Study Design. A prospective cohort study was conducted on workers claiming earnings-related compensation for low back pain. Information obtained at the time of the initial claim was linked to compensation status (still claiming or not claiming) 3 months later.Objective. To identify individual, psychosocial, and workplace risk factors associated with the transition from acute to chronic occupational back pain.Summary of Background Data. Despite the magnitude of the economic and social costs associated with chronic occupational back pain, few prospective studies have investigated risk factors identifiable in the acute stage.Methods. At the time of the initial compensation claim, a self-administered questionnaire was used to gather information on a wide range of risk factors. Then 3 months later, chronicity was determined from claimants' computerized records.Results. The findings showed that 3 months after the initial assessment, 204 of the recruited 854 claimants (23.9%) still were receiving compensation payments. A combined multiple regression model of individual, psychosocial, and workplace risk factors demonstrated that severe leg pain (odds ratio [OR], 1.9), obesity (OR, 1.7), all three Oswestry Disability Index categories above minimal disability (OR, 3.1-4), a General Health Questionnaire score of at least 6 (OR, 1.9), unavailability of light duties on return to work (OR, 1.7), and a job requirement of lifting for three fourths of the day or more all were significant, independent determinants of chronicity (P Ͻ 0.05).Conclusions. Simple self-report measures of individual, psychosocial, and workplace factors administered when earnings-related compensation for back pain is claimed initially can identify individuals with increased odds for development of chronic occupational disability. Low back pain is recognized as the leading cause of occupational injury in developed countries. 1,25 There is strong evidence, however, that approximately 10% of the cases cause more than 80% of the cost for low back pain because of their chronicity. 26,36,41 At this writing, most research efforts have been directed at investigating risk factors for the incidence or reporting of acute back pain. 9,16,19,31,33,40,42 Unfortunately, the findings have not been consistent, probably because of difficulties dissociating occupational back pain from the underlying high incidence of low back pain found in any general community. Inconsistency in the findings also can be attributed to differences in the range of risk factors or occupational groups chosen for investigation. Primary prevention of occupational back pain injury remains elusive and possibly unattainable to any significant degree. 8 Risk factors associated with the transition from acute to chronic back pain differ from those associated with the incidence or reporting of back pain. 6,8,18,21,28,29,36,38 In contrast to acute back pain, individual 41 and psychosocial factors 9,21 are hypothesized to be more highly associated with chronic back pain than objective physical or biomecha...

Identification of child abuse by mental health services is important for formulation of the causes of presenting problems and for development of comprehensive treatment plans. A small but growing number of studies suggest, however, that the majority of child sexual abuse cases are not identified by mental health services. A similarly small literature also suggests that abuse survivors are extremely reluctant to spontaneously tell anyone about the abuse, indicating that professionals have a responsibility to ask rather than wait for spontaneous disclosures. The purpose of this study, therefore, was to add to these two bodies of literature with a New Zealand sample. A postal questionnaire was completed by 191 women who had received counselling for childhood sexual abuse. The average amount of time taken to tell anyone about the abuse was 16 years. Only 22% of those who had been in contact with public mental health services had ever been asked about abuse by those services. It was concluded that New Zealand women are reluctant to disclose abuse and that mental health services are, as is the case elsewhere, failing to assist them with this process. The need for staff training is discussed, and an example described.

Objective-To describe the long term eVectiveness of a community based program targeting prevention of burns in young children. Design-Quasiexperimental. Setting-The Norwegian city of Harstad (main intervention), six surrounding municipalities (intervention diVusion), and Trondheim (reference). Participants-Children under age 5 years in the three study populations. Methods-Outpatient and inpatient hospital data were coded according to the Nordic system, and collected as part of a national injury surveillance system. Burn data collection started in May 1985. The first 19.5 months of the study provided baseline data, while the last 10 years involved community based intervention, using a mix of passive and active interventions. Results-The mean burn injury rate decreased by 51.5% after the implementation of the intervention in Harstad (p<0.05) and by 40.1% in the six municipalities (not significant). Rates in the reference city, Trondheim, increased 18.1% (not significant). In Harstad and the six surrounding municipalities there was a considerable reduction in hospital admissions, operations, and bed days. Interventions with passive strategies were more eVective, stove and tap water burns being eliminated in the last four years, while active strategies were less eVective. Conclusions-A program targeting burns in children can be eVective and sustainable. Local injury data provided the stimulus for community action. (Injury Prevention 1998;4:176-180)

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