Marianne Engberg

The course of low back pain in a general population. results from a 5-year prospective study

OBJECTIVES To investigate the course of low back pain (LBP) in a general population over 5 years. DESIGN Prospective population-based survey by postal questionnaires in 1991, 1992, and 1996. SETTING The municipal of Ebeltoft, Denmark. SUBJECTS Two thousand people aged 30 to 50 years, representative of the Danish population. Main outcome measure Number of days with low back pain during the past year. RESULTS One thousand three hundred seventy were recruited of whom 813 (59%) were followed to 5 years. The responders could be divided into 3 groups with regard to LBP: no pain, short-term pain, and long-lasting/recurring pain. More than one third of people who experienced LBP in the previous year did so for >30 days. Forty percent of people with LBP >30 days at baseline remained in that group 1 and 5 years later, and 9% with LBP >30 days in year 0 were pain free in year 5. People with LBP in year 0 were 4 times more likely to have LBP in year 1, and 2 times more likely to be affected in year 5. CONCLUSIONS Low back pain should not be considered transient and therefore neglected, since the condition rarely seems to be self-limiting but merely presents with periodic attacks and temporary remissions. On the other hand, chronicity as defined solely by the duration of symptoms should not be considered chronic.

The Association Between Physical Workload and Low Back Pain Clouded by the "Healthy Worker" Effect : Population-Based Cross-Sectional and 5-Year Prospective Questionnaire Study

Study Design. A population-based cross-sectional and 5-year prospective questionnaire study. Objective. To investigate self-reported physical workload as a risk factor for low back pain. Summary of Background Data. Both physical and psychosocial workplace factors are considered risk factors for low back pain. However, today no consensus has been reached regarding the exact role of these factors in the genesis of low back pain. Methods. Questionnaire data were collected at baseline for 1397 (and after 5 years for 1163) men and women aged 31–50 years at baseline. Low back pain (“any low back pain within the past year,” “low back pain ≤ 30 days in total during the past year,” “low back pain > 30 days in total during the past year”) was analyzed in relation to physical workload (sedentary, light physical, and heavy physical work) using logistic regression and controlling for age, gender, and social group. The proportions of workers changing between the workload groups over the 5-year period were analyzed in relation to low back pain status. Results. At baseline no statistically significant differences in low back pain outcomes were found for workers exposed to sedentary, light physical, or heavy physical work. This was true for all age, gender, and social groups. At follow-up there was a statistically significant dose–response association between any low back pain and longstanding low back pain within the past year and increasing physical workload at baseline also after controlling for age, gender, and social group. Subjects with heavy physical workload at baseline changed statistically significantly more often to sedentary work if they experienced low back pain for more than 30 days out of the past year. Conclusions. Having a sedentary job might have a protective or neutral effect in relation to low back pain, whereas having a heavy physical job constitutes a significant risk factor. Because of migration between exposure groups (the “healthy-worker” effect), longitudinal studies are necessary for investigating the associations between physical workload and low back pain.

Adverse social factors predict early ageing in middle-aged men and women: the Ebeltoft Health Study, Denmark.

Aims: This study examined whether adverse social factors are associated with an increased rate of biological ageing in middle-aged subjects. Methods: The authors investigated five markers of biological ageing in 690 subjects followed for five years in Ebeltoft, Denmark. Mean age at baseline was 40 years (range 30 - 50 years). These markers included repeated measures of pulse pressure, lung function, hearing, physical work capacity and a cardiovascular risk score. A z-score was calculated based on a factor analysis of the five markers used. The relative biological age was finally calculated in relation to chronological age in subgroups of different social class (occupation, educational level) and marital status, at baseline and after follow-up. Results: Men and women from a higher social class appeared to be biologically younger than corresponding subjects from a lower social class (p<0.001). This difference was still evident after 5 years of follow-up (p<0.01) for men and women of different occupations and for women of different educational levels (p<0.01). Married/cohabiting men were biologically younger than single men and this difference increased during the follow-up period in that the difference between groups at five-year follow-up was significant (p<0.05). Conclusions: Middle-aged men and women from a higher social class showed signs of being biologically younger than their corresponding chronological age, while the opposite was found for men and women of lower social class. This discrepancy was still evident after five years of follow-up, and even tended to increase for single men. Differential ageing may thus be an important biological aspect of differences in health according to social class.

A Five-Year Longitudinal Study of Hearing in a Danish Rural Population Aged 31–50 Years

Abstract This paper aims to report changes in hearing sensitivity over five years in a rural population aged 31–50 years and to identify risk factors associated with hearing deterioration. The study is prospective and based on data from pure tone audiometry and questionnaires in the Ebeltoft Health Promotion Project in Denmark. A representative sample of 705 subjects had a complete follow-up, including audiometry. The median hearing deterioration was 2.5 dB at 3–4 kHz and 0 dB at 0.5–2 kHz. There was a high degree of individual variability in deterioration. The overall deterioration of hearing sensitivity of the population was largely predicted from the cross-sectional findings reported previously. In the analysis of risk factors, hearing deterioration was defined as an average deterioration 10 dB/5 years at 3–4 kHz in at least one ear. Deterioration was present in 23.5% of the sample. The 41–50-year-olds had a relative risk of deterioration of 1.32 (95% CI 1.01–1.73) compared with the 31–40-year-olds. Males had a relative risk of 1.35 (1.03–1.76) compared with females. The risk was not significantly elevated for a range of other possible risk factors confirmed by logistic regression analysis. In conclusion, deterioration in hearing sensitivity on population level can be predicted on the basis of cross-sectional findings. Hearing sensitivity deteriorated mainly at 3–4 kHz. The deterioration increased with age and was higher in males than in females. Other risk factors were not found. The present study does not support the hypothesis that hypertension or tobacco smoking is associated with deterioration in hearing.

Health tests and health consultations reduced cardiovascular risk without psychological strain, increased healthcare utilization or increased costs: An overview of the results from a 5-year randomized trial in primary care. The Ebeltoft Health Promotion Project (EHPP)

Background: Few randomized controlled trials (RCT) have evaluated health tests and health consultations in primary care with a long follow-up period. The Ebeltoft Health Promotion Project (EHPP) evaluated health tests and health consultations over a period of 5 years in the frame of a health technology assessment. Objective: To review the results of EHPP. Design: RCT with a control group answering questionnaires and two intervention groups having questionnaires, a comprehensive health test with written advice followed by either a normal consultation on demand or a planned 45 minutes patient-centred consultation. Setting: Primary care. Participants: The target population was all 30—49 year old persons in the municipality of Ebeltoft, Denmark. Invitations were received by 2000 randomly selected persons. Intervention: A comprehensive biomedical health test including a cardiovascular risk score (CVRS) followed by written advice and health consultations. Main outcome measures: Biomedical measures, psychological measures, healthcare contacts, life years gained, direct and total health costs. Results: At baseline 75% participated. During the 5 years 85% participated at least once. Elevated CVRS was found in 19% in the control group compared to 10% in the intervention groups (p<0.01) after 5 years. There were no measurable long term psychological reactions. Numbers of contacts to the healthcare system were not increased. Significantly better life expectancy was found without extra direct and total costs. Conclusions: An offer of health tests and patient-centred health consultations to the middle-aged population can be cost-effective and may be considered in the fight against the increasing burden of lifestyle diseases.

No long-term psychological reaction to information about increased risk of coronary heart disease in general practice:

Background Randomised, controlled trials focusing on long-term psychological reactions to information about increased risk of coronary heart disease are scarce. Design A population-based randomised, controlled, 5-year follow-up trial was conducted in general practice. Methods In 1991, invitations were sent to 2,000 middle-aged people registered in the general practices in the district of Ebeltoft, Denmark. A total of 1,507 (75.4%) agreed to participate and were randomised into a control group and two intervention groups: one included health screening, a written feedback and an optional follow-up visit with the general practitioner; the other included health screening, written feedback and a planned 45-min follow-up visit with the general practitioner. The participants were informed at screening about their risk of developing coronary heart disease. Psychological distress was measured by the GHQ-12 before screening and at the 1 and the 5-year follow-up. Results Before the screening (0 year), 1 and 5 years after there were no significant differences in the GHQ-12 score between the control group and the two intervention groups. Nor were there any differences related to information about increased risk of coronary heart disease between scores obtained at the 1 and the 5-year follow-up. Conclusion Middle-aged persons had no long-term psychological reaction after information about increased risk of developing coronary heart disease following a health screening in general practice evaluated by the GHQ-12,1 year and 5 years after the examinations.

Inverse Association Between Birth Weight, Birth Length and Serum Total Cholesterol in Adulthood

Objectives - To investigate whether impaired fetal growth, measured by low birth weight and short birth length, is linked with raised levels of serum lipids and increased risk and mortality of coronary heart disease. Design - The association between birth length, birth weight, Ponderal Index and total serum cholesterol was examined in 545 Danish men and women aged 31 to 51 years who participated in the Ebeltoft Health Promotion Project in Denmark. Results - No associations were found in women. For men, a negative association was found between birth weight and serum total cholesterol, with a fall in mean serum total cholesterol from 6.03 mmol/l at birth weight below 3300 g to 5.64 mmol/l at birth weight above 4000. A similar association was found between birth length and serum cholesterol, with a mean value of 6.23 mmol/l at birth length below 51 cm and a mean value of 5.56 mmol/l at birth length above 54 cm. No associations were found for Ponderal Index. Between 3% and 8% of the variance in serum total cholesterol could be explained by the statistical models used in this study. Conclusion - Our findings support the hypothesis of a negative association between birth weight, birth length and elevated serum cholesterol in adult life, but only in men.OBJECTIVES To investigate whether impaired fetal growth, measured by low birth weight and short birth length, is linked with raised levels of serum lipids and increased risk and mortality of coronary heart disease. DESIGN The association between birth length, birth weight, Ponderal Index and total serum cholesterol was examined in 545 Danish men and women aged 31 to 51 years who participated in the Ebeltoft Health Promotion Project in Denmark. RESULTS No associations were found in women. For men, a negative association was found between birth weight and serum total cholesterol, with a fall in mean serum total cholesterol from 6.03 mmol/l at birth weight below 3300 g to 5.64 mmol/l at birth weight above 4000. A similar association was found between birth length and serum cholesterol, with a mean value of 6.23 mmol/l at birth length below 51 cm and a mean value of 5.56 mmol/l at birth length above 54 cm. No associations were found for Ponderal Index. Between 3% and 8% of the variance in serum total cholesterol could be explained by the statistical models used in this study. CONCLUSION Our findings support the hypothesis of a negative association between birth weight, birth length and elevated serum cholesterol in adult life, but only in men.

Discordance between self-evaluated health and doctor-evaluated health in relation to general health promotion

Objective – To describe the occurrence of “health realists”, “health pessimists” and “health optimists” in a non-patient population by identifying cases of concordance and discordance between doctor-evaluated health and self-evaluated health and to describe the distribution of selected life-style-related physiological risk factors among these health-groups. Design – Comparative study. Setting – Primary health care. Subjects – 456 middle-aged persons registered with a general practitioner (GP) were after a general health screening invited to a health discussion. Prior to the health screening the participants had assigned their health status to one of five categories ranging from “very poor” to “excellent”. After the health discussion the GP rated the participants’ general health status on a visual analogue scale. On basis of this information patients were classified as “health realists”, “health optimists” and “health pessimists”. Results – 54% of the participants could be classified as “good-health realists”, 14% as “poor-health realists”, 22% as “health optimists”, and 10% as “health pessimists”. “Poor-health realists” had the greatest accumulation of risk factors, followed by “health optimists”, “health pessimists” and “good-health realists”. Among the “health pessimists” there was a significantly higher risk score of future cardiovascular disease and poor physical endurance compared with the “good-health realists”. Conclusion – Discordance between doctor-evaluated health and self-evaluated health was found in 32% of the cases studied. “Health pessimists” had more risk factors than “good-health realists” even though the GPs had rated their general health status as good in both cases.

Fetal Growth and Blood Pressure in a Danish Population Aged 31-51 Years

During the past decade, studies have shown an inverse association between birth weight and blood pressure and risk of coronary heart disease in adult life. From old public archives we were able to trace the birth records of 545 out of 905 persons (60.2%) aged 31-51 years who participated in the Ebeltoft Health Promotion Project in Denmark. We examined the associations between birth weight, length at birth, Ponderal Index and systolic and diastolic blood pressure. No associations were found for women. For men, the mean systolic blood pressure fell from 131.1 mmHg with a birth weight of less than 3300 g to 129.6 mmHg with a birth weight of more than 4000 g, and for diastolic blood pressure 81.6 mmHg to 80.3 mmHg, respectively. For men, the mean systolic blood pressure fell from 135.7 mm Hg with a birth length of 30-51 cm to 131.6 with a birth length of 55-62 cm, and for diastolic blood pressure 83.0 mmHg to 78.8 mmHg, respectively. The associations may reflect organ programming in fetal life.During the past decade, studies have shown an inverse association between birth weight and blood pressure and risk of coronary heart disease in adult life. From old public archives we were able to trace the birth records of 545 out of 905 persons (60.2%) aged 31-51 years who participated in the Ebeltoft Health Promotion Project in Denmark. We examined the associations between birth weight, length at birth, Ponderal Index and systolic and diastolic blood pressure. No associations were found for women. For men, the mean systolic blood pressure fell from 131.1 mmHg with a birth weight of less than 3300 g to 129.6 mmHg with a birth weight of more than 4000 g, and for diastolic blood pressure 81.6 mmHg to 80.3 mmHg, respectively. For men, the mean systolic blood pressure fell from 135.7 mm Hg with a birth length of 30-51 cm to 131.6 with a birth length of 55-62 cm, and for diastolic blood pressure 83.0 mmHg to 78.8 mmHg, respectively. The associations may reflect organ programming in fetal life.

Markers of fetal growth and serum levels of insulin-like growth factor (IGF) I, -II and IGF binding protein 3 in adults

Fetal growth has been linked with increased risk of cancer and cardiovascular disease later in life. The insulin-like growth factor (IGF) axis has recently been proposed as a predictor of risk of subsequent cancer and cardiovascular disease. However, only few data are available on the possible association between fetal growth and levels of IGFs later in life. We examined the association between markers of fetal growth, i.e. birth weight, birth length and Ponderal Index, from birth records and serum IGF-I, IGF-II, and IGF binding protein 3 (IGFBP-3) levels in 545 middle-aged Danish men and women. We fitted separate multivariate models including birth weight, birth length, Ponderal Index and serum IGF-I, IGF-II, and IGFBP-3, respectively. After adjustment for age, alcohol intake, smoking, diabetes mellitus, systolic and diastolic blood pressure, serum total cholesterol and current height and weight, we found negative associations between birth weight and Ponderal Index, respectively, and serum IGF-II in men, i.e. the mean regression coefficients were −49.41 (95% CI: −87.06–11.77) (μg/l)/kg and −3.49 (95% CI: −6.73–0.25) (μg/l)/(kg/m3), respectively. Furthermore, in men birth weight was negatively associated with the (IGF-I + IGF-II)/IGFBP-3 and IGF-II/IGFBP-3 ratios, which are believed to be indicators of bioavailable IGF and IGF-II, respectively. However, no other associations were found in any of the models. Between 1 and 16% of the variance in serum IGF-I, IGF-II, and IGFBP-3, respectively, could be explained by the statistical models used in the analyses. We found very little support to the hypothesis of an association between fetal growth and the IGF axis throughout life.