Solbjørg Makalani Myrtveit

Adolescent Neck and Shoulder Pain—The Association With Depression, Physical Activity, Screen-Based Activities, and Use of Health Care Services

PURPOSE Neck and shoulder pain is frequent in adolescents, and multiple factors seem to affect the risk of such symptoms. We aimed to investigate the prevalence of neck and shoulder pain in Norwegian adolescence and to examine whether behavioral and emotional factors were associated with the risk of neck and shoulder pain. Finally we aimed to investigate whether neck and shoulder pain was related to the use of health services. METHOD Data from the population-based study ung@hordaland were used. Participants were asked how often during the last 6 months they had experienced neck and shoulder pain. The association between frequent neck and shoulder pain and physical activity, symptoms of depression, and screen-based activities was evaluated using logistic regression analyses stratified by gender. The relative risk of visiting health services when reporting neck and shoulder pain was calculated using multiple logistic regression analyses. RESULTS Frequent neck and shoulder pain was reported by 20.0% (1,797 of the total 8,990) and more often by girls than boys (p < .001). A high score of depressive symptoms was the strongest risk factor for neck and shoulder pain in both boys and girls (odds ratio = 6.14 [95% confidence interval 4.48-8.42] and odds ratio = 3.10 [95% confidence interval 2.63-3.67], respectively). Frequent screen-based activities slightly increased the risk while physical activity was protective. Individuals reporting neck and shoulder pain more often visited their general practitioner (47.1% vs. 31.8%) and school health services (24.6% vs. 13.5%). CONCLUSION Frequent neck and shoulder pain was reported in 20% of Norwegian adolescents. Symptoms of depression and screen-based activities increased the risk of neck and shoulder pain while physical activity was protective. Individuals reporting neck and shoulder pain visited health services more frequently than others.

What characterizes individuals developing chronic whiplash?: The Nord-Trøndelag Health Study (HUNT)

OBJECTIVE Most individuals experiencing whiplash accidents recover rapidly. A considerable proportion, however, develop chronic symptoms. Psychological factors may slow recovery, possibly by increasing the likelihood of other symptoms being misattributed to, and amplified by the whiplash injury. We aimed to investigate how pre-injury mental and somatic symptoms, self-rated health, use of health-services and medications, health-behavior and socio-demographics predict the development of chronic whiplash. METHODS Data from two waves of a large, population based study (HUNT2 (baseline) and HUNT3) were used. Individuals reporting no whiplash at baseline were identified in HUNT3. Characteristics reported at baseline were compared between those who had developed chronic whiplash in HUNT3 (n=199) and those who had not (n=20,600), using Pearsons chi-squared tests, independent sample t-tests and logistic regression analyses. RESULTS Individuals developing chronic whiplash reported worse baseline health than those reporting no chronic whiplash. Poor self-rated health was a strong risk factor for subsequent chronic whiplash (OR=2.26, 95%CI: 1.68-3.04). Musculoskeletal pain also increased the risk (OR=1.21, 95%CI: 1.15-1.26), as did diffuse somatic symptoms (OR=2.09, 95%CI: 1.47-2.96), use of different health services (OR=1.31, 95%CI: 1.19-1.45), high use of medications (OR=1.28, 95%CI: 1.14-1.43) and symptoms of anxiety (OR=1.93, 95%CI: 1.39-2.68). Physical activity was protective (OR=0.67, 95%CI: 0.49-0.91). Most socio-demographic variables were not significantly associated with chronic whiplash. CONCLUSION Poor somatic and mental pre-injury health increased the risk of subsequent chronic whiplash. This suggests that chronic whiplash is not merely an organic disorder, and highlights the importance of individual expectations, symptom reattribution and amplification in development of chronic whiplash.

Somatic symptoms beyond those generally associated with a whiplash injury are increased in self-reported chronic whiplash. A population-based cross sectional study: the Hordaland Health Study (HUSK)

BackgroundChronic whiplash leads to considerable patient suffering and substantial societal costs. There are two competing hypothesis on the etiology of chronic whiplash. The traditional organic hypothesis considers chronic whiplash and related symptoms a result of a specific injury. In opposition is the hypothesis that chronic whiplash is a functional somatic syndrome, and related symptoms a result of society-induced expectations and amplification of symptoms.According to both hypotheses, patients reporting chronic whiplash are expected to have more neck pain, headache and symptoms of anxiety and depression than the general population. Increased prevalence of somatic symptoms beyond those directly related to a whiplash neck injury is less investigated.The aim of this study was to test an implication derived from the functional hypothesis: Is the prevalence of somatic symptoms as seen in somatization disorder, beyond symptoms related to a whiplash neck injury, increased in individuals self-reporting chronic whiplash? We further aimed to explore recall bias by comparing the symptom profile displayed by individuals self-reporting chronic whiplash to that among those self-reporting a non-functional injury: fractures of the hand or wrist. We explored symptom load, etiologic origin could not be investigated in this study.MethodsData from the Norwegian population-based “Hordaland Health Study” (HUSK, 1997–99); N = 13,986 was employed. Chronic whiplash was self-reported by 403 individuals and fractures by 1,746. Somatization tendency was measured using a list of 17 somatic symptoms arising from different body parts and organ systems, derived from the research criteria for somatization disorder (ICD-10, F45).ResultsChronic whiplash was associated with an increased level of all 17 somatic symptoms investigated (p<0.05). The association was moderately strong (group difference of 0.60 standard deviation), only partly accounted for by confounding. For self-reported fractures symptoms were only slightly elevated. Recent whiplash was more commonly reported than whiplash-injury a long time ago, and the association of interest weakly increased with time since whiplash (r = 0.016, p = 0.032).ConclusionsThe increased prevalence of somatic symptoms beyond symptoms expected according to the organic injury model for chronic whiplash, challenges the standard injury model for whiplash, and is indicative evidence of chronic whiplash being a functional somatic syndrome.

Physical activity is independently associated with reduced mortality: 15-years follow-up of the Hordaland Health Study (HUSK)

Background Physical activity (PA) is associated with lower risk for non-communicable diseases and mortality. We aimed to investigate the prospective association between PA and all-cause and cause-specific mortality, and the impact of other potentially contributing factors. Method Data from the community-based Hordaland Health Study (HUSK, 1997–99) were linked to the Norwegian Cause of Death Registry. The study included 20,506 individuals born 1950–1957 and 2,225 born in 1925–1927 (baseline age 40–49 and 70–74). Based on self-report, individuals were grouped as habitually performing low intensity, short duration, low intensity, longer duration or high intensity PA. The hazard ratios (HR) for all-cause and cause-specific mortality during follow-up were calculated. Measures of socioeconomic status, physical health, mental health, smoking and alcohol consumption were added separately and cumulatively to the model. Results PA was associated with lower all-cause mortality in both older (HR 0.75 (95% CI 0.67–0.84)) and younger individuals (HR 0.82 (95% CI 0.72–0.92)) (crude models, HR: risk associated with moving from low intensity, short duration to low intensity, longer duration PA, and from low intensity, longer duration to high intensity). Smoking, education, somatic diagnoses and mental health accounted for some of the association between physical activity and mortality, but a separate protective effect of PA remained in fully adjusted models for cardiovascular (HR 0.78 (95% CI 0.66–0.92)) and respiratory (HR 0.45 (95% CI 0.32–0.63) mortality (both age-groups together), as well as all-cause mortality in the older age group (HR 0.74, 95%CI 0.66–0.83). Conclusion Low intensity, longer duration and high intensity physical activity was associated with reduced all-cause, respiratory and cardiovascular mortality, indicating that physical activity is beneficial also among older individuals, and that a moderate increase in PA can be beneficial.

A population based validation study of self-reported pensions and benefits: the Nord-Trøndelag health study (HUNT)

BackgroundMeasures of disability pensions, sickness certification and long-term health related benefits are often self-reported in epidemiological studies. Few studies have examined these measures, and the validity is yet to be established.We aimed to estimate the validity of self-reported disability pension, rehabilitation benefit and retirement pension and to explore the benefit status and basic characteristics of those not responding to these items.A large health survey (HUNT2) containing self-reported questionnaire data on sickness benefits and pensions was linked to a national registry of pensions and benefits, used as “gold standard” for the analysis. We investigated two main sources of bias in self-reported data; misclassification - due to participants answering questions incorrectly, and systematic missing/selection bias - when participants do not respond to the questions.Sensitivity, specificity, positive (PPV) and negative (NPV) predicative value, agreement and Cohen’s Kappa were calculated for each benefit. Co-variables were compared between non-responders and responders.ResultsIn the study-population of 40,633, 9.2% reported receiving disability pension, 1.4% rehabilitation benefits and 6.1% retirement pension. According to the registry, the corresponding numbers were 9.0%, 1.7% and 5.4%. Excluding non-responders, specificity, NPV and agreement were above 98% for all benefits. Sensitivity and PPV were lower. When including non-responders as non-receivers, specificity got higher, sensitivity dropped while the other measures changed less.Between 17.7% and 24.1% did not answer the questions on benefits. Non-responders were older and more likely to be female. They reported more anxiety, more depression, a higher number of somatic diagnoses, less physical activity and lower consumption of alcohol (p < 0.001 for all variables). For disability pension and retirement pension, non-responders were less likely to receive benefits than responders (p < 0.001). For each benefit 2.1% or less of non-responders were receivers. False positive responses were more prevalent than false negative responses.ConclusionsThe validity of self-reported data on disability pension, rehabilitation benefits and retirement pension is high – it seems that participants’ responses can be trusted. Compared to responders, non-responders are less likely to be receivers. If necessary, power and validity can be kept high by imputing non-responders as non-receivers.

Initial healthcare and coping preferences are associated with outcome 1 year after whiplash trauma: a multicentre 1-year follow-up study

Objective Individuals exposed to whiplash collisions have to cope with the stressful event as well as early physical symptoms. As in other chronic pain conditions, coping has been associated with outcome after whiplash. In this study, our aim was to examine whether initial coping preferences were associated with the development of chronic whiplash. Design Prospective study. Setting Primary care. Methods 740 acute whiplash patients were recruited from emergency units and general practitioners after car collisions in Denmark. Within 10 days postinjury, participants were asked what they believed could help them get better. At 12-month follow-up, the level of neck pain and capability to work was obtained. Whether coping preferences (baseline) were associated with outcome was investigated using multiple regression analyses. Results Persistent neck pain was most strongly associated with preferring medications (mean difference=1.24 (95% CI 0.67 to 1.82)) and sickness absence (mean difference=1.18 (95% CI 0.53 to 1.82)). Reduced work capability was most strongly associated with preferring medications (OR=3.53 (95% CI 2.13 to 5.86)), sickness absence (OR=3.05 (95% CI 1.80 to 5.17)) and being referred to a physiotherapist/chiropractor (OR=3.03 (95% CI 1.33 to 6.91)). Active coping was associated with better outcomes: Participants preferring to change their lifestyle were protected against reduced work capability (OR=0.11 (95% CI 0.01 to 0.78)). Individuals who wanted to keep living as usual only (no other preference reported) were protected against neck pain (mean difference −1.62 (95% CI −2.39 to −0.84)) and reduced work capability (OR=0.09 (95% CI 0.01 to 0.64)). Conclusions A simple nine-item measure of coping preferences is associated with the development of chronic neck pain and reduced capability to work following whiplash trauma and may be used to identify individuals at risk of poor recovery.

Pain and pain tolerance in whiplash-associated disorders: A population-based study.

Pain is a cardinal symptom in individuals with whiplash‐associated disorders (WAD). We aimed to compare pain characteristics between individuals with WAD and individuals reporting chronic pain from other causes, and to determine whether potential differences were accounted for by experimental pain tolerance.

The Norwegian student introductory week: who takes part, and is participation associated with better social integration and satisfaction among students?

ABSTRACT Norwegian universities and university colleges yearly arrange an introductory week to welcome new students. This study provides new insight about who takes part in the event, to what degree students are satisfied with the event, and whether participation is associated with social integration. Data from the Norwegian study of students’ health and well-being was used. Satisfaction with the introductory week and other variables of interest were described for individuals taking part, partly taking part and not taking part in the event. The associations between participation, satisfaction and social integration were investigated (linear regression). More than 70% of students were satisfied with the introductory week and the opportunity it provided for getting to know other students. Participation in the event was associated with higher satisfaction with the student community and student city, and better social integration. Individuals who were younger, single and had moved to the student city were more likely to participate in the event, alcohol abstainers were less likely to participate. Though the introductory week is associated with beneficial outcomes with regards to satisfaction and social integration, the event might be in danger of excluding individuals who cannot or do not want to consume alcohol.

Chronic whiplash, pain and pain tolerance

Abstract Aim Among individuals who experience whiplash accidents, around 20% develop chronic pain. We aimed to compare number of painful locations and pain intensity between individuals with chronic whiplash and individuals with other chronic pain, and to investigate whether differences could be explained by pain tolerance. Methods Employing data from the sixth wave of the Tromsø Study, individuals reporting whiplash were compared to individuals with other chronic pain. Number of pain locations was compared using Poisson regression, pain intensity using linear regression. Pain tolerance (cold-pressor test) was compared using cox regression; one model compared individuals with whiplash to those with other chronic pain, another model compared the two groups with chronic pain to pain-free controls. In order to investigate whether pain tolerance could account for differences in pain, the regression models were adjusted for time-till-failure in the cold-pressor test. Results Individuals with whiplash reported a higher number of painful locations (IRR = 5.23, 95%CI: 4.93–5.53 versus IRR = 3.57, 95%CI: 3.50–3.65) and higher pain intensity (mean: 7.80, 95%CI: 7.58–8.02 versus mean: 7.14, 95%CI: 7.08–7.21) than individuals with other chronic pain. Pain tolerance did not differ between these two groups, but compared to pain-free controls individuals in both groups had reduced pain tolerance. Conclusions Individuals with chronic whiplash had reduced pain tolerance compared to individuals without chronic pain, but not compared to individuals with other chronic pain. Reduced pain tolerance can account for some of the increased pain reported by individuals with chronic whiplash compared to controls but not compared to individuals with other chronic pain.

P02-315 - Somatic symptoms amongst individuals also reporting whiplash: a Norwegian population-based study (HUSK)

Objectives Whiplash associated disorder (WAD) is a common, yet poorly understood condition. It has both been considered a chronic pain disorder, due to injury in neck, and a functional somatic syndrome. Based on the hypothesis that chronic WAD lies closer to functional somatic syndromes than to organic pain disorders, we compared the reported level of symptoms associated to somatization (including among others, abdominal pain, nausea, chest pain, breathlessness, skin discoloring and headache) of persons reporting WAD and persons not reporting WAD. Methods Data from the population based Hordaland Health Study (HUSK) in Norway 1997-99 (n = 18.581) were used. In this study, 489 participants reporting whiplash also answered questions on symptoms linked to somatic syndromes. These questions were also answered by 13.490 participants without whiplash. Comparing these two groups, independent t-tests were employed for a range of somatic symptoms. Subsequently, a linear regression model was used, enabling adjustment for possible confounding factors, including gender, anxiety, depression, education, poor sleep, benefit recipiency, physical activity, alcohol consumption, smoking, somatic diagnoses and marital status. Results The WAD group reported a significantly higher prevalence of all the reported somatic symptoms (all p Conclusion Our results indicate an association between WAD and somatic symptoms, supporting the notion that WAD should be considered a functional somatic syndrome.