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.

Self-reported bodily pain in schoolchildren.

It has been suggested that musculoskeletal symptoms develop from early age and can be regarded as a lifespan phenomenon. The study of childhood pain might provide a better understanding of the origin of chronic pain in adults. In a study of 569 schoolchildren, aged 10-15 years, in a local community close to Oslo, 75% reported that they usually experience bodily pain. Girls reported more pain than boys. 25% of those reporting pain experience symptoms several days a week. Knee symptoms and back pain were most frequently reported. Thirty-seven % of the girls reported headache, only 20% of the boys. Girls also reported more neck and shoulder pain than boys. The oldest respondents reported symptoms from more body parts. Symptoms from several body parts were more frequent among girls. Thirty-eight % of the respondents reported that it sometimes is hard to concentrate because of the pain, and 26% reported that they sometimes have to use medication. The consequences of pain increased with increasing age and increasing number of body parts affected. The results are consistent with findings in the adult population.

Serum lipoprotein(a) and cardiovascular disease in non-insulin-dependent diabetes mellitus.

OBJECTIVE: To examine whether lp(a) can explain a) the increased cardiovascular morbidity in patients with non-insulin-dependent diabetes mellitus (NIDDM) and b) the wide variation in the tendency for such complications to develop in the patients. DESIGN: Cross-sectional study. SETTING: General practice in a local community in Norway. SUBJECTS: One hundred and thirty NIDDM patients and a reference group drawn from a twin study. MAIN OUTCOME MEASURES: Lp(a), self-reported cardiovascular disease, urinary albumin excretion. RESULTS: The level of lp(a) was equally distributed in our NIDDM population and a reference group. We found no association between lp(a) and self-reported cardiovascular disease and urinary albumin excretion (UAE). CONCLUSION: Lp(a) cannot explain the increased risk for cardiovascular disease in NIDDM patients, nor can it explain the variation in the tendency for such complications to develop.

Smoking as a predictor of long-term work disability in physically active and inactive people.

Data from a Norwegian 4-year prospective questionnaire study were used to test our hypothesis that smoking is a weaker predictor of long-term work disability in physically active than inactive persons. Of 1,788 respondents who were working and not older than 62 years in 1990, 1,426 (80%) also returned a questionnaire in 1994. For respondents who were taking physical exercise less than once a week, smoking predicted long-term work disability four years later [odds ratio (OR) = 2.24; 95% confidence interval (CI) = 1.30-3.87; p < 0.01], when adjusting for age, sex, work-hours per week, heavy lifting at work, emotional symptoms and musculoskeletal pain at time 0. In respondents who were exercising at least once a week, there was no association between smoking and long-term work disability.

[Medical consultation about Pakistani immigrants. The pattern of consultations and diagnosis at a health center in Oslo]. / Legesøkning blant pakistanske innvandrere. Konsultasjonsmønster og diagnosefordeling ved et helsesenter i Oslo.

The purpose of this study was both to ascertain the extent to which Pakistanis, compared with Norwegians, consult a doctor and to discover possible differences in the type of diagnosis received by the two groups, 6867 consultations where the patient was either Pakistani or Norwegian were registered over a period of one year at Stovner Health Centre. The frequency of the consultations differed more between men and women than between Pakistanis and Norwegians. On the whole the Pakistani patients received more symptom diagnoses and fewer diagnoses of illness than the Norwegians did, but here too there was a greater difference between the sexes than between the nationalities-women received most symptom diagnoses. Women practitioners gave symptom diagnoses more often than their male colleagues, did. Our study has shown that differences between the sexes are greater than differences between the races. This may help to break down barriers between "US" and "them".

[Reduced prescription of benzodiazepine preparations in general practice. Much to gain with little effort]. / Reduksjon av B-preparatforskrivning i allmennpraksis. Stor gevinst med liten innsats.

Many patients experience side effects from prolonged use of benzodiazepines and analgesics containing codeine. Therefore 66 daily users of these drugs (average dose before intervention 34 DDD/month) were encouraged to take part in a cessation experiment. They were told that a large share of their symptoms which were the indication for benzodiazepines and analgesics might be side effects from this medication. They were also given a cessation plan. Over two years the prescriptions (measured in DDD) for this group were reduced by 57%, and 26% of the patients stopped taking these medicines. A strategy is proposed for cessation of use of benzodiazepines and codeine-containing analgesics in general practice.

Oral glucose tolerance test in general practice--when is it worthwhile?

OBJECTIVE: To examine the probability of impaired glucose tolerance and diabetes, diagnosed with oral glucose tolerance test, at different levels of fasting blood glucose. DESIGN: When indicated, fasting capillary whole blood glucose was measured. Patients with blood glucose ranging from 4.4 to 6.6 mmol/l had an oral glucose tolerance test. SETTING: General practice. SUBJECTS: 355 patients had an oral glucose tolerance test. RESULTS: 33% had impaired glucose tolerance and 12% had diabetes. One or more diabetics were found at every level of fasting blood glucose. The probability of finding a diabetic was ten times larger in the fasting blood glucose stratum 6.1 to 6.6 mmol/l than in the fasting blood glucose stratum 4.4 to 4.9 mmol/l. Likelihood ratio increased 30 times from the lowest to the highest stratum. No cutoff point in the interval 4.4 to 6.6 mmol/l had both a high sensitivity and a high specificity for the diagnosis of diabetes. CONCLUSION: If it is of great importance to find every patient with impaired glucose tolerance and diabetes, one has to do an oral glucose tolerance test in every fraction of the fasting blood glucose range 4.4 to 6.6 mmol/l (according to WHO's diagnostic criteria). Using 5.2 mmol/l as a cutoff point for an oral glucose tolerance test, the sensitivity is still high (0.95), but one would miss a few with diabetes.

Fructosamine cannot replace HbA1c in the management of type 2 diabetes (NIDDM).

OBJECTIVE: To compare HbA1c, fructosamine, and blood glucose and discuss to what degree Hba1c can be replaced by fructosamine. DESIGN: Cross-sectional study. PATIENTS: 87 unselected patients coming for 112 consecutive consultations. MAIN OUTCOME MEASURES: Fructosamine, HbA1c, blood glucose. RESULTS: The following Pearson correlation coefficients were found: Blood glucose/fructosamine 0.45, HbA1c/blood glucose 0.64, and HbA1c/fructosamine 0.39. Sensitivity and specificity of fructosamine and blood glucose to detect HbA1c > or = 8.0% was shown. CONCLUSION: Our study indicates that fructosamine and fasting capillary blood glucose are poor indicators of the level of HbA1c in NIDDM patients.

[Treatment of chronic musculoskeletal pain. Physical training and group discussions in general practice]. / Behandling av kroniske muskel- og skjelettsmerter. Fysisk trening og samtalegruppe gjennomført i allemennpraksis.

Treatment of chronic musculoskeletal pain is a challenge. 16 female patients with problems of this kind underwent a 12 week course of treatment consisting of selected physical exercises and group discussions. Twice a week a physiotherapist led indoor training to music with this group. The discussion group, which met once a week, was led by a doctor. All the participants completed the treatment. The results of the treatment were evaluated by means of talks with the patients, observation, an assessment form and five questionnaires. The participants were examined three months before treatment commenced, and immediately before and after the treatment period. The patients profited by the treatment. They expressed this opinion spontaneously during training, on the assessment form and during group discussions. It was also noticeable to us. This impression was confirmed by reduced experience of pain measured by visual analogue scale and enhanced well-being assessed by General Health Questionnaire. Exercise improved the physical condition of the participants and also induced a positive attitude to physical activity. Mutual support and the sharing of common experiences were important factors in the discussion group.

[Musculoskeletal complaints in a population. Occurrence and localization]. / Muskel- og skjelettplager i en befolkning. Forekomst og lokalisasjon.

Musculo-skeletal complaints are widespread. In a population survey in Ullensaker, a local community 40 kilometers north-east of Oslo, only 15% reported no musculo-skeletal symptoms during the last year. Just as many, 15%, predominantly women aged 50-70 years years, reported having such symptoms every day during the last year. 53% reported that they had experienced low back pain during the last year. The corresponding figures for headache, neck symptoms and shoulder symptoms were 49%, 48% and 46% respectively. Headache was most common among the younger women and neck and shoulder symptoms among middle-aged, while hip and knee symptoms were most frequent in the elderly women. Women in all age groups reported symptoms from more parts of the body than the men did.

Measuring functional status in a population survey. The Dartmouth COOP functional health assessment charts/WONCA used in an epidemiological study.

In a population study, a random sample of 398 persons from 20 to 72 years answered the six item version of the Dartmouth COOP functional health assessment charts/WONCA. The results according to age and sex are presented. The charts have been developed primarily for use in clinical settings. In a cross-sectional study in a normal population, the instrument seems feasible in use and it differentiates between the sexes and age groups.

[Dyspepsia and life style]. / Dyspepsi og livsstil.

Information on eating habits, life situation and perceived stress was collected from 100 patients who consulted general practitioner because of dyspeptic complaints. This information was compared with information from a control group with no dyspeptic symptoms. The patients reported a higher degree of stress in connection with occupation and family, and more economic worries, than the control group. Patients with ulcus also tended to have a higher consumption of tobacco. There were no significant differences in eating habits or alcohol consumption between the groups.

[Health services for physicians. Experiences from a pilot project]. / Helsetjeneste for leger. Erfaringer fra et pilotprosjekt.

The topic of article is a two-year trial of health service for doctors in the districts of Asker and Eidsvoll, under the auspices of the Akershus branch of the Norwegian Medical Association. The object of the trial was to develop a model for a health service for doctors. All doctors in the selected districts, except those covered by occupational health services, were invited to take part in the trial. Doctors recruited as doctors for colleagues, were given systematic tutoring and teaching throughout the trial period. The authors describe how the trial was organized and carried out, and summarize the practical experience gained so far. They also give a brief account of the continued efforts of the Akershus branch of the Norwegian Medical Association to develop a better health service for doctors.

[Physician and patient at the same time. Experiences from participants of a health service trial for physicians]. / Lege og pasient på samme tid. Erfaringer som deltaker i en helsetjeneste for leger.

A health service for doctors was made available in two municipalities. 28 doctors participated in a trial lasting two years. The overall evaluation included an interview by telephone, and the participants were asked to give their opinion of the trial. The response was unanimously positive. Most participants felt a clear need for contact, something which was not always apparent to the doctors' doctor. The participants appreciated the psychosocial aspect of the trial most of all. Lowest marks were awarded to the part dealing with the working environment. Few doctors found it difficult to fit into the patient's role. The selection of doctors' doctors, and their tutoring and preparation for this role, are probably the main factors behind the success of the trial. The evaluation clearly supports the creation of a health service for doctors.