How to make a workplace health promotion questionnaire process applicable, meaningful and sustainable.

BACKGROUND: In workplace health promotion, a questionnaire could be of great use. Unfortunately, fatigue regarding answering questionnaires has recently become greater than before. An action research approach could be a possible way of increasing employee participation. AIM: This study reports an attempt to explore key aspects for participation in, and commitment to, a workplace health promotion questionnaire process. METHOD: The study was conducted at two wards in a Swedish hospital. Data was collected during an action research process. Data were analysed with regard to a framework of questions. FINDINGS: The three key aspects for participation in, and commitment to, a workplace health promotion questionnaire process were: an applicable questionnaire, a meaningful questionnaire process and a continuous and sustainable questionnaire process. A structure is presented as practical advice to managers, describing how such a process could be established to be applicable, meaningful and sustainable. CONCLUSION: This study has identified key aspects and prerequisites for questionnaire processes. The prerequisites - share decision-making, involve a core group and follow a structure - are discussed and proposed for managers and workgroups to consider in further workplace health promotion questionnaire processes. IMPLICATIONS FOR NURSING MANAGEMENT: The key aspects and prerequisites presented could provide a stimulating standpoint or advice, useful for planning and accomplishing workplace questionnaire processes.

Increased serum uric acid--a marker of non-gouty widespread pain? A study of female patients with inflammatory and non-inflammatory pain.

OBJECTIVE: To study the relationship between reported chronic pain and the level of serum urate (SU) among women with various diagnoses of the musculoskeletal system. METHODS: Consecutive female patients (aged 20-70 years, n = 124), at rheumatology and rehabilitation practices, with chronic musculoskeletal pain of different origins were followed for 1 year after an initial survey of pain, lifestyle, quality of life, and disability. Repeated blood samples (including urate, creatinine, cholesterol, and glucose) were analysed. Multiple regression analysis was performed to explain initial variations in SU level in relation to pain and confounding factors. RESULTS: The level of SU was increased among individuals with widespread pain (>5 locations) independent of underlying diagnoses compared to those with fewer pain sites (270.5 vs. 241.2 micromol/L). Serum creatinine, body mass index (BMI), the number of pain locations, and sleep disturbances independently contributed to the SU level and explained 43% of the variation in SU. Individual variation in SU during 4 months was low. CONCLUSIONS: Epidemiological data on the relationship between the extent of body pain and SU were confirmed in a clinical setting. Besides known factors such as impaired renal function and obesity, widespread pain and sleep disturbances were related to an increase in SU. Medication and alcohol intake could not explain the findings. Longitudinal studies are necessary to elucidate whether the level of SU has any implications for the prognosis of chronic pain.

Effects of surface irregularities on flow resistance in differently shaped arterial stenoses.

The combined influence of an asymmetric shape and surface irregularities has been explored in a computational study of flow through arterial stenoses with 48% areal occlusion. Contrary to the conclusion of an earlier investigation, namely that the resistance to laminar flow through a stenosed artery is being reduced in the presence of surface irregularities, the present predictions demonstrate that the flow resistance is practically unaffected by surface irregularities at low Reynolds numbers, whereas an excess pressure drop up to 10% above that for a smooth stenosis is observed for higher Reynolds numbers. For a given areal occlusion, the flow resistance is reduced with increasing degree of stenosis asymmetry and this effect may more than outweigh the influence of surface irregularities. This effect is moreover prevailing throughout the entire range of Reynolds numbers considered.

Impact of chronic pain on health care seeking, self care, and medication. Results from a population-based Swedish study.

STUDY OBJECTIVE: To explore individual and social factors that could predict health care utilisation and medication among people with chronic pain in an unselected population. DESIGN: A mailed survey with questions about pain and mental symptoms, disability, self care action, visits to health care providers, and medication. SETTING: General populations in two Swedish primary health care (PHC) districts. Medical care was given in a state health system. PARTICIPANTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1806). MAIN RESULTS: Among people reporting chronic pain 45.7% (compared with 29.8 of non-chronic pain persons, p < 0.05) consulted a physician and 7.2% (compared with 1.2%, p < 0.05) a physiotherapist during three months. Primary health care was the most frequent care provider. High pain intensity, aging, depression, ethnicity, and socioeconomic level had the greatest impact on physician consultations. Alternative care, used by 5.9%, was associated with high pain intensity and self care. Use of self care was influenced by high pain intensity, regular physical activity, and ethnicity. Alternative care and self care did not imply lower use of conventional health care. Women reporting chronic pain consumed more analgesics and sedatives than corresponding men. Besides female gender, high pain intensity, insomnia, physician consultation, social network, and self care action helped to explain medication with analgesics. Use of herbal remedies and ointments correlated to self care action, visit to an alternative therapist, high pain intensity, and socioeconomic level. CONCLUSIONS: The presence of chronic pain has an impressive impact on primary health care and medication. Various therapeutic actions are common and are partly overlapping. The use of health care among people with chronic pain depends above all on pain perception and intensity of pain but is also affected by ethnicity, age, socioeconomic level, and depressive symptoms. Among people with chronic pain use of analgesics is common in contrast with other types of pain relief (acupuncture, physiotherapy) suitable for treating chronic pain symptoms.

Musculoskeletal chronic pain in general practice. Studies of health care utilisation in comparison with pain prevalence.

OBJECTIVE: To study the relations between population prevalence of chronic pain and pain-related diagnoses (musculoskeletal and headaches) in primary health care (PHC) and to examine longitudinal variations in these diagnoses. DESIGN: A population-based mailed survey to catch prevalence data and continuous computerised diagnosis registration in PHC. SETTING: General population in a well-defined Swedish PHC district. SUBJECTS: A random sample of 15% of the population aged 25-74, n = 1101. Annual visitors to district physicians at the health centre. MAIN OUTCOME MEASURES: Rates of pain-related diagnoses in PHC in relation to population prevalence of chronic pain. Comparisons of the number of individuals (annual visiting rates) with pain-related diagnoses 1987-1996. RESULTS: Population pain prevalence and pain-related diagnoses in PHC corresponded as regards the magnitude and distribution of chronic pain by age and partly by pain location. Compared to low-back and widespread pain, neck-shoulder pain and headaches were less frequent in PHC in relation to reported prevalence. From 1987 to 1996 we found an increasing number of individuals seeking primary care with pain-related diagnoses. The increase was mainly assigned to the groups of fibrositis/myalgia and headache. CONCLUSION: Pain-related diagnoses in PHC reflect partly the occurrence of self-reported chronic pain symptoms in the population. The observed increase in visits with pain-related diagnoses in the last 10 years is due to an increased number of individuals with soft-tissue rheumatism and headaches. Future studies will have to elucidate whether these findings are due to an increase in morbidity or changes in care-seeking and social conditions.

Blood pressure and metabolic factors in relation to chronic pain.

Physical pain is a major trigger for changes in many homeostatic systems of the body physiology. Our aim was to study the relationship between blood pressure, metabolism and pain perception in subjects with chronic pain symptoms. This was undertaken in a population-based study in primary health care, including subjects with widespread pain (n = 16), or localized pain (n = 15), and pain-free controls (n = 14). The main outcome measures were office and ambulatory blood pressure, glucose, insulin, lipids, and beta-endorphin. Subjects with widespread pain were more obese and showed higher levels than controls (p < 0.05) of fasting glucose (4.9 vs 4.5 mmol/l), cholesterol (6.9 vs 5.8 mmol/l) and office systolic blood pressure (133 vs 120 mmHg), while the subjects reporting localized pain had values in-between. Ambulatory blood pressure, insulin and beta-endorphin levels did not differ between the groups. In conclusion, subjects with widespread and/or intense chronic pain have higher BMI, more pronounced metabolic disturbances and higher (office) systolic blood pressure, but not ambulatory blood pressure, than subjects without chronic pain. Future epidemiological studies are needed to test whether this is compatible with increased cardiovascular risk.

Characteristics of subjects with chronic pain, in relation to local and widespread pain report. A prospective study of symptoms, clinical findings and blood tests in subgroups of a geographically defined population.

The relation between reported chronic pain and clinical findings was studied by comparing survey data six months before and eighteen months after a clinical examination. Studied individuals (n = 165) were randomly selected from subsamples of an initial survey (n = 1806) to a general population. Among individuals reporting chronic pain 85% were assessed to have chronic pain at the examination. Diagnoses were found in 22% of examined pain individuals. Myofascial pain syndrome and myalgia were the most common findings. Compared with located neck-shoulder pain, widespread pain had a greater impact on the individual, a worse prognosis regarding pain duration and working capacity, and revealed a raised serum urate level of unclear significance. Although no specific cause of pain is found in individuals with widespread pain it is important to identify and treat this group due to the great effects on functional capacity and the worse prognosis.

The epidemiology of chronic pain in a Swedish rural area.

In order to establish basic epidemiological data on chronic pain (duration > 3 months) in a rural population, a survey of pain symptoms was conducted by means of a postal questionnaire. The questionnaire was sent to a random sample (from the population register) of 15% of the population aged 25-74 (n = 1806) in two Swedish primary health care districts. The response rate was 90%. In a follow-up study individuals selected among the responders (neck-shoulder pain, widespread pain and controls without pain; n = 213) were examined and interviewed. They were requestioned about pain symptoms 24 months after the initial survey. Without sex differences 55% of the population had perceived persistent pain for 3 months and 49% for 6 months. Women experienced more multiple localizations of pain and had pain in neck, shoulder, arm and thigh to a greater extent than men. Prevalence of pain increased by age up to 50-59 years for both genders and then slowly decreased. The neck-shoulder area was the most common site of pain (women 32.9%, men 27.5%). Blue-collar workers and employers (including farmers) reported chronic pain to a greater extent than other groups. In 13% of the population, manifest pain problems were associated with reduced functional capacity. Examination of selected pain groups indicated a high proportion of unspecific musculoskeletal symptoms. Diagnosis with definite definitions, explaining the pains, were found in 40% of the individuals. Individuals with widespread pain had a higher pain intensity, more somatic symptoms, were more depressive and had the lowest scores for quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization.

OBJECTIVE: To establish basic epidemiological data on chronic pain (duration > 3 months) in a defined population. Relationships between age, gender, and social class were tested. DESIGN: A survey of pain symptoms, including location, intensity, duration, and functional capacity, was conducted by means of a mail questionnaire. SETTING: General populations in two Swedish primary health care districts. Medical care was provided in a state health system. SUBJECTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1,806). The response rate was 90%. OUTCOME MEASURES: Descriptive epidemiologic data in relation to objectives of the study. RESULTS: Without sex differences, 55% (95% confidence interval, 53-58%) of the population had perceived persistent pain for 3 months and 49% for 6 months. Among individuals with chronic pain, 90% localized their pain to the musculoskeletal system to a variable extent. Women experienced more multiple localizations of pain and had pain in the neck, shoulder, arm, and thigh to a greater extent than men. Prevalence of pain increased by age up to 50-59 years for both genders and then slowly decreased. The neck-shoulder area was the most common site of pain (30.2%), followed by the lower back (23.2%). Even in the youngest age groups more than one of four reported chronic pain. Blue-collar workers and employers (including farmers) reported chronic pain to a greater extent than other groups. In 13% of the population, manifest pain problems were associated with reduced functional capacity. CONCLUSION: Chronic pain symptoms are common but unevenly distributed in a general population. The results may influence planning and consultation in primary health care as well as warranting selective prevention activities.