Objective To classify paediatric chronic pain referrals in Ireland using the ICD-11 classification. In addition, differences between primary and secondary pain groups were assessed. Methods Retrospective review of complex pain assessment forms completed at the time of initial attendance at paediatric chronic pain clinics in Dublin, Ireland. Patients were classified as having a chronic primary (CPP) or chronic secondary (CSP) pain condition as per ICD-11 classification. Secondary analysis of between-group and within-group differences between primary and secondary pain conditions was undertaken. Results Of 285 patients coded, 123 patients were designated as having a CPP condition (77% of which were assigned an adjunct parent code) and 162 patients as having a CSP condition (61% of which were assigned an adjunct parent code). Between-group comparisons found that the lowest reported pain scores were higher in CPP than CSP conditions. In the CSP group, there were stronger correlations between parental pain catastrophizing and pain intensity, school attendance, and pain interference with social activities, than in the CPP group. Conclusions The majority of children with both CPP and CSP were assigned multiple parent codes. There appears to be a gradient in the differences in biopsychosocial profile between CPP and CSP conditions. Additional field testing of the ICD-11 classification in paediatric chronic pain will be required.

No abstract

Changes to the present age policy of cervical screening are currently under consideration. We conducted a retrospective matched case-control study and cost analysis study to identify risk factors for the development of an abnormal smear after age 50 and to determine the impact of age-restricted cervical screening on the annual cost of the screening program. All women (229) from an 11-year birth cohort who developed an abnormal smear at age 50 or over were age-matched for two controls with negative smears. Routine screening smears taken between age 48 and 52 were tested for human papillomavirus (HPV) subtypes 16 and 18. Epidemiologic data were collected by postal questionnaire. Changes in costs under a policy of HPV testing and age-restricted screening were assessed. We found that HPV 16 status was the only independently significant risk factor for abnormal cytology after age 50 with an odds ratio of 10.26 (95% CI 1.25–84.11). A policy of early withdrawal from screening at age 50 on the basis of HPV testing would produce net cost savings. These findings suggest that HPV testing could be a valuable means of identifying the small proportion of women still at risk after 50, and of releasing health care resources.

No abstract

The model of language suggested by James Britton which is represented at its simplest by the diagram Participant----------------Spectator Transactional expressive Poetic ha> for some time been one of those notions with which teachers interested in language are vaguely familiar, but which, I suspect, is not often seen as a useful weapon in the teacher's armoury.'. . . approach to meaning restores experience In different form . . .' wrote T. S. Eliot, and, because I do think that this way of considering language use really can be of prxtical help to teachers at all levels of education, I want to show in 'different form' some of the theoretical views that underlie the model, to give a personal in:crpretation of it and of its uses, and also, tentatively, to suggest a slightly diii'erent way of formulating it. By showing how I adapt it in my own mind, I h(:pe to encourage others to bring it close to their own ways of viewing language, arid even, if it seems useful, to modify its formulation still further.James Britton developed the model in the form above in the course of ccliisidering what kinds of writing are demanded in schools, how useful to the lexning process school writing is and-to help in making such writing more pi1 rposeful-how we can first categorize and then evaluate it.'That explanation is over-simplified. At the same time, Britton was pursuing v;; rious trains of thought that would ultimately be brought together in Language mid Learning'; and both he and the colleagues working with him on aspects of w:-iting research were, from the earliest days, inevitably concerned with the spoken as well as with the written language.The model has become immensely influential at the theoretical level. Very few articles or books in the field published recently in Britain have not acknowledged some debt to it. Partly, of course, this has been because Britton a i d his successive 'teams' at the London University Institute of Education were for many years the chief activists in the development of truly 'secondary' level studies in English. But the model has a much wider influence than through the Britton 'school', if the gradually changing groups at the Institute can be described in that way. In Britton, we have an original mind, of the sort, rare in airy one generation, which synthesizes current ways of thinking about some subject of central importance into a form useful in a practical way to those who h%ive not studied its theoretical background-useful, that is, to those whom H alliday, McIntosh and Strevens2 describe as the third stratum of students-tLose who actually teach the subject at primary and secondary level.As is always the case with well-found, elegantly neat formulations, the model dcm run several risks. Its employment to by-pass active thinking cannot be piwented-but, at least, competent users will do no harm with it as it does not