AIMS: To examine the association between self reported physical workload and low back pain (LBP) in younger twins. To investigate whether genetic factors interact with physical workload in relation to LBP. METHODS: A twin control study was performed within a population based twin register using 1910 complete monozygotic (MZ) and same sexed dizygotic (DZ) twin pairs aged 25-42 and discordant for LBP. LBP in the affected twins was divided into two groups: "LBP for 30 days during the past year". Physical workload was divided into four categories: "sitting", "sitting/walking", "light physical", and "heavy physical". Data were analysed in a matched design using conditional logistic regression. MZ and DZ twins were analysed separately and together in order to determine possible genetic influences in relation to physical workload and LBP. RESULTS: Statistically significant graded relations were found for increasing workload and LBP of longer duration but not for LBP of shorter duration (
PURPOSE: To identify factors that influence American and Icelandic parents' health perceptions among families of infants or young children with asthma. DESIGN: A cross-sectional research design of 76 American families and 103 Icelandic families. Data were collected mainly in the Midwest of the United States (US) and in Iceland from August 1996 through January 2000. METHOD: Parents in these two countries who had children aged 6 or younger with chronic asthma completed questionnaires regarding family demands, caregiving demands, family hardiness, sense of coherence, and health perceptions. Descriptive statistics, chi-square tests and t tests were compiled. Multiple regression analysis was used to test path models and for mediation. FINDINGS: American parents differed from their Icelandic counterparts in family hardiness. In both countries, significant differences were found in caregiving demands and health perceptions between mothers and fathers. Illness severity and caregiving demands affected health perceptions of both mothers and fathers. Sense of coherence mediated the relationship between family demands and parents' perceptions for both parents. For mothers only, family hardiness mediated the relationship between family demands and health perceptions. CONCLUSIONS: The Resiliency Model of Family Stress, Adjustment, and Adaptation was useful for building knowledge on parents' health perceptions in two Western cultures for families of young children with asthma. Interventions emphasizing family and individual resiliency and strengths have the potential to affect parents' views of their children's health.
OBJECTIVES: The aim was to study the associations between self-rated psychosocial work conditions and the characteristics and location of musculoskeletal symptoms, signs, and syndromes. METHODS: Perceived psychosocial work conditions were recorded in a cross-sectional study with 358 men and women in various occupations. Symptoms were recorded from the musculoskeletal system with a questionnaire, and signs were detected in a medical examination of all body regions. The analyses of statistical associations between the psychosocial factors and musculoskeletal disorders were performed with control for age, gender, and physical load. RESULTS: The most consistent and pronounced associations were mainly seen between poor psychosocial work conditions and coexisting symptoms and signs of the neck and back regions. Poor psychosocial work conditions were more consistently and strongly associated with signs of muscular (soft tissue) tenderness than with signs of tenderness in the joints, tendons, or muscular insertions or signs in nerve compression tests. Mainly low social support at work, but also high psychological demands and high job strain, were associated with such symptoms and signs, whereas decision latitude at work showed few associations with musculoskeletal disorders. CONCLUSIONS: Perceived poor psychosocial work conditions are statistically associated mainly with symptoms and signs of muscular tenderness in the central body regions. Studies on associations between psychosocial work conditions and musculoskeletal disorders should separate effect measures of different clinical signs and different body regions in order to avoid attenuation of the risk estimates.
AIMS: The aim of this study is to analyse how increasing demands from work and family life affect the level of strain and whether there are any significant gender differences in this respect. This is be done by testing the following hypotheses: An increase in work and family demands causes (a) an increased risk of suffering from fatigue; (b) an increased need for working fewer hours. METHODS: The hypotheses are analysed by using a longitudinal data set consisting of nearly 9,000 Swedish individuals. RESULTS: Multiple demands increase the risk of suffering from fatigue among both women and men, but it is only among women that an increase in the percentage desiring a reduction in their working hours can be found. CONCLUSIONS: The results support the role stress theory, especially among women.
In this study, we examined Balint group participants' sense of control and satisfaction in their work situation and their attitudes towards caring for patients with psychosomatic problems. Forty-one GPs filled in a questionnaire with a 10-point visual analogue scale. Of these, 20 had participated in Balint groups for more than one year and 21 were a reference group. The Balint physicians reported better control of their work situation (e.g. taking coffee breaks and participating in decision making), thought less often that the patient should not have come for consultation or that psychosomatic patients were a time-consuming burden, and were less inclined to refer patients or take unneeded tests to terminate the consultation with the patient. These results might indicate higher work-related satisfaction and better doctor-patient relationship.
OBJECTIVES: Farmers have a low risk for cardiovascular disease, which may be related to a favourable blood lipid profile. In order to study the blood lipid levels and evaluate the effect of other cardiovascular risk factors on the blood lipid profile, this cross-sectional study was made. MATERIAL AND METHODS: A total of 1013 farmers and 769 non-farming rural men in nine different Swedish counties were examined, interviewed, and replied to questionnaires. The inter-relationships between different risk factors were analysed using a multivariate linear regression model. RESULTS: The farmers had a significantly more favourable blood lipid profile than the non-farmers although the total cholesterol levels were almost the same for the two groups. In the total study population there were significant positive relationships between total cholesterol level and body mass index (BMI), diastolic blood pressure and smoking. The high-density lipoprotein (HDL) level was positively related to physical workload and alcohol consumption, and negatively related to BMI, waist/hip ratio and smoking. Triglyceride levels showed a positive relationship to BMI, waist/hip ratio and blood pressure. Differences between farmers and other rural males were seen, especially with respect to the effect of physical activity and psychosocial factors. Among the farmers, a negative correlation between the Karasek-Theorell authority over work index and total cholesterol, the low-density lipoprotein (LDL)/HDL ratio and triglyceride levels was observed. CONCLUSIONS: This study indicated that diet is of minor significance for the blood lipid profile, whereas factors such as physical activity, body weight and the waist/hip ratio, smoking, alcohol consumption, and perhaps psychosocial working conditions are major independent factors affecting the blood lipid profile most prominently among farmers, but also among non-farming rural men.
BACKGROUND: The effect of antihypertensive medication on cardiovascular diseases is based on results achieved in prospective and controlled clinical studies. Comparable results in clinical practice can be achieved only when the quality of management for subjects with high blood pressure is comparable with the quality achieved in clinical studies. MATERIAL AND METHODS: This study consists of two parts; an attempt to implement an computer-based clinical decision support system for management of hypertension in primary health care in two counties in Norway, and a questionnaire survey among doctors in primary care and specialists in internal medicine in hospitals in other counties. We asked what they expected would be the result of the specific implementation strategy for the computer-based program. The objectives were to evaluate the results of the implementation strategy and to compare these results with expectations expressed in the filled-in questionnaires by doctors without any obligations to the main study. RESULTS: A total of 175 doctors were invited to implement the clinical decision support system. 85% responded; 44% of these, or 37% of the invited doctors, were willing to participate. After 12 months with recurrent visits by one of the authors, only six out of 74 doctors participating in the intervention study still used the program. The questionnaire were completed and returned by 203 doctors, who expected that 55% of the invited doctors would accept the invitation following the implementation strategy used. In general the validity of the information given by the questionnaire was poor and unreliable. INTERPRETATION: We conclude that introduction of a computer-based clinical decision support system is difficult in a busy primary care setting. Availability and simplicity are crucial requirements, and doctors would need financial compensation if they were to use such a system.
The goal of the study was to compare working conditions in a hospital with the conditions in a specialized hospital-based home care (HBHC) unit, which aims to replace hospital care for patients in need of institutional car. Staff (doctors included) in a HBHC unit (n = 35) and on three hospital wards (n = 113) participated in the study. All staff members worked regularly with severely ill cancer patients. Question about stress, job satisfaction and working conditions were asked in a self-administered questionnaire. Both groups showed a limited degree of continuous stress and a high degree of job satisfaction. Thus, the overall perception was than the working conditions were good. When significant differences were found, the responses of the HBHC staff were more positive. This included items such as more freedom to make their own decisions (P
Little is known either about how telemedicine changes the job situation or about how the working environment might be improved for those involved in telemedicine. To investigate these issues, qualitative interviews were carried out with 30 people in Norway working with telepsychiatry (12 respondents), teledermatology (six respondents), a telepathology frozen-section service (10 respondents) and tele-otolaryngology (two respondents). The median annual number of remote consultations in telepsychiatry was nine, in teledermatology 81 and in the telepathology frozen-section service nine. The positive aspects of working with telemedicine included less travelling, which gave more time for other work, less need to travel in poor weather, new contacts, an increased sense of professional security (because support was readily available) and the satisfaction of seeing partners in communication. At its present volume, telemedicine generally fits into daily work patterns quite well. Problems do occur, but they can be solved by appropriate organizational measures. Long-term scheduling of telemedical sessions may be important. Many telemedicine workers want to have the equipment in their own office. Working with telemedicine can be tiring and those interviewed wanted to limit the number of hours per week. A solution may be to use large clinics, such as university clinics, where the telemedical work could be distributed between several specialists. Large telemedicine clinics with a full-time dedicated staff would need careful consideration of working practices.
INTRODUCTION: The aim of this paper is to describe elderly people living in different care settings in Sweden according to prevalence of dementia, ADL functions, psychiatric symptoms, behavioural symptoms and workload imposed on the staff. MATERIAL & METHODS: In total 842 persons living in different settings (nursing homes, homes for the aged, service houses and group-livings) has been investigated. The MDDAS scale has been used to measure motor functions, vision, hearing, speech, ADL functions, behavioural disturbances, psychiatric symptoms and workload imposed on the staff. RESULTS: Probands cared for in different settings differ considerably as to prevalence of dementia, ADL functions, behaviour and psychiatric symptoms. Those living in nursing homes were most impaired and imposed the heaviest workload on the staff. The study has also shown that the nursing load is increasing rapidly in the homes for the aged.