Göran Ejlertsson

Widespread musculoskeletal chronic pain associated with smoking : an epidemiological study in a general rural population

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

Musculoskeletal chronic pain in general practice : studies of health care utilisation in comparison with pain prevalence

OBJECTIVE To study the relations between population prevalence of chronic pain and pain-related diagnoses (musculoskeletal and headaches) in primary health care (PHC) and to examine longitudinal variations in these diagnoses. DESIGN A population-based mailed survey to catch prevalence data and continuous computerised diagnosis registration in PHC. SETTING General population in a well-defined Swedish PHC district. SUBJECTS A random sample of 15% of the population aged 25-74, n = 1101. Annual visitors to district physicians at the health centre. MAIN OUTCOME MEASURES Rates of pain-related diagnoses in PHC in relation to population prevalence of chronic pain. Comparisons of the number of individuals (annual visiting rates) with pain-related diagnoses 1987-1996. RESULTS Population pain prevalence and pain-related diagnoses in PHC corresponded as regards the magnitude and distribution of chronic pain by age and partly by pain location. Compared to low-back and widespread pain, neck-shoulder pain and headaches were less frequent in PHC in relation to reported prevalence. From 1987 to 1996 we found an increasing number of individuals seeking primary care with pain-related diagnoses. The increase was mainly assigned to the groups of fibrositis/myalgia and headache. CONCLUSION Pain-related diagnoses in PHC reflect partly the occurrence of self-reported chronic pain symptoms in the population. The observed increase in visits with pain-related diagnoses in the last 10 years is due to an increased number of individuals with soft-tissue rheumatism and headaches. Future studies will have to elucidate whether these findings are due to an increase in morbidity or changes in care-seeking and social conditions.

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

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

Self‐reported health, self‐esteem and social support among young unemployed people: a population‐based study

A population-based study was performed in southern Sweden in the autumn of 1998. The aim was to study connections between self-reported health, self-esteem and social support among unemployed (≥ th ...

Inequalities of quality of life in unemployed young adults: A population-based questionnaire study

BackgroundIt is well known that unemployment is a great problem both to the exposed individual and to the whole society. Unemployment is reported as more common among young people compared to the general level of unemployment. Inequity in health status and life-satisfaction is related to unemployment. The purpose of this population-based study was to describe QOL among unemployed young people compared to those who are not unemployed, and to analyse variables related to QOL for the respective groups.MethodsThe sample consisted of 264 young unemployed individuals and 528 working or studying individuals as a reference group. They all received a questionnaire about civil status, educational level, immigration, employment status, self-reported health, self-esteem, social support, social network, spare time, dwelling, economy and personal characteristics. The response rate was 72%. The significance of differences between proportions was tested by Fishers exact test or by χ2 test. Multivariate analysis was carried out by means of a logistic regression model.ResultsOur results balance the predominant picture of youth unemployment as a principally negative experience. Although the unemployed reported lower levels of QOL than the reference group, a majority of unemployed young adults reported good QOL, and 24% even experienced higher QOL after being unemployed. Positive QOL related not only to good health, but also to high self-esteem, satisfaction with spare time and broad latitude for decision-making.ConclusionEven if QOL is good among a majority of unemployed young adults, inequalities in QOL were demonstrated. To create more equity in health, individuals who report reduced subjective health, especially anxiety need extra attention and support. Efforts should aim at empowering unemployed young adults by identifying their concerns and resources, and by creating individual programmes in relation not only to education and work, but also to personal development.

Continuity-of-care Measures: An Analytic and Empirical Comparison

The authors compared four different continuity-of-care measures recently suggested in the literature. First, an analytic comparison is made and useful inequalities are derived. Then the continuity indexes are applied to an extensive data material from a Swedish ambulatory care center. The four indexes give fairly similar results, and the basic finding is the substantially higher index values for elderly patients. Finally, computed index values are compared with what could be expected under a scheme of random assignment of patients to doctors

Immigration and Socio-economy as Predictors of Early Retirement Pensions

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

Predictors of positive health in disability pensioners : a population-based questionnaire study using Positive Odds Ratio

BackgroundDeterminants of ill-health have been studied far more than determinants of good and improving health. Health promotion measures are important even among individuals with chronic diseases. The aim of this study was to find predictors of positive subjective health among disability pensioners (DPs) with musculoskeletal disorders.MethodsTwo questionnaire surveys were performed among 352 DPs with musculoskeletal disorders. Two groups were defined: DPs with positive health and negative health, respectively. In consequence with the health perspective in this study the conception Positive Odds Ratio was defined and used in the logistic regression analyses instead of the commonly used odds ratio.ResultsPositive health was associated with age ≥ 55 years, not being an immigrant, not having fibromyalgia as the main diagnosis for granting an early retirement, no regular use of analgesics, a high ADL capacity, a positive subjective health preceding the study period, and good quality of life.ConclusionPositive odds ratio is a concept well adapted to theories of health promotion. It can be used in relation to positive outcomes instead of risks. Suggested health promotion and secondary prevention efforts among individuals with musculoskeletal disorders are 1) to avoid a disability pension for individuals <55 years of age; if necessary, to make sure rehabilitation actions continue, 2) to increase efforts to support immigrants to adjust to circumstances connected to ill-health and retirement, 3) to pay special attention to individuals with fibromyalgia and other general pain disorders, and 4) to strengthen ADL activities to support an independent active life among disability pensioners.

Predictors of strong sense of coherence and positive attitudes to physical education in adolescents.

Aims: The aim of this study was to find variables related to positive attitudes to physical education (PE) and strong sense of coherence (SOC) among adolescents. Methods: The study included three parts: seven physical tests; a questionnaire which included ways of living, attitudes to PE, and subjective health, the 13-question version of SOC; and information on every students grades. The study group comprised 301 teenagers (131 girls and 170 boys, aged 16—19 years) attending upper secondary school. Positive odds ratio was used in the logistic regression analyses with SOC and attitudes to PE as dependent variables. Results: Variables related to positive attitudes to PE were strong SOC, high physical capacity, high leisure-time physical activity (PA), high grades in PE, and little time spent watching TV. Variables related to strong SOC were positive attitudes to PE, high grades in PE, very good subjective health, and feeling comfortable in school. Highest physical capacity, highest mean grades, and highest grades in PE were found among adolescents who reported exercise four times or more per week. Conclusions: An interrelation between attitudes to PE and SOC was shown. The relation between positive attitudes to PE and high scores in SOC indicated that past experiences of PA and PE could contribute to the development of SOC, and actual levels of SOC could influence the persistent attitudes to PE and be important for lifelong PA. One means of identification of favourable or unfavourable health behaviour among young people might be through PA patterns, and relations between attitudes to PE and SOC.

Development and quality analysis of the Salutogenic Health Indicator Scale (SHIS)

Background: Current health measurement instruments tend to measure aspects of ill-health rather than health in general. There is a need for a salutogenic perspective when describing health and developing a health measurement instrument. The aim of this article is to present the development process and quality assessment of a salutogenic health indicator scale. Methods: A description of health, emanating from the concept of health, positive health and well-being, was used as a basis for the construction of the scale. The scale is a semantic differential consisting of 12 indicator items covering nine heath-related dimensions. A principal component analysis was performed, and three health indicator indexes were constructed. Correlation with self-rated health questions was investigated, weighted kappa values were calculated, and Cronbachs alpha (CA) was used to check internal consistency. Results: The analysis resulted in a two-factor model, and the indexes were named intrapersonal characteristics (CA= 0.90) and interactive function (CA= 0.84), summarised into health complete (CA= 0.92). Kappa values ranged from 0.44 to 0.67, and correlations with self-rated health status were stronger than those with self-rated sick-leave. Conclusions: Our health description was characterized by complexity, but the instrument is a short salutogenic health indicator scale. The shortness increases the usability. The instrument seems to be able to offset the current problem of there being a lack of salutogenic health measurement instruments. The results indicate that further testing is justified.