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AIMS: Low back pain (LBP) is a major public health problem in both Norway and Sweden. The aim of the study was to estimate the prevalence of LBP and sickness absence due to LBP in two neighbouring regions in Norway and Sweden. The two areas have similar socioeconomic status, but differ in health benefit systems. METHODS: A representative sample of 1,988 adults in Norway and 2,006 in Sweden completed questionnaires concerning LBP during 1999 and 2000. For this study only individuals in part or full time jobs, (n = 1,158 in Norway and n = 1,129 in Sweden) were included. RESULTS: In Norway the lifetime prevalence was 60.7% and in Sweden 69.6%, the one-year prevalence was 40.5% and 47.2%, and the point prevalence 13.4% and 18.2% respectively. There was a significantly higher risk of reporting LBP in Sweden, even after controlling for gender, age, education, and physical workload. There was no difference in risk of self-certified short-term sickness absence (1-3 days), but it was a 40% lower risk of sickness absence with medical sickness certification in Sweden compared with Norway. CONCLUSION: The prevalence of LBP was higher in the Swedish area than in the Norwegian. The risk of self-certified sickness absence, however, showed no differences and the risk of medically certified sickness absence was lower in the Swedish area. This contradiction might partly be explained by the economical 'disincentives' in the Swedish health compensation system. [ABSTRACT FROM AUTHOR]

Objective: To identify core elements of what patients with chronic low back pain perceive as good clinical communication and interaction with a specialist ('The Good Back-Consultation').Design: Qualitative study including observation of consultations and a subsequent patient interview. Quantitative data were also recorded.Subjects: Thirty-five patients with chronic low back pain referred to a specialist.Methods: Thirty-five consultations were observed with respect to history-taking, clinical examination and interaction between patient and doctor. Patients were subsequently interviewed about how they perceived the consultation. Fourteen specialists with various specialty branches and 35 patients (18 males) participated. For 3 of the specialists a positive effect (return to work) on patients with chronic low back pain had been documented in previous randomized controlled trials. Qualitative data analysis was performed using a template method.Results: Most patients thought that the history-taking and clinical examination had been thorough and satisfactory. Patients emphasized the importance of being given an explanation during the examination of what was being done and found, of receiving understandable information on the causes of the pain, of receiving reassurance, discussing psychosocial issues and discussing what can be done. The most important characteristic of 'The Good Back-Consultation' was that the specialist took the patient seriously.Conclusion: The findings may represent an important potential for enhancing clinical communication with patients. [ABSTRACT FROM AUTHOR]

Study Design: A randomized controlled trial with stratified block design.Objectives: To evaluate a treatment program focusing on whether specific stabilizing exercises for patients with pelvic girdle pain after pregnancy reduce pain, improve functional status, and improve quality of life. SUMMARY OF BACKGROUND DATA. : The evidence of effectiveness of treatment for pelvic girdle pain is weak. Recent research has focused on the importance of activation of muscles for motor control and stability of the lumbopelvic region. To the authors' knowledge, the efficacy of applying these principles for pelvic girdle pain has not previously been evaluated in a randomized controlled trial.Methods: Eighty-one women with pelvic girdle pain were assigned randomly to two treatment groups for 20 weeks. One group received physical therapy with a focus on specific stabilizing exercises. The other group received individualized physical therapy without specific stabilizing exercises. Assessments were administered by a blinded assessor, at baseline, after intervention and 1 year post partum. Main outcome measures were pain, functional status and quality of life.Results: There were no dropouts. After intervention and at 1 year post partum, the specific stabilizing exercise group showed statistically and clinically significant lower pain intensity, lower disability, and higher quality of life compared with the control group. Group difference in median values for evening pain after treatment was 30 mm on the Visual Analog Scale. Disability was reduced by more than 50% for the exercise group; changes were negligible in the control group. Significant differences were also observed for physical tests, in favor of the specific exercise group.Conclusion: An individualized treatment approach with specific stabilizing exercises appears to be more effective than physical therapy without specific stabilizing exercises for women with pelvic girdle pain after pregnancy. [ABSTRACT FROM AUTHOR]

The Patient Perspective Survey (PPS) is designed to enhance consultation outcome and patient participation among general practice patients with complex health problems. This article presents the final version of the survey. This version is more condensed, tested for psychometric and clinical properties, and with increased emphasis on coping. The development and testing was performed in two phases with two groups of GPs and patients. Indications for use and criteria for rejection of items were defined, based on comprehensive data analysis and clinical judgement. The number of items was reduced to 38 items. The majority of diagnoses were related to psychosocial or musculoskeletal disorders. For the survey's main dimensions (psychological and somatic items, everyday life situation and coping) sound psychometric properties were identified. Seven open-ended questions were found useful for obtaining important new information and stimulating processes, often related to coping aspects. The revised 38-item PPS represents a condensed and final version, with increased focus on coping, and sound psychometric properties. [ABSTRACT FROM AUTHOR]

Subjects and design: The study was based on the total patient sample (n =110) of a randomized controlled trial comparing two intervention methods advising cardiovascular high-risk men of lifestyle changes in general practice. Behaviour and risk factor changes during the one-year intervention study were analysed using multiple regression and logistic regression analyses with the above-mentioned independent variables. Setting: Twenty-two general practice centres in the county of Hordaland, western Norway. Results: Self-efficacy of increased physical exercise was the only variable significantly related to exercise change. Age and self-efficacy were statistical significant predictors of smoking cessation success. None of the independent variables was statistically significantly related to blood pressure or cholesterol change. Educational level related negatively, although statistically insignificantly, with total risk change. Conclusion: The study confirms the importance of self-efficacy in both human behaviour and motivation for behaviour change. Objectives: The objectives of the study were to explore the impact of possible predictors for cardiovascular risk behaviour change; predictors such as education, age, self-efficacy, doctors' interpersonal skills, and number of appointments. [ABSTRACT FROM AUTHOR]

Background: Registration studies have shown great variations in prescribing volume and prescribing patterns of benzodiazepines (BZDs) and minor opiates among GPs.Objectives: We aimed to form a basis for hypotheses and build theories about prescribing, in order to investigate how high-prescribing doctors can legitimize their own prescribing pattern.Methods: A qualitative interview study of doctors with previously known high, medium and low prescribing volumes was performed. The interpretation focused on the doctors' self-explanations and how they influence their daily decision of prescribing.Results and Conclusions: It was a striking feature that many of the attitudes towards the drugs were common both within and between the three groups of prescribers. All doctors regarded the task of prescribing as difficult, and the great majority strongly advocated restriction in prescribing. In order to cope with daily practice and to live with high prescribing volumes, doctors make use of effective working strategies. These strategies, of ascribing responsibility to the previous doctor, to patient autonomy and responsibility, to the patient's age and to concomitant diseases, are described in this study. An allocation of responsibility to other persons or circumstances delimits the doctors' professional discretion in this matter. Striking differences between prescriber groups were not found in the analysis, but when all small tendencies in all steps of the decision-making process were added, a clear trend was revealed. [ABSTRACT FROM AUTHOR]

Background and Objectives: The success of national breast screening programmes hinges on women's adherence. By monitoring patients' perceptions, potential barriers to attendance may be detected, measured and possibly alleviated. Consequently a new questionnaire MGQ, measuring patients' experience of and satisfaction with mammography, has been developed. As discomfort is a predictor of non-attendance, a dimension measuring physical and psychological discomfort was included.Methods: The internal structure of observed variables was tested using factor analysis as part of the validation process. The study was conducted in six radiological departments in Norway including 550 patients presenting for mammography. The analysis suggested eight factors explaining 56.7% of the variance.Results: Construct validity was supported since the factor scales covered all hypothesized dimensions and all but one subdimension. The factors were internally consistent and externally independent, indicating that distinct aspects of patients' experience with mammography may be assessed and thus possibly improved.Conclusions: A relationship between pain and re-attendance was suggested as pain and worries about the next mammography belonged to the same factor. This underlines the importance of including a discomfort dimension when monitoring patient satisfaction with mammography. [ABSTRACT FROM AUTHOR]

Eighty-four male patients with a mean age of 56.4 years (range 34 to 65 years) were subjected to a semistructured interview 12–21 weeks after acute myocardial infarction in order to elucidate possible positive changes in family or spouse relationships induced by or following on from the disease. There were appreciable positive alterations in the love and caring domains and in communication, especially in those patients (one third of the total) who considered their total life situation to be improved after the myocardial infarction. A majority of the patients judged their family's adaptation to the myocardial infarction as good. The authors argue that it is important to discover, and reinforce, possible positive changes within the family after a myocardial infarction in one of its members and not merely to focus on negative effects. [ABSTRACT FROM PUBLISHER]

Purpose: To compare sociodemographic, life style and clinical characteristics in patients operated for lumbar disc herniation in public and private clinics in Norway, and evaluate whether selection for surgery and surgical treatment were different across the two settings., Methods: A cross-sectional multicenter study of patients who underwent elective surgeries for lumbar disc herniation at 41 (31 public and 10 private) hospitals. Data were included in the Norwegian Registry for Spine Surgery., Results: Of the 5,308 elective surgical procedures, 3,628 were performed at public hospitals and 1,680 at private clinics. Patients in the private clinics were slightly younger, more likely to be man, have higher level of education, and more likely to be employed. Disability and retirement pensions were more than double in the public as compared to the private clinics. Mean duration of sick leave was 24 weeks (SD 36.4) in the public and 15 weeks (20.7) in the private clinics. There were minor differences in pain, disability and quality-of life, number of verified disc herniations and radiological findings. Number of days at hospital, total operation time and proportion of complications were significantly higher in the public than in the private clinics., Conclusion: Patients having elective surgery due to lumbar disc herniation in public and private clinics were different with respect to many sociodemographic and life style variables. There were minor differences with respect to clinical variables and selection of patients for surgery, but substantial differences related to aspects of the surgical treatment.

Background: Mass media influence peoples' attitudes and conduct. We set out to investigate what Norwegian mass media write about back pain and whether this information is in accordance with national interdisciplinary guidelines for low back pain (published in 2002)., Material and Methods: Quantitative content analysis of 495 news stories from Norwegian newspapers and magazines published in 2001-03 and 2005-06., Results: Most publications were about a single case. Risk factors for low back pain, examinations, treatment and prevention were frequent topics. No publication was in direct disagreement with the clinical guidelines. Dependent on the media type, 44 to 62 % of the publications supported the guidelines' main messages of regaining daily normal activities, including work and exercises, as soon as possible., Interpretation: Norwegian mass media communicate evidence-based information about low back pain to a large extent. We regard these media as collaborators in the communication of important recommendations in guidelines about low back pain.