High Prevalence of Hypermobility and Benign Joint Hypermobility Syndrome (BJHS) in Oman

PURPOSE: To ascertain the prevalence of hypermobility and BJHS in a female patient population with musculoskeletal pain and compare the associated features with a pain free control group. RELEVANCE: Hypermobility is linked with increased musculoskeletal signs and symptoms. The existence of hypermobility with pain may indicate the presence of BJHS, which is a heritable connective tissue disorder synonymous with Ehlers-Danlos type III. Hypermobility is known to be race dependant with Asians and Africans being more hypermobile than Caucasians. The fragility of tissues in those with BJHS makes them more vulnerable to pain associated with soft tissue overuse injuries, traumatic synovitis, sprains and recurrent shoulder dislocations (Grahame 2000; Grahame et al 1981; Finterbush and Pogund 1982) it is also associated with delayed tissue healing, impaired proprioception (Mallik et al 1994; Hall et al 1995) and chronic pain. (Harding and Grahame 1990) PARTICIPANTS: 94 Female Omani patients with musculoskeletal pain attending the rehabilitation department outpatient clinics of the Khoula Hospital aged 18–50 were examined. 90 controls of the same age were recruited from the female Omani hospital staff. METHODS: All patients and controls were examined and questioned by one physiotherapist (CC), who had received training from a rheumatologist (RG) in clinical examination of patients at the hypermobility clinic, University College Hospital, London. Patients and controls were examined using the Beighton score and Brighton Criteria. ANALYSIS: Analysis was by χ2 for number of individuals and t-test for joint mobility scores. (Excel® 2002) RESULTS: 51% of patients were found to be hypermobile as opposed to 30% of controls (p = 0.015). 55.3% of patients had features of BJHS as opposed to 21.1% of controls. (p ≤ 0.0001). Significantly more patients presenting with knee pain had BJHS (p = 0.02). There was a non-significant trend for patients with BJHS to re-attend the out patient clinics (p= 0.06). CONCLUSIONS: This study established that this patient population was significantly more hypermobile than a control population. The incidence of BJHS in patients in this study was higher than that noted amongst female Caucasians, but similar to non Caucasians attending rheumatological clinics in the UK. (Grahame and Hakim 2004). Further epidemiological studies are required in other populations to look at patient re-attendance in musculoskeletal clinics and more specifically for those presenting with back and knee pain. IMPLICATIONS: Better recognition and awareness of hypermobility and BJHS will enable patients to receive treatment programmes, modified to take into account tissue fragility, hypermobile joints, impaired proprioception and chronic pain. KEYWORDS: Hypermobility, Pain, Joints. FUNDING ACKNOWLEDGEMENTS: No funding. Jane Simmonds, UCL supervising team, Professor R. Grahame and Dr. A. Hakim from the Hypermobility clinic UCH, London, Professor H. Holmberg, Khoula Hospital Director, Samia Al Marjeby head of rehabilitation, the staff and patients of Khoula Hospital, Muscat, Oman. CONTACT: [email protected] ETHICS COMMITTEE: Khoula Hospital Ethics committee, Khoula Hospital, Muscat, Oman (12/11/2003

Changing Consumption, Changing Consumers: An Analysis of Changing Food Consumption in Southern Italy in the Mid-twentieth Century

Italy’s “Economic Miracle” is often perceived as a time of change in living conditions as accelerating economic development led to more affluent lifestyles. Such changes are thought to have been reflected in what people ate and how they thought about food. While the post-World War Period has been identified as a time of radical improvements in living conditions and expectations, we can question the assumption that this was a one-way, sudden process whereby new consumer ideals simply superseded previously held values and behaviours. This paper identifies the impact of these changes on food consumption in the Amalfi Coast in the period 1945-1960. These changes may have influenced the homes in which people lived, what they did during leisure time, and what they ate, on an everyday level. It is clear, however, that pre-existing socio-economic conditions, and geographical and cultural factors, shaped both the extent to which new patterns of consumerism were adopted and the ways in which new behaviours and attitudes were worked into daily life in the area. Using information drawn from interviews conducted with inhabitants of the Amalfi Coast, this paper explores changing patterns of food consumption by assessing how food habits and traditions were directly influenced by the physical landscape, and this framed the reception of new ideas, as well as the ways by which new products were introduced into peoples’ lives and changed them in the process. The paper argues that the purchase and integration of consumable and durable items were not influenced solely by the physical possibility of buying something, but also by an element of local acceptance of the product and an understanding of how it might be integrated into daily life - factors that were constantly being negotiated with pre-existing socio-economic habits and wider cultural influences

School Based Decision Making

The 1989 Task Force on Education Reform adopted 12 systemic principles used in drafting the 1990 Kentucky Education Reform Act (KERA). One of the principles formed the basis for School Based Decision Making (SBDM). It stated: School accountability and school-based authority are two intertwined parts of the same proposition (Foster, 1999; Task Force on Education Reform, 1989, p. 2). In other words, once the Task Force selected schools as the unit for the commonwealth\u27s new accountability and assessment system, the General Assembly agreed that schools should have statutory authority to plan and make policy addressing achievement of accountability goals. The legislation mandating SBDM in conjunction with KERA\u27s other systemic features was enacted in 1990 and codified as KRS § 160.345

Teaching and Learning Reform: Curriculum, the Kentucky Department of Education, & The Educational Professional Standards Board

For explanatory purposes, the 1990 Kentucky Education Reform Act (KERA) is generally divided into three major clusters of initiatives: finance, curriculum, and governance. As explained elsewhere in this volume, the systemic complexity of KERA makes any divisions of its initiatives, artificial, and ultimately, insufficient, in describing the decade-old scope of Kentucky’s radical education reforms (Rinehart & Lindle, 1997; Steffy, 1993). For the purposes of this retrospective review of research, this chapter was designed to focus on the very heart of KERA’s purpose, the improvement of teaching and learning. For that reason, this chapter addresses a teaching-learning-oriented KERA initiative, curriculum, and the development and reorganization of two state agencies primarily involved in teaching and learning, the Kentucky Department of Education (KDE) and the Education Professional Standards Board (EPSB)

A Rhetorical Legacy for Leadership: Humor .

This article treats humor as one of the rhetorical arts which educational leaders must possess to facilitate problem solving among teachers, students, and parents

Research in Brief: Shared Decision Making Enhances Instructional Leadership

A study of three middle school principals about their instructional leadership activities before and after the establishment of shared decision making revealed an enhancement of leadership. The nature of the middle school teacher\u27s role demands participative leadership and communication and decision making revolved around instructional issues

Judicial Interference With the NLRB: Yeshiva University and the Definition of Managerial

On February 20, 1980, the United States Supreme Court, in NLRB v. Yeshiva University, decided that the full-time faculty members of Yeshiva University are managerial employees excluded from the coverage of the National Labor Relations Act. The decision was an affirmation of the Second Circuit Court of Appeals and a rejection of the position taken by the National Labor Relations Board. This paper reviews judicial interference with National Labor Relations Board decision-making generally, comments on the merits of the Yeshiva decision, and assesses the particular significance of the Court\u27s interference with the National Labor Relations Board definition of managerial

Hasn\u27t Anyone Else Done This Right? A Field Note on the Political Realities and Perceptions in Modifying Kentucky\u27s High Stakes Accountability System

This paper is a case study of Kentucky\u27s attempt to fix not only failing schools but a failing public school system. It reports on the policy making and implementation conundrums of the debate over Kentucky\u27s high stakes accountability system. As a political policy analysis, the study relies on documents, media reports, and interviews with key players to expand understanding of the issues. The paper reports primary and secondary focus group and interview data from a variety of professional educators and parents. The combined frameworks of political culture and authentic policy perspectives are useful for depicting the story of Kentucky\u27s debate over accountability and assessment. Political culture emerges as a defining influence on Kentucky\u27s educational accountability debate. What becomes of assessment and accountability in Kentucky remains to be seen, but it is apparent that fixing failing schools has enormous political overtones. However, the power of professional culture must not be underestimated in this equation. An appendix contains the statement of principles from the Kentucky Task Force on Education Reform