Factors associated with young children's self-perceived physical competence and self-reported physical activity.

The aim of this study was to identify factors associated with self-reported physical activity (PA), self-perceived physical fitness and competence in physical education (PE) among young children. The study included physical tests, anthropometric measures and a questionnaire. The study group comprised 206 children (114 boys and 92 girls, aged 8-12 years). Positive Odds Ratio was used in the logistic regression analyses. High level of self-reported PA was associated with membership of sport clubs and high self-perceived physical fitness. Variables associated with high self-perceived competence in PE were low age, high physical performance, living with both parents, high self-perceived physical fitness, male gender and enjoying PE. Variables associated with high self-perceived physical fitness were low age, high performance in endurance running, high self-reported PA, positive self-perceived body function and high self-perceived competence in PE. Correlations between children's self-perceived competence in PE and actual measured physical performance, between the self-perceived fitness and endurance performance and between self-reported PA and physical performance could be seen as a form of concurrent validity. One implication of the study for practitioners might be that children's own perceptions of their physical competence and activity levels could be used to roughly identify groups of children who are at risk of remaining physically inactive and therefore more prone to be unhealthy.

Physical benefits of expanded physical education in primary school: findings from a 3-year intervention study in Sweden.

The aim of this study was to assess whether a school-based program with expanded physical education lessons was effective in increasing children's physical capacity and in preventing excessive weight gain in children. The study performed in 2000-2003 comprised 132 children, 73 boys and 59 girls at baseline 6-9 years and in follow-up 9-12 years, attending two different schools with a similar size, appearance and structure in a rural area. The norm school (N-school) followed the stipulated curricular time, one to two physical education lessons a week, while the intervention school (I-school) increased it to four lessons. More positive changes in physical index (the sum of the age-standardized results in 11 physical tests) were found among children in the I-school than in the N-school. The number of children who increased body mass index (BMI) increased in both schools, but a lower increase in BMI could be seen in the I-school. Expanded physical education lessons could increase physical status among both overweight and normal-weight children, in particular aerobic fitness. The weekly dose of physical activity must be higher than 40 min a day and must start earlier in children's life to be more effective in combating BMI increase.

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.

Quality of life among early retirees.

Explanatory variables concerning poor quality of life (QL) were established among disability pensioners with musculoskeletal disorders and a control group. In both groups health status, leisure time activities, and social network were important for QL. Among the retirees immigration, employment before retirement and a negative attitude to the disability pension were related to poor QL.

Low physical capacity among adolescents in practical education.

The aim of this study was to obtain better knowledge about teenagers' physical capacity and physical activity. The study group consisted of 301 students in upper secondary school, 191 students in practical education (74 girls and 117 boys) and 110 students in theoretical education (57 girls and 53 boys). The adolescents were 16-19 years old and lived in southern Sweden. The study comprised three parts: a questionnaire, seven physical tests (one test to predict maximal oxygen uptake, three strength tests, two flexibility tests and one balance test) and information on each pupil's grades. Pupils in practical education for occupations like industrial- and building workers, mechanics, assistant nurses and hairdressers, all of which are occupations involving physical effort, had lower physical capacity than pupils in theoretical education among both girls and boys. A correlation was found between physical capacity and grades.

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.

Widespread musculoskeletal chronic pain associated with smoking. An epidemiological study in a general rural population.

Data on smoking and pain symptoms from a random sample (n = 1806) of a general population were used to evaluate the association between chronic pain at various locations and smoking. In both genders current smoking was associated with reports of increased pain in low back, neck and with multiple locations. In a multiple logistic regression analysis current smoking was associated with an increase in widespread chronic musculoskeletal pain (OR 1.60, CI 1.04-2.46, in relation to non-smokers) and chronic low back pain (OR 1.58, CI 1.13-2.20, in relation to non-smokers). A dose-response relationship was found between the daily cigarette consumption and the prevalence of chronic low back pain. Smoking is associated not only with low back pain but also with chronic widespread musculoskeletal pain. No conclusive decrease in pain prevalence was found after quitting smoking. Further studies are necessary to elucidate an aetiologic relationship between smoking and chronic pain.

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.

Health and health care utilization among early retirement pensioners with musculoskeletal disorders.

OBJECTIVE: To estimate subjective health status among early retired individuals pensioned due to disorders of the musculoskeletal system. DESIGN: A survey of self-reported health status and health care utilization by means of a mailed questionnaire. SETTING: Early retirees (cases) and a random sample (controls) of individuals from the municipality of Kristianstad, Sweden. CASES: all individuals aged 25-59 years granted a full-time early retirement pension during the period 1986-1990 due to disorders of the musculoskeletal system (n = 450). The response rate was 83.6%. CONTROLS: An age- and sex-matched sample (n = 450). The response rate was 82.7%. MAIN OUTCOME MEASURES: Self-reported health status and health care utilization. RESULTS: Early retirement entailed a deterioration in self-reported health status among men, all ages, and women aged 25-54 years. Female retirees aged 55-64 reported an improvement in health status since retirement. Early retired female immigrants were less satisfied with their health status than the Swedish ones. Early retirees reported higher health care utilization than controls, but with a reduction since retirement. Drug consumption was high. CONCLUSION: The beneficial effects of early retirement were evident among old women. Men and young and middle-aged women may need support to adjust to life as a retiree. Special attention should be given to the female immigrant retiree.

Immigration and socio-economy as predictors of early retirement pensions.

The purpose of this study, performed in a Swedish municipality, was to obtain a view of early retirement pensioners, focusing on immigration and socio-economy as predictors of early retirement pensions. A questionnaire was sent to 453 early retirement pensioners with disorders of the musculoskeletal system. A corresponding questionnaire was sent to a randomly selected, age- and sex-matched control group of the same size. The response rate was 83%. The study concludes that immigration and low socio-economy are predictors of early retirement pension (ERP). The rate of immigrants was 19% among the ERPs compared to 5% among the controls. The early retired immigrants were comparatively young, and some of them were overqualified for their previous jobs. Of the ERPs 74% were blue-collar workers compared to 39% of the controls. Neither work satisfaction nor unemployment was found to predict ERP.

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.

[Can the chronically ill become the chronically healthy?]. / Kan långtidssjuka bli långtidsfriska?

Sick leave from work is on the increase throughout the Western world, despite improvements in welfare and the continual mechanization of heavy industry. By means of early, active rehabilitation measures in cases of musculoskeletal disorders, the duration of sick certification can be reduced and extended absence from work prevented. This has been demonstrated in a successful cooperative project involving the health and social services where, after two years in operation, the saving in costs to the community is calculated to have been SEK 4.5 millions. A brief outline of the project is given in the article.

The district nurse and the district physician in health care teams. An analysis of the content of primary health care.

An assessment of community nursing in relation to physician care has been made in a Swedish primary care district. The staff was organized in health care teams. A totally integrated, comprehensive care service for everyone in the geographically defined district was made possible, as all members of the team used the same medical records. Visits in district care (district nurse, practical nurse) amounted to more than 50% of the visits to the teams. The visiting pattern in district care was dominated by the young and the old, the ages below 5 years of age making 3.7 visits per year, and the ages above 75 years making 10.0 visits. Health care was an important task among the children, while chronic ulcer of skin, senile dementia and diabetes were the most common diagnoses among the elderly. Every third visit in district care was a home visit. In almost 50% of the visits no appointment had been made in advance, which demonstrates a high accessibility to the district nurse. The distribution of diagnoses presented several social problems. Diagnoses like neuroses, alcoholism, and senile dementia produced many visits by few patients. Compared to physician visits, the district nurse made more home visits, had more visits among the young and the old, and had a different distribution of diagnoses. Regardless of, or despite, their different ways of working, the district nurse and the district physician complemented each other in the team co-operation. Besides her role as a health professional concerned about health care and medical treatment, the district nurse is an important social contact for many individuals living in her district.

Utilization of health services in a defined Swedish population.

With the aid of a data registration system and person-specific information, utilization behaviour has been studied in a defined Swedish population. Information from three registers was linked together in order to produce the current results: a medical information system in primary care, a population register, and a register of property. The higher health care consumption for females is shown to occur independently of diagnosis, even if diseases of the genitourinary system, psychoneurosis and rheumatoid arthritis were more common among females. The consultation rate was inversely related to the distance to the surgery from the patient's residence. There was less demand for primary health care during the summer months, July and August. For the rest of the year there were no differences.

Is fatness really a risk indicator of death? A 10-16-year prospective study of patients attending the primary health care services.

A 10-16-year prospective study comprising more than 26 000 person-years was performed, to analyse whether or not patients receiving care within the primary health care services had a body mass index (BMI) related to mortality. When the mortality in the high and low BMI groups was compared with the medium one, the ratios did not differ significantly from one another. Thus, in this study, comprising patients attending primary health care, neither high BMI nor low BMI was found to be a risk indicator of death, thereby supporting earlier results from studies on BMI as a function of morbidity. BMI, or the degree of fatness, should therefore not be stressed as a general risk indicator of morbidity or mortality in patients attending the primary health care services.

Continuity of care in health care teams. A comparison of continuity measures and organisational solutions.

With the aid of a continuity index (K), ranged from 0 to 100% and previously described, a comparison has been made in a primary care district before and after the opening of a new health care centre. An organization with health care teams seems to have contributed to a considerable improvement in continuity. The K index increased from 28 to 69% for scheduled and acute visits taken together. About 90% of the visits to the ordinary district physicians were made by people living in the "correct" geographical area. The corresponding figure as regards visits to the district nurse and nurse was 97%. When the service time at a health centre, not organised with health care teams, was expanded and the number of physicians increased, the K index rose from 43 to 54%. When three positions as full-time physicians were divided into six half-time, the K index dropped from 53% to 42%. In order to assess the K index, it was compared to three other measures (UPC, COC and SECON). They all tended to give fairly similar results when applied to empirical data, although the K index required less detailed data to compute. Therefore, the K index can be considered to be a worthwhile measure to use, when analyzing the effects of organizational changes.

Low prevalence of abdominal aortic aneurysm in hypertensive patients. A population-based study.

The prevalence of abdominal aortic aneurysms (AAA) was estimated by ultrasonography in hypertensives in the age group 50-70 years in geographically defined population. Only one case of AAA was found among 245 patients. This rather unexpected result implies a probability of less than 5% that the true prevalence of AAA is as high as 2% in hypertensives. Our population-based study indicates a lower prevalence than earlier studies based on necropsies and is an example of research cooperation between primary health care and specialized hospital care.

Both high and low blood pressures risk indicators of death in middle-aged males. Isotonic regression of blood pressure on age applied to data from a 13-year prospective study.

This study was performed to investigate whether a moderately sized population of men (n = 954) living in a geographically defined area could be utilized and give valid results in a 13-year prospective study regarding mortality as a function of blood pressure. Isotonic regression of blood pressure on age was used to define groups of men with low, medium, and high blood pressure. Men aged 40-69 years in both extreme groups showed an excess death risk in comparison with those in the medium group. Thus, mortality appeared to be a U-shaped function of blood pressure in this age group. The mortality ratios of the low and high blood pressure groups vis-à-vis the medium group were higher during the first than during the second half of the observation period. Chronic diseases at the time of the initial examination were more common among men who died in the lowest blood pressure group than among those who died in the medium group. In males aged 70-99 years, blood pressure appeared to be of less importance as a risk indicator of death.