Low back pain (LBP) is common already in adolescence, and many risk indicators including both psychosocial and lifestyle factors have been recognized. Our purpose was to assess whether the co-occurrence of psychosocial (externalizing and internalizing) problems and lifestyle factors (leisure time physical activity, sedentary behaviour, sleep, smoking, and overweight/obesity) associate with LBP at 16 years cross-sectionally or with new LBP at 18-year follow-up.
The study population, drawn from the Northern Finland Birth Cohort 1986, consisted of 1625 participants (712 boys and 913 girls) who completed a questionnaire on potential explanatory factors at 16 years and on LBP at 16 and 18 years. The outcome measure was 'reporting LBP' or 'consultation for LBP' during the past 6 months. Latent Class Analysis (LCA) was utilized to study the co-occurrence of the explanatory factors.
Among both genders, four clusters were found. Externalizing behaviour problems were associated with 'reporting LBP' (RR 1.5, boys 1.4, girls) and 'consultation for LBP' (RR 1.6 for both genders) at baseline among both genders. In addition, the cluster of multiple risk behaviours was associated with both 'reporting LBP' (RR 1.3) and 'consultation for LBP' (RR 2.5) and the obese cluster with 'consultation for LBP' (RR 1.7) among girls. Externalizing behaviour problems at 16 years predicted 'consultation for LBP' at 18 years among girls (RR 3.6).
Our results stress the role of psychosocial factors in reporting and seeking care for adolescent LBP.
The objective of this cross-sectional study was to study associations between low back pain (LBP) and modes of transport to school and leisure activities among adolescents. The study population included all adolescents in eighth and ninth grade in two geographic areas in eastern Norway. Eighty-eight adolescents participated (mean age 14.7 years), making the response rate 84%. Data concerning active (walking/bicycling) and passive (bus/car) journeys were obtained from lists and maps from local authorities, and from the pupils, using a questionnaire that also included LBP, activities and wellbeing. Distance walked/bicycled to school was slightly shorter among those reporting LBP in bivariate analyses. Walking/bicycling more than 8 km weekly to regular activities was inversely associated with LBP in multivariate analysis (OR 0.3; 95% confidence interval 0.1-1.0). No associations were found between passive journeys and LBP. The results raise the question for future research of whether lack of active transport may be one cause behind the increase in juvenile LBP.
Semistructured interviews, group discussions, and a mailed survey.
To identify barriers to the use of active sick leave (ASL) and to design an intervention to improve the use of ASL by patients with low back pain.
ASL was introduced in Norway in 1993 to encourage people on sick leave to return to modified work. With ASL the National Insurance Administration (NIA) pays 100% of wages, thereby allowing the employer to engage a substitute worker at no extra cost, in addition to the worker on ASL. Arranging ASL requires cooperation between the general practitioner (GP), employer, local NIA staff, and the patient, which may explain why ASL was used in less than 1% of the eligible sick leave cases in 1995, despite strong support from all players.
The authors conducted five in-depth interviews at a workplace where ASL was successfully implemented. Questionnaires were sent to 89 GPs, 102 workplace representatives, and 22 local NIA officers in three counties. Five patients with back pain who had used ASL were interviewed in a focus group, and 10 patients with back pain who had not used ASL were interviewed using a structured guide. Five workplaces participated in a dialogue conference. Data collection and analysis were iterative, and new data were constantly compared with the previously analyzed materials.
About 80% of the GPs, employers, and NIA officers believed ASL is effective in reducing long-term sick leave. Among the barriers identified were lack of information, lack of time, and work flow barriers such as poor communication and coordination of activities between the players required to carry out ASL. Two strategies were designed to improve the workflow between them. A passive implementation strategy was designed to require a minimum amount of economic and administrative support. It included targeted information, clinical guidelines for low back pain, a reminder to GPs in the sick leave form, and a standardized agreement. A proactive strategy included the same four elements plus a kick-off continuing education seminar for GPs and a trained resource person to facilitate the use of ASL.
Having all the players onside may be essential, but it is not sufficient to bring about action in workplace strategies for patients with low back pain. If early return to modified work is effective, implementing it may require interventions targeted at identified barriers.
One hundred eighty patients with acute low-back pain (LBP) were compared to 608 age- and sex-matched controls with regard to somatic and personality characteristics. The low-back-pain group had a fourfold increase (median) in sick-leave episodes for reasons other than spinal morbidity during the preceding 2 years. In the same period, the median number of episodes of sick leave for LBP was 1 in the patients and 0 in the controls. The mean number of days off for other reasons was 34 (median = 20.5) in the patients compared to 9 (median = 0) in the controls, and days off for LBP were 20 (median = 5) and 5 (median = 0), respectively. Analysis of other factors than those directly related to LBP disclosed significant differences in marital status and smoking habits between patients and controls. Furthermore, LBP patients estimated their work to be physically heavier. We conclude that medical intervention should focus not only on the spine, but also on a wide range of other aspects of the patient's situation. Even in the acute phase of LBP, the previous sick-leave records should be analyzed to provide adequate measures to prevent future sick leaves. Presently, the sociomedical costs for a subset of the population who repeatedly seek help for LBP are significantly higher than those for the non-LBP population.
We conduced a cross sectional study in the period Gen - Dec 2006 to examine the relationship between acute lumbago in health workers and exposition to a moderate level of exposure index Movement and Assistance of Hospital Patients (MAPO). The study ruled 240 health workers (M: 180; F: 60), the mean age was 44,9 years (range 24 - 64); was evaluated the occurrence of acute lumbago in the last 12 months. The objective of this study was to describe the trends over a specific time of the association between the moderate MAPO index and acute lumbago in this sample of health care workers. The results indicate that healthcare workers exposed to moderate MAPO index appear to incur a greater risk of acute lumbago than general population, but lower than that evidenced by Italian and Sweden authors between nursing staffs. Medical surveillance of exposed workers is confirmed as necessary method of secondary prevention and also it is useful in the diagnosis of worker's susceptibilities.
To study the association of age at menarche with presence of pelvic girdle syndrome in pregnancy.
A total of 74 973 pregnant women in the Norwegian Mother and Child Cohort Study.
Data were obtained by self-administered questionnaires in weeks 17 and 30 of gestation.
Pelvic girdle syndrome in pregnancy at 30 weeks of gestation, defined as pain in the pubic symphysis in the anterior pelvis and in both sacroiliac joints in the posterior pelvis.
The prevalence of pelvic girdle syndrome was 20.6% (328/1593) in women with menarche before the age of 11, it was 16.3% (3200/22 044) in women with menarche at the age of 12 and 12.7% (1252/9859) in women with menarche after the age of 14 (chi-square test for trend, P
BACKGROUND: The role of lifestyle factors is an important issue in the prevention and treatment of disease. Although certain lifestyle factors in relation to low-back pain have evoked much interest, interest has not focused on alcohol consumption. An appraisal of the epidemiologic literature seems warranted. OBJECTIVES: To establish if there is evidence in the literature for a causal link between alcohol consumption and low-back pain. Data Sources: Nine original research reports published between 1987 and 1995 were obtained through a MEDLINE search for the years 1992 to 1998, with various combinations of the terms "alcohol," "substance abuse," "life-style, " "risk factor," "epidemiology" and "low back pain." An additional manual search was made of relevant bibliographies without limitation for year of publication. Data Synthesis: A systematic review was made of the epidemiologic literature to uncover any evidence for a causal relation between alcohol consumption and low-back pain. RESULTS: None of the studies reported a positive link between alcohol consumption and low-back pain, and no positive gradient was found in studies that included an analysis of the dose-response. None of the studies was prospective in design. CONCLUSIONS: Alcohol consumption does not seem to be associated with low-back pain, but well-designed specific alcohol/low-back pain-centered studies are lacking.
OBJECTIVES: To describe workers with low back symptoms, to identify risk factors and to assess the occupational consequences separately in men and women. METHODS: A descriptive study was conducted between 1 October 1996 and 31 December 1996 in a sample of workers selected at random from all types of small companies in the Paris area. A group of 202 occupational physicians interviewed 7129 workers with a standardised questionnaire including the Nordic questionnaire. Data analysis was performed by sex in the two groups: with low back pain and without low back pain over the previous 12 months. The group with low back pain was then divided into four subgroups: mild cases (without referred pain), moderate cases (with referred pain above the knee), serious cases (with referred pain below the knee), and low back pain with occupational consequences. RESULTS: 7010 questionnaires were able to be evaluated. The sample consisted of 54.8% of men (3842) and 45.2% of women (3168), with a mean age of 37.8 and 37.0 years, respectively (p 10 kg, in women (OR 1.69, 95% CI 1.27 to 2.25) and in men (OR 1.27, 95% CI 1.06 to 1.53), uncomfortable working positions (OR 2.04, 95% CI 1.58 to 2.17 and OR 1.85, 95% CI 1.69 to 2.43), and absence of means to achieve good quality work (OR 1.39, 95% CI 1.19 to 1.63 and OR 1.38, 95% CI 1.15 to 1.65), respectively. Driving was a risk factor only in men and its importance increased with driving time (driving > 4 hours a day (OR 1.61, 95% CI 1.24 to 2.09)). Severe low back pain was linked to female sex (10.2% of women v 6.6% of men), high BMI, aging, and uncomfortable working positions. Low back pain with occupational consequences (n = 258) was not linked to sex, but only to aging and severity. CONCLUSIONS: The incidence and severity of low back pain were higher in women, although they seemed to be less exposed to known occupational risk factors. However, our results indicate a preponderance of these risk factors among female workers. Particular attention must therefore be paid to lifting of weights and uncomfortable working positions in female jobs (clerk, trading, health care staff).