Hege Eriksen

Aims: The aims of this project were to study the distribution of sickness leave in a population of Norwegian power company workers, and to characterise those with most sickness leave. Method: A survey was done in 13 power companies during the autumn of 1999. 2435 employees participated, the response rate was 73%. The employees were asked to fill in questionnaires about sickness leave, physical work environment, stress, coping, psychological demands, control, and subjective health complaints. Results: A group of 10% of the employees reported 82% of the sickness leave. They were characterised by hea-vy physical work, lower education, and high levels of many health risk factors, such as smoking, low job satis-faction, sleeping badly, job stress, and low levels of physical exercise. They also had more health complaints. Conclusion: The person most at risk was the old-fashioned manual labourer with low education and heavy physical work. Interventions aiming to reduce sickness leave shoul...

Aims: The aims of this project were to study the distribution of sickness leave in a population of Norwegian power company workers, and to characterise those with most sickness leave. Method: A survey was done in 13 power companies during the autumn of 1999. 2435 employees participated, the response rate was 73%. The employees were asked to fill in questionnaires

To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain. Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design. 181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom. 1287 (96%) of 1334 trial participants. Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months. Over one year, mean treatment costs relative to "best care" were 195 pounds sterling (360 dollars; 279 euros; 95% credibility interval 85 pounds sterling to 308 pounds sterling) for manipulation, 140 pounds sterling (3 pounds sterling to 278 pounds sterling) for exercise, and 125 pounds sterling (21 pounds sterling to 228 pounds sterling) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost 3800 pounds sterling; in economic terms it had an "incremental cost effectiveness ratio" of 3800 pounds sterling. Manipulation alone had a ratio of 8700 pounds sterling relative to combined treatment. If the NHS was prepared to pay at least 10,000 pounds sterling for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of 8300 pounds sterling relative to best care. Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.

The cognitive activation theory of stress (CATS) offers a psychobiological explanation for the relationship between life events, from hassles in worklife to dramatic events, and individual health. It differs from other prevalent stress theories by offering a formal system of systematic definitions, it relies on cognitive formulations within learning theory, it offers a consistent pathophysiological model for health and disease, and it is valid across species and cultures. The aim of this paper was to compare CATS with other prevalent theories with respect to the relationships between worklife and health. The main concern was the comparison with the demand–control theory of Karasek & Theorell. A brief review is presented of interventions based on CATS positions, in particular interventions aimed at modifying patients’ expectations, as well as at attempts to prevent illness and disease in the working population.

A controlled randomized clinical trial was performed. To investigate the effect of a light mobilization program on the duration of sick leave for patients with subacute low back pain. Early intervention with information, diagnostics, and light mobilization may be a cost-effective method for returning patients quickly to normal activity. In this experiment, patients were referred to a low back pain clinic and given this simple and systematic program as an outpatient treatment. In this study, 457 patients sick-listed 8 to 12 weeks for low back pain, as recorded by the National Insurance Offices, were randomized into two groups: an intervention group (n = 237) and a control group (n = 220). The intervention group was examined at a spine clinic and given information and advice to stay active. The control group was not examined at the clinic, but was treated with conventional primary health care. At 12-month follow-up assessment, 68.4% in the intervention group had returned to full-duty work, as compared with 56.4% in the control group. Early intervention with examination, information, and recommendations to stay active showed significant effects in reducing sick leave for patients with low back pain.

Background: Sick leave and return to work are common outcome variables in studies where the aim is to measure the effect of targeted interventions for individuals that are on sick leave benefits or other allowances. Use of official register data is often restricted, and research on sick leave and return to work are often based on the participants self-reports. However, there is insufficient documentation that there is agreement between self-reports and register data on sick leave benefits and allowances.Aims: The aim of this study was to analyse the individuals' knowledge about states of sick leave benefits or allowances compared with register data from The Labour and Welfare Administration (NAV) in Norway.Method: 153 individuals, sick-listed or on allowances, participated in a 4-week inpatient occupational rehabilitation program. 132 (86%) answered a questionnaire on assessments of work, sick leave, and allowances three months after completed rehabilitation. Self-reported data ...

Increasing social inequalities in health have been ascribed to unequal distribution of resources, and to exposure factors. We propose that these differences also may be explained by principles from cognitive stress theory. There seems to be consensus in the stress literature that the stress response is not predicted from the external situation. The acquired expectancies to stimuli and response outcome

The potential advantage of including a psychological test battery in the selection process for service in the Antarctic was examined in 348 applicants for employment in Antarctica with the British Antarctic Survey (BAS). Applicants were screened with the Selection of Antarctic Personnel battery (SOAP) consisting of nine well-known psychological instruments. The SOAP scores were not revealed to the BAS selection panel members, who based the selection on operational criteria, interview, and a general medical examination. The SOAP scores of those selected (n = 177) were further compared with station commanders' reports of winter adaptation (n = 140), and subjective health complaints (SHC) (n = 86). There were no significant agreements between SOAP scores (n = 348) and those actually selected by the BAS panel (121 accepted, 227 not accepted) (Cohen's Kappas for inter-rater agreement < 0.20). Participants characterized as exceptionally well adapted by the station commanders ha...

Modifying effects in multivariate analyses of a randomized controlled trial. To identify prognostic factors for the effect of a brief intervention ("modifiers") at a spine clinic on return to work in patients with subacute low back pain. A previous study of a brief intervention showed significant reduction of sick leave, compared with usual primary healthcare treatment. Randomized controlled trials give data only on the group as an average. Identifying prognostic factors that interact with the treatment ("modifiers") may identify specific groups requiring this or other types of treatment. A total of 457 patients who had been sick-listed 8 to 12 weeks for low back pain were randomized into an intervention group (spine clinic with medical examination, information, reassurance, encouragement to engage in physical activity, n = 237), and a control group (primary health care, n = 220). All subjects filled out questionnaires. Logistic regression and tests for interacti...

This paper presents a cognitive activation theory of stress (CATS), with a formal system of systematic definitions. The term "stress" is used for four aspects of "stress", stress stimuli, stress experience, the non-specific, general stress response, and experience of the stress response. These four meanings may be measured separately. The stress response is a general alarm in a homeostatic system, producing general and unspecific neurophysiological activation from one level of arousal to more arousal. The stress response occurs whenever there is something missing, for instance a homeostatic imbalance, or a threat to homeostasis and life of the organism. Formally, the alarm occurs when there is a discrepancy between what should be and what is-between the value a variable should have (set value (SV)), and the real value (actual value (AV)) of the same variable. The stress response, therefore, is an essential and necessary physiological response. The unpleasantness ...

Occupational and social factors are thought to be important determinants of health inequality. The aim of this study was to examine the relationships between occupation, lifestyle and subjective health complaints (SHC). SHC and self-reported sickness absence were recorded in a cross-sectional study of 662 individuals aged between 16 and 67 from five occupational groups: blue-collar, school/education, health service, white-collar and service. Differences in SHC and sickness absence were investigated. A model of sociodemographic, lifestyle and work-related factors was tested to examine associations with SHC. Few differences in SHC and sickness absence were found when educational level, age and gender were controlled for. Female health service workers did, however, show significantly higher prevalence of pseudoneurological complaints compared with white-collar workers. Male blue-collar workers had significantly higher frequency of sickness absence than white-collar workers; otherwise, ...

ABSTRACT Aims The objective of this study was to examine differences in the social support rehabilitation patients received from rehabilitation staff and from support providers outside rehabilitation, and to examine the relationships between social support and the patients' reports of subjective health complaints (SHC).

The objective of the present study was to explore whether a culturally adapted lifestyle education programme would improve the risk factor profile for type 2 diabetes (T2D) and the metabolic syndrome (MetS) among Pakistani immigrant women in Oslo, Norway. The randomised controlled trial (the InnvaDiab study), lasting 7 ± 1 months, comprised six educational sessions about blood glucose, physical activity and diet. Participants (age 25-62 years) were randomised into either a control (n 97) or an intervention (n 101) group. Primary outcome variables were fasting and 2 h blood glucose, and secondary outcome variables were fasting levels of insulin, C-peptide, lipids, glycated Hb, BMI, waist circumference and blood pressure, measured 1-3 weeks before and after the intervention. During the intervention period, the mean fasting blood glucose decreased by 0·16 (95 % CI -0·27, -0·05) mmol/l in the intervention group, and remained unchanged in the control group (difference between the groups, P=0·022). Glucose concentration 2 h after the oral glucose tolerance test decreased by 0·53 (95 % CI -0·84, -0·21) mmol/l in the intervention group, but not significantly more than in the control group. A larger reduction in fasting insulin was observed in the intervention group than in the control group (between-group difference, P= 0·036). Among the individuals who attended four or more of the educational sessions (n 59), we found a more pronounced decrease in serum TAG (-0·1 (95 % CI -0·24, 0·07) mmol/l) and BMI (-0·48 (95 % CI -0·78, -0·18) kg/m²) compared with the control group. During the intervention period, there was a significant increase in participants having the MetS in the control group (from 41 to 57 %), which was not seen in the intervention group (from 44 to 42 %). Participation in a culturally adapted education programme may improve risk factors for T2D and prevent the development of the MetS in Pakistani immigrant women.

A controlled randomized clinical trial was performed. To investigate the effect of a light mobilization program on the duration of sick leave for patients with subacute low back pain. Early intervention with information, diagnostics, and light mobilization may be a cost-effective method for returning patients quickly to normal activity. In this experiment, patients were referred to a low back pain clinic and given this simple and systematic program as an outpatient treatment. In this study, 457 patients sick-listed 8 to 12 weeks for low back pain, as recorded by the National Insurance Offices, were randomized into two groups: an intervention group (n = 237) and a control group (n = 220). The intervention group was examined at a spine clinic and given information and advice to stay active. The control group was not examined at the clinic, but was treated with conventional primary health care. At 12-month follow-up assessment, 68.4% in the intervention group had returned to full-duty work, as compared with 56.4% in the control group. Early intervention with examination, information, and recommendations to stay active showed significant effects in reducing sick leave for patients with low back pain.

Cross-sectional study. To compare subjective health complaints in subacute patients with low back pain with reference values from a Norwegian normal population. Comorbidity is common with nonspecific low back pain. We wanted to investigate if these complaints were specific or part of a more general unspecific condition comparable to subjective health complaints in the normal population. The study group consisted of 457 patients sick-listed 8 to 12 weeks for low back pain. All subjects filled out questionnaires. The subjective health complaints in the study group were compared with reference values from a Norwegian normal population using logistic regression analysis. Compared with the normal reference population, the patients with low back pain had significantly more low back pain, neck pain, upper back pain, pain in the feet during exercise, headache, migraine, sleep problems, flushes/heat sensations, anxiety, and sadness/depression. The prevalence of pain in arms, pain in shoulders, and tiredness was also high, but not significantly higher than in the reference population. Our findings indicate that patients with low back pain suffer from what may be referred to as a "syndrome," consisting of muscle pain located to the whole spine as well as to legs and head, and accompanying sleep problems, anxiety, and sadness/depression.

The aim of this study was to examine the perception of low back pain care and consequences according to what Deyo refers to as seven "myths" about back pain, in the Norwegian population. In spring 2001, seven questions, corresponding to Deyo's myths, were included in an opinion poll (telephone interviews) of a representative sample (n=1015) of the Norwegian population. In total, 41% of the population held that 'If you have a slipped disc you must have surgery'. Approximately 50% believed that 'X-ray and newer imaging tests can always identify the cause of pain' and 'Most back pain is caused by injury and heavy lifting'. Almost 60% agreed that 'Everyone with back pain should have a spine X-ray'. However, only one-quarter believed that 'If your back hurts, you should take it easy until the pain goes away', and approximately one-fifth believed that 'Back pain is usually disabling'. Only 12% believed that 'Bed rest is the mainstay of therapy'. More individuals in the lower- compared with the higher-educated groups believed in the myths. Information concerning current knowledge on healthcare and health consequences of low back pain had reached only a small part of the general population. The most important factor for lack of knowledge was education. Developing effective methods to promote adequate self-care and treatment and reduce the risk of chronicity of low back pain in the lower-educated groups should be a top priority.

As subjective health complaints are one of the major reasons for short- and long-term sickness absence it is important to know the prevalence of these conditions in the general population. In this cross-sectional study, 1,240 individuals (aged 15-84 years) from the normal population in Norway answered the Subjective Health Complaint (SHC) inventory in spring 1996. The prevalence of reporting subjective health complaints was high: 80% reported musculoskeletal complaints, 65% reported "pseudoneurological" complaints (tiredness, depression, dizziness), 60% gastrointestinal complaints, 34% allergic complaints, and 54% flu-like complaints. The prevalence of substantial complaints was low: 13% reported musculoskeletal complaints, 5% reported "pseudoneurological" complaints, 4% gastrointestinal complaints, 2% allergic complaints, and 18% flu-like complaints. Women had higher prevalence of musculoskeletal, "pseudoneurological", and allergic complaints compared with men, and reported more substantial complaints on all subscales. Individuals older than 50 years were less likely to report headache, tiredness, eczema, and flu-like complaints compared with individuals younger than 30 years. However, they had higher risk of arm pain, shoulder pain, palpitations, and several gastrointestinal and allergic complaints. The intensity of musculoskeletal, gastrointestinal, and allergic complaints was significantly higher in the oldest age group. Subjective health complaints are very common in the normal population; there are gender and age differences in both prevalence and degree of complaints. The intensity of subjective health complaints forms a continuum, and there are no obvious cut-off point to indicate what are "normal" complaints and what is illness.

Deyo's seven "myths" about back pain are based on common misconceptions of causality and therapy of back pain. These myths were alive in the Norwegian population in 2001; this report investigates whether this is true two years later. A representative sample of the Norwegian population in 2003 (n = 1,014) were asked to rate their agreement with the seven myths. There is significantly less acceptance of all myths except "Most back pain is caused by injuries or heavy lifting" in 2003. Myths concerning the use and importance of X-ray were still common: 43% agreed that "X-ray and newer imaging tests can always identify the cause of pain" and 50% that "Everyone with back pain should have a spine X-ray". Low level of education is still associated with high acceptance of the myths, but the changes from 2001 are most pronounced for these groups. Perceptions in the general population in Norway are slowly changing to be more in accordance with existing knowledge on accurate behaviour and treatment of back pain. This may be related to introduction of new evidence-based guidelines. The difference between educational groups is reduced, but is still a challenge to health professionals and health authorities.

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. 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. 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. 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.

Patients (n=997) visiting general practitioners in an area in Western Norway completed a battery of questionnaires related to subjective health complaints and fatigue. An additional 78 patients were referred directly to the hospital for neurasthenia. After screening the questionnaires and interviews with a selected sample, a total of 73 patients were finally accepted as 'neurasthenia' patients satisfying the ICD-10 diagnosis. These patients were compared with the remaining 1002 patients. Patients with neurasthenia had more prevalent and more severe subjective health complaints, particularly pseudoneurological and musculoskeletal complaints than the reference population of patients. They reported low levels of instrumental coping and poorer physical fitness, in spite of a comparable level of self reported physical activity and exercise. Women were over-represented in this group. This overall higher score on subjective complaints from all organ systems is in accordance with the hypothesis of an overall and general sensitization to the afferent inputs from their psychophysiological systems.

... with few or no objective findings, and include muscle pain, tiredness, mood disturbances, fatigue, headaches, sleep problems, and ... and (2) different types of “workaholism” are expected to relate differently to reports of job stress, burnout, work engagement, and SHC. ...