Low back pain in Australian adults: the economic burden.

This paper reports the results of a "cost-of-illness" study of low back pain (LBP) in Australian adults. It estimates the direct cost of LBP in 2001 to be AU dollars 1.02 billion. Approximately 71% of this amount is for treatment by chiropractors, general practitioners, massage therapists, physiotherapists and acupuncturists. However, the direct costs are minor compared to the indirect costs of AU dollars 8.15 billion giving a total cost of AU dollars 9.17 billion. LBP in Australian adults represents a massive health problem with a significant economic burden. This burden is so great that it has compelling and urgent ramifications for health policy, planning and research. This study identifies that research should concentrate on both direct but particularly the indirect costs including cost-effective management regimes that encourage an early return to duties.

Causes of admission of African patients to Gelukspan Hospital, North West Province, South Africa.

An enquiry has been made into the causes of admission in 1994 of African patients to Gelukspan Hospital, North West Province, South Africa. The study concerned 3791 patients of whom 3533 (93.2%) were classifiable. Two groups were not included in this number, namely, 1584 'lodgers' (e.g. mothers of infants), and 1868 females admitted for normal pregnancy. Of the 3533 patients, 940 (26.6%) were aged 14 years and younger; 545 (58.0%) these were boys and 395 (42.0%) were girls. The main causes of their admission were pneumonia, gastroenteritis, trauma, poisoning, and infections. Of the 2593 adults, 1418 (54.7%) were males and 1175 (45.3%) females. Among males, chief causes were pulmonary tuberculosis, trauma and accidents, congestive cardiac failure, psychosis, cancer and diabetes. Of the females, chief causes were pulmonary tuberculosis, trauma and accidents, pregnancy related disorders, gastroenteritis, anaemia and pneumonia. Regarding other diseases, 4.5% of adults were admitted for cancer, and 1.8% for diabetes. The general pattern of admissions is similar to that reported in other rural hospitals. The causes of admissions are discussed, regarding; (i) public health improvements occurring, and (ii) means of promoting further improvements by community self-help, and by help from State health and other services.

Assessment of back pain. Part II--clinical examination.

A review of the important aspects of physical examination of the patient with back pain in a chiropractic setting are presented.

Assessment of back pain. Part I--the history.

A review of the important points of history taking in chiropractic practice for back pain are presented.

Body image and eating behaviour in interethnic adolescent girls.

Reports of major dissatisfaction among adolescent girls over body shape and their associated eating behaviour, prompted determining anthropometric and questionnaire studies on series of rural and urban black, Indian, and white girls aged 14-19 years. Variables were concern over weight, desired weight loss, also practices regarding binge eating, fasting, vomiting and laxative use. Black girls have low weight-for-age, yet experience more obesity than white girls; yet weight reduction, although desired, is seldom seriously attempted. Indian girls have low weight-for-age, principally for genetic, not social class, reasons; they also, even some underweight, desired weight reduction. White girls are also dissatisfied, although less acutely than girls in the US. The current attitudes of South African adolescent girls, apart from extremes, are unlikely to seriously prejudice their health.

Obesity in indigent elderly rural African women: effects on hypertension, hyperlipidaemia and hyperglycaemia.

To learn more of the sequelae of obesity in South African elderly rural indigent black women (aged 58-85 years), studies were made on 40 women with BMI greater than or equal to 30, and on 50 non-obese women with BMI of 25 or less, all in outward good health. In the two groups, hypertension (greater than or equal to 160/95 mm Hg) was present in 9 and 5 women (22% and 10%), hypercholesterolaemia (greater than or equal to 5.2 mmol/l) in 28 and 26 women (70% and 52%), hypertriglyceridaemia (greater than or equal to 1.8 mmol/l) in 20 and 16 (50% and 32%), and hyperglycaemia (greater than or equal to 6.7 mmol/l) in 8 and 7 women (20% and 14%). Differences between the obese and non-obese attained significance with blood pressure and serum lipids (P less than 0.01), although not with blood glucose. Both groups were habituated to a low fat high fibre diet. In this context, obesity appeared less evocative of adverse sequelae than prevails in a white population. However, for appropriate validation, longitudinal studies are required.

Growth of South African Indian schoolchildren in different social classes.

The height and weight of 4594 Indian schoolchildren aged 6 to 17 years, in Durban, South Africa, were measured at schools selected by inspectors as representative of upper, intermediate, and lower socio-economic populations. Significant superiority, anthropometrically, prevailed at all ages in upper compared with lower or poor-class children, but tended to lessen at 17 years. In the affluent group, in the age period studied the proportions under the 5th percentile of USA NCHS reference values were--concerning height-for-age 4.7% to 22.0% of boys and 5.0% to 20.7% of girls; and concerning weight-for-age, 20.3% to 45.0% of boys and 9.3% to 37.7% of girls. In the affluent group, at full growth at 17 years, means of height and weight were highly significantly lower, namely, roughly by 7cm and 10kg, compared with respective mean values given in USA reference values. Hence, in Indian schoolchildren a genetic factor, and not dietary inadequacy, appears primarily responsible for both slower post-pubertal growth and lower ultimate height attainment.

School nutrition programmes--do they fulfil their purpose?

School meals in the USA have been in operation for half a century, yet no associated benefits have been claimed, apart from a slight increase in weight-for-age. In the UK, Netherlands and other European countries, associated benefits have been slight or scarcely apparent. In developing populations, school meals, although little practised, appear less beneficial than expected. In western populations evaluations have been entirely incommensurate with extent and cost of the practice, for, largely, only assessments of dietary intake and anthropometric parameters have been studied. There has been insufficient enquiry into which intakes of nutrients, and which percentiles of growth standards, relate most meaningfully to scholastic prowess, biochemical and clinical parameters in youth, and health experience in later years. Since school meals, a highly emotional subject, are strongly bound up with national agriculture, and clearly are unlikely to discontinue, the authors consider that attempted modifications should be in line with current recommendations of authoritative dietary bodies, i.e. to encourage reduction in fat intake and an increased intake of fibre-containing foods.

Knowledge of nutrition among housewives in three South African ethnic groups.

Studies on housewives and other groups in Western populations have revealed: (i) a generally high level of claimed or "perceived' knowledge of nutrition; (ii) a much lower level of accurate knowledge; and (iii) an often unsatisfactory application of correct knowledge. Since little is known of knowledge of nutrition in South African populations. White, Indian and Coloured housewives were questioned by use of a questionnaire similar to that used overseas. While the local populations had a fair knowledge of the identity of most nutritional components, their knowledge about good sources of these components and of foods commendable for body building, energy, and slimming, or of those which promote fattening, was only moderately satisfactory. Misconceptions were similar to those reported elsewhere. Factors having a bearing on inadequate or incorrect information are discussed, as is the extent to which this may affect health and disease patterns in Third World and Western populations. Factors detrimental to progress are differences of opinion among nutrition experts and insufficient knowledge on the health/ill-health patterns of those who are knowledgeable of nutrition compared with those who are less knowledgeable.

Appendicectomy prevalences in South African adolescents.

From questioning 16,939 South African pupils of 16-18 years, in 56 high schools, mean prevalences of appendicectomies in representative segments of ethnic groups were found to be: rural Blacks 0.6%; urban Blacks 0.7%; Indians, 2.9%; Coloureds (Eur-African-Malay), 1.7%; Whites, 10.5%. Percentages in the sexes were similar. Only those of Indian and Coloured pupils appear to be increasing. Blacks and Whites, respectively, have high and low intakes of fibre-containing foods, which are negatively correlated with appendicectomy prevalences. However, although intakes of fibre-containing foods are slightly higher in Indians and Coloureds than in Whites, the former's appendicectomy prevalences are lower than would be dietarily expected.

Tonsillectomy prevalences in South African schoolchildren.

Tonsillectomy prevalences, using questionnaires, were determined on series of school pupils (total number 10,271), aged 16-18 years, in four South African ethnic groups. Prevalence were, approximately: rural Blacks 2%, urban Blacks 3%, Indians 8%, Coloureds (Eur-African-Malay) 9% and Whites 44%. The inter-ethnic profile of differences is similar to the inter-ethnic profiles of other differences (e.g. in appendicectomy prevalences).