[show abstract][hide abstract] ABSTRACT: Knowledge about the prevalence and consequences of osteoarthritis (OA) in the Norwegian population is limited. This study has been designed to gain a greater understanding of musculoskeletal pain in the general population with a focus on clinically and radiologically confirmed OA, as well as risk factors, consequences, and management of OA.
The Musculoskeletal pain in Ullensaker STudy (MUST) has been designed as an observational study comprising a population-based postal survey and a comprehensive clinical examination of a sub-sample with self-reported OA (MUST OA cohort). All inhabitants in Ullensaker municipality, Norway, aged 40 to 79 years receive the initial population-based postal survey questionnaire with questions about life style, general health, musculoskeletal pain, self-reported OA, comorbidities, health care utilisation, medication use, and functional ability. Participants who self-report OA in their hip, knee and/or hand joints are asked to attend a comprehensive clinical examination at Diakonhjemmet Hospital, Oslo, including a comprehensive medical examination, performance-based functional tests, different imaging modalities, cardiovascular assessment, blood and urine samples, and a number of patient-reported questionnaires including five OA disease specific instruments. Data will be merged with six national data registries. A subsample of those who receive the questionnaire has previously participated in postal surveys conducted in 1990, 1994, and 2004 with data on musculoskeletal pain and functional ability in addition to demographic characteristics and a number of health related factors. This subsample constitutes a population based cohort with 20 years follow-up.
This protocol describes the design of an observational population-based study that will involve the collection of data from a postal survey on musculoskeletal pain, and a comprehensive clinical examination on those with self-reported hand, hip and/or knee OA. These data, in addition to data from national registries, will provide unique insights into clinically and radiologically confirmed OA with respect to risk factors, consequences, and management.
[show abstract][hide abstract] ABSTRACT: Symptoms for which doctors cannot find a clear medical explanation, medically unexplained symptoms (MUS), represent a challenge in medical practice. Recent proposals to define this phenomenon are based on patients' symptom count, without distinguishing between medically explained and unexplained symptoms. We describe how general practitioners (GPs) evaluate multiple and medically unexplained symptoms, and how these dimensions are interconnected. Furthermore, we explore how the number of patient-reported symptoms is associated with the two axes.
A multi-centre, doctor-patient-linked cross-sectional study in general practice. GPs rated consecutive patients along two 11 point ordinal scales assessing multiple (Multi-scale) and medically unexplained symptoms (MUS-scale). Patients completed a questionnaire addressing 38 symptoms experienced during the previous week and 866 linked questionnaires were available for analysis.
GPs used the whole range of the scales, rating only a minority of the patients as "0 (not at all)". The two scales were highly correlated (r=0.80), with a quadratically weighted kappa of 0.73, reflecting substantial agreement between the scales. MUS-scores were highest in middle age. There was a tendency that Multi-scores increased with age and that correlations between the scales decreased with age, in both sexes, although partly non-significant. The number of patient-reported symptoms was moderately correlated with the two scales.
Multisymptomatology captures MUS as a continuous construct to a great degree in GPs' clinical evaluations, although the two cannot be regarded as the same phenomenon. Patient-reported symptoms seem to be a less valid proxy for MUS.
Journal of psychosomatic research 03/2013; 74(3):186-90. · 2.91 Impact Factor
[show abstract][hide abstract] ABSTRACT: Objective. To determine the number of symptoms experienced in an adult population and their relationship with self- reported health, demographic, and lifestyle factors. Design. A postal questionnaire addressing 23 different symptoms, health, demographic, and lifestyle factors. Setting. The community of Ullensaker, Norway, in 2004. Subjects. 3325 subjects (participation rate = 54.4%). Main outcome measure. Number of self-reported symptoms. Results. At least one symptom was reported by 91.9% of the participants, 46.7% reported six or more, and 17.3% reported 10 or more symptoms. Symptom reporting was frequent in all age groups, also among young people. Women reported a greater mean number of symptoms than men (6.7 vs. 5.1). Those reporting poor health, receipt of social security benefit, unemployment, low education, or obesity had most symptoms. The proportion of respondents with these characteristics increased almost linearly with increasing number of symptoms. According to an adjusted multivariate model, self-reported overall health explained 28.2 % of the variance in the number of symptoms. Conclusion. A large proportion of the responders reported a high number of symptoms. A simple method of counting symptoms may be useful in approaching patients in general and multi-symptom patients in particular, because the total burden of symptoms is strongly associated with the patient's self-reported health and may even be a predictor of future disability.
Scandinavian journal of primary health care 01/2013; · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: There is evidence to support that the number of self-reported symptoms is a strong predictor of health outcomes. In studies examining the link between symptoms and functional status, focus has traditionally been on individual symptoms or specific groups of symptoms. We aim to identify associations between the number of self-reported symptoms and functional status. METHODS: A questionnaire was sent to people in seven age groups (N = 3227) in Ullensaker municipality in Southern Norway. The Standardised Nordic Questionnaire and the Subjective Health Complaints Inventory were used to record 10 musculoskeletal symptoms and 13 non-musculoskeletal symptoms, respectively. Four COOP-WONCA charts were used to measure functional status. RESULTS: We found a strong linear association between the number of self-reported symptoms and functional status. The number of symptoms explained 39.2% of the variance in functional status after adjusting for the effects of age and sex. Including individual symptoms instead of only the number of symptoms made little difference to the effect of musculoskeletal pain but affected the influence of non-muscular symptoms. Including even minor problems captured substantially more of the variance in functional status than including only serious problems. CONCLUSIONS: The strong association between the number of symptoms and functional status, irrespective of type of symptom, might indicate that the symptoms share some common characteristics. The simple act of counting symptoms may provide an approach to study the relationships between health and function in population studies and might be valuable in research on medically unexplained conditions.
BMC Public Health 12/2012; 12(1):1085. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: Admission to disability pension (DP) in Norway, like most other countries, requires a medical condition as the main cause of income reduction. Still, a widespread assumption is that much of the recruitment to the programme is rather due to non-medical, mainly labour market factors. In this article, we study the grey zones between acceptance and rejection of DP applications, in light of the concept of marginalisation.
From the total Norwegian population, aged 18-66 in 1998, we included all first-time applications for DP between 1998 and 2004. Logistic regressions of both application and application outcome were then performed, controlling for a range of socioeconomic variables and medical diagnosis.
Medical diagnosis had the strongest impact on application outcome, together with the applicant's age. High rejection risk was found among applicants with complex musculoskeletal diagnoses, and also for complex psychiatric diagnoses as compared to well-defined ones. Persons having previously received social assistance more often applied for a DP and more often were rejected. The same is true, though on a lesser scale, for people with a weak affiliation to the labour market.
The DP programme in Norway is to a large degree medically oriented, not only judicially but also in practice. Nevertheless, non-medical factors have a bearing on both application rates and application outcome. The control system seems to work in a way that excludes the most marginalised applicants, thus possibly contributing to further marginalisation of already disadvantaged groups.
Scandinavian Journal of Public Health 03/2012; 40(2):142-9. · 1.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: There is a lack of knowledge about the pattern of symptom reporting in the general population as most research focuses on specific diseases or symptoms. The number of musculoskeletal pain sites is a strong predictor for disability pensioning and, hence, is considered to be an important dimension in symptom reporting. The simple method of counting symptoms might also be applicable to non-musculoskeletal symptoms, rendering further dimensions in describing individual and public health. In a general population, we aimed to explore the association between self-reported non-musculoskeletal symptoms and the number of pain sites.
With a cross-sectional design, the Standardised Nordic Questionnaire and the Subjective Health Complaints Inventory were used to record pain at ten different body sites and 13 non-musculoskeletal symptoms, respectively, among seven age groups in Ullensaker, Norway (n = 3,227).
Results showed a strong, almost linear relationship between the number of non-musculoskeletal symptoms and the number of pain sites (r = 0.55). The number and type of non-musculoskeletal symptoms had an almost equal explanatory power in the number of pain sites reported (27.1% vs. 28.2%).
The linear association between the number of non-musculoskeletal and musculoskeletal symptoms might indicate that the symptoms share common characteristics and even common underlying causal factors. The total burden of symptoms as determined by the number of symptoms reported might be an interesting generic indicator of health and well-being, as well as present and future functioning. Research on symptom reporting might also be an alternative pathway to describe and, possibly, understand the medically unexplained multisymptom conditions.
[show abstract][hide abstract] ABSTRACT: Immigrants from low-income countries are more likely than ethnic Norwegians to receive disability pensions. In a previous study in Oslo, we showed that occupational position probably accounted for all of this difference. The present article presents a study of the total population, with data on education and age at receipt of pension. Census and social security data for all persons living in Norway from 1992 to 2003 were used to identify new disability pensions to those aged 30-55 years and eligible in 1992, comprising 15.9% females and 11.4% males. Age-adjusted relative risk was 2.03 (95% CI 1.97-2.08) for non-Western males and 1.30 (1.26-1.36) for non-Western females compared with Westerners, and more than three times higher for males from North Africa/the Middle East. Education did not explain any of the risk differences, but when adjusting for age at pension receipt the differences disappeared completely. This is probably due to their being in predominantly unskilled occupations where there is also a low pension age among ethnic Norwegians.
Journal of Immigrant and Minority Health 12/2010; 14(2):259-63. · 1.16 Impact Factor
[show abstract][hide abstract] ABSTRACT: Musculoskeletal pain is one of the most common reasons for seeking both traditional and alternative medical treatment. The aim of this study was to provide an overview of musculoskeletal disorders in Norway.
The article is based on a Norwegian report on musculoskeletal disorders from 2004, and a non-systematic search in PubMed for relevant literature from the period 2005-2009.
Musculoskeletal pain is common in the Norwegian population, and 75-80% will have experienced such pain during a month. More women than men report musculoskeletal pain, and the prevalence increases with increasing age. Musculoskeletal pain from only one area is unusual (11%), while pain from five or more areas is reported by approximately 40%. A high number of painful areas is associated with reduced general functioning and an increase in work disability and sick leave. The prevalence of musculoskeletal pain in the population seems to be stable over time, but the proportion of work disability caused by these disorders has decreased the last 10 years. Despite of this, musculoskeletal disorders are still the most frequent cause of work disability.
Many are affected by musculoskeletal disorders, and they are still the most common cause of disability benefits in Norway.
Tidsskrift for den Norske laegeforening 12/2010; 130(23):2365-8.
[show abstract][hide abstract] ABSTRACT: Musculoskeletal disorders make up a heterogeneous group. Our aim was to describe the variation in social insurance benefits for the most prevalent disorders within this group.
The study was based on the Norwegian labour and welfare administration's registers on sickness benefits and disability benefits.
Of the musculoskeletal disorders, low back conditions are the most frequent causes of sick leave and disability benefits, and account for 11 and 9% respectively. Neck and shoulder disorders are also common causes of sick leave, while osteoarthritis and fibromyalgia are common causes of disability benefits and each account for 5% of all new cases.
The labour and welfare administration should continue to focus on musculoskeletal disorders to prevent long-term sick leave and permanent absence from work.
Tidsskrift for den Norske laegeforening 12/2010; 130(23):2369-70.
[show abstract][hide abstract] ABSTRACT: Although the Norwegian Welfare Law includes rigorous medical criteria for granting disability pensions, several non-medical factors have been shown to be associated with and possible causal factors of pensioning.
We analysed the relationship between disability pension and detailed information on educational attainment in different diagnostic groups.
All ethnic Norwegians aged 18-66 years and alive on 31 December 2003 (n = 2,522,430) were included. Age, sex, the receipt of a disability pension on 31 December 2003, and the diagnosis on the medical certificate were taken from a national social security file. The file also included six levels of education: primary school, low-level secondary school, secondary school, low-level university, university, and research level.
We found a dramatic increase in the prevalence of persons granted disability pension with decreasing years of education across all levels of education. The disparities were much stronger than those seen for other health-related parameters and were especially strong for those with musculoskeletal diagnoses. The disability pension is more a consequence of health problems than a proxy for health status. The demonstrated relationship between education and disability pension may be partly explained by exclusion from the work force because of health-related work problems.
To facilitate a more inclusive working life, attention should be focused on the work place's capacity to include people with different levels of competence and functioning rather than on the health problems of the employees.
Scandinavian Journal of Public Health 11/2010; 38(7):686-90. · 1.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: Cross-sectional, population-based postal survey.
To investigate the relationship between neck pain, pain in other sites and functioning.
Neck pain is one of the most commonly reported musculoskeletal pain sites, and people with neck pain often report pain in other pain sites. Reduced functioning is associated with widespread pain. The relationship between neck pain with and without pain from other pain sites and functioning has not been described.
In 2004, a questionnaire about musculoskeletal pain and functioning was sent to 7 birth cohorts in Ullensaker municipality in Norway, to which 3325 of 6108 persons (54.4%) responded. Musculoskeletal symptoms were registered using the Standard Nordic Questionnaire. Neck pain was categorized as localized neck pain (neck), regional neck pain (neck, shoulder, head, upper back), neck pain as part of scattered pain (1-3 other pain sites and not regional), or widespread pain (neck and ≥4 other pain sites). Functional status was assessed using the Norwegian Function Assessment Scale.
The 1-week prevalence of any neck pain was 34.4% (95% CI, 32.8-36.0). Localized neck pain was reported by only 1.4% of our population. Neck pain was most often regional (15.9%) or part of widespread pain (14.8%). People with neck pain as part of widespread pain had reduced function compared with any other group with neck pain.
Localized neck pain was rare, and neck pain was almost always a part of either regional or widespread pain. Research on neck pain and functioning that do not assess other pain sites may miss a crucial dimension.
[show abstract][hide abstract] ABSTRACT: Women have more spells of sickness absence than men but the reasons for this are unknown. We wanted to see if occupation, working conditions, income, health and mental distress may explain this gender difference.
In a health survey in 2000-01 of all Oslo inhabitants aged 40, 45, and 59/60 years, 11,072 (48.7%) participated. Survey data were linked to the National Insurance Administration and Statistics Norway for the 8,174 eligible for sickness pay in the next four years. Occupation, working conditions, general health and mental distress were self-reported, and income was from official statistics. Long-term sickness absence (>16 days) was calculated for 2001-04 as cumulative incidence and number of days reimbursed.
Cumulative incidence was 50.1% for women and 34.7% for men in the four years after the survey. An age-adjusted female overweight of 48% was only reduced to 41% by adjusting for occupation, working conditions, income, self-reported health and mental distress. Duration of long-term sickness absence was 17 days more for women than for men, and was not influenced by adjustments.
We have not explained why women have more sickness absence than men, either by work-related factors or by general health or mental distress. Factors explaining the gender divide should be sought elsewhere.
Scandinavian Journal of Public Health 09/2009; 37(7):674-81. · 1.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this study was to explore the prevalence of dizziness in a general population and the association between dizziness and socio-demographic variables, self-reported diseases and medicines used. We hypothesize that dizziness was associated with different diseases and medicines as well as the number of diseases and the number of medicines used.
We used data from a cross-sectional survey with 17,638 participants aged 30, 40, 45, 59/60 and 75/76 in the Oslo Health Study who had answered a self-administered questionnaire in 2000-2001. Associations were analyzed by descriptive statistics, chi-square tests, independent t-tests and logistic regression.
The prevalence of self-reported faintness or dizziness was 28.7%, reported more often by women than men and by age group 75/76. Participants with neck shoulder pain/stiffness, mental disorders, fibromyalgia/chronic pain syndrome, stroke/cerebral haemorrhage, angina pectoris and chronic bronchitis/emphysema, as well as use of tranquillizers, sedatives, and ''other medicines on prescription,'' had a significantly increased likelihood of being troubled by faintness or dizziness. An increasing number of reported diseases and an increasing number of medicines used gave an increasing likelihood of faintness or dizziness. In the multivariate analysis controlling for socio-demographic variables, diseases and use of medicines, the oldest did not have an increased likelihood of faintness or dizziness.
Self-reported diseases and medicines used could explain a modest rise in the prevalence of faintness or dizziness by age. Sum of diseases and sum of medicines used were associated with reporting dizziness to a greater extent than the different diseases and medicines used.
Scandinavian Journal of Public Health 05/2009; 37(6):613-20. · 1.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: We aimed to test the hypothesis that differences in disability pensioning among different ethnic groups were attributable to differences in occupation, income, health, and mental distress.
In a health survey conducted between 2000 and 2001 in Oslo, nearly half (48.7%; 11,072) of all inhabitants aged 40, 45 and 59-60 years participated. Survey data related to work, general health and mental distress were linked to disability pension data from the National Insurance Administration, and to income and country of origin data from Statistics Norway. A total of 9195 persons were eligible for disability pension at the end of 2000.
Approximately 5% received a disability pension in the 4 years following the health survey. An age- and gender-adjusted odds ratio of 2.27 (95% confidence interval (CI) 1.55-3.23) among immigrants from developing countries and Eastern Europe as compared to ethnic Norwegians was reduced to 0.88 (95% CI 0.46-1.67) after adjusting for occupation, working conditions, and income. The odds ratio was further reduced to 0.63 (95% CI 0.32-1.25) when self-reported health and mental distress were added to the model.
The higher risk of receiving a disability pension among immigrants from developing countries and Eastern Europe than among ethnic Norwegians was largely explained by work factors and level of income. The addition of mental distress and self-reported health to the multivariate model further reduced the risk, although not significantly different from ethnic Norwegians.
Scandinavian Journal of Public Health 05/2009; 37(4):395-400. · 1.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: Musculoskeletal pain that affects multiple body sites is typically regarded as comorbidity to single-site pain. Pain present in multiple sites, however, is more severe and disabling compared to single-site pain. This study aimed to prospectively investigate the change in the number of pain sites over 14years, in addition to identifying predictors of multi-site pain. In 1990 and 2004, questionnaires about musculoskeletal pain were mailed to six birth cohorts in Ullensaker, Norway. Data on demographic, lifestyle, and health-related variables were also collected. Participation rate in 1990 was 67.2% and among those 60.4% participated in 2004. A slight increase in the average number of pain sites occurred between 1990 and 2004, but results showed a relatively stable pattern of pain reporting over a period of 14 years. Several demographic, lifestyle, and health-related variables in 1990 predicted the number of pain sites at follow-up in the bivariate analyses. However, only sex, age, sleep quality, and educational level remained significant in the final multivariate model after controlling for the number of pain sites at baseline. The final model explained 35% of the variance, of which nearly 80% was accounted for by the number of pain sites at baseline. As the pattern of reporting the number of pain sites appears relatively stable across adulthood and baseline multi-site pain demonstrated strong predictive utility, studies investigating the occurrence of multi-site pain in children and adolescents are recommended to determine potential causal factors contributing to the early course and development of multi-site musculoskeletal pain.