Patients' experiences with Behçet's syndrome: structured interviews among patients with different types of organ involvement

OBJECTIVES

Behçet's syndrome (BS) is a multisystem variable-vessel vasculitis with significant life impact. The aim of this study was to explore the perspectives of patients with BS with different types of organ involvement.

METHODS

Semi-structured qualitative interviews were conducted with 20 patients with BS with different types of organ involvement. Interviews were audio-recorded, transcribed, and translated into English. A Grounded Theory approach was employed in thematic analysis of translated interviews.

RESULTS

Interviews with participants yielded four themes, including symptoms (skin problems, pain, vision problems, fatigue/sleep disturbances, and gastrointestinal/weight loss), impact on function (impact on speech and vision, mobility, energy for tasks, adaptations, and self-care), psychological impact (emotions and emotional management techniques), and social impact (ability to socialize generally and impact on familial relationships).

CONCLUSIONS

Patients with BS identified several domains, including physical functioning, psychological state, and social identity that are significantly modulated by the symptoms of BS. Those are inter-related with physical symptoms, reflecting the multi-system character of BS, and impair patients' function impacting on psychological and social identities. This work advances an understanding of BS, and will be useful in developing patient-oriented outcome measures for use in studying BS.

The spread of EBV to ectopic lymphoid aggregates may be the final common pathway in the pathogenesis of ME/CFS

According to the hypothesis presented here, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) develops over 3 steps: Step 1 is characterized by the aggregation of lymphoid cells in dorsal root ganglia or other nervous structures. The cause of this formation of ectopic lymphoid aggregates may be an acute infection, asymptomatic reactivations of a common neurotropic virus, exposure to a neurotoxin, or physical injury to peripheral nerves. In step 2, Epstein-Barr virus (EBV)-infected lymphocytes or monocytes bring EBV from the circulation to one or several of these lymphoid aggregates, whereupon cell-to-cell transmission of EBV and proliferation of latently EBV-infected lymphocytes lead to the presence of many EBV-infected cells in the lymphoid aggregates. The EBV-infected cells in the aggregates ignite an inflammation in the surrounding nervous tissue. This local inflammation elicits, in turn, a wave of glial cell activation that spreads from the EBV-infected area to parts of the nervous system that are not EBV-infected, disturbing the neuron-glial interaction in both the peripheral - and central nervous system. In step 3, immune cell exhaustion contributes to a consolidation of the pathological processes. There might be a cure: Infusions of autologous EBV-specific T-lymphocytes can perhaps remove the EBV-infected cells from the nervous system.

Sleep problems: a predictor of long-term work disability?

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.

Marital disruption and long-term work disability

Data from a community-based four-year prospective study were used to investigate the relationship between marital disruption and long-term work disability. In 1990, all inhabitants of the municipality Ullensaker, Norway, belonging to six cohorts (20-22 years, 30-32 years, 40-42 years, 50-52 years, 60-62 years and 70-72 years) were sent a questionnaire. Of the 1,359 respondents who were working, married or cohabiting, and not older than 62 years, 1,115 (82%) returned a second questionnaire four years later (1994). Separation or divorce between 1990 and 1994 was related to long-term work disability in 1994 (OR=3.02; 95% CI: 1.57-5.81), even after adjustments for age, sex, work characteristics, number of work hours per week, job satisfaction, body mass index, having pre-school children, smoking, physical leisure activity, emotional symptoms and musculoskeletal pain (all measured in 1990). Emotional problems evoked by the marital disruption may be part of the explanation.

Invited commentary: Interpreting associations between high birth weight and later health problems

High birth weight (>4.0 kg) has been associated with a wide range of health problems later in life. The interpretation of these statistical associations may be difficult, however. These difficulties are closely linked to methodological challenges in this research, such as filtering out confounding from family factors, disentangling associations with prenatal processes from associations with postnatal processes, and uncovering what birth weight actually represents. The well-conducted study by Kristensen et al. (Am J Epidemiol. 2014;180(9):876-884), presented in this issue of the Journal, offers an interesting example of how one can filter out confounding from family factors. In an elegant series of analyses, the authors show how an apparent inverse association between birth weight and later intelligence among those in the highest range of the birth weight scale became a positive association when proper adjustment for family factors was made. Sibling comparisons were important here.

Adult body height of twins compared with that of singletons: a register-based birth cohort study of Norwegian males

In the present study, we evaluated whether childhood differences in body height between singletons and twins persist into adulthood. Data from the Medical Birth Register of Norway were linked with data from the Norwegian National Conscript Service. This study used data on the 457,999 males who were born alive and without physical anomalies in single or twin births in Norway during 1967-1984 and who were examined at the mandatory military conscription (age 18-20 years; 1985-2003). For sibling comparisons, the authors selected the 1,721 sibships of full brothers that included at least 1 male born in a single birth and at least 1 male born in a twin birth (4,520 persons, including 2,493 twins and 2,027 singletons). An analysis of the total study population using generalized estimating equations showed that the twins were 0.6 cm (95% confidence interval: 0.4, 0.7) shorter than were the singletons after adjustment for a series of background factors. The fixed-effects regression analysis of the sibships that included both twins and singletons showed that the twins were 0.9 cm (95% confidence interval: 0.6, 1.2) shorter than were their singleton brothers. The study suggests that male twins born in Norway during 1967-1984 were slightly shorter in early adulthood than were singletons.

Birth weight standardized to gestational age and intelligence in young adulthood: a register-based birth cohort study of male siblings

The authors aimed to determine the relation between birth-weight variations within the normal range and intelligence in young adulthood. A historical birth cohort study was conducted. Data from the Medical Birth Register of Norway were linked with register data from the Norwegian National Conscript Service. The sample comprised 52,408 sibships of full brothers who were born singletons at 37-41 completed weeks' gestation during 1967-1984 in Norway and were intelligence-tested at the time of mandatory military conscription. Generalized estimating equations were used to fit population-averaged panel data models. The analyses showed that in men with birth weights within the 10th-90th percentile range, a within-family difference of 1 standard deviation in birth weight standardized to gestational age was associated with a within-family difference of 0.07 standard deviation (99% confidence interval: 0.03, 0.09) in intelligence score, after adjustment for a range of background factors. There was no significant between-family association after adjustment for background factors. In Norwegian males, normal variations in intrauterine growth are associated with differences in intelligence in young adulthood. This association is probably not due to confounding by familial and parental characteristics.

Register data suggest lower intelligence in men born the year after flu pandemic

OBJECTIVE

To test the hypothesis that prenatal exposure to the Hong Kong flu, an influenza pandemic that haunted Europe during winter 1969 to 1970, was associated with reduced intelligence in adulthood.

METHODS

Data from the Medical Birth Register of Norway were linked with register data from the National Conscript Service. The sample comprised all registered boys born alive in single birth after 37 to 43 weeks' gestation during 1967 to 1973 (n = 205,634). Intelligence test scores, recorded at military conscription, were available for 182,913 individuals.

RESULTS

The mean intelligence score increased from one birth year to another, except for a downturn in 1970. The birth year 1970 was inversely associated with intelligence score (-0.03 standard deviation [SD]; p < 0.001) after adjustments for birth characteristics, parental characteristics, and the trend of increasing scores over the 7 birth years. Analyses with the sample stratified by birth month showed that the inverse association between the birth year 1970 and intelligence score was significant only among men born in July (-0.04 SD; p = 0.049), August (-0.05 SD; p = 0.013), September (-0.09 SD; p < 0.001), and October (-0.06 SD; p = 0.008). Thus, the intelligence scores of the men born 6 to 9 months after the epidemic were lower than the mean values for the men born in the same months a few years before or after.

INTERPRETATION

Early prenatal exposure to the Hong Kong flu may have interfered with fetal cerebral development and caused reduced intelligence in adulthood.

Intelligence Correlations Between Brothers Decrease With Increasing Age Difference

Research on twins and unrelated persons living together indicates that, although differences in intelligence between persons are caused by both genetic and environmental factors, similarities—and especially those between adults—are mostly or exclusively due to shared genes. However, twin and adoption designs have been criticized for incorrectly estimating the effects of the environment on the similarity between relatives, and studies of environmental effects in other family constellations may be enlightening. In a sample comprising more than 334,000 pairs of brothers (ages 18–21 years) who were tested at the mandatory conscription for military service in Norway, correlations between brothers' intelligence-test scores decreased with increasing age difference between the brothers. This result indicates that family environmental factors have an impact on the intelligence of young adults. Analyses of subgroups defined by family size and parental education demonstrated that the effects of age difference are essentially independent of these factors.

Work factors as predictors of poor sleep in nurses' aides

OBJECTIVES

The aim was to identify work factors that predict poor sleep in nurses' aides (assistant nurses).

METHODS

The study was based on a randomly selected, nationwide sample of Norwegian nurses' aides. Of 5,513 nurses' aides, not on leave when they completed a mailed questionnaire in 1999, 4,771 (86.5 %) completed a second questionnaire 3 months later. A wide spectrum of work factors was assessed at baseline by questions from the General Nordic Questionnaire for Psychological and Social factors at Work. Subjective sleep quality during the previous 3 months was measured at baseline and follow-up by a question from the Basic Nordic Sleep Questionnaire. Poor sleep was defined as the subjective experience of not sleeping well.

RESULTS

Medium and high demands, high demand-control ratio, frequent exposure to role conflicts, and frequent exposure to threats and violence at work were associated with increased odds of poor sleep during the successive 3 months, after adjustments for sleep quality during the 3 months before baseline, other work factors, and background factors. High support from immediate superior, frequent rewards for well-done work, and high control of decisions that influence own work situation were associated with or tended to be associated with reduced odds of poor sleep.

CONCLUSION

Psychosocial work factors which are likely to produce sustained arousal, such as frequent exposure to role conflicts and violence, may contribute to poor sleep in nurses' aides. Support and encouragement from superiors, and high control at work seem to reduce the risk of poor sleep.

Work factors and psychological distress in nurses' aides: a prospective cohort study

Background

Nurses' aides (assistant nurses), the main providers of practical patient care in many countries, are doing both emotional and heavy physical work, and are exposed to frequent social encounters in their job. There is scarce knowledge, though, of how working conditions are related to psychological distress in this occupational group. The aim of this study was to identify work factors that predict the level of psychological distress in nurses' aides.

Methods

The sample of this prospective study comprised 5076 Norwegian nurses' aides, not on leave when they completed a mailed questionnaire in 1999. Of these, 4076 (80.3 %) completed a second questionnaire 15 months later. A wide spectrum of physical, psychological, social, and organisational work factors were measured at baseline. Psychological distress (anxiety and depression) was assessed at baseline and follow-up by the SCL-5, a short version of Hopkins Symptom Checklist-25.

Results

In a linear regression model of the level of psychological distress at follow-up, with baseline level of psychological distress, work factors, and background factors as independent variables, work factors explained 2 % and baseline psychological distress explained 34 % of the variance. Exposures to role conflicts, exposures to threats and violence, working in apartment units for the aged, and changes in the work situation between baseline and follow-up that were reported to result in less support and encouragement were positively associated with the level of psychological distress. Working in psychiatric departments, and changes in the work situation between baseline and follow-up that gave lower work pace were negatively associated with psychological distress.

Conclusion

The study suggests that work factors explain only a modest part of the psychological distress in nurses' aides. Exposures to role conflicts and threats and violence at work may contribute to psychological distress in nurses' aides. It is important that protective measures against violent patients are implemented, and that occupational health officers offer victims of violence appropriate support or therapy. It is also important that health service organisations focus on reducing role conflicts, and that leaders listen to and consider the views of the staff.

Practice area and work demands in nurses' aides: a cross-sectional study

Background

Knowledge of how work demands vary between different practice areas could give us a better understanding of the factors that influence the working conditions in the health services, and could help identify specific work-related challenges and problems in the different practice areas. In turn, this may help politicians, and healthcare administrators and managers to develop healthy work units. The aim of this study was to find out how nurses' aides' perception of demands and control at work vary with the practice area in which the aides are working.

Methods

In 1999, 12 000 nurses' aides were drawn randomly from the member list of the Norwegian Union of Health – and Social Workers, and were mailed a questionnaire. 7478 (62.3 %) filled in the questionnaire. The sample of the present study comprised the 6485 nurses' aides who were not on leave. Respondents working in one practice area were compared with respondents not working in this area (all together). Because of multiple comparisons, 0.01 was chosen as statistical significance level.

Results

Total quantitative work demands were highest in somatic hospital departments, nursing homes, and community nurse units. Physical demands were highest in somatic hospital departments and nursing homes. Level of positive challenges was highest in hospital departments and community nurses units, and lowest in nursing homes and homes or apartment units for the aged. Exposure to role conflicts was most frequent in nursing homes, homes or apartment units for the aged, and community nurse units. Exposure to threats and violence was most frequent in psychiatric departments, nursing homes, and institutions for mentally handicapped. Control of work pace was highest in psychiatric departments and institutions for mentally handicapped, and was lowest in somatic hospital departments and nursing homes. Participation in decisions at work was highest in psychiatric departments and community nurse units, and was lowest in somatic hospital departments and nursing homes.

Conclusion

The demands and control experienced by Norwegian nurses' aides at work vary strongly with the practice area. Preventive workplace interventions should be tailored each area.

Work factors as predictors of persistent fatigue: a prospective study of nurses' aides

OBJECTIVES

To identify work factors that predict persistent fatigue in nurses' aides.

METHODS

The sample comprised 5547 Norwegian nurses' aides, not on leave when they completed a mailed questionnaire in 1999. Of these, 4645 (83.7%) completed a second questionnaire 15 months later. The outcome measure was the occurrence of persistent fatigue, defined as having felt "usually fatigued" or "always fatigued" in daytime during the previous 14 days.

RESULTS

In respondents without persistent fatigue at baseline, medium and high work demands, heavy smoking, being single, and having long term health problems were associated with increased risk of persistent fatigue at follow up. Medium and high rewards for well done work, medium levels of leadership fairness, and regular physical exercise were associated with reduced risk of persistent fatigue at follow up. In respondents with persistent fatigue at baseline, medium and high levels of positive challenges at work, high support from immediate superior, medium feedback about quality of one's work, and changes of work or work tasks that resulted in less heavy work or lower work pace were associated with increased odds of recovery (no persistent fatigue at follow up). Working in a nursing home and being intensely bothered by long term health problems were associated with reduced odds of recovery.

CONCLUSIONS

High demands and lack of rewards at work may cause persistent fatigue in nurses' aides. Reduction of demands, adequate feedback, and mental stimulation in the form of support and positive challenges may facilitate recovery in those who have persistent fatigue. Leaders in the health services may be in a position to regulate factors that influence the level of fatigue in nurses' aides.

Work factors and smoking cessation in nurses' aides: a prospective cohort study

BACKGROUND

The prevalence of smoking in nursing personnel remains high. The aim of this study was to identify work factors that predict smoking cessation among nurses' aides.

METHODS

Of 2720 randomly selected, Norwegian nurses' aides, who were smoking at least one cigarette per day when they completed a questionnaire in 1999, 2275 (83.6 %) completed a second questionnaire 15 months later. A wide spectrum of work factors were assessed at baseline. Respondents who reported smoking 0 cigarettes per day at follow-up were considered having stopped smoking. The odds ratios and 95 % confidence intervals of stopping smoking were derived from logistic regression models.

RESULTS

Compared with working 1-9 hours per week, working 19-36 hours per week (odds ratio (OR) = 0.35; 95 % confidence interval (CI) = 0.13 - 0.91), and working more than 36 hours per week (i.e. more than full-time job) (OR = 0.27; CI = 0.09 - 0.78) were associated with reduced odds of smoking cessation, after adjustments for daily consumption of cigarettes at baseline, age, gender, marital status, and having preschool children. Adjusting also for chronic health problems gave similar results.

CONCLUSION

There seems to be a negative association between hours of work per week and the odds of smoking cessation in nurses' aides. It is important that health institutions offer workplace-based services with documented effects on nicotine dependence, such as smoking cessation courses, so that healthcare workers who want to stop smoking, especially those with long working hours, do not have to travel to the programme or to dedicate their leisure time to it.

Work factors as predictors of smoking relapse in nurses’ aides

OBJECTIVES

The prevalence of tobacco smoking in nurses' aides (assistant nurses) is high. Many smokers make attempts to stop smoking, but a large portion of these relapse after some period of time. The objective of this study was to identify work factors that predict smoking relapse in nurses' aides.

METHODS

Of 1,373 Norwegian nurses' aides--who were former smokers, not current smokers, and not on leave when they completed a questionnaire in 1999--1,203 (87.6%) filled in a second questionnaire 15 months later. A wide spectrum of physical, psychological, social, and organisational work factors were assessed by validated questionnaires at baseline. Respondents who reported smoking at least one cigarette per day at the follow-up were considered having resumed daily smoking (relapse).

RESULTS

Social climate in the work unit (index with 3 items: supportive, trustful, relaxed) and frequency of exposure to threats and violence were the only work factors that were associated with the occurrence of relapse after adjustments for background factors. In a logistic regression analysis, frequent exposure to threats and violence at work (odds ratio (OR)=2.08; 95% confidence interval (CI): 1.01-4.29), and the lowest quintile of the social climate index (OR=2.12; CI: 1.03-4.36) were associated with increased risk of smoking relapse, after adjustments for age, gender, marital status, and having preschool children.

CONCLUSIONS

A poor social climate in the work unit and frequent exposure to threats and violence at work may be predictors of smoking relapse in nurses' aides. It is essential that leaders in the health services put more emphasis on creating a supportive, relaxed, and trustful social climate in the work unit. It is also important that protective measures against violent patients are implemented, and that occupational health officers offer victims of violence appropriate support or therapy.

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.

Do people who were passive smokers during childhood have increased risk of long-term work disability?: A 15-month prospective study of nurses' aides

BACKGROUND

Regular inhalation of tobacco smoke, whether it be voluntary or not, may have profound negative effects on the body. Also intervertebral discs may be affected. The objective of the present study was to test the hypothesis that nurses' aides who were exposed to environmental tobacco smoke (ETS) at home during childhood have an increased risk of long-term sick leave.

METHODS

The sample comprised 5563 Norwegian nurses' aides, not on sick leave when they completed a mailed questionnaire in 1999. Of these, 4744 (85.3%) completed a second questionnaire 15 months later. The outcome measure was the incidence proportion of long-term sick leave during the 12 months prior to the follow-up.

RESULTS

Respondents who reported at baseline that they had been exposed to ETS at home during childhood had increased risk of sick leave exceeding 14 days attributed to neck pain (odds ratio (OR) = 1.34; 95% confidence interval (CI): 1.04-1.73), high back pain (OR=1.49; CI: 1.07-2.06), low back pain (OR=1.21; CI: 0.97-1.50), and any illness (OR=1.23; CI: 1.07-1.42), after adjustments for demographic and familial characteristics, former smoking, current smoking, physical leisure-time activities, work factors, prior neck injury, and affective symptoms. They also had increased risk of sick leave exceeding 8 weeks (OR=1.29; CI: 1.08-1.55).

CONCLUSION

The study supports the hypothesis that nurses' aides who were exposed to ETS at home during childhood have an increased risk of long-term sickness absence.

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.

Linking work factors to neck myalgia: the nitric oxide/oxygen ratio hypothesis

The pathophysiological link between work-related exposures and neck myalgia remains a puzzle. According to the hypothesis presented here, neck myalgia is evoked when low-level contractions in the trapezius muscle are combined with sympathetic vasoconstriction due to psychological stress or prolonged head-down neck flexion at work. These ischemic contractions increase nitric oxide/oxygen concentration ratio in the muscle fibres, enhancing herewith the reversible inhibition of mitochondrial cytochrome oxidase by nitric oxide. The result is depletion of adenosine triphosphate, which elicits production/efflux of lactic acid, in turn activating and sensitising proton-sensitive nociceptive fibres in the connective tissue, causing myalgic pain and tenderness. High estrogen-level, which gives a high expression of nitric oxide synthase in the muscle, accentuates the situation. During episodes of sustained inhibition of cytochrome oxidase by nitric oxide, peroxynitrite may be produced and cause irreversible inactivation of several enzymes in the mitochondrial electron-carrier chain. With repeated episodes, an increasing part of the enzymatic capacity for cellular respiration is inactivated. Even if this process only takes place within a small portion of the muscle fibres, it may contribute to frequent exacerbations of pain. Effects of peroxinitrite may also explain the mitochondrial abnormalities found in the trapezius muscle of many neck myalgia patients. Adrenergic antagonists and nitric oxide synthase inhibitors could reduce symptoms. Ascorbic acid, alpha tocopherol, and flavonoids, which are safe and effective scavengers of peroxynitrite, could prevent chronicity. The most effective non-pharmacological measure may be to reduce exposure to prolonged head-down neck flexions and psychosocial stress at work.

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.

The prevalence of musculoskeletal pain in Norwegian nurses? aides

OBJECTIVES

To determine the prevalence of musculoskeletal pain in Norwegian nurses' aides and how it varies with demographic factors, number of working hours per week, and service sector.

METHODS

A random sample of nurses' aides, represented by the Norwegian Union of Health and Social Workers, was mailed a questionnaire in 1999. The 6,485 vocationally active respondents who were not on leave because of illness or pregnancy comprised the sample of the present study.

RESULTS

The prevalence (previous 14 days) of musculoskeletal pain was 88.8% [95% confidence interval (CI) 88.0-89.6%]. The prevalence of intense musculoskeletal pain was 51.1% (CI 49.9-52.3%). The prevalence of widespread pain was 26.6% (CI 25.5-27.7%). The prevalence of pain in the extremities increased with increasing age, whereas the prevalence of headache decreased with increasing age. Neck, shoulder, elbow, high back, and hip pains were more prevalent in women than in men. The prevalence of neck pain increased with increasing working hours per week. Low back pain was most prevalent in persons working in nursing homes. Pain in the extremities was most prevalent in persons working in nursing homes and in those who were working in somatic hospital departments for adults. Headache was most prevalent in persons working in institutions for mentally handicapped people. The prevalence of musculoskeletal pain was lowest in persons working in psychiatric and paediatric departments and the community-nursing service.

CONCLUSIONS

The prevalence of musculoskeletal pain in Norwegian nurses' aides is very high. Not only the lower back but also several other regions of the body are frequently affected. The prevalence rates vary with age, gender, working hours per week, and the service sector in which the aides are working.

Service sector and perceived social support at work in Norwegian nurses' aides

OBJECTIVES

Social support at work is associated with reduced risk of illness and sickness absence. Identifying determinants of social support at work is, hence, important. The objective of this study was to determine the relationship between service sector and level of social support at work in nurses' aides.

METHODS

A random sample of nurses' aides, organised by the Norwegian Union of Health-and Social Workers, was mailed a questionnaire in 1999. Of 12,000 recipients, 7,478 (62.3%) completed the questionnaire. The 6,234 vocationally active, female respondents comprised the sample of this study. Perceived social support at work was assessed by scales in the standardised questionnaire, the General Nordic Questionnaire for Psychological and Social Factors at Work (QPSNordic). Each service sector was compared with all other sectors. Because of multiple comparisons, the significance level was set at 0.01, and 99% confidence intervals were used.

RESULTS

The following associations were found, after adjustments for age and work schedule: high levels of support from the immediate superior were reported more often by aides in the psychiatric sector [odds ratio (OR) 1.72; 99% confidence interval (CI) 1.29-2.29] and community-nurse service (OR 1.22; CI 1.01-1.48), and less often by aides in nursing homes (OR 0.67; CI 0.58-0.77). Encouraging and supportive culture in the work unit was reported more often by aides in the psychiatric sector (OR 1.55; CI 1.13-2.13), and less often by aides in nursing homes (OR 0.79; CI 0.69-0.92).

CONCLUSIONS

In nurses' aides, perceived level of social support at work varies with service sector. Differences in organisational structure, personnel resources, and work tasks could explain the results. It is essential that managers in nursing homes put more emphasis on creating a supportive culture in their work units. Reorganisation and training of personnel could be elements of this effort. Higher grants may also be needed.

Low back pain as a predictor of long-term work disability

AIM

To investigate low back pain (LBP), with and without other musculoskeletal pains, as a predictor of long-term work disability.

METHOD

A four-year prospective study was conducted. All inhabitants in the municipality of Ullensaker, Norway, born in 1928-30, 1938-40, 1948-50, 1958-60 and 1968-70, received a mailed questionnaire in 1990 and 1994. The present study comprised the 1.788 responders who were working in 1990. Of these, 1426 (80%) returned the questionnaire four years later. The main outcome measure was long-term work disability (>eight weeks) in 1994.

RESULTS

LBP in 1990 predicted long-term work disability in 1994 (odds ratio (OR) = 1.95, 95% confidence interval (CI) = 1.39-2.74). Localized LBP however, did not predict long-term work disability, while LBP accompanied by widespread pain did (OR = 3.52, 95% CI = 1.09-11.37), also after adjustments for demographic, lifestyle, and work-related factors. Other predictors of long-term work disability were high age, sick leave last year, heavy lifting in the job, poor sleep quality and smoking.

CONCLUSION

LBP in persons with widespread musculoskeletal pain predicted long-term work disability, while localized LBP did not.

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.

Physical leisure-time activities and long-term sick leave: a 15-month prospective study of nurses' aides

The objective of the study was to determine the relationship between physical leisure-time activities and the occurrence of long-term sick leaves in nurses' aides. Of 5563 Norwegian nurses' aides who were not on sick leave when they completed a questionnaire in 1999, 4744 (85.3%) completed a second questionnaire 15 months later. Brisk walks (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.63 to 0.98), aerobics or gymnastics (OR, 0.71; 95% CI, 0.49 to 1.02), and other physical leisure activities (OR, 0.81; 95% CI, 0.66 to 1.00) for 20 minutes or more at least once a week predicted fewer long-term sick leaves (> 14 days), after adjustments for baseline health complaints, demographic and familial characteristics, former and current smoking, and work factors. In conclusion, regular physical leisure-time activity may be associated with a reduced risk of long-term sickness absence in nurses' aides.

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.

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.

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.

Marital disruption and long-term work disability. A four-year prospective study

Data from a community-based four-year prospective study were used to investigate the relationship between marital disruption and long-term work disability. In 1990, all inhabitants of the municipality Ullensaker, Norway, belonging to six cohorts (20-22 years, 30-32 years, 40-42 years, 50-52 years, 60-62 years and 70-72 years) were sent a questionnaire. Of the 1,359 respondents who were working, married or cohabiting, and not older than 62 years, 1,115 (82%) returned a second questionnaire four years later (1994). Separation or divorce between 1990 and 1994 was related to long-term work disability in 1994 (OR = 3.02; 95% CI: 1.57-5.81), even after adjustments for age, sex, work characteristics, number of work hours per week, job satisfaction, body mass index, having pre-school children, smoking, physical leisure activity, emotional symptoms and musculoskeletal pain (all measured in 1990). Emotional problems evoked by the marital disruption may be part of the explanation.

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.

Smoking, heavy physical work and low back pain: a four-year prospective study

Data from a community-based four-year prospective study were used to test the hypothesis that heavy physical work is a stronger predictor of low back pain in smokers than in non-smokers. Of 708 working responders without low back pain during the entire year prior to 1990, 562 (79%) completed a questionnaire four years later in 1994. A job involving heavy lifting and much standing in 1990 was a strong predictor of low back pain in smokers four years later [odds ratio (OR) = 5.53, 95% confidence interval (CI) = 1.93-15.84, p < 0.01) after having adjusted for other job characteristics, demographic factors, emotional symptoms, physical exercise and musculoskeletal pain elsewhere. In non-smokers, having a job with heavy lifting and much standing was not associated with low back pain. One explanation may be that smoking leads to reduced perfusion and malnutrition of tissues in or around the spine and causes these tissues to respond inefficiently to mechanical stress.

Physical leisure activity level and physical fitness among women with fibromyalgia

To determine selfreported physical leisure activity level and physical fitness in women with fibromyalgia we sent questionnaires to the female members of a local fibromyalgia association and the same questionnaire to the women in a population based cohort study. The fibromyalgia patients had higher physical leisure activity level, but lower physical fitness than the women in the population survey. The difference in physical leisure activity persisted even after controlling for a series of possible confounders, including employment status and work load in a logistic regression analysis.

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.

Social support and the smoking behaviour of parents with preschool children

In a study of the relationship between social support and smoking behaviour, 1046 parents coming with their children for well-child control at health centres in Oslo, Norway, completed a questionnaire. The prevalence of daily smoking increased with decreasing social support. However, this association did not remain significant when adjusting for demographic and household characteristics. Among smoking parents, indoor smoking at home was related to medium (OR = 1.97; CI: 1.01-3.81) and low social support (OR = 2.35; CI: 1.19-4.63) when adjusting for demographic and household characteristics. Smoking parents smoked more cigarettes per day when they had low social support. However, this association was only seen in parents with several children. In this group, smoking 10 cigarettes per day or more was strongly related to medium (OR = 5.05; CI: 1.66-15.35) and low social support (OR = 7.81; CI: 2.44-25.01).

Breastfeeding, smoking and the presence of the child's father in the household

The breastfeeding practice of 312 mothers attending mother and child health centres in Oslo, Norway, was measured using self-administered questionnaires. Having started with supplements at 3 months postpartum was related to having a spouse/cohabitant, smoking, and having only one child (logistic regression with civil state, age, education, smoking, number of children, social support, smoking x civil state, and education x civil state as independent variables). The frequency of having started with supplements increased with increasing maternal cigarette consumption. Among non-smoking, married/cohabiting mothers, the frequency of having started with supplements at 3 months postpartum was 41% if the spouse/cohabitant smoked, compared with 18% if he did not smoke (p < 0.01).

Does dietary supplementation of cod liver oil mitigate musculoskeletal pain?

OBJECTIVE

To investigate the relationship between dietary supplementation of cod liver oil and the intensity of pain in people with musculoskeletal pain.

DESIGN

Cross-sectional study.

SETTING

Data from the Norwegian Health Survey 1985.

SUBJECTS

All adult respondents who had reported musculoskeletal pain (n = 4490).

MAIN OUTCOME MEASURES

Intensity of musculoskeletal pain as assessed by self reports during an interview.

RESULTS

In logistic regression analyses (adjusting for age, gender, socioeconomic status, civil status, smoking habits, physical exercise, mental distress, and use of medicines), there was a negative association between regular intake of cod liver oil during the previous week and intense pain (OR = 0.75; 95% CI: 0.56-1.00; P = 0.048) and considerable/intense pain (OR = 0.81; 95% CI: 0.67-1.00; P = 0.045). The association was stronger in the 33% of the respondents who reported a musculoskeletal disease, as expressed by the relationship of cod liver oil to intense pain (OR = 0.64; 95% CI: 0.43-0.95; P = 0.028) and considerable/intense pain (OR = 0.74; 95% CI: 0.54-1.03; P = 0.076). The association varied between diagnostic groups, and was not seen in people who did not report a musculoskeletal disease.

CONCLUSION

The study suggests that people with musculoskeletal pain experience less pain if they take cod liver oil.

Is there an increased lability in parents' smoking behaviour after a childbirth?

OBJECTIVE

To test our hypothesis that there is an increased lability in parents' smoking behaviour after a childbirth, and to search for demographic factors associated with lability in parents' smoking behaviour.

DESIGN

A one month, prospective questionnaire study.

SETTING

Maternal and child health centres in Oslo, Norway.

SAMPLE

222 families in which at least one adult was smoking were enrolled in the study. 37 families dropped out (16.7%) and 185 families completed both questionnaires.

MEASUREMENTS

Changes in daily smoking, smoking quantity, and practical measures to prevent passive smoking by the children, as assessed by parental reports.

RESULTS

Families with a child aged less than one year (infant) were more likely to make one or another positive change (quit, reduce, stop smoking indoors, stop smoking in living rooms) than families with only older children. There was a trend for families with an infant to make negative changes more often (start smoking, increase) as well. Older parents made positive changes more often than younger ones. Single parents were less likely to make positive changes.

CONCLUSIONS

The study indicates that there is an increased lability in parents' smoking behaviour after a childbirth.

Effects of information on smoking behaviour in families with preschool children

An information programme on measures to prevent passive smoking by children, designed for use during well-child visits, was tested. A total of 443 consecutive families with one or two smoking parents, attending mother and child health centres in Oslo, Norway, were randomly allocated to an intervention group (n = 221) and a control group (n = 222). Eighty families (18%) dropped out during the study period. For the intervention group, the communication between the health visitor and the family was prolonged at one well-child visit with a brief session on smoking, and the parents were given three brochures. The families in the control group received no information on smoking. Changes in practical measures to prevent passive smoking by the children (e.g. no smoking indoors) as well as changes in daily smoking and smoking quantity were assessed by parental reports. We found no significant differences between the groups with respect to change in smoking behaviour.

Smoking behaviour in young families. Do parents take practical measures to prevent passive smoking by the children?

OBJECTIVE

To investigate smoking behaviour in young families.

DESIGN

Cross-sectional study.

SETTING

Mother and child health centres in Oslo, Norway.

SUBJECTS

The families of 1,046 children attending the health centres for 6-weeks-, 2- or 4- year well child visits.

MAIN OUTCOME MEASURES

Daily smoking, smoking quantity and practical measures taken by the parents to prevent passive smoking among the children as assessed by parental reports.

RESULTS

In 48% of the families at least one adult was smoking. 33% of the smoking parents smoked more than ten cigarettes per day. 47% of the smoking families reported that they did not smoke indoors.

CONCLUSIONS

The parents were less likely to smoke if they were more than 35 years of age, had a child aged less than one year, had a spouse/co-habitee or had a long education. Smoking parents smoked less if they had a spouse/co-habitee, had a child aged less than one year or had few children. Smoking parents were more often careful and did not smoke indoors if they had a child aged less than one year, had a spouse/co-habitee, did not have a smoking spouse/co-habitee or smoked a low number of cigarettes per day.

The role of social support in the pathogenesis of coronary heart disease. A literature review

A possible effect of social support on the pathogenesis of coronary heart disease (CHD) would have practical implications, especially from a general practitioner's point of view. This paper reviews studies on the relationship between social support and CHD/CHD risk factors. Several prospective studies show a negative correlation between the level of social support and CHD mortality/CHD morbidity. These associations may be due to a protective effect of social support. This conclusion is supported by several investigations indicating that social support is capable of moderating potentially harmful negative emotions and the potentially harmful cardiovascular response to psychological challenge. However, a lack of control with personality factors in most of the studies makes this conclusion uncertain.