterns is thus a progressive process, with walking maturing at an earlier age than running. As 10-12yo were unable to swiftly adapt gait patterns to the changing task demands, their control mechanisms of gait may not have fully matured yet.

The impact of national guidelines covering moving and handling of people on injury rates and related costs.

Objective National guidelines for moving and handling of people (MHP) were introduced in New Zealand in 2012 to reduce MHP-related injuries in the healthcare sector. This study assessed the effectiveness of this on MHP-related injury claims. Methods MHP-related injury claims were identified from the national injury claims database, which included 118 755 accepted claims for 2005-2016 across 14 industries. Interrupted time-series analysis was used to assess temporal changes in MHP-related claims rates, costs, and causes for the period before (2005-2012) and following (2013-2016) the introduction of the national guidelines. Results Prior to the introduction of the guidelines, MHP-related claims were estimated to be 39 209 (33.0% of all accepted injury claims), with claims rates and associated costs for the 14 industries decreasing by 0.4 [95% confidence interval (CI) -0.5‒ -0.2, P<0.001] and NZ$ 230 per claim (95% CI -324‒ -136, P=0.001) respectively. In the year following the introduction of the guidelines, there were no overall changes in claim rates or costs. However, significant increases in claim rates [ranging from 1.27-1.99 (P=0.004-0.010)] and claim costs [ranging from NZ$ 724-987 per claim (P=0.032-0.045)] were found 2-4 years later. More than 65% of all MHP-related claims were caused by lifting/carrying/strain, and there was a significant increase in claim numbers due to this cause, ranging from 431.7-594.0 (P=0.001-0.008) in the four years following the introduction of the guidelines. Conclusions The introduction of national MHP-guidelines in 2012 in New Zealand did not reduce MHP-related injury rates and costs. On the contrary, there were statistically significant increases 2-4 years after introduction of the guidelines.

The effects of introducing electric adjustable height desks in an office setting on workplace physical activity levels: A randomised control field trial.

BACKGROUND: Electric adjustable height desks (EAHD) have been promoted as an opportunity for desk based workers to stand at work but there is limited evidence that they have an effect on light physical activity. OBJECTIVE: The main objective was to determine if there would be a change in light physical activity with the introduction of EAHD. The secondary objective was to assess if there was an associated change in leisure time activity. METHODS: Activity levels were measured by step counts, self-reported activity levels and pre- and post-trial recall levels. Statistical analysis of the data was performed with the software R. Generalised linear models were fitted to the data. A Poisson regression was used for count data. Statistical hypotheses were deemed significant if their p values were less than 0.05. RESULTS: There was a significant (p < 0.001) effect on step counts associated with allocation of EAHD and a significant (p < 0.001) increase in self-reported activity for the Intervention (EAHD) group. Having an EAHD was associated with increased activity during leisure (p = 0.039). CONCLUSIONS: Activity levels, especially light physical activity, were significantly increased with the allocation of an electric adjustable height desk. This pilot study showed that the environmental change of introduction of electric adjustable height desks into an office workplace can increase physical activity and reduce sitting durations. There is limited evidence that the increase in work activity has a positive impact on leisure time activity.

How was a national moving and handling people guideline intended to work? The underlying programme theory.

In healthcare, moving and handling people (MHP) often cause musculoskeletal disorders. To prevent musculoskeletal disorders due to MHP, many national evidence-based guidelines have been developed. However, little is known about how these guidelines were intended to work, i.e. their 'programme theory', how implementation by intended users is influenced by contextual factors and mechanisms to produce outcomes. This paper identifies the programme theory of a national MHP guideline (MHPG) using thematic analysis of the MHPG document, three organisational planning documents, and interviews with MHPG developers. The analysis identified the intended users of the MHPG as health and safety managers and MHP coordinators. The programme theory comprised contextual factors, potentially hindering (e.g. budget constraints) or facilitating (e.g. changing demographics) implementation, being influenced by mechanisms mainly based on ethical (quality of care, evidence-based practices), and economic reasoning (reducing cost of MHP, return on investment) to reduce injuries caused by MHP - the intended outcome.

What factors determine the preferred gait transition speed in humans? A review of the triggering mechanisms.

Human locomotion is a fundamental skill that is required for daily living, yet it is not completely known how human gait is regulated in a manner that seems so effortless. Gait transitions have been analyzed to gain insight into the control mechanisms of human locomotion since there is a known change that occurs as the speed of locomotion changes. Specifically, as gait speed changes, there is a spontaneous transition between walking and running that occurs at a particular speed. Despite the growing body of research on the determinants of this preferred transition speed and thus the triggering mechanisms of human gait transitions, a clear consensus regarding the control mechanisms of gait is still lacking. Therefore, this article reviews the determinants of the preferred transition speed using concepts of the dynamic systems theory and how these determinants contribute to four proposed triggers (i.e. metabolic efficiency, mechanical efficiency, mechanical load and cognitive and perceptual) of human gait transitions. While individual anthropometric and strength characteristics influence the preferred transition speed, they do not act to trigger a gait transition. The research has more strongly supported the mechanical efficiency and mechanical load determinants as triggering mechanisms of human gait transitions. These mechanical determinants, combined with cognitive and perceptual processes may thus be used to regulate human gait patterns through proprioceptive and perceptual feedback as the speed of locomotion changes.

Interaction between physical and psychosocial risk factors on the presence of neck/shoulder symptoms and its consequences.

This study aimed to quantify the interaction between physical and psychosocial factors on the presence of neck/shoulder symptoms (NSS) and its consequences (reduced activities and absenteeism) among 1294 coal mining workers in Indonesia. A self-administered questionnaire was used to obtain information on current workplace exposure and NSS and its consequences. Participants were grouped into one of four combination exposure groups: low physical and low psychosocial (as the reference group); low physical and high psychosocial; high physical and low psychosocial, and high physical and high psychosocial (HPhyHPsy). The attributable proportion (AP) due to interaction between both factors was examined. Individuals in the HPhyHPsy group were most likely to report NSS [odds ratio (OR) 4.83, 95% confidence interval (CI) 2.43-9.58], reduced activities (OR 3.90, 95% CI 2.36-6.43), and absenteeism (OR 3.91, 95% CI 2.11-7.25). This study has shown an interaction between physical and psychosocial factors that increases the OR of NSS (AP 0.49, 95% CI 0.08-0.89). Practitioner Summary: Although physical and psychosocial factors are known to be predictors for NSS, little is known about their interaction. Self-reported questionnaire was used to obtain information about physical and psychosocial factors at work. This study found an interaction between the physical and psychosocial risk factors that increases the odds ratio of NSS.

Interaction between physical and psychosocial work risk factors for low back symptoms and its consequences amongst Indonesian coal mining workers.

This study assessed the interaction between physical and psychosocial factors for low back symptoms (LBS) and its consequences (reduced activities and absenteeism) in a developing country. A sample of 1294 Indonesian coal mining workers reported occupational exposures, LBS and its consequences using a self-administered questionnaire. Respondents were placed into one of four combination exposure groups: high physical and high psychosocial (HPhyHPsy); high physical and low psychosocial (HPhyLPsy); low physical and high psychosocial (LPhyHPsy), and; low physical and low psychosocial (LPhyLPsy). The attributable proportion due to interaction between physical and psychosocial factors was examined. Individuals in the HPhyHPsy group were most likely to report LBS (OR 5.42, 95% CI 3.30-8.89), reduced activities (OR 4.89, 95% CI 3.09-7.74), and absenteeism (OR 4.96, 95% CI 3.05-8.06). Interactions between physical and psychosocial factors were present for LBS, reduced activities, and absenteeism; although for LBS and absenteeism the interactions were not significant. Current smokers were more likely to report LBS consequences. Permanent employment and night shift work increased the odds of LBS and its consequences. We conclude that interventions aimed at reducing LBS and its consequences should address both physical and psychosocial factors, with a focus on smokers, permanent employment and night shift work.

The combined effect of physical, psychosocial/organisational and/or environmental risk factors on the presence of work-related musculoskeletal symptoms and its consequences.

This study assessed the combined effect of physical and psychosocial/organisational and/or environmental factors on the presence of musculoskeletal symptoms (MSS) and its consequences (reduced activities and absenteeism due to MSS) in a random sample of 3003 workers in New Zealand. By telephone interview, participants reported their current workplace exposures and MSS (neck/shoulder, arm/elbow, wrist and low back) and its consequences. Data were analysed using multivariable logistic regression. Combined exposure to physical and psychosocial/organisational and/or environmental factors increased the odds of MSS in the neck/shoulder (OR 3.14, 95% CI 1.79-5.52), arms/elbow regions (OR 4.14, 95% CI 2.21-7.76) and low back (OR 1.74, 95% CI 1.28-2.37) and its consequences, i.e. reduced activities due to neck/shoulder symptoms (OR 5.45, 95% CI 2.28-13.00), absenteeism due to neck/shoulder symptoms (OR 5.19, 95% CI 2.24-12.01) and absenteeism due to low back symptoms (OR 4.37, 95% CI 2.92-6.53). In contrast, favourable psychosocial/organisational work conditions reduced the odds of wrist symptoms due to poor physical work conditions (OR 2.19, 95% CI 1.44-3.34). We conclude that to reduce MSS and its consequences, employers need to adopt a multifaceted approach: concentrate on improving physical conditions as well as the psychosocial/organisational and environmental aspects of the working environment.

Prevalence of low back symptoms and its consequences in relation to occupational group.

BACKGROUND: The purpose of this study was to examine: (1) the prevalence of low back symptoms (LBS) and its consequences (reduced activities and absenteeism); (2) the association between occupational group and LBS; and (3) the association between LBS and its consequences. METHODS: A self-administered questionnaire was used to determine the prevalence of LBS in 1,294 Indonesian coal mining workers. A Cox proportional hazards model was developed to quantify the 12-monthly hazard of LBS. Logistic regression models were developed to identify risk factors for reduced activity and absenteeism from the workplace. RESULTS: The 12-month period prevalence for LBS, reduced activities, and absenteeism were 75%, 16%, and 13%, respectively. The 12-monthly hazard of LBS for blue-collar workers was 1.85 (95% CI: 1.06-3.25) times that of white-collar workers. LBS and smoking increased the risk of reduced activity and absenteeism. CONCLUSIONS: Indonesian coal mining workers have a high prevalence of LBS. The findings imply that efforts to reduce LBS and in the workplace should focus on blue-collar workers. For smokers who report reduced activities and/or absenteeism, there should be a focus on rehabilitation and/or return-to-work programs.

Gender differences in work-related risk factors associated with low back symptoms.

The prevalence of low back symptoms (LBS) in many working populations is high and differences in prevalence between genders are inconsistent. However, gender-specific risk factors for LBS have seldom been examined. Hence, the aim of the present study was to indicate gender-specific LBS risk factors. A sample of 3003 people was interviewed by telephone to get information about current workplace exposure and LBS. The risk of LBS for the whole population increased with work in awkward/tiring positions (OR 1.37, 95% CI 1.12-1.68) and very/extremely stressful jobs (OR 1.46, 95% CI 1.05-2.03). None of the explanatory variables were significantly associated with LBS for males but working in awkward/tiring positions (OR 1.51, 95% CI 1.04-2.20), dissatisfaction with contact and cooperation with management (OR 1.68, 95% CI 1.02-2.78) and finding their job to be very/extremely stressful (OR 2.27, 95% CI 1.46-3.52) were significantly associated with LBS for females. Interventions to reduce LBS in workplaces should focus on reducing working in awkward/tiring positions, improving contact and cooperation with management, and reducing stressful jobs, especially amongst females. PRACTITIONER SUMMARY: Strategies to prevent or reduce LBS should focus on reducing exposure to awkward or tiring positions at work, improving contact and cooperation with management, and reducing stressful jobs, especially for females.

Raising awareness of psychosocial factors in the occurrence of low back symptoms in developing countries.

Although there is strong evidence that single physical, psychosocial and organisational risk factors are each independent predictors of low back symptoms (LBS), little is known about their combination/interaction, particularly in those working in developing countries. A total of 1294 Indonesian coal mining industry workers reported information about physical, psychosocial, and organisational factors using self-reported questionnaires and were placed into one of four combination exposure groups: 1) high physical (working with bent trunk; whole body vibration exposure; lifting) and high psychosocial (high effort; low reward; work stress), 2) high physical and low psychosocial, 3) low physical and high psychosocial, and 4) low physical and low psychosocial (as the reference group). The odds of LBS in the high physical and high psychosocial group was 5.15 times (95% confidence interval 2.69-9.86) that of the reference group. Psychosocial factors played a more important role than physical factors in increasing the likelihood of reporting LBS. Permanent and night shift workers were more likely to report LBS. These findings imply that efforts to reduce LBS in this workplace should address both psychosocial and physical factors but psychosocial factors should be the priority, with a special focus on permanent and night shift workers.

How to use programme theory to evaluate the effectiveness of schemes designed to improve the work environment in small businesses.

Due to the many constraints that small businesses (SBs) face in meeting legislative requirements, occupational health and safety (OHS) regulatory authorities and other OSH actors have developed programmes which can reach out to SBs and motivate and assist them in improving the work environment. A number of conceptual models help to enhance our understanding of OHS interventions in SBs and their effectiveness. However, they have mainly been evaluated on output rather than the process relating to the change theory underlying the intervention, and hence have seldom been rigorously evaluated. Thus little is known about how particular features of SBs can be taken into account when designing and implementing national programmes. This paper shows how realist analysis and programme theory may be used as a framework for evaluating, developing and improving national intervention programmes for the improvement of the work environment and reducing injuries in SBs. It illustrates this for a specific New Zealand intervention: the Workplace Safety Discount scheme and its implementation in the agriculture sector. In practice, realist analysis should be performed during the planning, implementation and management stages so that ongoing findings can be fed back to the participant social actors to help them make appropriate changes to enhance the likelihood of success.

Could mild hypoxia impair pilot decision making in emergencies?

The decreased pressure in the cabin of a pressurised aircraft (typically equivalent to ~8000 ft) reduces the oxygen level so that the blood oxygen saturation of all occupants falls from >97% (normoxia) at sea-level to below 92% (mild hypoxia). Although exposure to mild hypoxia does not affect well-learned cognitive and motor performance of aircrew, it has been proposed that it can affect the performance of some complex cognitive performance tasks involving multiple demands typical of emergency tasks that may have to be performed by pilots. In order to simulate some of these complex cognitive demands, 25 student volunteers participated in an experiment which assessed performance of complex logical reasoning and and multiple memory tasks before and after 2 hours of exposure to normoxia and mild hypoxia. Performance for the more difficult components of the complex reasoning task, especially involving conflict decisions, were marginally significantly degraded by mild hypoxia. Since the effects were only marginally significant future studies should investigate the effects of mild hypoxia on more subtle complex decision-making tasks.

Prevalence and work-related risk factors for reduced activities and absenteeism due to low back symptoms.

Although quite a lot is known about the risk factors for low back symptoms (LBS), less is known about the risk factors for the consequences of LBS. A sample of 3003 men and women randomly selected from the New Zealand Electoral Roll, were interviewed by telephone about self reported physical, psychosocial, organizational, environmental factors and the consequences of LBS (i.e. self-reported reduced activities and absenteeism). The 12-month period prevalence of reduced activities and absenteeism were 18% and 9%, respectively. Lifting (OR 1.79 95% CI 1.16-2.77) increased the risk of reduced activities. Working in awkward/tiring positions (OR 2.11 95% CI 1.20-3.70) and in a cold/damp environment (OR 2.18 95% CI 1.11-4.28) increased the risk of absenteeism. Among those with LBS, reduced activities increased with working in a hot/warm environment (OR 2.14 95% CI 1.22-3.76) and absenteeism was increased with work in awkward/tiring positions (OR 2.06 95% CI 1.13-3.77), tight deadlines (OR 1.89 95% CI 1.02-3.50), and a hot/warm environment (OR 3.35 95% CI 1.68-6.68). Interventions to reduce the consequences of LBS should aim to reduce awkward/tiring positions, lifting and work in a cold/damp environment. For individuals with LBS, additional focus should be to reduce tight deadlines, and work in hot/warm environments.

Risk factors associated with back pain in New Zealand school children.

This study investigated risk factors associated with back pain in 245 New Zealand intermediate school children aged 11-14 years in a cross-sectional survey, using a self-completion questionnaire for demographic details, pain prevalence, psychosocial parameters, school and leisure activities and family characteristics. The strongest relationships were between back pain and common childhood complaints (stomach ache, headache and sore throats) (p < 0.01) and psychosocial factors (conduct and hyperactivity) (p < 0.01). For physical factors, there was a significant relationship between neck and low back pain and attributes of chairs. Low back pain was significantly related to low desk height (as reported by students) (p < 0.05). School bag weight was not significantly related to low back pain but carrying the bag on one shoulder was (p < 0.05). It is concluded that, amongst these intermediate school children, psychological, social and emotional factors had a stronger relationship with back pain than physical factors. STATEMENT OF RELEVANCE: This study investigated risk factors associated with back pain amongst New Zealand intermediate school children. It showed that psychological, social and emotional factors may have a stronger relationship with back pain than physical factors.

The prevalence and characteristics of back pain among school children in New Zealand.

A cross-sectional survey among 245 children was conducted to establish the prevalence and characteristics of back pain in school children aged 11-14 years. A self-complete questionnaire was used to ascertain demographic details, pain prevalence, psychosocial parameters, school and leisure activities and family characteristics. In the last month, 58% of children had experienced spinal pain. In total, 31% of children reported that pain occurred in one part of the back, while 28% stated that pain presented in more than one spinal region. Pain in the last month was found to be equally prevalent in the low back (35%) and neck (36%) regions. Low back pain was associated with the most severe pain and pain lasting for the longest duration when compared with the upper back and neck regions. Further research should be directed towards investigating pain in the neck region and understanding the characteristics of symptom co-occurrence. STATEMENT OF RELEVANCE: A survey was conducted to establish the prevalence and characteristics of back pain in school children. The results provide additional evidence that back pain is a serious problem in children aged 11-14 years, whilst also indicating widespread co-occurrence of pain in the neck, upper back and lower back spinal regions.