Benny Karpatschof

Do fear-avoidance beliefs play a role on the association between low back pain and sickness absence? A prospective cohort study among female health care workers.

Health care workers have a high prevalence of sickness absence because of low back pain (LBP). This study examined whether fear-avoidance beliefs (FAB): 1) predicted sickness absence and 2) moderated the association between LBP and sickness absence among 1724 newly educated health care workers with LBP ≥ day during the previous 12 months. High FAB was associated with sickness absence days 1 year later (relative risk, 1.45, 95% confidence interval = 1.24 to 1.70), controlled for LBP, previous sickness absence, and age. When controlling for work environmental factors, the association remained significant but decreased. Furthermore, the results showed that health care workers with high degree of LBP would have more sickness absence days if they also had high FAB. To reduce sickness absence, education about pain management must be presumed to be beneficial.

A simple and objective marker for stress

Abstract Objective: To examine the association between pressure pain sensitivity (PPS) at sternum and various well established physiological stress measures among opera singers during a performance as a measure for transitional stress, and resting values in out-clinic patients as a measure for persistent stress. Methods: Changes in PPS on the index finger and sternum, middle blood pressure (MAP), heart rate (HR), pressure-rate-product (PRP) and salivary cortisol (SCO) were recorded in 26 opera solo singers during a performance. Resting PPS, HR, MAP, PRP and presence of a noxious withdrawal reflex (NWR) were recorded in 181 out-clinic patients. Results: During opera performance, the PPS on sternum changed concomitantly with MAP (correlation coefficient (r) r=0.42, p<0.005), HR (r=0.55, p<0.001), PRP (r=0.54, p<0.001) and SCO (r=0.26, p=0.066). During rest, a significant correlation was found between PPS on sternum and HR, PRP and presence of noxious withdrawal reflex (all p<0.01). Conclusions: The PPS measurement at sternum was associated with well established physiological stress measures and may represent a simple, objective and reliable measure of physiological stress used by both non-professional and professionals.

Regression to the mean effect: When to be concerned and how to correct for it

The paper deals with the problem of regression to the mean when testing hypotheses of change dependent on the level of the measure of interest at the time of the first measurement in longitudinal studies. The paper includes: A discussion on the nature of regression to the mean and when to be aware of it in relation to different fields of psychological research. An example of the severe implications regression to the mean can have for interpretation of results, based on Nielsen’s research on changes in the learning styles of Danish university students. Finally, a relatively easy way to correct for regression to the mean in connection with paired sample t-tests of no change for persons with either low or high scores at the first measurement is demonstrated.

Long-Term Effects of Integrated Rehabilitation in Patients with Stroke: A Nonrandomized Comparative Feasibility Study

BACKGROUND AND PURPOSE Integrated rehabilitation (IR) in patients with stroke with respect to death rate and feasibility, initiated as a reduced death rate, was observed in patients with angina pectoris receiving IR. DESIGN A case-control study included 73 consecutive patients with ischemic stroke. Death rates were compared with those of the general Danish population matched for age, gender, and observation period, as well as data from the community-based Copenhagen Stroke Study. INTERVENTIONS IR was conducted in an outpatient clinic, by professionals as well as by the patient: the former as a specific acupuncture treatment, the latter as a comprehensive biofeedback guided stress management program including diets, physical- and relaxation exercise, Chinese health philosophy, cognitive and mindfulness-related exercises, and specific biofeedback guided acupressure. RESULTS The 4(1/2)-year accumulated risk of death was 11.6% (95 confidence limits: 3.2%-20.0%) for the 73 patients with stroke treated with IR, compared to 18.4% for the general Danish population matched for sex, age, and time period. The corresponding figures for patients receiving conventional stroke treatment were 43.2% (95 confidence limits: 39.7%- 46.7%), and 20.0% for the general Danish population matched for sex, age, and time period. CONCLUSIONS IR was found to be feasible for patients with stroke as a complementary treatment to conventional stroke treatment, and added no risk of dying when compared to Danish stroke patients receiving conventional medical treatment. The results invite further testing in a randomized trial.

Bringing quality and meaning to quantitative data – Bringing quantitative evidence to qualitative observation

Based on the author’s methodological theory defining the distinctive properties of quantitative and qualitative method the article demonstrates the possibilities and advantages of combining the two types of investigation in the same research project. The project being an effect study of a counselling for children in grief.

The association between changes in pressure pain sensitivity and changes in cardiovascular physiological factors associated with persistent stress

Abstract Objectives. To evaluate the possible association between pressure pain sensitivity of the chest bone (PPS) and cardiovascular physiological factors related to persistent stress in connection with a three-month PPS-guided stress-reducing experimental intervention programme. Methods. Forty-two office workers with an elevated PPS (≥ 60 arbitrary units) as a sign of increased level of persistent stress, completed a single-blinded cluster randomized controlled trial. The active treatment was a PPS (self-measurement)-guided stress management programme. Primary endpoints: Blood pressure (BP), heart rate (HR) and work of the heart measured as Pressure-Rate-Product (PRP); Secondary endpoints: Other features of the metabolic syndrome. Results. PPS decreased and changes in PPS after the intervention period were significantly associated with HR, PRP, body mass index (BMI) and visceral fat index (all correlation coefficients > 0.2, p < 0.05). Compared to the control cluster group, the active cluster group obtained a significant reduction in PPS, Low-density lipoprotein (LDL) cholesterol and total number of elevated risk factors (p < 0.05). On an individual level, significant and clinically relevant between-group reductions were observed in respect to BP, HR, PRP, total and LDL cholesterol, and total number of elevated risk factors (p < 0.05). Conclusions. The stress intervention method applied in this study induced a decrease in PPS which was associated with a clinically relevant decrease in resting blood pressure, heart rate, work of the heart and serum cholesterols.

Association between pressure pain sensitivity and autonomic function as assessed by a tilt table test

Abstract Background. We tested the hypothesis that pressure sensitivity of the sternum (PPS) is associated with autonomic nervous system (ANS) function as assessed by tilt table test (TTT). in patients with stable ischemic heart disease. Objectives. (1) To evaluate an association between PPS and systolic blood pressure (SBP) and heart rate (HR) responses to TTT; and (2) to test the hypothesis that a reduction of resting PPS raises the PPS, SBP and HR responses to TTT response and lowers risk factors for ANS dysfunction (ANSD). Methods. Cross-sectional study: In 361 patients with stable ischemic heart disease we measured PPS, SBP, and HR during TTT. Intervention study: We reassessed subjects with persistent stress who concluded a stress intervention trial by a second TTT. Results. Cross-sectional study: Resting PPS and the PPS response to TTT were correlated (r = − 0.37). The PPS response to TTT was correlated with that of SBP (r = 0.44) and HR (r = 0.49), and with the number of risk factors for ANSD (r = − 0.21) (all p < 0.0001). Intervention study: A reduction in resting PPS was associated with an increment in PPS response to TTT (r = − 0.52, p < 0.0001). The greater this increment, the greater was the reduction in ANSD risk factors (r = − 0.23; p = 0.003). Conclusion. The results are consistent with the hypothesis that PPS at rest and in response to TTT reflects ANS function.

Pressure pain sensitivity as a marker for stress and pressure pain sensitivity-guided stress management in women with primary breast cancer.

Abstract Objectives. To validate (1) Pressure Pain Sensitivity (PPS) as a marker for stress and (2) a PPS-guided intervention in women with primary Breast Cancer (BC). Methods. (1) A total of 58 women with BC were examined before and after 6 months of intervention. A control group of 165 women office employees was divided in a High Stress Group (HSG, n = 37) and a Low Stress Group (LSG, n = 128) to evaluate the association between PPS, questionnaire-related Quality of Life (QOL) and self-evaluated stress. (2) A PPS-guided stress management program (n = 40) was compared to a Psychosocial Group Intervention (PGI, n = 91) and no treatment (n = 86) with respect to a European Organization for Research and Treatment of Cancer (EORTC) questionnaire measured QOL. Results. (1) Resting PPS and changes in PPS during the intervention period correlated significantly to EORTC and Short Form 36 (SF 36) main scores: (all p < 0.05). Between BC, HSG and LSG there was a significant and positive correlation with respect to PPS, SF 36 main scores, depression, and clinical stress scores (all p < 0.05). However, the BC group scored significantly lower than both HSG and LSG (both p < 0.05) with respect to self-evaluated stress. (2) The PPS-guided intervention group improved EORTC main score, pain and nausea, when compared to the control groups (all p < 0.05). Conclusions. PPS was positively associated with QOL, which was in contrast to self-evaluated stress. PPS-guided intervention improved QOL in women with breast cancer.

Play, But Not Simply Play: The Anthropology of Play

Play seems to a distinctive trait for the human species. We share the inclination of this seemingly nonsensical behaviour with the other higher vertebrates, especially the mammals. All the same play is a distinctive trait for the human being, for the play found among the mammals is restricted to a shorter period of their childhood, after which the adult mammals get more important things to do than fooling around.