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STUDY DESIGN: Cohort study with 5-, 10-, and 28-year follow-up. OBJECTIVES: To examine associations between baseline serum lipid concentrations and later low back pain (LBP). SUMMARY OF BACKGROUND DATA: Atherosclerosis of the lumbar vessels has been suggested as a mechanism leading to disc degeneration and LBP. Cholesterol is considered essential for atherosclerosis development. METHODS: A sample (n = 902) of employees in an engineering company was examined for serum total cholesterol and triglycerides, body mass index (BMI), smoking, exercise, work history, and LBP in 1973. By November 2000, 232 subjects had died. In 1978, 748 (84% of the survivors), in 1983, 654 (76%), and in 2000, 546 (81%) responded to a follow-up questionnaire. RESULTS: In men, baseline serum total cholesterol predicted new cases of radiating LBP in the 5-year follow-up (highest tertile vs. lowest: odds ratio [OR], 2.5; 95% confidence interval [CI], 1.1-5.9) and in the 10-year follow-up (OR, 2.8; 95% CI, 1.3-6.1), adjusted for age, occupational class, work history, BMI, smoking and exercise. Also, serum triglycerides predicted new cases in the latter examination (OR, 2.6; 95% CI, 1.2-5.8). In women, no associations were seen until the 10-year follow-up, when their results were similar to those in men. In the total material, serum total cholesterol predicted radiating LBP reported both at the 10- and the 28-year follow-up. CONCLUSIONS: High serum lipids predicted incident radiating LBP, consistent with the atherosclerosis-LBP hypothesis. [ABSTRACT FROM AUTHOR]

Study Design: A prospective cohort study.Objective: To study the relationship of sleep disturbances with severe back disorders leading to hospitalization.Summary Of Background Data: Sleep disturbances are associated with persistent pain syndromes, but little is known about their relationship with back disorders.Methods: The first hospital admission for back disorders from 1973 to 2000 was studied in a cohort of metal industry workers (n = 902). The occurrence of sleep disturbances at baseline was categorized as: none; 1 type (either difficulties in falling asleep/waking up at night or nightmares); or both types. Cox proportional hazards regression was used to estimate the time between the assessment of risk factors and first hospital admission for back disorders.Results: Those individuals who had 1 type of sleep disturbance had a 2.1-fold (95% confidence interval 1.1-3.8) risk of back-related hospitalization, and those with both types of disturbance a 2.4-fold (1.2-4.6) risk, compared with those with no sleep disturbances. The hazard ratios were 2.1; 1.0-4.6 and 2.9; 1.2-7.1, respectively, when patients with chronic back disease or recurrent back symptoms at baseline were excluded from the analyses.Conclusion: These findings suggest that sleep disturbances are predictive of hospitalization for back disorders. The mechanism underlying this association warrants further study. [ABSTRACT FROM AUTHOR]

Study Design: Prospective cohort study.Objective: To study symptoms, chronic disorders, and clinical findings in the low back, and work absenteeism, as predictors of hospitalization.Summary Of Background Data: Socioeconomic and lifestyle factors are associated with back-related hospitalization, but the significance in the working normal population of low back symptoms and clinical findings are not known.Methods: The cohort (n = 902) was drawn in 1973 from among employees in the metal industry (n = 2,653). The data were collected by questionnaire and a structured clinical assessment by a physiotherapist. Weight was measured. A sum score of local and radiating low back symptoms (frequency during the past year on a 4-point Likert scale) was categorized as no/yes and no/infrequent/frequent. Local and radiating symptoms were considered also separately. The data were linked with those from the Finnish Hospital Discharge Register during 1973 to 2000. Logistic regression and the Cox proportional hazard models were used.Results: As compared with persons without low back pain, those with frequent or radiating low back pain had an increased risk of hospitalization due to low back disorders (hazard rate ratio (HRR), 3.0; 95% confidence interval (CI), 1.4-6.5, and 3.7; 1.8-7.7, respectively) after adjustment for age, gender, and occupational class. Similarly, clinical findings (HRR, 2.4; 95% CI, 1.3-4.7), back-related absenteeism (HRR, 3.3; 95% CI, 1.6-6.7), and chronic low back disorders (HRR, 2.8; 95% CI, 1.5-5.4) predicted hospitalization. The associations persisted when further adjusted for smoking, body mass index, and distress symptoms at baseline.Conclusion: Frequent or radiating low back symptoms, chronic low back disorders, back-related work absenteeism, and having clinical findings in the low back predicted inpatient hospital care for low back disorders. [ABSTRACT FROM AUTHOR]

Study Design: A prospective cohort study.Objectives: To study the association of psychosocial factors at work with severe back disorders leading to hospitalization.Summary Of Background Data: Some psychosocial factors at work have been related to back pain, but little is known about their predictive role in severe back disorders.Methods: Psychosocial factors at work were studied by questionnaire and interview in 1973 among a cohort of 902 metal industry employees. Information on hospital admissions for back disorders from the Finnish Hospital Discharge Register in 1973-2000 was linked to the data. Cox proportional hazards regression was used to estimate the time between the assessment of risk factors and the first hospital admission for intervertebral disc disorders (36 cases) and other back disorders (47 cases).Results: In a model including psychosocial factors and potential confounders, low job control versus high control was associated with a 3.2-fold risk (95% confidence interval, 1.3-7.8) of hospitalization for back disorders other than those of the intervertebral disc. The corresponding rate ratio for low versus high supervisor support was 2.9 (95% confidence interval, 1.3-6.3). Job demands, coworker support, and distress were not independently associated with these disorders. The result did not change when patients with chronic back disorder at baseline were excluded from the analysis. There was no association between psychosocial factors at work and hospitalizations for intervertebral disc disorders.Conclusion: Low job control and low supervisor support seem to increase the risk of hospitalization for back disorders other than intervertebral disc disorders. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: A prospective cohort study. OBJECTIVE: To study the relationship of smoking and overweight with severe back disorders leading to hospitalization. SUMMARY OF BACKGROUND DATA: Many epidemiological studies have shown an association between smoking or overweight and back pain, but the results are still equivocal. Longitudinal studies are few. METHODS: A cohort of metal industry employees (n = 902) was studied for lifestyle, work history, and health in 1973 by questionnaire and interview. The weight of the subjects was measured and body mass index (kg/m2) was calculated. Based on intensity and duration, smoking was categorized as: never smoked (reference), stopped smoking, smoked 9 pack-years. Information on hospital admissions from 1973 to 2000 from the Finnish Hospital Discharge Register was linked to the data. Seventy-five individuals had been admitted to hospital because of back disorders. Intervertebral disc disorders and other common back disorders were analyzed separately. Cox proportional hazards regression was used to estimate the time between the assessment of potential risk factors and the first hospitalization for a back disorder. RESULTS: The rate ratio of heavy smokers (>9 pack-years) for hospitalization because of intervertebral disc disorders was 3.4 (95% confidence interval 1.3-9.0) as compared with never-smokers, allowing for other risk factors. Accordingly, the rate ratio of body mass index >27.5 kg/m2 was 2.7 (1.1-6.45) as compared with people with normal weight. The results retained when patients with chronic back disease at baseline were excluded from the analyses. Other back-related diagnoses of hospitalization were not consistently associated with smoking or overweight. CONCLUSION: Heavy smoking and overweight predicted hospitalization for intervertebral disc disorders. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Population-based cross-sectional study of clinically assessed low back syndromes. OBJECTIVE: To investigate whether exposure to professional car driving, either alone or in combination with strenuous physical work is associated with clinically defined sciatica or other clinically diagnosed chronic low back syndromes. SUMMARY OF BACKGROUND DATA: Several studies have found an association between professional driving and back disorders, but drivers' histories of heavy physical work tasks has rarely been taken into account. METHODS: The nationally representative sample comprised of 2323 men aged 30 to 64 (the Health 2000 Survey). The diagnoses of sciatica and chronic low back syndromes were based on a standardized clinical examination by specially trained physicians. Life-long exposure to professional car driving and to physically demanding work was assessed retrospectively via interviews. Logistic regression was used to estimate the risk of clinical chronic low back syndromes related to these exposures, and the risks were presented with odds ratios (OR) with 95% confidence intervals (95% CI). RESULTS: The prevalence of physician-diagnosed sciatica was 5.4% and that of other chronic low back syndromes 4.0%. Professional car driving in general was associated with sciatica at an OR of 1.42 (95% CI 0.92-2.18) and with other chronic low back syndromes at an OR of 1.31 (0.80-2.16), after adjustment of covariates and strenuous physical work. Exposure to driving without exposure to physical work was not associated with the outcomes, whereas driving in combination with strenuous physical work increased the risk for sciatica threefold (3.22; 1.86-5.59), and that of low back syndromes twofold (2.08; 1.12-3.87). CONCLUSION: The increased risk of low back disorders related to professional car driving is more likely due to strenuous work tasks rather than to driving itself. [ABSTRACT FROM AUTHOR]

We identified factors protective of all-cause sickness absence (SA) among subjects with multisite musculoskeletal pain (MSP). The nationally representative source sample comprised 3420 actively working Finns aged 30 to 55 in year 2000 and alive at follow-up. Pain in 18 body locations was combined into four sites (neck, low back, upper limbs, and lower limbs). The baseline prevalence of MSP (pain in ≥ 2 sites) was 32%. Baseline data on sociodemographic factors, work ability, work, health, and lifestyle were gathered by questionnaire, interview, and clinical examination and linked with national registers on all-cause SA (periods lasting ≥10 workdays) for 2002 to 2008. Based on trajectory analysis, 74% of those with MSP had a low and 26% a high probability of SA. In logistic regression analysis, younger age, male sex, and professional occupational group were inversely associated with SA. Allowing for these, good physician-assessed work ability, physically light work, possibility to adjust workday length, encouraging workplace atmosphere, no problems with working community or mental stress, normal weight, and no sleep disorders were predictive of lower SA rates (odds ratios between 0.47 and 0.70). In a final stepwise model adjusted for age, sex, and occupational group, no exposure to lifting (odds ratio 0.58, 95% confidence interval 0.39-0.85) and to repetitive hand movements (0.57, 0.39-0.83), possibility to adjust workday length (0.73, 0.53-0.99), and normal weight (0.59, 0.40-0.87) were inversely associated with SA. In conclusion, several modifiable factors related to work and lifestyle were found as predictive of lower rates of longer SA among occupationally active subjects with MSP.

Objective: To examine the associations between occupational psychosocial factors and obesity among 31-year-olds, adjusting for adolescent body mass index, physical strenuousness of work, and adverse health behaviors (ie, stress-related eating/drinking, leisure-time physical inactivity, smoking, and high alcohol consumption)., Methods: The study population comprised 2083 men and 1770 women from the Northern Finland Birth Cohort 1966. Obesity was defined as a body mass index of 30.0 kg/m or more. Psychosocial exposures were defined in terms of demands, control, and social support at work., Results: Among men, high job demands and low worksite social support were independently associated with obesity. Among women, stress-related eating/drinking and physical inactivity seemed to promote obesity. Body mass index at age 14 was an important predictor of obesity for both sexes., Conclusions: In workplace obesity prevention programs, it might be beneficial to improve the psychosocial work environment and promote healthy behaviors simultaneously.

Objective: To examine the relationship of musculoskeletal pain and depressive symptoms, occurring alone or both together, with self-rated current work ability and thoughts of early retirement., Methods: In a nationally representative sample drawn in 2000-2001, we studied actively working subjects aged 30 to 64 years (n = 4009)., Results: Musculoskeletal pain was associated with moderate/poor physical work ability (adjusted odds ratio [OR] = 2.9; 95% confidence interval [CI], 2.0 to 4.2) and mental work ability (OR = 1.6; 95% CI, 1.2 to 2.2). Depressive symptoms were associated with moderate/poor mental work ability only (adjusted OR = 4.2; 95% CI, 2.3 to 7.9). Moreover, only musculoskeletal pain was associated with thoughts of early retirement (OR = 1.4; 95% CI, 1.1 to 1.8). There was an interaction between musculoskeletal pain and depressive symptoms regarding physical work ability and thoughts of early retirement., Conclusion: Co-occurrence of musculoskeletal pain and depressive symptoms is strongly related to poor self-rated physical work ability.

We studied the number of musculoskeletal pain sites as a predictor of sickness absence during a 7-year follow-up among a nationally representative sample (the Health 2000 survey) of occupationally active Finns 30 to 55years of age (3420 subjects who did not retire or die during the follow-up). Baseline data (questionnaire, interview, clinical examination by a physician) were gathered in 2000 to 2001 and linked with information from national registers on annual compensated sickness absence periods (⩾10workdays) covering the years 2002 to 2008. Pain during the preceding month in 18 body locations was inquired and combined into 4 sites (neck, upper limbs, low back, lower limbs). Demographic factors, BMI, smoking, leisure-time physical activity, sleep disorders, physical and psychosocial workload, and chronic diseases were assessed. Four distinct sickness absence trajectories emerged, labeled as Low (59% of the subjects), Ascending (21%), Mixed (11%), and High (9%). In multinomial logistic regression, the odds ratios (ORs) for belonging to the High vs. the Low trajectory increased with the number of pain sites, being 2.1 for single-site pain, 2.6 for 2 pain sites, 2.9 for 3 pain sites, and 4.1 for 4 pain sites, after adjustment for chronic diseases, demographic and lifestyle factors, and workload. The confidence intervals of the ORs did not include unity. The adjusted ORs for belonging to the Ascending trajectory were 1.1, 1.3, 1.7, and 1.7, respectively. As the number of pain sites was a strong independent predictor of work absenteeism, early screening of workers with multisite pain and interventions to support work ability seem warranted., (Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

Study Design: Cross-sectional study with retrospectively assessed work determinants., Objective: To study the association between the history of physically demanding work and sciatica, among the occupationally active, and among persons of working age who are not occupationally active., Summary of Background Data: Few studies have examined the association of physically loading work with sciatica, and studies concerning women are scarce., Methods: A nationally representative sample of The Health 2000 survey comprised 4811 Finns aged 30 to 64, which we further stratified into 2 groups based on working status during the preceding 12 months. The diagnosis of sciatica was based on characteristic symptoms and a standardized clinical examination by physicians trained for the purpose. Life-long exposure to physically demanding work tasks was assessed retrospectively by interview., Results: A total of 3.8% of working subjects and 7.9% of nonworking subjects had sciatica; men more often than women. In the multivariable logistic regression models, a history of physically demanding work in general was associated with sciatica among men. The risk increased with the length of exposure for the first 20 years (OR: 1.85; 95% CI: 1.17-2.91 for 1-10 years and 2.67; 1.61-4.43 for 11-20 years of exposure), but decreased thereafter. When analyzing manual handling of heavy objects, bending, and kneeling separately, odds ratios for these factors were high for both working and nonworking men. However, they remained at the borderline of statistical significance among working men. None of the physical work exposures were associated with sciatica among working women, whereas a long history of handling heavy objects and bending were related to sciatica among nonworking women., Conclusion: Physically demanding work in general is a risk factor for sciatica among men. Sciatica may be a significant cause of premature health-related selection out of the heavy work among both genders.

The antioxidant properties of hydroxymatairesinol (HM-3000) were studied in vitro in lipid peroxidation, superoxide and peroxyl radical scavenging, and LDL-oxidation models in comparison with the known synthetic antioxidants Trolox (a water-soluble vitamin E derivative), butylated hydroxyanisol (BHA) and butylated hydroxytoluene (BHT). On a molar basis HM-3000 was a more effective antioxidant than Trolox in all assays and more effective than BHT or BHA in lipid peroxidation and superoxide scavenging test. The in vivo antioxidative effect (evaluated as the weight gain of C57BL/6J mice fed an alpha-tocopherol-deficient diet) of HM-3000 (500 mg/kg per day) was comparable to that of DL-alpha-tocopherol (766 mg/kg per day). The antitumor activity of HM-3000 was studied in dimethylbenz[a]anthracene (DMBA)-induced rat mammary cancer. HM-3000 had a statistically significant inhibitory effect on tumor growth. Prevention of tumor formation was also evaluated in the Apc(Min) mice model, which develops intestinal polyps spontaneously. HM-3000 was given in diet at 30 mg/kg per day and decreased the formation of polyps and prevented beta-catenin accumulation into the nucleus, the pathophysiological hallmark of polyp formation in this mouse model. In short-term toxicity studies (up to 28 days) HM-3000 was essentially non-toxic when given p.o. to rats and dogs (daily doses up to 2000 and 665 mg/kg, respectively); HM-3000 was shown to be well absorbed (> 50% of the dose) and rapidly eliminated. In human studies HM-3000 has been given in single doses up to 1350 mg to healthy male volunteers without treatment-related adverse events. Rapid absorption from the gastrointestinal tract and partial metabolism to enterolactone in humans was demonstrated. In summary, HM-3000 is a safe, novel enterolactone precursor lignan with antioxidant and antitumor properties.

The EORTC Melanoma Cooperative Group conducted a phase II trial (study number 18891) to study the effect of Toremifene in 45 patients with advanced, metastatic melanoma. Male and female patients, median age 61 (range 23-88) years received a mean total dose of 11 g (4.3-62.6) orally for at least 6 weeks. No objective remissions were seen. Four patients (3 women and 1 man; 9%) experienced 3-6 months' disease stabilization. The toxicity of the drug, given at a dose of 240 mg daily, was negligible. Because of the minimal side-effects, Toremifene may be recommended for patients who have only a small number of slowly growing metastases, in particular to soft tissue and lung.

The subrenal capsule assay in normal immunocompetent mice was used to test the responsiveness of ovarian cancer to combination chemotherapy. Of the assays, 42 were of untreated tumors and 19 of previously treated tumors. Fifty-nine (97%) of the assays were evaluable. The previously treated tumors were less sensitive than the untreated ones. Of the treated tumors 44% were sensitive, 33% intermediately sensitive, and 22% resistant versus 56, 44, and 0%, respectively, of the untreated tumors (P less than .01). Repeat assays for the tumors of seven patients were performed successfully after five to eight courses of therapy with the combination of doxorubicin, cyclophosphamide, and cisplatin. The responsiveness to this combination had weakened significantly (P less than .01); the response of only one tumor remained unchanged. The rates of resistance to the drug combinations doxorubicin-cyclophosphamide-cisplatin, doxorubicin-cyclophosphamide-tegafur, and cyclophosphamide-vincristine were 11, 10, and 21%, respectively; there was, however, considerable interindividual variation in tumor responses to these combinations. Of other combinations, hexamethylmelamine combined with 4-epidoxorubicin, aclarubicin, or chlorambucil and cisplatin had effect, whereas the combinations of cisplatin and etoposide and of tegafur and methotrexate or mitomycin were quite ineffective, as measured by the assay. The reliability of the subrenal capsule assay in normal immunocompetent mice is discussed, and it is concluded that the assay can be used to assess the response of ovarian cancer to chemotherapy, including multidrug therapy, without routine histologic control.