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Background: Evidence shows that low back specific patient information is effective in sub-acute low back pain (LBP), but effectiveness and cost-effectiveness (CE) of information in early phase symptoms is not clear. We assessed effectiveness and CE of patient information in mild LBP in the occupational health (OH) setting in a quasi-experimental study.Methods: A cohort of employees (N = 312, aged <57) with non-specific, mild LBP (Visual Analogue Scale between 10-34 mm) was selected from the respondents of an employee survey (N = 2480; response rate 71 %). A random sample, representing the natural course of LBP (NC, N = 83; no intervention), was extracted as a control group. Remaining employees were invited (181 included, 47 declined, one excluded) into a randomised controlled study with two 1:1 allocated parallel intervention arms ("Booklet", N = 92; "Combined", N = 89). All participants received the "Back Book" patient information booklet and the Combined also an individual verbal review of the booklet. Physical impairment (PHI), LBP, health care (HC) utilisation, and all-cause sickness absence (SA) were assessed at two years. CE of the interventions on SA days was analysed by using direct HC costs in one year, two years from baseline. Multiple imputation was used for missing values.Results: Compared to NC, the Booklet reduced HC costs by 196€ and SA by 3.5 days per year. In 81 % of the bootstrapped cases the Booklet was both cost saving and effective on SA. Compared to NC, in the Combined arm, the figures were 107€, 0.4 days, and 54 %, respectively. PHI decreased in both interventions.Conclusions: Booklet information alone was cost-effective in comparison to natural course of mild LBP. Combined information reduced HC costs. Both interventions reduced physical impairment. Mere booklet information is beneficial for employees who report mild LBP in the OH setting, and is also cost saving for the health care system.Trial Registration: ClinicalTrials.gov NCT00908102. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between leisure physical activity and various pain symptoms in adolescents.Methods: In this nationwide cohort based cross sectional study in Finland, 698 schoolchildren, 344 girls and 354 boys, aged 10 to 17 years responded to a questionnaire on pain symptoms (neck and shoulder pain, upper back pain, low back pain, upper limb pain, lower limb pain, headache, and abdominal pain) and physical activity habits and also participated in a fitness test.Results: Reported physical activity correlated with measured fitness. Musculoskeletal pains (p = 0.013) (in particular low back pain (p = 0.022), upper limb pain (p<0.001), and lower imb pain (p<0.001)) were found more often in subjects participating in large amounts of leisure physical activity, while non-musculoskeletal pains (p = 0.065) (in particular headache among boys (p = 0.004)) tended to be less common. Co-occurrence of different musculoskeletal pains was common in subjects participating in sports.Conclusions: In addition to its likely long term health benefits, vigorous physical activity causes musculoskeletal pains during adolescence. This should be considered when tailoring health promotion programmes to adolescents. Also, co-occurrence of musculoskeletal pains may occur as the result of sports activity, which should be considered as a confounder in epidemiological studies on fibromyalgia and related issues. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the role of physical workload in low back pain (LBP) among adolescents. Methods Working history and physical workload factors at 18 years were assessed for 1984 members of the Northern Finland Birth Cohort 1986. The associations between work characteristics and LBP were analysed by multinomial logistic regression. Those with and without LBP at 18 years of age were compared in two subsamples. The incidence of LBP was studied among the 986 subjects without LBP at 16 years of age. Persistence of LBP was studied among the 728 subjects with LBP at 16 years of age. Latent class analysis (LCA) was used to form natural clusters of workload factors and their associations with LBP were investigated using log-binomial regression. Results 753 (75%) subjects without LBP at 16 years of age had been working during the 2-year follow-up period. The average duration of work was 6.2 months. In adolescent girls, working regularly or irregularly and duration of work exposure were associated with incident LBP. Of specific physical workload factors, only awkward trunk postures were associated with incident LBP in both genders (RR 1.2 in girls and 1.7 in boys). The work exposure patterns in adolescent girls and boys were different. In the LCA, subjects in a cluster with high exposure to awkward trunk postures or an overall physically demanding job had a higher likelihood of incident LBP in both genders (RR 1.3-1.9). None of the specific workload factors or clusters was associated with persistent LBP. Conclusions Physical workload factors constitute a risk for LBP even in adolescents. [ABSTRACT FROM AUTHOR]

In this cohort study, dynamic trunk extensor performance was studied as a predictor of permanent work disability due to back disorders. As part of the comprehensive Mini-Finland Health Survey in 1978-80, the back muscle performance of 535 persons (267 men, 268 women) was measured using standardized repetitive arch-up and sit-up tests. At baseline, the participants were between 30 and 64 years of age. Retirements were followed for 12 years on average. During the follow-up, 56 subjects developed permanent work disability; 15 of these cases were back-related. Good dynamic trunk extensor performance was predictive of a decreased incidence of work disability due to chronic back disorders but not work disability due to other diseases. The risk of back-related work disability in the three highest quartiles in relation to the lowest quartile of dynamic trunk extension capacity was 0.28 (95% confidence interval, 0.09-0.94). Our study suggests that good dynamic trunk extension performance may protect against back-related permanent work disability. [ABSTRACT FROM AUTHOR]

Background: Low educational level is associated with an increased risk of coronary heart disease. The aim of the present study was to examine the relationships between education and common cardiovascular risk factors in young adults.Methods: Trends in conventional risk factors of young adults aged 21, 24, 27 and 30 years in 1992 (n = 443) were examined across the educational groups as part of a 12-year follow-up study, the Cardiovascular Risk in Young Finns Study. Education was determined as participants' own educational level and as parental years of schooling.Results: In males, subject's own education was related inversely and independently of parental school years to serum total and low density lipoprotein (LDL) cholesterol concentration, smoking and body mass index. In females, participant's own educational level associated inversely with smoking and physical inactivity. Parental school years was associated inversely and independently of one's own educational level with serum total and LDL cholesterol values and waist-hip ratio in females. In both genders, parental education was a stronger determinant of diet (butter use) than one's own educational level.Conclusions: The least educated young adults have adopted a more adverse lifestyle than the more educated. The risk factor profile in young adulthood, especially in females, is still affected by parental education. The influences of one's own and parental educational level on vascular risk profile should be taken into consideration when planning public health campaigns among young adults. [ABSTRACT FROM AUTHOR]

In this 3-year longitudinal study, we studied lumbar mobility and the occurrence of low back pain among 98 adolescents who were free of previous severe low back pain: 33 nonathletes (16 boys, 17 girls), 34 boy athletes (ice hockey and soccer players) and 31 girl athletes (figure skaters and gymnasts). During the followup, low back pain lasting longer than 1 week was reported by 29 athletes (15 boys and 14 girls) and by 6 nonathletes (3 boys and 3 girls). In multivariate analyses, participation in sports and low maximal lumbar flexion at the baseline predicted low back pain during the followup among boys; however, these factors accounted for only 16% of the variability between the groups with and without low back pain. Among girls, decreased range of motion in the lower lumbar segments, low maximal lumbar extension, and high body weight at the baseline were predictive of low back pain during the followup, accounting for 31% of the variability between the groups. The girls in the lowest tertile of maximal lumbar extension at baseline had a relative risk of 3.4 to have future low back pain compared with those in the highest tertile. We conclude that the low individual physiologic maximum of lower segment lumbar extension mobility may cause overloading of the low back among athletes involved in sports with frequent maximal lumbar extension and that it predicts future low back pain. [ABSTRACT FROM AUTHOR]

Leino M (Cardiorespiratory Research Unit, University of Turku, Kiinamyllynkatu 10, FIN-20520 Turku, Finland), Porkka K V K, Raitakari O T, Laitinen S, Taimela S and Viikari J S A. Influence of parental occupation on coronary heart disease risk factors in children. The Cardiovascular Risk in Young Finns Study. International Journal of Epidemiology 1996; 25: 1189–1195.Background The Influence of parental occupation on selected coronary heart disease risk factors was studied in a cohort of Finnish children aged 9, 12 and 15 years (n = 1211) as part of the Cardiovascular Risk in Young Finns Study in 1986. Methods The relationships of parental occupation to serum lipid and apolipoprotein concentrations, blood pressure, obesity, smoking, physical activity, diet and birthweight were examined. The occupation of the parents was obtained by a questionnaire and classified as I: upper non-manual (22%), II: lower non-manual (26%), III: upper manual (32%), IV: lower manual (5%) and F: farmers (15%). Results Highest serum total and low density lipoprotein cholesterol concentrations were found in classes IV and F. Boys from class IV had 7.1% higher total cholesterol concentrations compared to class I (4.98 mmol/l versus 4.65 mmol/l, P = 0.0033), whereas farmers' girls had 10.% higher concentrations than girls from class III (5.31 mmol/l versus 4.81 mmol/l, P = 0.0057). Blood pressure was related to parental occupation only in boys, and the values were highest in class F. Boys from class IV smoked most often, and they also had lowest values for physical activity index and highest obesity indices. Farmers' children consumed significantly more saturated fat and cholesterol than children from other classes. In boys, the percentage of subjects with a low birthweight (≤10th percentile) was smallest in class I and greatest in class IV (7.1% versus 20.7%, P = 0.0330). Conclusions Socioeconomic status based on parental occupation is associated with several coronary heart disease risk factors already present in children. These differences should be taken into account in prevention programmes aimed at children at an increased risk for developing coronary heart disease as adults. [ABSTRACT FROM PUBLISHER]

Patellofemoral relationships were analyzed in 11 patients (13 knees) with patellar dislocation and 15 asymptomatic subjects (15 knees) at 0 degree and 20 degrees of flexion. The measurements were made from five consecutive axial images through the patellofemoral joint. The six indices measured were lateral patellar tilt (LPT), lateral patellofemoral angle (LPA), lateral patellar displacement (LPD), patella-lateral condyle index (L/PW), congruence angle (CA), and sulcus angle (SA). The reproducibility of the method was evaluated. The difference between the two study groups was more evident at 0 degree than at 20 degrees of knee flexion. Significant differences were noted between measurements made at different levels of the joint, particularly in the controls. Isometric contraction of the quadriceps muscle lateralized and tilted the patella slightly in both groups. L/PW with and without quadriceps muscle contraction, and LPA with reference to the anterior condyles differentiated between the two study groups most clearly. LPT and LPA with reference to the anterior condyles differentiated the study groups better than LPT and LPA with reference to the posterior condyles. The reproducibility was good except for inter-observer comparison of CA and SA. The use of an imaging plane selected at the midpoint of the patellar articular cartilage increases the sensitivity of the measurements, since it takes into account both the height of the patella and the tendency towards lateralization. These results indicate that patellar tilt is best measured with the LPA index and patellar lateralization with the L/PW index at 0 degree knee flexion. This study should always include isometric contraction of the quadriceps muscle. [ABSTRACT FROM AUTHOR]