Christine Brulin

Increasing prevalence of overweight in young schoolchildren in Umeå, Sweden, from 1986 to 2001.

Aim: To investigate the current prevalence and trend of overweight in young schoolchildren in Umeå, Sweden. Methods: Two cross‐sectional samples of children were studied: 1115 randomly selected children from preschool class to grade 6 (aged 6–13 y) attending school in 2001 and a matched sample of 507 schoolchildren from grades 0, 1 and 4 (aged 6–11 y) attending school in 1986. Overweight was defined according to age‐ and gender‐specific body mass index (BMI) cutoff values, corresponding to BMI values of 25 kg/m2 (level 1) and 30 kg/m2 (level 2) at late adolescence. Results: In the population from 2001, the prevalence of overweight was 23% (18% at level 1, 5% at level 2). The prevalence differed with age, with a higher prevalence at the ages of 6 and 13 y. Comparing children from grades 0, 1 and 4, attending school in 1986 and 2001, respectively, the total prevalence of overweight was twice as high in 2001 as in 1986. Regarding severe overweight (level 2), the difference was even larger (five times). In the 1986 sample, the prevalence of overweight did not differ between girls and boys, while significantly more girls than boys were overweight in 2001.

Recurrent pain symptoms in young schoolchildren are often multiple

Abstract Different recurrent pain symptoms in children have mainly been investigated separately and comprehensive studies exploring the relationship between several of the most common recurrent pain symptoms simultaneously are few. The present study investigated frequency and co‐occurrence of recurrent headache, stomach‐ache, and backache in young schoolchildren (6–13 years of age). A randomized cluster sample of 1155 children from grades 0 to 6 completed a questionnaire; the youngest children helped by their parent. The results showed that 2/3 of the children reported having pain at least once every month, 1/3 at least once a week, and 6% reported experiencing pain symptoms every day. Half of the children with recurrent pain symptoms reported pain symptoms from several body locations, and, in children with weekly pain symptoms, two out of three reported multiple pain. Multiple, but not single, pain symptoms became more prevalent with age. The only difference between girls and boys was a higher prevalence of multiple weekly pain symptoms in girls. In conclusion, this study shows that a great number of young schoolchildren suffer from frequently recurring and co‐occurring pain symptoms, indicating an urgent need for preventive and curative programs starting already in the first school years. Furthermore, the high prevalence of multiple symptoms indicates that recurrent pain symptoms in children, particularly frequent symptoms, should be regarded a potential general pain disorder rather than merely a localized body disorder.

High prevalence of tiredness and pain in young schoolchildren

Aims: This study presents the prevalence of tiredness, headache, stomach ache, and backache in young schoolchildren. Methods: A randomized cluster sample of 1,155 children from grade 0 to 6 (aged 6 - 13 years) in Umeå, a city in northern Sweden, completed a questionnaire. Results: Tiredness was the most frequently reported complaint. One-third (31%) of the children felt tired at least once a week, when starting school in the morning, and 16% felt tired almost every day. Headache was the most commonly reported pain: 23% reported weekly recurrent headache and 9% had headache more than once a week. However, in the two lowest grades, stomach ache was more common than headache. The prevalence of weekly recurrent stomach ache was 19% while 8% experienced stomach ache more than once a week. Recurrent monthly backache was reported by 18% of the children, approximately half of them reporting weekly complaints. In general, the prevalence of complaints increased by grade. Headache and stomach ache were more prevalent among girls compared with boys, while no gender difference was seen for tiredness and backache. Conclusions: This study shows that tiredness, headache, stomach ache, and backache are common also among young schoolchildren. The results suggest a need of preventive efforts addressing these complaints at early age.

Relationships between work-related factors and disorders in the neck-shoulder and low-back region among female and male ambulance personnel

Relationships between work‐related factors and disorders in the neck‐shoulder and low‐back region among female and male ambulance personnel: Ulrika Aasa, et al. Centre for Musculoskeletal Research, University of Gävle, Sweden—This cross‐sectional study on a random sample of 1,500 ambulance personnel investigated the relationships between self‐reported work‐related physical and psychosocial factors, worry about work conditions, and musculoskeletal disorders among female and male ambulance personnel. Three different outcomes, complaints, activity limitation, and sick leave, for the neck‐shoulder and low‐back region, respectively, were chosen. Among the female personnel, physical demands was significantly associated with activity limitation in the neck‐shoulder (OR 4.13) and low‐back region (OR 2.17), and psychological demands with neck‐shoulder (OR 2.37) and low‐back (OR 2.28) complaints. Among the male personnel, physical demands was significantly associated with low‐back complaints (OR 1.41) and activity limitation (OR 1.62). Psychological demands and lack of social support were significantly associated with neck‐shoulder complaints (OR 1.86 and OR 1.58, respectively) and activity limitation (OR 3.46 and OR 1.71) as well as activity limitation due to low‐back complaints (OR 2.22 and OR 1.63). Worry about work conditions was independently associated with activity limitation due to low‐back complaints among the female (OR 5.28), and to both neck‐shoulder and low‐back complaints (OR 1.79 and OR 2.04, respectively) and activity limitation (OR 2.32 and OR 1.95) among the male personnel. In conclusion, the association patterns between physical and psychological demands and MSDs suggest opportunities for intervention.

Pleasant human touch is represented in pregenual anterior cingulate cortex

Touch massage (TM) is a form of pleasant touch stimulation used as treatment in clinical settings and found to improve well-being and decrease anxiety, stress, and pain. Emotional responses reported during and after TM have been studied, but the underlying mechanisms are still largely unexplored. In this study, we used functional magnetic resonance (fMRI) to test the hypothesis that the combination of human touch (i.e. skin-to-skin contact) with movement is eliciting a specific response in brain areas coding for pleasant sensations. The design included four different touch conditions; human touch with or without movement and rubber glove with or without movement. Force (2.5 N) and velocity (1.5 cm/s) were held constant across conditions. The pleasantness of the four different touch stimulations was rated on a visual analog scale (VAS-scale) and human touch was rated as most pleasant, particularly in combination with movement. The fMRI results revealed that TM stimulation most strongly activated the pregenual anterior cingulate cortex (pgACC). These results are consistent with findings showing pgACC activation during various rewarding pleasant stimulations. This area is also known to be activated by both opioid analgesia and placebo. Together with these prior results, our finding furthers the understanding of the basis for positive TM treatment effects.

Time Trends in Symptoms and Prehospital Delay Time in Women vs. Men with Myocardial Infarction Over a 15-Year Period. The Northern Sweden MONICA Study

Background: Few studies have examined the time between onset of myocardial infarction (MI) symptoms and arrival at hospital (prehospital delay time) and symptoms in men vs. women. Aims: To describe prehospital delay time and symptoms in men vs. women with MI and to analyse trends over time and according to age. Methods: The Northern Sweden MONICA myocardial infarction registry, 1989–2003, included 5072 men and 1470 women with a confirmed MI. Results: Typical pain was present in 86% of the men and 81% of the women. The proportion with typical symptoms decreased over time for men and increased for women. Typical symptoms were more common among younger persons than older persons. Insufficiently reported symptoms was unchanged in men over time and decreased among women. Up to the age of 65, no gender differences were seen in the prehospital delay. In the oldest age group (65–74 years) time to hospital was longer than among the younger groups, especially among women. Conclusion: There were no major gender differences in prehospital delay or type of symptoms. However, over time the proportion with typical symptoms decreased in men and increased in women. Older patients had longer prehospital delay and less typical symptoms.

Preanalytical venous blood sampling practices demand improvement — A survey of test-request management, test-tube labelling and information search procedures ☆

BACKGROUND Most errors in laboratory medicine are preanalytical in nature. In the present study, we aimed to survey preanalytical steps in venous blood sampling, prior to actual sample collection. These steps included test-request management and test-tube labelling, as well as information search procedures. METHODS Venous blood sampling staff (n=314, response rate 94%) in hospital wards and laboratories completed a questionnaire related to clinical chemistry testing. RESULTS Instructions for test-request management and test-tube labelling were not always followed. For example, only 66% of the ward staff reported always checking the test-request if someone else completed it, compared to 90% of the laboratory staff (p=0.003). As few as 16% of the ward staff reported desirable practices regarding test-tube labelling, compared to 100% of the laboratory staff (p<0.001). Furthermore, 18% of the ward staff reported always using online manuals (the only source of updated information), compared to 63% of the laboratory staff (p<0.001). CONCLUSIONS Our results indicate a substantial risk of preanalytical error in test-request management, test-tube labelling, and information search practices, particularly in the wards. Our findings thus underscore the importance of quality control in venous blood sampling, in order to increase patient safety in modern health care.

Physiological responses to touch massage in healthy volunteers.

OBJECTIVES To evaluate effects of touch massage (TM) on stress responses in healthy volunteers. METHODS A crossover design including twenty-two (mean age=28.2) healthy volunteers (11 male and 11 female) cardiac autonomic tone was measured by heart rate (HR) and heart rate variability (HRV). Stress hormone levels (cortisol) were followed in saliva. We also measured blood glucose and serum insulin. Extracellular (ECV) levels of glucose, lactate, pyruvate and glycerol were followed using the microdialysis technique (MD). TM was performed on hands and feet for 80 min, during control, participants rested in the same setting. Data were collected before, during, and after TM and at rest. Saliva cortisol, serum glucose, and serum insulin were collected before, immediately following, and 1 h after intervention or control, respectively. RESULTS After 5 min TM, HR decreased significantly, indicating a reduced stress response. Total HRV and all HRV components decreased during intervention. Saliva cortisol and insulin levels decreased significantly after intervention, while serum glucose levels remained stable. A similar, though less prominent, pattern was seen during the control situation. Only minor changes were observed in ECV levels of glucose (a decrease) and lactate (an increase). No significant alterations were observed in glycerol or pyruvate levels throughout the study. There were no significant differences between groups in ECV concentrations of analyzed substances. CONCLUSIONS In healthy volunteers, TM decreased sympathetic nervous activity, leading to decreased overall autonomic activity where parasympathetic nervous activity also decreased, thereby maintaining the autonomic balance.

Effect of a general fitness program on musculoskeletal symptoms, clinical status, physiological capacity, and perceived work environment among home care service personnel

The aim of the present controlled study was to evaluate the effect of a general fitness program, performed by an occupational health service, using pre-post assessment for a number of different outcome measures. A total of 160 employees working in the central home care service district of Umeå, Sweden were asked to participate in a program of a 1-year long exercise program. Of the 160 selected, 54 subjects declined to participate and nine subjects were rejected after a medical check up. The remaining 97 subjects participated in a schedule consisting of pre-post medical and physiotherapy examinations, questionnaires concerning sociodemography, musculoskeletal and general health complaints and work environment, physiological tests of cardiovascular fitness, and of strength and endurance of shoulder flexors and knee extensors, and registration of sick leave. The subjects were randomly assigned to an exercise (treatment) or control group. The exercise group trained twice a week for 1 year using a mixed program including exercises for coordination, strength/endurance, and fitness. The test schedule was repeated for both groups after 1 year. The exercise intervention was associated with positive changes in prevalence and intensity of musculoskeletal and psychosomatic complaints, better physiotherapy status (less muscle tightness, better neck mobility, and less tender points), increased shoulder strength and increased coordination in thigh muscles. However, the exercise group reported worse situations post-exercise concerning aspects of their physical and psychosocial work-environment (i.e., concerning ergonomy, influence, appreciation and communication with work manager), which might have been due to stress associated with the exercise situation.

Preanalytical errors in primary healthcare: a questionnaire study of information search procedures, test request management and test tube labelling.

Abstract Background: Most errors in laboratory medicine occur in the preanalytical phase and are the result of human mistakes. This study investigated information search procedures, test request management and test tube labelling in primary healthcare compared to the same procedures amongst clinical laboratory staff. Methods: A questionnaire was completed by 317 venous blood sampling staff in 70 primary healthcare centres and in two clinical laboratories (response rate = 94%). Results: Correct procedures were not always followed. Only 60% of the primary healthcare staff reported that they always sought information in the updated, online laboratory manual. Only 12% reported that they always labelled the test tubes prior to drawing blood samples. No major differences between primary healthcare centres and clinical laboratories were found, except for test tube labelling, whereby the laboratory staff reported better practices. Re-education and access to documented routines were not clearly associated with better practices. Conclusions: The preanalytical procedure in the surveyed primary healthcare centres was associated with a risk of errors which could affect patient safety. To improve patient safety in laboratory testing, all healthcare providers should survey their preanalytical procedures and improve the total testing process with a systems perspective. Clin Chem Lab Med 2009;47:195–201.