Factors related to self-rated health: a survey among patients and their general practitioners.

OBJECTIVE: To explore associations between general practice patients' SRH and symptoms, diagnoses, chronic conditions, unexplained conditions, and life stressors. DESIGN: A cross-sectional study. Data were collected from GP and patient questionnaires. SETTING: General practices in Southeast Norway. SUBJECTS: 47 general practitioners (GPs) who included 866 consecutive patients. MAIN OUTCOME MEASURES: SRH was measured with a single question from the COOP-WONCA overall health chart and dichotomized into good/poor SRH. Binary logistic regression models were used in the analyses. RESULTS: Poor SRH was reported by 48% of the patients in the past week. A higher prevalence of poor SRH was found for women, middle-aged, recipients of social security grants, patients diagnosed with asthenia, lower back pain, and depression/anxiety, and for patients with reported life stressors and unexplained conditions. We found an almost linear association between the number of symptoms and the likelihood of reporting poor SRH. The probability of reporting poor SRH increased along with an increasing number of symptoms for common diagnoses. In a multivariate analysis, the only number of symptoms, being in receipt of social security grants and being retired was associated with poor SRH. CONCLUSION: The likelihood of reporting poor SRH increased with an increasing number of symptoms, partly independent of the diagnosis given by GPs. This result coincides with our previous findings of a strong association between the number of symptoms, function, and health. The symptom burden thus appears to be an important factor for SRH among patients in general practice.KEY POINTSThere is a high prevalence of poor SRH in general practice patients.The likelihood of reporting poor SRH is partly independent of the diagnosis given.The number of symptoms was the factor strongest associated with poor SRH.

Case-specific colleague guidance for general practitioners' management of sickness absence.

BACKGROUND: General practitioners (GPs) report sickness absence certification as challenging. They express need for support with functional assessment beyond guidelines and reforms. Case-specific collegial one-to-one guidance for other clinical topics has proved popular with GPs and may be an acceptable and effective way to improve GPs skills and competence in sickness absence certification. AIMS: To present a new model of case-specific colleague guidance focusing on the management of long-term sickness absence and to describe its feasibility in terms of application and reception among GPs, and also GPs' self-reports of effects on their practice. METHODS: Randomly selected GPs received case-specific collegial guidance over a 12-month period, in two Norwegian trials, delivered by former GPs employed by the social security administration. We measured reception and perceived effects by GPs' self-report and registered participation and withdrawal rates. RESULTS: The participation rate (n = 165) was 94%, and no GPs withdrew during training. Among the 116 GPs responding to the survey (70%), 112 (97%; 95% CI 92-99) stated they would recommend it to their colleagues. Considerable benefit from the guidance was reported by 68 (59%; 95% CI 50-68). The GPs self-reported other effects on their sickness absence certification, specifically an increased use of part-time sickness absence (Fit-Note equivalent). CONCLUSIONS: This model of case-specific colleague guidance to aid GPs' management of long-term sickness absence is feasible and was popular. This type of guidance was perceived by GPs to be somewhat beneficial and to alter their sickness absence certification behaviour, though the true impact requires further testing in controlled trials.

Do physical leisure time activities prevent fatigue? A 15 month prospective study of nurses' aides.

OBJECTIVE: To test the hypothesis that physical leisure time activities reduce the risk of developing persistent fatigue. METHODS: The hypothesis was tested in a sample that was homogeneous with respect to sex and occupation, with a prospective cohort design. Of 6234 vocationally active, female, Norwegian nurses' aides, not on leave because of illness or pregnancy when they completed a mailed questionnaire in 1999, 5341 (85.7%) completed a second questionnaire 15 months later. The main outcome measure was the prevalence of persistent fatigue-that is, always or usually feeling fatigued in the daytime during the preceding 14 days. RESULTS: In participants without persistent fatigue at baseline, reported engagement in physical leisure time activities for 20 minutes or more at least once a week during the three months before baseline was associated with a reduced risk of persistent fatigue at the follow up (odds ratio = 0.70; 95% confidence interval 0.55 to 0.89), after adjustments for age, affective symptoms, sleeping problems, musculoskeletal pain, long term health problems of any kind, smoking, marital status, tasks of a caring nature during leisure time, and work factors at baseline. CONCLUSION: The study supports the hypothesis that physical leisure time activities reduce the risk of developing persistent fatigue.

Work factors as predictors of intense or disabling low back pain; a prospective study of nurses' aides.

AIMS: To identify the work factors that predict intense low back pain (LBP) and LBP related sick leaves in nurses' aides. METHODS: The sample comprised 4266 randomly selected Norwegian nurses' aides, not bothered or only a little bothered by LBP during the previous three months, and not on sick leave when completing a mailed questionnaire in 1999. Of these, 3808 (89.3%) completed a second questionnaire 3 months later and 3651 (85.6%) completed a third questionnaire 15 months later. Intensity of low back symptoms and certified sick leaves attributed to LBP during the observation period were assessed by self reports at the follow ups. RESULTS: After adjustments for LBP during the three months prior to baseline, baseline health complaints, demographic and familial factors, and a series of physical, psychological, and social work factors, logistic regression analyses revealed the following associations: intense low back symptoms were predicted by frequent positioning of patients in bed, perceived lack of support from immediate superior, and perceived lack of pleasant and relaxing culture in the work unit. LBP related sick leaves were predicted by frequent handling of heavy objects, medium level of work demands, perceived lack of supportive and encouraging culture in the work unit, working night shifts, and working in a nursing home. Long term LBP related sick leaves were associated with changes of work or work tasks during the observation period that resulted in a perceived reduction of support and encouragement at work. CONCLUSIONS: Not only frequent mechanical exposures, but also organisational, psychological, and social work factors, such as night shift work, perceived lack of support from superior, and perceived lack of a pleasant and relaxing or supporting and encouraging culture in the work unit, are associated with an increased risk of intense low back symptoms and LBP related sick leaves in nurses' aides.

Work factors as predictors of sickness absence attributed to airway infections; a three month prospective study of nurses' aides.

AIMS: To identify the work factors that are related to sickness absence attributed to airway infections (AAI) in nurses' aides. METHODS: The sample comprised 5563 Norwegian nurses' aides, not on sick leave when they completed a mailed questionnaire in 1999. Of these, 4931 (88.6%) completed a second questionnaire three months later. The outcome measure was the three month incidence proportion of certified AAI (>3 days), assessed by self reports at follow up. RESULTS: Working in a paediatric ward (odds ratio (OR) 2.42; 95% confidence interval (CI) 1.39 to 4.21), perceived lack of encouraging and supportive culture in the work unit (OR 1.78; 95% CI 1.21 to 2.61), and reporting medium (OR 1.52; 95% CI 1.09 to 2.12), and high levels (OR 1.60; 95% CI 1.13 to 2.26) of role conflicts at work were associated with an increased risk of AAI, after adjustments for baseline health complaints, demographic and familial factors, smoking, and a series of physical, psychological, and organisational work factors. The individual level factors male gender, smoking 10 cigarettes per day or more, having widespread pain, having had an accident related neck injury, and having long term health problems also predicted AAI. CONCLUSIONS: In nurses' aides, sickness absence attributed to airway infections seems to be related to the type of ward in which the aides are working, and to psychological and social work factors. Declaring airway infections as occupational diseases would have important consequences for the social security system.

International monitoring of musculoskeletal complaints: a need for consensus.

Musculoskeletal pain is the complaint most frequently reported in health interview surveys. There is a confusing magnitude of names given to musculoskeletal pain complaints reflecting diverging opinions and a lack of consensus of what it is all about. This article discusses how to monitor the occurrence of unspecified musculoskeletal complaints and possible sources of information are presented. The main focus of the article is on how to include musculoskeletal complaints in health interview surveys, and a standard question to be included in all general health questionnaires is recommended.

Work factors as predictors of sickness absence: a three month prospective study of nurses' aides.

AIMS: To identify the work factors that predict sickness absence in nurses' aides. METHODS: The sample comprised 5563 Norwegian nurses' aides, not on leave because of illness or pregnancy when they completed a mailed questionnaire in 1999. Of these, 4931 (88.6%) completed a second questionnaire three months later. The outcome measure was the three month incidence proportion of certified sickness absence (>3 days), as assessed by self reports at follow up. RESULTS: Perceived lack of encouraging and supportive culture in the work unit (odds ratio (OR) 1.73; 95% confidence interval (CI) 1.28 to 2.34), working in psychiatric and paediatric wards, having injured the neck in an accident, and health complaints were associated with higher risk of sickness absence, after adjustments for a series of physical, psychological, and organisational work factors, personal engagement in the work unit, demographic characteristics, and daily consumption of cigarettes. Having untraditional jobs (for nurses' aides) (OR 0.53; 95% CI 0.36 to 0.77), and engaging in aerobics or gym were associated with a lower risk of sickness absence. CONCLUSIONS: The study suggests that the three month effects of work factors on rates of certified sickness absence are modest in nurses' aides. The most important work factor, in terms of predicting sickness absence, seems to be perceived lack of encouraging and supportive culture in the work unit.

Cattle eradication and malnutrition in under five's: a natural experiment in Botswana.

BACKGROUND: An outbreak of contagious bovine pleuropneumonia (CBPP) in the northern part of Botswana in 1996 was contained through eradication of all heads of cattle in Ngamiland district (Ngami East and West) in the period April 1996 to February 1997. This disaster posed a serious threat to those who depended on the livestock sector for sustenance and to the nutrition security of the population, especially the under five's. AIM: The aim of this study was to assess the impact of the cattle eradication on the nutritional status of children. METHOD: A secondary analysis of existing data from the Botswana National Nutrition Surveillance System enabled us to study the impact of this disaster on malnutrition in the under five's by comparing quarterly malnutrition rates for Ngami East with national figures for the period of January 1995 to March 1998. RESULTS: While the risk for malnutrition among under five's in Ngami East increased from 0.046 to 0.105 during the study period, giving a relative risk of 2.299, the increase in risk for Botswana was from 0.133 to 0.139, giving a relative risk of 1.048. The attributable risk for cattle eradication impact on malnutrition was 4.6% for Botswana and 54.4% for Ngami East. CONCLUSION: The cattle eradication impacted seriously on the food and nutrition security of the under five's in Ngami East, compared with the country as a whole.

Localized low back pain and low back pain as part of widespread musculoskeletal pain: two different disorders? A cross-sectional population study.

In a cross-sectional postal questionnaire study we compared individuals with localized low back pain (LBP) with individuals with LBP as part of widespread musculoskeletal pain, according to demographic and lifestyle characteristics and functional ability. All the inhabitants in Ullensaker county born 1918-20, 1928-30, 1938-40, 1948-50, 1958-60 and 1968-70 were sent a questionnaire in 1994. The study population comprised 2,893 responders. LBP as part of widespread pain indicated reduced functional ability, and the groups differed in several demographic and lifestyle characteristics.

Sleep problems: a predictor of long-term work disability? A four-year prospective study.

AIMS: This study investigates sleep problems as a predictor of long-term work disability. METHODS: Data from a community-based four-year prospective study were used. In 1990, all inhabitants of the municipality of Ullensaker, Norway, belonging to six age cohorts (20-22, 30-32, 40-42, 50-52, 60-62, and 70-72 years), were mailed a questionnaire. Of the 1,788 responders who were working and not older than 62 years, 1,426 (80%) returned a second questionnaire four years later (1994). RESULTS: Reporting mediocre or poor sleep (in contrast to good) in 1990 was significantly related to long-term work disability (> 8 weeks) during the previous 12 months in 1994 (odds ratio = 2.16; 95% confidence interval = 1.26-3.72), after adjustments for age, gender, civil status, body mass index, emotional symptoms, musculoskeletal pain, self-evaluated health, smoking, physical exercise, job satisfaction, and work characteristics. CONCLUSION: The study indicates that sleep problems are a predictor of long-term work disability.

Relations between medical history, clinical findings and plasma N-terminal proatrial natriuretic peptide in patients in primary health care.

BACKGROUND: recent studies indicate that measurement of natriuretic peptides may be a valuable tool to improve the quality of the diagnosis of heart failure in general practice. AIM: the aim of the present study was to examine the relationship between the plasma level of the natriuretic peptide N-terminal proANP and symptoms and signs of heart failure in patients from general practice in the Oslo area. METHODS AND RESULTS: we undertook a survey of 499 patients consecutively enrolled from the practice of 27 practitioners. One hundred and twenty-nine patients were classified as having possible or some degree of heart failure. The plasma concentration of N-terminal proANP increased with severity of heart failure as judged from clinical examination. In multivariate analysis age, history of heart disease, plasma creatinine, use of beta-blockers and digitalis, oedemas and atrial fibrillation were the main determinants of plasma N-terminal proANP. CONCLUSION: while there was an overall increase in N-terminal proANP values with increasing symptoms and degree of heart failure, no single finding was closely related to N-terminal proANP. Treatment effects and diagnostic errors may both influence the relationship between N-terminal proANP and clinical findings. The current study has demonstrated the feasibility of using N-terminal proANP by general practitioners for the potentially improved diagnosis of heart failure. Further research is required to determine the precise role of this assay in clinical practice.

[Children and bodily pain. Strong association between bodily pain, mental problems and sleep disorders among school children]. / Barn og kroppssmerte. Sterk sammenheng mellom kroppssmerte, psykiske problemer og søvnvansker hos skolebarn.

Body pain is frequently reported in children, and it has been suggested that childhood pain could be the beginning of chronic disabling pain. Three hypotheses were tested: 1. Body pain is associated with mental distress and sleeping problems; 2. The association is dependent on the localisation of the pain; 3. The association increases with the number of painful areas. 86 percent of the pupils (569) in the 4th form (mean age 10.5 years), 7th form (mean age 13.5 years) and 9th form (mean age 15.5 years) from all the schools in a local community answered a questionnaire about self esteem, body image, physical activity and body pain. A strong association was found between the reporting of pain, mental distress and sleeping problems. Knee pain was the only problem reported more frequently by boys than by girls, and did not show the same association with mental distress and sleeping problems as pain from other regions.

[Physical activity and bodily pain in children]. / Fysisk aktivitet og kroppssmerter hos barn.

BACKGROUND: Musculoskeletal complaints are frequently reported not only by adults, but also by children. Sedentary lifestyle has been suggested as a possible cause. MATERIAL AND METHODS: 569 pupils in primary school in a Norwegian municipality, aged 10-15 years, answered a questionnaire on bodily pain, self-esteem, body image and physical activity. RESULTS: We found a tendency that the least and the most physically active children reported most complaints. The two groups reported complaints from different regions. INTERPRETATION: Whether complaints in childhood develop into adult chronic pain conditions, and whether increased activity among the most physically passive children can hinder such a development are still unanswered questions.

Bodily pain, sleep problems and mental distress in schoolchildren.

UNLABELLED: It has been suggested that childhood pain could be the beginning of a career with chronic disabling pain. Bodily pain is frequent in children. We examined the association between self-reported bodily pain, mental distress and sleep problems in schoolchildren to test the following hypotheses: (i) that self-reported bodily pain is associated with mental distress and sleep problems, (ii) that the association is dependent on the localization of pain, and (iii) that the association increases with number of painful areas. Eighty-six percent of the pupils (569) in the 4th form (mean age 10.5 y), 7th form (mean age 13.5 y) and 9th form (mean age 15.5 y) from all the schools in a local community answered a questionnaire about self-esteem, body-image, physical activity and bodily pain. We found a strong association between the reporting of pain, mental distress and sleep problems. Pain in the knees was the only problem reported more frequently by boys than by girls, and knee pain did not show the same association with mental distress and sleep problems as pain from other regions. CONCLUSIONS: A possible cause-effect relationship between pain, mental distress and sleep problems is discussed, and the possibility that all the complaints are the simultaneous signs of a multisymptom syndrome is introduced.

Smoking and the functional status of young adults.

OBJECTIVE: To investigate the relationship between smoking and the functional status of young adults. DESIGN: A 4-year prospective questionnaire study. SETTING: The municipality of Ullensaker, Norway. SUBJECTS: 1084 subjects, 20-22 years or 30-32 years of age (the two youngest age-cohorts in a larger population study), completed a mailed questionnaire in 1990. A second questionnaire, mailed to the respondents in 1994, was completed by 753 (69.5%) individuals. MAIN OUTCOME MEASURES: Self-evaluated functional status as measured with the COOP/Wonca Charts. RESULTS: In 1994, respondents who were daily smokers in 1990 reported lower physical fitness, poorer overall health, and more pain, emotional problems, limitations of social activities, and problems in performing daily tasks than nonsmokers. Smoking in 1990 was associated with moderate or low physical fitness (OR = 2.21; 95% CI: 1.19-4.11) and moderate or severe pain (OR = 2.28; 95% CI: 1.32-3.94) in 1994, after adjustment for age, gender, civil state, workplace characteristics, physical exercise, and emotional symptoms. CONCLUSION: Even young adults report a lower functional status if they smoke. If this reflects a causal relationship it could be an important argument when trying to persuade young people to avoid smoking.

Job characteristics as predictors of neck pain. A 4-year prospective study.

Data from a community-based 4-year prospective study were used to investigate job characteristics as predictors of neck pain. Of 1791 working responders who completed a questionnaire in 1990, 1429 (79.8%) returned a second questionnaire 4 years later (1994). In responders without neck pain during the previous 12 months in 1990, the "little influence on own work situation" factor predicted neck pain during the previous 12 months (odds ratio = 2.21; 95% confidence interval, 1.18 to 4.14) and previous 7 days in 1994 (OR = 2.85; 95% confidence interval, 1.21 to 6.73) after adjustment for a series of potential confounders. In responders with neck pain in 1990, the little influence on own work situation factor was associated with persistent neck pain 4 years later. The study indicates that having little influence on one's own work situation is a predictor of neck pain.