Initial healthcare and coping preferences are associated with outcome 1†year after whiplash trauma: a multicentre 1-year follow-up study.

OBJECTIVE: Individuals exposed to whiplash collisions have to cope with the stressful event as well as early physical symptoms. As in other chronic pain conditions, coping has been associated with outcome after whiplash. In this study, our aim was to examine whether initial coping preferences were associated with the development of chronic whiplash. DESIGN: Prospective study. SETTING: Primary care. METHODS: 740 acute whiplash patients were recruited from emergency units and general practitioners after car collisions in Denmark. Within 10 days postinjury, participants were asked what they believed could help them get better. At 12-month follow-up, the level of neck pain and capability to work was obtained. Whether coping preferences (baseline) were associated with outcome was investigated using multiple regression analyses. RESULTS: Persistent neck pain was most strongly associated with preferring medications (mean difference=1.24 (95% CI 0.67 to 1.82)) and sickness absence (mean difference=1.18 (95% CI 0.53 to 1.82)). Reduced work capability was most strongly associated with preferring medications (OR=3.53 (95% CI 2.13 to 5.86)), sickness absence (OR=3.05 (95% CI 1.80 to 5.17)) and being referred to a physiotherapist/chiropractor (OR=3.03 (95% CI 1.33 to 6.91)). Active coping was associated with better outcomes: Participants preferring to change their lifestyle were protected against reduced work capability (OR=0.11 (95% CI 0.01 to 0.78)). Individuals who wanted to keep living as usual only (no other preference reported) were protected against neck pain (mean difference -1.62 (95% CI -2.39 to -0.84)) and reduced work capability (OR=0.09 (95% CI 0.01 to 0.64)). CONCLUSIONS: A simple nine-item measure of coping preferences is associated with the development of chronic neck pain and reduced capability to work following whiplash trauma and may be used to identify individuals at risk of poor recovery.

The relationship between the belief in a genetic cause for breast cancer and bilateral mastectomy.

OBJECTIVE: Most women develop causal beliefs following diagnosis with breast cancer and these beliefs can guide decisions around their care and management. Bilateral mastectomy rates are increasing, although the benefits of this surgery are only established in a small percentage of women. In this study we investigated the relationship between causal beliefs and the decision to have a bilateral mastectomy. METHOD: Women (N = 2,269) from the Army of Women's breast cancer research registry completed an online survey. Women were asked what they believed caused their cancer and responses were coded into 8 causal categories. Participants were also asked about the type of surgery they underwent following their breast cancer diagnosis. The odds ratios for having a double mastectomy were calculated for each causal category using random/bad luck as a referent category. RESULTS: Hormonal factors (22%) and genetics (19%) were the most common causal belief, followed by don't know (19%), environmental toxins (11%), negative emotions (9%), poor health behavior (8%), other (6%) and random/bad luck (6%). Compared with the referent category, the odds ratio of having a bilateral mastectomy was significantly higher in both the genetics and hormonal causal belief groups (OR = 2.36, 95% CI [1.38, 4.02] and OR = 1.98, 95% CI [1.16, 3.38], respectively). CONCLUSIONS: Beliefs in a genetic cause for breast cancer are common and are associated with high rates of bilateral mastectomy. This is despite evidence that the actual genetic contribution to breast cancer is much lower than perceived and that bilateral mastectomy is, in most cases, unlikely to improve survival. (PsycINFO Database Record

Abstention, alcohol consumption, and common somatic symptoms: the Hordaland Health Study (HUSK).

BACKGROUND: The association between alcohol consumption and somatic symptoms is unclear. PURPOSE: The aim of this study was to examine the cross-sectional association between the whole continuum of alcohol consumption, ranging from abstention to high-level consumption, and the overall level of common somatic symptoms in a large population-based sample. METHODS: Data are from the Hordaland Health Study, conducted in 1997-1999 with participants aged 40-46 years (N = 15,018). The main exposure was a categorical variable based on self-reported abstention and alcohol consumption, while self-reported overall level of somatic symptoms was the outcome. The outcome was defined by the mean overall frequency of 17 commonly experienced somatic symptoms. Potential confounders included sociodemographic information, somatic diagnoses, and health-related behaviors. Linear regression models were computed in the statistical analyses. RESULTS: We found no association between different levels of alcohol consumption and overall level of somatic symptoms. Abstainers reported, however, a higher overall level of somatic symptoms compared to those who consumed alcohol at any level, even after adjusting for potential confounders. Investigating the individual somatic symptoms, we found that the abstainers had a higher frequency of 10 of the 17 symptoms compared to the remainder, while higher frequency was found for only 2 somatic symptoms among the 5% with the highest alcohol consumption. CONCLUSIONS: We found no support for an association between alcohol consumption and overall level of somatic symptoms. There was, however, a small association between being abstinent and increased level of somatic symptoms. These findings may have several different explanations, and further investigation is called for.

Adolescent neck and shoulder pain--the association with depression, physical activity, screen-based activities, and use of health care services.

PURPOSE: Neck and shoulder pain is frequent in adolescents, and multiple factors seem to affect the risk of such symptoms. We aimed to investigate the prevalence of neck and shoulder pain in Norwegian adolescence and to examine whether behavioral and emotional factors were associated with the risk of neck and shoulder pain. Finally we aimed to investigate whether neck and shoulder pain was related to the use of health services. METHOD: Data from the population-based study ung@hordaland were used. Participants were asked how often during the last 6 months they had experienced neck and shoulder pain. The association between frequent neck and shoulder pain and physical activity, symptoms of depression, and screen-based activities was evaluated using logistic regression analyses stratified by gender. The relative risk of visiting health services when reporting neck and shoulder pain was calculated using multiple logistic regression analyses. RESULTS: Frequent neck and shoulder pain was reported by 20.0% (1,797 of the total 8,990) and more often by girls than boys (p < .001). A high score of depressive symptoms was the strongest risk factor for neck and shoulder pain in both boys and girls (odds ratio = 6.14 [95% confidence interval 4.48-8.42] and odds ratio = 3.10 [95% confidence interval 2.63-3.67], respectively). Frequent screen-based activities slightly increased the risk while physical activity was protective. Individuals reporting neck and shoulder pain more often visited their general practitioner (47.1% vs. 31.8%) and school health services (24.6% vs. 13.5%). CONCLUSION: Frequent neck and shoulder pain was reported in 20% of Norwegian adolescents. Symptoms of depression and screen-based activities increased the risk of neck and shoulder pain while physical activity was protective. Individuals reporting neck and shoulder pain visited health services more frequently than others.

Factors related to non-recovery from whiplash. The Nord-Trøndelag Health Study (HUNT).

BACKGROUND: Whiplash injuries show a variable prognosis which is difficult to predict. Most individuals experiencing whiplash injuries rapidly recover but a significant proportion develop chronic symptoms and ongoing disability. PURPOSE: By employing longitudinal data, we investigated how psychological and physical symptoms, self-rated health, use of health services and medications, health behavior and demographic factors predict recovery from whiplash. METHOD: Data from two waves of a large, Norwegian, population-based study (The Nord-Trøndelag Health Study: HUNT2 and HUNT3) were used. Individuals reporting whiplash in HUNT2 (baseline) were identified in HUNT3 11 years later. The characteristics of individuals still suffering from whiplash in HUNT3 were compared with the characteristics of individuals who had recovered using Pearson's chi-squared test, independent sample t-tests and logistic regression. RESULTS: At follow-up, 31.6 % of those reporting whiplash at baseline had not recovered. These individuals (n = 199) reported worse health at baseline than recovered individuals (n = 431); they reported poorer self-rated health (odds ratio [OR] = 3.12; 95 % confidence interval [CI], 2.20-4.43), more symptoms of anxiety (OR = 1.70; 95 % CI, 1.15-2.50), more diffuse somatic symptoms (OR = 2.38; 95 % CI, 1.61-3.51) and more musculoskeletal symptoms (OR = 1.21; 95 % CI, 1.13-1.29). Individuals still suffering from whiplash also visited more health practitioners at baseline (OR = 1.18; 95 % CI, 1.06-1.32) and used more medications (OR = 1.24; 95 % CI, 1.09-1.40). CONCLUSION: Poor self-rated health seems to be a strong risk factor for whiplash injuries becoming chronic. Diffuse somatic symptoms, musculoskeletal symptoms and symptoms of anxiety at baseline are important prognostic risk factors. Knowledge of these maintaining risk factors enables identification of individuals at risk of non-recovery, facilitating adequate treatment for this vulnerable group.

What characterizes individuals developing chronic whiplash?: The Nord-Trøndelag Health Study (HUNT).

OBJECTIVE: Most individuals experiencing whiplash accidents recover rapidly. A considerable proportion, however, develop chronic symptoms. Psychological factors may slow recovery, possibly by increasing the likelihood of other symptoms being misattributed to, and amplified by the whiplash injury. We aimed to investigate how pre-injury mental and somatic symptoms, self-rated health, use of health-services and medications, health-behavior and socio-demographics predict the development of chronic whiplash. METHODS: Data from two waves of a large, population based study (HUNT2 (baseline) and HUNT3) were used. Individuals reporting no whiplash at baseline were identified in HUNT3. Characteristics reported at baseline were compared between those who had developed chronic whiplash in HUNT3 (n=199) and those who had not (n=20,600), using Pearson's chi-squared tests, independent sample t-tests and logistic regression analyses. RESULTS: Individuals developing chronic whiplash reported worse baseline health than those reporting no chronic whiplash. Poor self-rated health was a strong risk factor for subsequent chronic whiplash (OR=2.26, 95%CI: 1.68-3.04). Musculoskeletal pain also increased the risk (OR=1.21, 95%CI: 1.15-1.26), as did diffuse somatic symptoms (OR=2.09, 95%CI: 1.47-2.96), use of different health services (OR=1.31, 95%CI: 1.19-1.45), high use of medications (OR=1.28, 95%CI: 1.14-1.43) and symptoms of anxiety (OR=1.93, 95%CI: 1.39-2.68). Physical activity was protective (OR=0.67, 95%CI: 0.49-0.91). Most socio-demographic variables were not significantly associated with chronic whiplash. CONCLUSION: Poor somatic and mental pre-injury health increased the risk of subsequent chronic whiplash. This suggests that chronic whiplash is not merely an organic disorder, and highlights the importance of individual expectations, symptom reattribution and amplification in development of chronic whiplash.

A population based validation study of self-reported pensions and benefits: the Nord-Trøndelag health study (HUNT).

BACKGROUND: Measures of disability pensions, sickness certification and long-term health related benefits are often self-reported in epidemiological studies. Few studies have examined these measures, and the validity is yet to be established.We aimed to estimate the validity of self-reported disability pension, rehabilitation benefit and retirement pension and to explore the benefit status and basic characteristics of those not responding to these items.A large health survey (HUNT2) containing self-reported questionnaire data on sickness benefits and pensions was linked to a national registry of pensions and benefits, used as "gold standard" for the analysis. We investigated two main sources of bias in self-reported data; misclassification - due to participants answering questions incorrectly, and systematic missing/selection bias - when participants do not respond to the questions.Sensitivity, specificity, positive (PPV) and negative (NPV) predicative value, agreement and Cohen's Kappa were calculated for each benefit. Co-variables were compared between non-responders and responders. RESULTS: In the study-population of 40,633, 9.2% reported receiving disability pension, 1.4% rehabilitation benefits and 6.1% retirement pension. According to the registry, the corresponding numbers were 9.0%, 1.7% and 5.4%. Excluding non-responders, specificity, NPV and agreement were above 98% for all benefits. Sensitivity and PPV were lower. When including non-responders as non-receivers, specificity got higher, sensitivity dropped while the other measures changed less.Between 17.7% and 24.1% did not answer the questions on benefits. Non-responders were older and more likely to be female. They reported more anxiety, more depression, a higher number of somatic diagnoses, less physical activity and lower consumption of alcohol (p < 0.001 for all variables). For disability pension and retirement pension, non-responders were less likely to receive benefits than responders (p < 0.001). For each benefit 2.1% or less of non-responders were receivers. False positive responses were more prevalent than false negative responses. CONCLUSIONS: The validity of self-reported data on disability pension, rehabilitation benefits and retirement pension is high - it seems that participants' responses can be trusted. Compared to responders, non-responders are less likely to be receivers. If necessary, power and validity can be kept high by imputing non-responders as non-receivers.

Somatic symptoms beyond those generally associated with a whiplash injury are increased in self-reported chronic whiplash. A population-based cross sectional study: the Hordaland Health Study (HUSK).

BACKGROUND: Chronic whiplash leads to considerable patient suffering and substantial societal costs. There are two competing hypothesis on the etiology of chronic whiplash. The traditional organic hypothesis considers chronic whiplash and related symptoms a result of a specific injury. In opposition is the hypothesis that chronic whiplash is a functional somatic syndrome, and related symptoms a result of society-induced expectations and amplification of symptoms. According to both hypotheses, patients reporting chronic whiplash are expected to have more neck pain, headache and symptoms of anxiety and depression than the general population. Increased prevalence of somatic symptoms beyond those directly related to a whiplash neck injury is less investigated. The aim of this study was to test an implication derived from the functional hypothesis: Is the prevalence of somatic symptoms as seen in somatization disorder, beyond symptoms related to a whiplash neck injury, increased in individuals self-reporting chronic whiplash? We further aimed to explore recall bias by comparing the symptom profile displayed by individuals self-reporting chronic whiplash to that among those self-reporting a non-functional injury: fractures of the hand or wrist. We explored symptom load, etiologic origin could not be investigated in this study. METHODS: Data from the Norwegian population-based "Hordaland Health Study" (HUSK, 1997-99); N = 13,986 was employed. Chronic whiplash was self-reported by 403 individuals and fractures by 1,746. Somatization tendency was measured using a list of 17 somatic symptoms arising from different body parts and organ systems, derived from the research criteria for somatization disorder (ICD-10, F45). RESULTS: Chronic whiplash was associated with an increased level of all 17 somatic symptoms investigated (p<0.05). The association was moderately strong (group difference of 0.60 standard deviation), only partly accounted for by confounding. For self-reported fractures symptoms were only slightly elevated. Recent whiplash was more commonly reported than whiplash-injury a long time ago, and the association of interest weakly increased with time since whiplash (r = 0.016, p = 0.032). CONCLUSIONS: The increased prevalence of somatic symptoms beyond symptoms expected according to the organic injury model for chronic whiplash, challenges the standard injury model for whiplash, and is indicative evidence of chronic whiplash being a functional somatic syndrome.