Juha Auvinen

Psychosocial, mechanical, and metabolic factors in adolescents’ musculoskeletal pain in multiple locations: A cross-sectional study

Recent studies indicate that adolescents often experience musculoskeletal pains in two or more body locations. However, previous studies have mainly focused on localized pains, and the determinants of multiple musculoskeletal pains in adolescents are not well known. The present study was set to evaluate the role of psychosocial, mechanical, and metabolic factors in adolescents’ musculoskeletal pains in multiple locations. The study population consisted of the 1986 Northern Finland Birth Cohort; 15‐ to 16‐year‐old adolescents (n=6986), who responded to a mailed questionnaire in 2001. We assessed the associations of emotional and behavioral problems, physical activity, sitting time, sleeping time, overweight and smoking with musculoskeletal pains using multinomial logistic regression. Multiple pains were common, 23% of boys and 40% of girls reported feeling pain in at least three locations over the past 6 months. These pains were not only associated with anxious/depressed symptoms, withdrawn/depressed symptoms, somatic complaints, rule‐breaking and aggressive behavior, social problems, thought and attention problems, but also with high physical activity level, long sitting time, short sleeping time and smoking, among both boys and girls. In addition, pain in three to four locations associated with overweight in girls. A high number of psychosocial, mechanical and metabolic factors associated strongly with multiple pains. In conclusion, multiple musculoskeletal pains were strongly associated with psychosocial complaints, but also with mechanical and metabolic factors. Reported musculoskeletal pains in multiple locations in adolescence may have both peripheral (trauma, decreased regenerative ability) and central (sensitivity) causes.

Risk factors for persistence of multiple musculoskeletal pains in adolescence: A 2-year follow-up study

Musculoskeletal pain in multiple sites is common already in adolescence, and may lead to subsequent musculoskeletal complaints in adulthood. We examined predictive factors for the persistence of multiple musculoskeletal pains in adolescence over a 2‐year time span. A postal questionnaire was administered to a subsample of the Northern Finland Birth Cohort 1986 (n = 1773) when subjects were aged 16 and 18. The adjusted odds ratios (OR) and 95% confidence intervals (CI) for the possible risk factors of new‐onset of multiple pains at 18 years and 2‐year persistence of multiple pains were obtained using multinomial logistic regression. Multiple musculoskeletal pains were common; 43% of boys and 63% of girls at 16, and 61% of boys and 81% of girls at 18 reported pain in more than one site during the last 6 months. Moreover, multiple pains had a high persistence rate, as 75% of boys and 88% of girls with multiple pains at 16 reported multiple pains also at 18. In the multivariate analysis, emotional and behavioral problems (internalizing problems, OR 2.3; externalizing problems, OR 2.2), and high sitting time (OR 1.6) among boys, and internalizing problems (OR 3.7), high physical activity level (OR 1.6), short sleeping time (OR 1.7), and smoking (OR 1.9) among girls were predictive factors for the persistence of multiple pains. No statistically significant associations between the baseline variables and new‐onset multiple pains were found. Multiple musculoskeletal pains appear to have a high tendency to persist in adolescence; both psychosocial factors and lifestyle factors contribute to this vulnerability.

Neck and shoulder pains in relation to physical activity and sedentary activities in adolescence.

Study Design. A cross-sectional survey among adolescents aged 15–16 years. Objective. To evaluate whether physical activity or sedentary activities associate with neck and shoulder symptoms among adolescents. Summary of Background Data. Findings of associations between physical exercise and neck or shoulder pain in adolescents are controversial. Methods. The study population consisted of adolescents belonging to the Northern Finland Birth Cohort 1986. The present analyses included 3185 girls and 2808 boys. Associations of physical activity level, total sitting time, and different kinds of sedentary activities with neck or occipital pain and shoulder pain were analyzed at 15–16 years of age using logistic regression. Reporting pain (not seeking medical help) and consultation for pain (seeking medical help) were assessed separately in girls but were combined in boys because of a low prevalence of severe pain. Results. Almost half of the girls and one third of the boys reported mild neck or occipital pain, or shoulder pain, and 5% of girls and 2% of boys reported severe neck or occipital pain, or shoulder pain during the past 6 months. High-level physical activity associated with an increased prevalence of both severe neck or occipital pain and severe shoulder pain in girls, but not in boys. Prolonged sitting was associated with a high prevalence of neck or occipital pain and shoulder pain in girls, and neck or occipital pain in boys. Of various sedentary activities, television watching and reading books associated with neck or occipital pain in girls, whereas playing or working with a computer associated with neck or occipital pain in boys. In girls, television watching also associated with mild shoulder pain. Conclusions. Neck or occipital pain and shoulder pain are very common symptoms among adolescents, and both prolonged sitting and a high level of physical activity seem to be related to them.

Musculoskeletal pain combinations in adolescents.

Study Design. A 2-year follow-up in a birth cohort of adolescents aged 15 to 19 years. Objective. To evaluate the prevalence of neck, shoulder, low back, peripheral (limb) pain, and combinations of pain at these anatomic locations. Summary of Background Data. Few previous studies have evaluated combinations of musculoskeletal pain among adolescents. Methods. Prevalence of neck, shoulder, low back, and peripheral pain (elbow, wrist, knee, and ankle-foot pain) during the previous 6 months were obtained by questionnaire in a follow-up study of the Northern Finland Birth Cohort 1986 at 16 and 18 years of age (n = 1773). Latent class analysis was used in clustering of pain combinations at both time points. Results. No pain at all in the past 6 months at 16 and 18 years was reported by 17% and 8% of girls, and 33% and 24% of boys, respectively. Only 1 pain location (neck, shoulder, low back, or peripheral pain) was reported by 21% of girls and 25% of boys at 16, and 11% of girls and 20% of boys at 18 years, while all 4 pain locations were reported by 15% of girls and 9% of boys at 16, and 27% and 15%, respectively, at 18 years. Latent class analysis resulted in 2 to 3 pain clusters in both genders at both time points. Probability of pain increased during the 2-year follow-up, with subjects more likely to belong to a cluster with a higher likelihood of pain. Conclusion. As very few adolescents did not report any pain, the relevance of self-reported pain is questionable without assessment of pain-related disability. The clinical relevance of these pain combinations must be evaluated in further studies.

Psychosocial and lifestyle correlates of musculoskeletal pain patterns in adolescence: a 2-year follow-up study.

The prevalence of musculoskeletal (MS) pain has been increasing among adolescents in the last decades. This may be related to either adverse changes in lifestyle and/or the psychosocial environment. Our study analysed the psychosocial and lifestyle correlates of musculoskeletal pain progression in adolescence.

Muscular Fitness in Relation to Physical Activity and Television Viewing among Young Adults

PURPOSE To study how time spent in physical activity and that in television (TV) viewing are associated with muscular fitness among young adults. METHODS The study population consisted of a cross-sectional sample of 381 males and 493 females aged 19.1 yr (SD 0.3) from the Northern Finland Birth Cohort 1986. Muscular fitness was measured by trunk muscle strength tests (trunk extension, flexion, and rotation) and jumping height test. Time spent on moderate- to vigorous-intensity physical activity and on TV viewing was self-reported by a questionnaire. RESULTS The most physically active young adults performed significantly better in most trunk muscle strength tests and the jumping test than the least active subjects. The mean difference between the most and least active groups was at minimum 1.6 kg (95% confidence interval (CI) = -0.5 to 3.7) and at maximum 10.6 kg (95% CI = 4.7-16.5) for different trunk muscle strength tests and at minimum 4.4 cm (95% CI = 2.7-6.1) for the jumping height test. Males and females who watched TV for >or=2 h x d(-1) performed significantly worse in trunk extension and flexion tests and females also performed worse in the jumping test compared with those who watched TV <2 h x d(-1), independent of their physical activity level. The mean difference between low and high TV users was at minimum -3.8 kg (95% CI = -6.7 to -0.9) for trunk extension and flexion strength and -1.2 cm (95% CI = -2.0 to -0.4) for jumping height in females. CONCLUSIONS Among young adults, daily TV viewing for >or=2 h, irrespective of physical activity level, was associated with poorer muscular fitness.

Overweight and obese but not normal weight women with PCOS are at increased risk of Type 2 diabetes mellitus-a prospective, population-based cohort study

STUDY QUESTION What are the respective roles of polycystic ovary syndrome (PCOS), long-term weight gain and obesity for the development of prediabetes or Type 2 diabetes mellitus (T2DM) by age 46 years? SUMMARY ANSWER The risk of T2DM in women with PCOS is mainly due to overweight and obesity, although these two factors have a synergistic effect on the development of T2DM. WHAT IS KNOWN ALREADY PCOS is associated with an increased risk of prediabetes and T2DM. However, the respective roles of PCOS per se and BMI for the development of T2DM have remained unclear. STUDY DESIGN, SIZE, DURATION In a prospective, general population-based follow-up birth cohort 1966 (n = 5889), postal questionnaires were sent at ages 14 (95% answered), 31 (80% answered) and 46 years (72% answered). Questions about oligoamenorrhoea and hirsutism were asked at age 31 years, and a question about PCOS diagnosis at 46 years. Clinical examination and blood sampling were performed at 31 years in 3127 women, and at 46 years in 3280 women. A 2-h oral glucose tolerance test (OGTT) was performed at 46 years of age in 2780 women. PARTICIPANTS/MATERIALS, SETTING, METHODS Women reporting both oligoamenorrhoea and hirsutism at age 31 years and/or diagnosis of PCOS by 46 years were considered as women with PCOS (n = 279). Women without any symptoms at 31 years and without PCOS diagnosis by 46 years were considered as controls (n = 1577). The level of glucose metabolism was classified according to the results of the OGTT and previous information of glucose metabolism status from the national drug and hospital discharge registers. MAIN RESULTS AND THE ROLE OF CHANCE PCOS per se significantly increased the risk of T2DM in overweight/obese (BMI ≥ 25.0 kg/m2) women with PCOS when compared to overweight/obese controls (odds ratio: 2.45, 95% CI: 1.28–4.67). Normal weight women with PCOS did not present with an increased risk of prediabetes or T2DM. The increase in weight between ages 14, 31 and 46 years was significantly greater in women with PCOS developing T2DM than in women with PCOS and normal glucose tolerance, with the most significant increase occurring in early adulthood (between 14 and 31 years: median with [25%; 75% quartiles]: 27.25 kg [20.43; 34.78] versus 13.80 kg [8.55; 20.20], P < 0.001). LIMITATIONS, REASONS FOR CAUTION The diagnosis of PCOS was based on self-reporting, and the questionnaire at 46 years did not distinguish between polycystic ovaries only in ultrasonography and the syndrome. Ovarian ultrasonography was not available to aid the diagnosis of PCOS. WIDER IMPLICATIONS OF THE FINDINGS These results emphasize weight management already during adolescence and early adulthood to prevent the development of T2DM in women with PCOS, as the period between 14 and 31 years seems to be a crucial time-window during which the women with PCOS who are destined to develop T2DM by 46 years of age experience a dramatic weight gain. Furthermore, our results support the view that, particularly in times of limited sources of healthcare systems, OGTT screening should be targeted to overweight/obese women with PCOS rather than to all women with PCOS. STUDY FUNDING/COMPETING INTEREST(S) Finnish Medical Foundation; North Ostrobothnia Regional Fund; Academy of Finland (project grants 104781, 120315, 129269, 1114194, 24300796, Center of Excellence in Complex Disease Genetics and SALVE); Sigrid Juselius Foundation; Biocenter Oulu; University Hospital Oulu and University of Oulu (75617); Medical Research Center Oulu; National Institute for Health Research (UK); National Heart, Lung, and Blood Institute (grant 5R01HL087679-02) through the STAMPEED program (1RL1MH083268-01); National Institute of Health/National Institute of Mental Health (5R01MH63706:02); ENGAGE project and grant agreement HEALTH-F4-2007–201413; EU FP7 EurHEALTHAgeing-277849 European Commission and Medical Research Council, UK (G0500539, G0600705, G1002319, PrevMetSyn/SALVE) and Medical Research Center, Centenary Early Career Award. The authors have no conflicts of interests. TRIAL REGISTRATION NUMBER N/A.

Effects of Leisure-Time Physical Activity on Vertebral Dimensions in the Northern Finland Birth Cohort 1966

Vertebral fractures are a common burden amongst elderly and late middle aged people. Vertebral cross-sectional area (CSA) is a major determinant of vertebral strength and thus associated with vertebral fracture risk. Previous studies suggest that physical activity affects vertebral CSA. We aimed to investigate the relationship between leisure-time physical activity (LTPA) from adolescence to middle age and vertebral dimensions in adulthood. We utilized the Northern Finland Birth Cohort 1966, of which 1188 subjects had records of LTPA at 14, 31 and 46 years, and had undergone lumbar magnetic resonance imaging (MRI) at the mean age of 47 years. Using MRI data, we measured eight dimensions of the L4 vertebra. Socioeconomic status, smoking habits, height and weight were also recorded at 14, 31 and 46 years. We obtained lifetime LTPA (14–46 years of age) trajectories using latent class analysis, which resulted in three categories (active, moderately active, inactive) in both genders. Linear regression analysis was used to analyze the association between LTPA and vertebral CSA with adjustments for vertebral height, BMI, socioeconomic status and smoking. High lifetime LTPA was associated with larger vertebral CSA in women but not men. Further research is needed to investigate the factors behind the observed gender-related differences.

Role of environmental factors and history of low back pain in sciatica symptoms among Finnish adolescents.

Study Design. Cross-sectional study in a subcohort of the 1986 Northern Finland Birth Cohort (n = 1987). Objective. To investigate the role of environmental factors and LBP history in sciatica symptoms among Finnish young adults. Summary of Background Data. History of low back pain (LBP), smoking, and male sex are associated with sciatica in adult populations. The role of the environmental determinants of sciatica has not been evaluated in populations consisting of only adolescents. Methods. Sciatic symptoms and environmental exposures were elicited by a mailed questionnaire and the associations were analyzed using multinomial logistic regression. Results. Female sex was associated with severe sciatica at 18 years (OR, 3.9; 95% confidence interval (CI), 1.6–9.3). Both reported LBP at 16 years and LBP requiring consultation of a health care professional were associated with mild sciatica at 18 years (OR, 2.5; 95% CI, 1.3–4.9; and OR, 3.8; 95% CI, 1.2–11.9). In addition, LBP at 16 years requiring consultation of a health care professional was associated with severe sciatica at 18 years (OR, 5.0; 95% CI, 1.7–15.3). Smoking, obesity, physical workload, and level of physical activity were not associated with sciatica. Conclusion. Females reported sciatic pain more often than males. LBP at 16 years predicted sciatica at 18 years. Level of Evidence: 2

Measuring Physical Activity in Free-Living Conditions—Comparison of Three Accelerometry-Based Methods

We examined the agreement in time spent on different physical activity (PA) levels using (1) mean amplitude deviation (MAD) of raw acceleration from the hip, (2) wrist-worn Polar Active, and (3) hip-worn Actigraph counts using Freedsons cut-points among adults under free-living conditions. PA was measured in 41 volunteers (mean age 47.6 years) for 14 days. Two MET-based threshold sets were used for MAD and Polar Active for sedentary time (ST) and time spent in light (LPA), moderate (MPA), and vigorous (VPA) PA. Actigraph counts were divided into PA classes, ≤100 counts/min for ST and Freedsons cut-points for LPA, MPA, and VPA. Analysis criteria were simultaneous use of devices for at least 4 days of >500 min/d. The between-method differences were analyzed using a repeated measures analysis of variance test. Bland-Altman plots and ROC graphs were also employed. Valid data were available from 27 participants. Polar Active produced the highest amount of VPA with both thresholds (≥5 and ≥6 MET; mean difference 17.9–30.9 min/d, P < 0.001). With the threshold 3–6 MET for MPA, Polar Active indicated 19.2 min/d more than MAD (95% CI 5.8–32.6) and 51.0 min/d more than Actigraph (95% CI 36.7–65.2). The results did not differ with 3.5–5 MET for MPA [F(1.44, 37.43) = 1.92, P = 0.170]. MAD and Actigraph were closest to each other for ST with the threshold < 1.5 MET (mean difference 22.2 min/d, 95% CI 7.1–37.3). With the threshold <2 MET, Polar Active and Actigraph provided similar results (mean difference 7.0 min/d, 95% CI −17.8–31.7). Moderate to high agreement (area under the ROC curve 0.806–0.963) was found between the methods for the fulfillment of the recommendation for daily moderate-to-vigorous PA of 60 min. In free-living conditions the agreement between MAD, Polar Active, and Actigraph for measuring time spent on different activity levels in adults was dependent on the activity thresholds used and PA intensity. ROC analyses showed moderate to high agreement for the fulfillment of the recommendation for daily MVPA. Without additional statistical adjustment, these methods cannot be used interchangeably when measuring daily PA, but any of the methods can be used to identify persons with insufficient daily amount of MVPA.