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The STarT Back Screening Tool (SBST) is a 9-item questionnaire designed for screening low back pain (LBP) patients into three prognostic groups for stratified care. The stratified care approach has proven to be clinically more beneficial and cost-effective than the current best physiotherapy practice. The objective of this study was to translate, culturally adapt and study psychometric properties of the SBST among Finnish LBP patients. The SBST was translated into Finnish using appropriate translation guidelines. A total of 116 patients were recruited from outpatient clinics. They were asked to fill out two questionnaires within 1–7 days. The first questionnaire set included the SBST, Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) and intensities of back and leg pain (10-cm Visual Analogue Scale). The second questionnaire form included the SBST and a question about persistence of symptoms. Some linguistic and cultural differences emerged during the translation process with item 1 (“spread down my legs”), item 2 (“neck and shoulder pain”), item 6 (“worrying thoughts”) and item 9 (“bothersome”). The test–retest reliability of the SBST total score was excellent (intraclass correlation coefficient 0.78) and of the psychosocial subscale good (0.68). Cronbach’s alpha for the psychosocial subscale was 0.55. Spearman’s correlation coefficient between SBST total score and BDI was 0.38, ODI 0.39, OMPSQ 0.45, intensity of leg pain 0.45 and LBP 0.31. Based on analysis of variance, the SBST discriminated low- and medium-risk groups better than medium- and high-risk groups. The Finnish translation of the SBST is linguistically accurate and has been adapted to the Finnish-speaking population. It showed to be a valid and reliable instrument and comparable with the original English version. Therefore, it may be used in clinical work with Finnish LBP patients.

Data on the birth weight–blood pressure relationship are inconsistent. Although an inverse association has been suggested in several large studies, interpretation is complicated by publication and other biases. Few data are available on the relationship between other early growth measures and blood pressure. We examined the shape and size of association between determinants of fetal growth, size at birth, growth in infancy, and adult systolic and diastolic blood pressure at 31 years in the prospective northern Finnish 1966 birth cohort of 5960 participants. Birth weight, birth length, gestational age, ponderal index, and birth weight relative to gestational age showed a significant inverse association with blood pressure at age 31. Rapid growth in infancy (“change-up”) was positively associated with blood pressure. Adjusted regression coefficients for birth weight indicated systolic/diastolic blood pressure lower by −1.7 (95% confidence interval [CI], −2.5, −1.0)/−0.7 (95% CI, −1.4, −0.02) mm Hg for 1 kg higher birth weight. The significant inverse association between birth weight and systolic blood pressure persisted without adjustment for adult body mass index for males. Among females, gestational age showed a stronger association with blood pressure than birth weight: gestational age higher by 7 weeks (equivalent to an average of 1 kg higher birth weight) among singletons associated with −2.9 (95% CI, −4.7, −1.1) mm Hg lower systolic blood pressure. Our results support the concept that birth weight, other birth measures, and infant growth are important determinants of blood pressure and hence cardiovascular disease risk in later life.

Objective. To investigate how self-reported musculoskeletal pain and health-related quality of life (HRQoL) are associated among young adults. Design and Setting. The study population consisted of a subgroup of the Northern Finland Birth Cohort 1986 at the age of 19 (N = 874), who completed the 15-dimensional (15D) HRQoL questionnaire (score 0 to 1) and answered questions about six-month period prevalence of musculoskeletal pain in neck, shoulder, low back, and peripheral location. Results. Half of the males and one third of the females reported a 15D score of at least 0.98 and were selected as the reference group in the multinomial logistic regression analysis. Young adults who reported multiple pains had significantly lower 15D scores than those reporting pain in only one location or no pain at all. After adjustments for other health problems, psychosocial distress, parental occupation, and the young adults' own employment status, the reporting of single musculoskeletal pain odds ratio (OR) 2.6 and multiple pains (ORs up to 11.9) among females, and multiple pains (ORs up to 4.6) among males were associated with a 15D score of 0.94 or less. Conclusions. The number of involved sites of self-reported musculoskeletal pain was associated with the level of reduction in HRQoL among young adults.

Musculoskeletal pain in multiple sites is common already in adolescence, and may lead to subsequent musculoskeletal complaints in adulthood. We examined predictive factors for the persistence of multiple musculoskeletal pains in adolescence over a 2-year time span. A postal questionnaire was administered to a subsample of the Northern Finland Birth Cohort 1986 (n = 1773) when subjects were aged 16 and 18. The adjusted odds ratios (OR) and 95% confidence intervals (CI) for the possible risk factors of new-onset of multiple pains at 18 years and 2-year persistence of multiple pains were obtained using multinomial logistic regression. Multiple musculoskeletal pains were common; 43% of boys and 63% of girls at 16, and 61% of boys and 81% of girls at 18 reported pain in more than one site during the last 6 months. Moreover, multiple pains had a high persistence rate, as 75% of boys and 88% of girls with multiple pains at 16 reported multiple pains also at 18. In the multivariate analysis, emotional and behavioral problems (internalizing problems, OR 2.3; externalizing problems, OR 2.2), and high sitting time (OR 1.6) among boys, and internalizing problems (OR 3.7), high physical activity level (OR 1.6), short sleeping time (OR 1.7), and smoking (OR 1.9) among girls were predictive factors for the persistence of multiple pains. No statistically significant associations between the baseline variables and new-onset multiple pains were found. Multiple musculoskeletal pains appear to have a high tendency to persist in adolescence; both psychosocial factors and lifestyle factors contribute to this vulnerability.

Study design A prospective cohort study in adolescents. Objective To evaluate whether smoking in adolescence is a risk factor of low back pain (LBP) among young adults. Summary of background data Smoking has been found to associate with LBP among adults. Longitudinal studies performed in adolescents are few. Methods The children belonging to the northern Finland Birth Cohort 1986 were examined at birth and at 16 years of age and followed up by a postal questionnaire at the age of approximately 18 years. The primary outcome was LBP during the past 6-month period. Incident cases reported LBP at 18 but not at 16 years. Persistent cases reported pain at both time points. Logistic regression analysis was used to evaluate the effect of smoking exposure on any LBP in both genders separately and multinomial regression analysis was used to evaluate the effect on the severity of LBP (No LBP, "Reporting LBP," "Consultation for LBP") in the total population. Parents' socioeconomic status, physical activity, body mass index, and depressive mood were used as confounders in the analyses. Results Regular smoking at 16 years was associated with persistent LBP in girls (OR: 2.52; 95% CI: 1.40-4.53). Daily smoking of over 9 cigarettes at 16 was associated with persistent LBP (2.57; 1.03-6.46) and predicted incident pain in girls (2.80; 1.11-7.09). Pack-years of smoking were associated with incident and persistent LBP in the girls with an exposure-response relationship, whereas these associations were inconsistent in the boys. Pack-years of smoking at 18 years showed an exposure-response relationship with persistent Consultation for LBP, which was strongest in those with over 1.5 pack-years of exposure (5.82; 1.39-24.42). Conclusion Regular smoking in adolescence was associated with LBP in young adults. Pack-years of smoking showed an exposure-response relationship among girls.

Study design A cross-sectional survey among adolescents aged 15-16 years. Objective To evaluate whether physical activity or sedentary activities associate with neck and shoulder symptoms among adolescents. Summary of background data Findings of associations between physical exercise and neck or shoulder pain in adolescents are controversial. Methods The study population consisted of adolescents belonging to the Northern Finland Birth Cohort 1986. The present analyses included 3185 girls and 2808 boys. Associations of physical activity level, total sitting time, and different kinds of sedentary activities with neck or occipital pain and shoulder pain were analyzed at 15-16 years of age using logistic regression. Reporting pain (not seeking medical help) and consultation for pain (seeking medical help) were assessed separately in girls but were combined in boys because of a low prevalence of severe pain. Results Almost half of the girls and one third of the boys reported mild neck or occipital pain, or shoulder pain, and 5% of girls and 2% of boys reported severe neck or occipital pain, or shoulder pain during the past 6 months. High-level physical activity associated with an increased prevalence of both severe neck or occipital pain and severe shoulder pain in girls, but not in boys. Prolonged sitting was associated with a high prevalence of neck or occipital pain and shoulder pain in girls, and neck or occipital pain in boys. Of various sedentary activities, television watching and reading books associated with neck or occipital pain in girls, whereas playing or working with a computer associated with neck or occipital pain in boys. In girls, television watching also associated with mild shoulder pain. Conclusions Neck or occipital pain and shoulder pain are very common symptoms among adolescents, and both prolonged sitting and a high level of physical activity seem to be related to them.

Objective. The objective of this study was to assess the association between optimism and self-reported facial pain. Material and Methods. Data were obtained for 5,696 subjects born in 1966 in Northern Finland and included in the study of the Northern Finland Birth Cohort. Data on facial pain were collected using a questionnaire. Optimism was measured using the revised version of the Life Orientation Test. Results. The data showed that optimism was inversely associated with facial pain. Associations were found only among non-depressive subjects. Conclusions. It can be concluded that optimism is an independent psychosocial determinant of pain experience that should be taken into account in assessing the prognosis of facial pain and its treatment.

Background: Several studies have suggested an association between IgE-mediated atopic allergies and depression, although thus far no epidemiologic evidence involving a large, unselected, general-population sample and valid methods in diagnosing atopy support this putative association. Methods: We used the Northern Finland 1966 Birth Cohort, which was followed prospectively to age 31. Of the total cohort, 5428 individuals underwent skin tests for three of the most common allergens (i.e., cat, birch, and timothy grass) and for dust mites ( Dermatophagoides pteronyssinus ). Data on doctor-diagnosed lifetime depression were obtained from questionnaires. Results: After adjusting for social class, mothers' parity, place of residence, and psychiatric morbidity, the logistic regression analysis showed that the risk of developing depression when compared with nonatopic subjects increased up to 1.8-fold in atopic women (adjusted odds ratio 1.8, 95% confidence interval [CI] 1.2–2.6) and, when compared with skin-test-negative female subjects without allergic symptoms, reached 2.7-fold increases (95% CI 1.6–4.6) in those suffering from clinically manifest atopic disorders. Corresponding associations were not found among male subjects. Conclusions: Our results indicate that women suffering from atopic diseases may possess an elevated risk for developing depression during early adulthood. Possible background theories (i.e., genetic abnormalities in serotonin metabolism, hypothalmic-pituitary-adrenal axis dysfunction, and histamine theory) are discussed.

Study Design. A prospective cohort study in adolescents aged 7 to 19 years. Objective. To evaluate whether persistent overweight increases the risk of low back pain (LBP) among adolescents. Summary of Background Data. Overweight and LBP are common health problems in adolescents. Their relationship is still controversial among adolescents, as well as among adults. Methods. The study population, the Oulu Back Study, was drawn from the Northern Finland Birth Cohort 1986. The final study sample included 1660 adolescents (56% females). The subcohort of 786 subjects (57% females) was used in the analysis of waist circumference. The association between the area under the curve of body mass index from 7 to 16 years, and from 16 to 18 years, and area under the curve of waist circumference from 16 to 19 years, and LBP during the past 6 months was evaluated separately for incident (reporting LBP at 18 or 19 yr but not at 16 yr) and persistent LBP (reporting LBP at 16 and 18 yr or 19 yr). Relative risks (RR) and their 95% confidence intervals (95% CI) were adjusted for smoking, leisure time physical activity, and family socioeconomic status at 16 years and stratified by sex. Results. Body mass index from 16 to 18 years among girls and body mass index from 7 to 16 years among boys predicted incident LBP at 18 years (girls: RR, 1.09; 95% CI, 1.01–1.18; boys: RR, 1.15; 95% CI, 1.00–1.32). Among boys, waist circumference from 16 to 19 years was also associated with incident LBP (RR, 1.16; 95% CI, 1.02–1.32). Overweight was not associated with persistent LBP. Conclusion. In this population-based cohort study, persistent overweight slightly increased the risk of incident LBP, but the time period during which overweight was related to incident LBP differed between sexes. Conclusion. Level of Evidence: 2

Lifestyle factors such as smoking, obesity, and level of physical activity predict low back pain (LBP) and sciatica. The authors investigated whether participating in sports, smoking, and being overweight or obese at 14 years of age predicted hospitalizations due to LBP or sciatica in adulthood. In 1980, at the age of 14 years, a total of 11,399 members of the 1966 Northern Finland Birth Cohort returned the postal questionnaire. Patients from the 1966 Northern Finland Birth Cohort who were hospitalized because of LBP or sciatica were followed to the end of 2008 through the Finnish Hospital Discharge Register. Data were analyzed using Cox's proportional hazards multistate model with the Markov clock forward time scale. During follow-up, 119 females (2.7%) and 254 males (5.6%) had been hospitalized at least once because of LBP or sciatica. Among females, overweight was associated with an increased risk of second-time hospitalization for surgical treatment for sciatica (hazard ratio = 7.1, 95% confidence interval: 1.5, 34.4). Among males, smoking was associated with an increased risk of first-time nonsurgical hospitalization (hazard ratio = 1.8, 95% confidence interval: 1.2, 2.7) and second-time surgical hospitalization (hazard ratio = 3.2, 95% confidence interval: 1.2, 8.2). The authors found potentially modifiable risk factors in adolescence that predicted hospital treatments for low back disorders during adolescence and young adulthood.

Musculoskeletal pain is common among adolescents, but little is known about the factors that affect seeking health care for the problem. We examined the care-seeking pattern among adolescents reporting musculoskeletal pain. The study consisted of adolescents aged 16 years from the 1986 Northern Finland Birth Cohort who responded to a mailed questionnaire in 2001 and reported musculoskeletal pain over the preceding 6 months (n=5052). Logistic regression analyses were performed to assess whether enabling resources, need factors, personal health habits, and psychological problems were associated with seeking health care for musculoskeletal pain. Musculoskeletal pain during the preceding 6 months was reported by 68% of boys and 83% of girls in the study population. Only 16% of boys and 20% of girls reporting pain had sought medical care. Among both boys and girls, care-seeking was associated with being a member of a sports club (boys, odds ratio [OR] 2.1; girls, OR 1.5) and having one (boys, OR 2.1; girls, OR 1.8) or at least 2 (boys, OR 2.2; girls, OR 2.1) other health disorders. In addition, it was associated with a high physical activity level (OR 1.5) and low self-rated (OR 1.5) health among girls. Reporting pain in other anatomical areas decreased the likelihood of seeking care for pain among both genders. In conclusion, relatively few adolescents with musculoskeletal pain had consulted a health professional for the problem. Being physically active (trauma), participating in organized sport (accessibility of care), and having other health problems may explain why an adolescent seeks care for musculoskeletal pain.

Study Design. A 2-year follow-up in a birth cohort of adolescents aged 15 to 19 years. Objective. To evaluate the prevalence of neck, shoulder, low back, peripheral (limb) pain, and combinations of pain at these anatomic locations. Summary of Background Data. Few previous studies have evaluated combinations of musculoskeletal pain among adolescents. Methods. Prevalence of neck, shoulder, low back, and peripheral pain (elbow, wrist, knee, and ankle-foot pain) during the previous 6 months were obtained by questionnaire in a follow-up study of the Northern Finland Birth Cohort 1986 at 16 and 18 years of age (n = 1773). Latent class analysis was used in clustering of pain combinations at both time points. Results. No pain at all in the past 6 months at 16 and 18 years was reported by 17% and 8% of girls, and 33% and 24% of boys, respectively. Only 1 pain location (neck, shoulder, low back, or peripheral pain) was reported by 21% of girls and 25% of boys at 16, and 11% of girls and 20% of boys at 18 years, while all 4 pain locations were reported by 15% of girls and 9% of boys at 16, and 27% and 15%, respectively, at 18 years. Latent class analysis resulted in 2 to 3 pain clusters in both genders at both time points. Probability of pain increased during the 2-year follow-up, with subjects more likely to belong to a cluster with a higher likelihood of pain. Conclusion. As very few adolescents did not report any pain, the relevance of self-reported pain is questionable without assessment of pain-related disability. The clinical relevance of these pain combinations must be evaluated in further studies.

Recent studies indicate that adolescents often experience musculoskeletal pains in two or more body locations. However, previous studies have mainly focused on localized pains, and the determinants of multiple musculoskeletal pains in adolescents are not well known. The present study was set to evaluate the role of psychosocial, mechanical, and metabolic factors in adolescents' musculoskeletal pains in multiple locations. The study population consisted of the 1986 Northern Finland Birth Cohort; 15- to 16-year-old adolescents (n=6986), who responded to a mailed questionnaire in 2001. We assessed the associations of emotional and behavioral problems, physical activity, sitting time, sleeping time, overweight and smoking with musculoskeletal pains using multinomial logistic regression. Multiple pains were common, 23% of boys and 40% of girls reported feeling pain in at least three locations over the past 6 months. These pains were not only associated with anxious/depressed symptoms, withdrawn/depressed symptoms, somatic complaints, rule-breaking and aggressive behavior, social problems, thought and attention problems, but also with high physical activity level, long sitting time, short sleeping time and smoking, among both boys and girls. In addition, pain in three to four locations associated with overweight in girls. A high number of psychosocial, mechanical and metabolic factors associated strongly with multiple pains. In conclusion, multiple musculoskeletal pains were strongly associated with psychosocial complaints, but also with mechanical and metabolic factors. Reported musculoskeletal pains in multiple locations in adolescence may have both peripheral (trauma, decreased regenerative ability) and central (sensitivity) causes.

Purpose: We examined the associations between participation in different sports and exercise activities and neck, shoulder, and low back pains in adolescents. Methods: This population-based study included the members of the Northern Finland Birth Cohort 1986, who, at the age of 15 to 16 yr, completed a questionnaire including items about their musculoskeletal pains and participation in various sport and exercise activities (N = 6945). Logistic regression analysis was used to evaluate how musculoskeletal pains are associated a) with participation in a certain type of sport or exercise activity and b) with the clusters formed by latent class analysis (LCA) according to the adolescents' profiles of participation in different sport and exercise activities. Results: Participation in certain sports showed some direct and inverse associations with musculoskeletal pains when adjusted for participation in other sports and for the amount of physical activity. However, after grouping the individuals into clusters by their participation in different sports, these associations vanished. Only the cluster characterized by boys' active participation in several sports (i.e., ice hockey, cycling, ice-skating, soccer, floorball, rinkball/bandy, swimming, roller-skating/skateboarding, Finnish baseball) had lower prevalence of neck pain compared with the physically inactive group. Conclusions: Physically active adolescents usually engage in several different sport and exercise activities, which make associations between single sports and musculoskeletal pains inconsequential in the general population of adolescents. Participation in several sports seemed to protect from harmful effects of a single risk sport. However, this finding cannot be generalized to adolescent elite athletes who are often involved in intense training for a single sport.

The aim of this study was to compare panoramic radiographic findings between subjects with reported facial pain and pain-free controls in a population-based sample of 34-year olds. The study was a part of a comprehensive medical survey including subjects born in the year 1966 in Northern Finland. A sub-sample of the cohort was formed based on the question concerning facial pain. A panoramic radiograph was taken of 48 subjects with facial pain and 47 pain-free controls. Pathological findings in the dentition, jaws, maxillary sinuses and temporomandibular joints (TMJs) were compared between the groups. The majority of the subjects in both groups did not have pathological findings. Compared with controls, the subjects with facial pain did not show significantly more pathological findings in the teeth, periodontium, maxillary sinuses, TMJs or in the other areas. Radiographic panoramic findings had no association with reported facial pain in the population-based sample of young adults, and have little impact on the diagnosis of facial pain.

Background: While some studies suggest that poor fetal growth rate, as indicated by lower birth weight, is associated with poor respiratory function in childhood, findings among adults remain inconsistent. A study was undertaken to determine the association between early growth and adult respiratory function. Methods: A longitudinal birth cohort study was performed of 5390 men and women born full term and prospectively followed from the fetal period to adulthood. Weight at birth and infancy were recorded, and forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC) were assessed by standard spirometry at age 31 years. Results: Adult FEV 1 and FVC increased linearly with higher birth weight in both men and women with no apparent threshold. After adjustment for sex, adult height and other potential confounders operating through the life course, every 500 g higher birth weight was associated with a higher FEV 1 of 53.1 ml (95% CI 38.4 to 67.7) and higher FVC of 52.5 ml (95% CI 35.5 to 69.4). These positive associations persisted across categories of smoking, physical activity and body mass index, with the lowest respiratory function noted among those with lower birth weight who were smokers, led a sedentary lifestyle or were overweight. Weight gain in infancy was also positively associated with adult lung function. Conclusion: Birth weight is continuously and independently associated with adult respiratory function. It is plausible that poor growth in early life may restrict normal lung growth and development, which could have long-term consequences on lung function later in life.

To investigate the existence of pain outside the facial area as well as pain sensitivity in a population-based sample of 34-year-old subjects with facial pain.Fifty-two facial pain cases (10 men, 42 women) and 52 pain-free controls (10 men, 42 women) included in the Northern Finland Birth Cohort of 1966 underwent a clinical musculoskeletal examination. Pain outside the facial area during the week prior to the examination was defined by means of a pain drawing. Eighteen fibromyalgia points were palpated in response to digital palpation with an algometer. Pressure pain thresholds were measured from the dorsal side of the wrist and from the highest points of the temporalis muscles.Compared to controls, pain cases reported significantly more pain in areas outside the face, with the exception of the shoulder and lower back. The number of painful fibromyalgia points was significantly higher in cases than in controls. Mean pressure pain thresholds were slightly lower in cases than in controls; the difference was significant in the left wrist.Subjects with facial pain reported more pain and had more mascular tenderness outside the facial area compared to controls. Pain symptoms outside the facial area should be assessed in patients seeking treatment for facial pain, and they should be taken into account when treatment is planned.

Objective : The aim of this study was to investigate the association between adverse physical disorders and violent/non-violent criminal behaviour. Design : The study material consisted of the large, prospectively followed, unselected and genetically homogenous Northern Finland 1966 Birth Cohort, the Finnish Hospital Discharge Registers and the National Crime Register ( n =10,934). Main results : The results of the logistic regression analyses showed that male offenders had statistically significantly more injuries (adj. OR=1.81, 95% CI=1.51–2.17), when compared with males without a criminal history. Violent male offenders exhibited greater morbidity to the diseases of the respiratory system (adj. OR=1.64, 95% CI=1.03–2.60) when compared with non-violent criminals. Female offenders suffered more commonly from poisonings (adj. OR=3.84, 95% CI=1.69–8.72), injuries (adj. OR=2.79, 95% CI=1.67–4.66), infections (adj. OR=1.87, 95% CI=1.16–2.99) and indefinite symptoms (adj. OR=2.02, 95% CI=1.20–3.40) than non-offending females. Conclusions : At epidemiological level, criminal behaviour seems to be associated especially with an increased risk of injuries for both sexes. The observed increase of the diseases of the respiratory system among violent but not among non-violent males calls for further investigations.

The purpose of this study was to test the hypothesis that traumatic brain injury (TBI) during childhood and adolescence is associated with psychiatric disorders, heavy alcohol use and criminal offenses in adulthood. We made use of an unselected, general population birth cohort ( n =12058) in Northern Finland, which was followed up prospectively up to the age of 31. The data on TBIs of the cohort members were collected from the hospital case notes of the outpatient clinics of the hospitals in the region and from the Finnish Hospital Discharge Registers (FHDR). The data on mental disorders including alcohol diagnoses were also collected from the FHDR after a careful validation process. The Ministry of Justice provided information on criminal offenses for all subjects. The final number of subjects in our study was 5589 males and 5345 females. We found that after controlling for confounders, TBI during childhood or adolescence increased the risk of developing mental disorders two-fold (OR 2.1, 95% CI 1.1–3.6) and TBI was significantly related to later mental disorder with coexisting criminality in male cohort members (OR 4.1, 95% CI 1.2–13.6). The results support the TBI's association with psychiatric morbidity, which should not be overlooked when treating psychiatric patients, especially those with comorbid criminality.

We evaluated the association between occupational physical activity and fitness in young workers, taking into account leisure-time physical activity, body size, and smoking.The study population comprised 2188 men and 1987 women, members of the Northern Finland birth cohort 1966, who participated in the 1997-1998 follow-up survey and were employed at the time of the survey. Cardiorespiratory fitness was measured by a 4-min step test and muscular fitness by tests of maximal isometric handgrip and isometric trunk extension. Information on occupational and leisure-time physical activity and smoking was obtained by questionnaire, and body height and weight were measured during medical examination. The data were analyzed by analysis of variance and Cox regression.Men doing heavy physical work scored better in cardiorespiratory fitness, handgrip strength, and trunk muscle endurance than men doing lighter work; the finding for cardiorespiratory fitness was similar in women. The associations were independent of leisure-time physical activity, body weight and height, and smoking.A positive association was found between heavy physical work and a high level of fitness in young workers. Due to limitations of the study setting, causality cannot be asserted, but a training effect of heavy work would not seem unreasonable. Previous studies have suggested a reversal of the positive effect of heavy work on fitness with advancing age. Therefore, regular monitoring of workers' fitness at an early phase is justified to enable assessment of workers' capacity for heavy jobs and any possible need for fitness-improving activities.

STUDY DESIGN A cohort study of 12,000 persons with a follow-up period ranging from birth to the age of 28 years. OBJECTIVES To determine the cumulative incidence of lumbar disc disease leading to hospitalization in a well-defined geographic population, with special emphasis on age of onset and differences between the genders and among disease categories. SUMMARY OF BACKGROUND DATA There are few published reports on low back pain in adolescence, and most of them are cross-sectional in design. METHODS The Finnish National Hospital Discharge Register was used to identify all possible cases of lumbar disc disease. Copies of all hospital records regarding the diagnosis and course of the disease were collected and the hospitalizations were classified into three categories: 1) confirmed herniated nucleus pulposus (HNP), 2) unconfirmed HNP (sciatica symptoms without visible herniation), and 3) other low back diseases. The patients were classified according to the highest category of diagnosis achieved by each. RESULTS Symptomatic low back pain leading to hospitalization first appeared around the age of 15 years, and the incidence rose more sharply from the age of 19, especially in men with other low back diseases. Men were hospitalized more than twice as often as women. CONCLUSIONS Lumbar disc diseases leading to hospitalization begin early.