The importance of skin area and gender in ticklishness.

The importance of skin area and gender in ticklishness was explored in the present study. No previous report has been published on stimulation of the body surface exposed when dressed in a swimsuit (supine and prone positions), and the use of a feather has not been reported before. Fifty-seven university students volunteered (female N = 26, age range: 19-25, mean = 22.4; male N = 31, age range: 20-26, mean = 23.1). Sessions were videotaped for scoring of local involuntary muscle contractions (IMC) and laughter. Smiles were not scored because the face was not visible in the prone position. Subjective ticklishness was scored on a visual analogue scale. Areas that gave rise to ticklishness, were hatched onto a figure of the body. A two-factor design (gender of tickler by gender of ticklee) explored effects on dependent measures. Results showed that laughter was most frequent in female ticklees, disregarding the gender of the tickler. Subjective ticklishness and IMC scored high in opposite gender constellations. Ticklish areas included the ankles, knees, medial sides of the thighs and legs, lateral sides of the upper part of the body, elbows, the upper parts of arms, and the neck and shoulders. It was proposed that laughter in response to tickling stimulation might express gender stereotypes of socio-expressive behavior in playful social interaction, whereas IMC and subjective ticklishness may reflect biological components of playfulness in opposite gender constellations when tickled by a feather.

A 15-Year Follow-Up Study of Sense of Humor and Causes of Mortality: The Nord-Trøndelag Health Study.

BACKGROUND: Associations between the sense of humor and survival in relation to specific diseases has so far never been studied. METHODS: We conducted a 15-year follow-up study of 53,556 participants in the population-based Nord-Trøndelag Health Study, Norway. Cognitive, social, and affective components of the sense of humor were obtained, and associations with all-cause mortality, mortality due to cardiovascular diseases (CVD), infections, cancer, and chronic obstructive pulmonary diseases were estimated by hazard ratios (HRs). RESULTS: After multivariate adjustments, high scores on the cognitive component of the sense of humor were significantly associated with lower all-cause mortality in women (HR = 0.52, 95% confidence interval [CI] = 0.33-0.81), but not in men (HR = 0.88, 95% CI = 0.59-1.32). Mortality due to CVD was significantly lower in women with high scores on the cognitive component (HR = 0.27, 95% CI = 0.15-0.47), and so was mortality due to infections both in men (HR = 0.26, 95% CI = 0.09-0.74) and women (HR = 0.17, 95% CI = 0.04-0.76). The social and affective components of the sense of humor were not associated with mortality. In the total population, the positive association between the cognitive component of sense of humor and survival was present until the age of 85 years. CONCLUSIONS: The cognitive component of the sense of humor is positively associated with survival from mortality related to CVD and infections in women and with infection-related mortality in men. The findings indicate that sense of humor is a health-protecting cognitive coping resource.

Insulin sensitivity after maximal and endurance resistance training.

The purpose of the study was to compare the effects of maximal resistance training (MRT) vs. endurance resistance training (ERT) on improvements in insulin levels and glucose tolerance in overweight individuals at risk of developing type 2 diabetes. Eighteen participants with baseline values suggesting impaired glucose tolerance were randomly assigned to 1 of 2 groups. Group 1 engaged in supervised MRT (Bernstein inverted pyramid system: 5 × 3-4, 60-85% 1 repetition maximum [1RM]), 3 d·wk(-1) over 4 months, whereas members of group 2 acted as controls. Later, group 2 engaged in supervised ERT (3 × 12-15, 45-65% 1RM), 3 d·wk(-1) over a 4 month period with the 2 prebaselines as controls. Both interventions consisted of 8 exercises that included the entire body. Glucose (fasting and 2-hour test), insulin and C-peptide measures were assessed from pre to post in both groups. The MRT led to reduced blood levels of 2-hour glucose (p = 0.044) and fasting C-peptide (p = 0.023) and decreased insulin resistance (p = 0.040). The ERT caused a significant reduction in the blood levels of insulin (p = 0.023) and concomitant positive effects on % insulin sensitivity (p = 0.054) and beta-cell function (p = 0.020). The findings indicate that both MRT and ERT lead to decreased insulin resistance in people with a risk of developing type 2 diabetes; MRT led to a greater increase in glucose uptake capacity (in muscles), whereas ERT led to greater insulin sensitivity, supporting the recommendation of both MRT and ERT as primary intervention approaches for individuals at a risk of developing type 2 diabetes.

Headache and musculoskeletal complaints among subjects with self reported whiplash injury: the HUNT-2 study.

BACKGROUND: To evaluate the life-time prevalence of self reported whiplash injury and the relationship to chronic musculoskeletal complaints (MSCs) and headache in a large unselected adult population. METHODS: Between 1995 and 1997, all inhabitants 20 years and older in Nord-Trondelag county in Norway were invited to a comprehensive health survey. Out of 92,936 eligible for participation, a total of 59,104 individuals (63.6%) answered the question about whiplash injury (whiplash). Among these, 46,895 (79.3%) responded to the questions of musculoskeletal complaints and headache. RESULTS: The total life-time prevalence of self reported whiplash injury was 2.9%, for women 2.7% and for men 3.0%. There was a significant association between self reported whiplash injury and headache (OR = 2.1; 95% CI 1.8-2.4), and chronic MSCs (OR = 3.3; 95% CI 2.8-3.8), evident for all ten anatomical sites investigated. The association was most pronounced for those with a combination of headache and chronic MSC for both men (OR = 4.8; 95% CI 3.6-6.2) and women (OR = 5.2; 95% CI 3.7-7.1). CONCLUSIONS: Subjects with self reported whiplash injury had significantly more headache and musculoskeletal complaints than those without, and may in part be due to selective reporting. The causal mechanism remains unclear and cannot be addressed in the present study design.

Motivation for lifestyle changes to improve health in people with impaired glucose tolerance.

AIM: To identify factors that could have motivational significance for lifestyle change to facilitate the reduction of Impaired Glucose Tolerance (IGT) and, consequently, the risk of having type 2 diabetes. METHODS: Eighteen people living in a municipality in central Norway participated in the study. A large-scale public health screening study had defined them as people with IGT. The participants took part in a semi-structured interview that focused on four aspects of everyday lifestyle: (1) structure and rhythm, (2) physical health, (3) physical activity and (4) social relations. RESULTS: The interviews showed that the participants in the study changed their priorities regarding daily living. Results indicated four domains of motivational factors that appeared as significant for lifestyle changes. The participants attributed great significance to their physical health and were strongly motivated to prevent disease development by improvement of everyday structure and rhythm, reduction of sickness risk, activity level and social relation. Research indicates, however, that lasting lifestyle changes take time and that health care support must be adapted to the individual in light of their social setting. CONCLUSION: Persons with IGT appear to benefit from lifestyle changes along four dimensions of motivational significance: Structure and rhythm, Sickness concerns, Activity levels, Social relations. This means that attention needs to be more carefully tailored the individual along these four dimensions than has been the case in traditional health care.

Treatment of tunnel phobia: an experimental field study.

The opening of the deepest undersea tunnel in the world (264 m below sea level, 5600 m in length) replaced the ferry from the island of Hitra to the mainland in Norway. This event provoked phobic anxiety for traveling through the undersea tunnel in a number of individuals in the area. A treatment program for tunnel phobia was designed to test whether such a phobia could be mitigated by procedures previously proven effective in the treatment of other phobias. The program was presented to 18 persons with a specific phobia for tunnels and included a general discussion on the construction of undersea tunnels, given by an engineer from the tunnel construction company, and on phobic anxiety. It further consisted of gradual exposure to the tunnel in situ. Treatment effects were strong. All patients were able to travel on their own by car through the tunnel after the treatment. Their somatic complaints and phobic thoughts related to the tunnel were substantially reduced, and their mastery of tunnel driving was convincingly increased compared with the wait-list reference group.

Sickness Absence due to Chronic Musculoskeletal Pain: The Exploration of a Predictive Psychological Model Including Negative Moods, Subjective Health and Work Efficacy in an Adult County Population (The HUNT Study).

The relation between musculoskeletal pain and sickness absence was tested in an adult county population. Maximal explained variance in absence from work due to chronic musculoskeletal pain (sickness absence) was tested in a model in which subjective health was expected to mediate the associations between such pain and dysphoria, respectively, and work efficacy. In turn, work efficacy was expected to mediate the link between subjective health and sickness absence. All the residents in the County of Nord-Trøndelag, Norway, aged 20 and older, were invited to take part in a public health survey during 1995-97 (HUNT-2), and 66,140 (71.2%) participated. Prevalence of musculoskeletal pain, dysphoria, subjective health and work efficacy were assessed, as well as sickness absence last year due to musculoskeletal pain. The model test was performed by use of the LISREL procedure based upon data from 30,158 employees reporting chronic musculoskeletal pain last year. The measurement model fitted the data well: χ2 = 9075, df = 52, p < .0004, Critical N = 1041, RMSEA = 0.038, CFI = 0.99, SRMR = 0.020. The structural model fitted the data equally well, and the best prediction of sickness absence was obtained with lower back pain, upper and lower extremity pain, as well as dysphoria as the primary variables affecting subjective health that, in turn, was the convergent predictor of work efficacy that, finally, best explained the variance in sickness absence (56%). The data supported an indirect sequence of complaint-health-efficacy (CHE-model) as the best predictor of sickness absence due to musculoskeletal pain.

Does hypertension protect against chronic musculoskeletal complaints? The Nord-Trøndelag Health Study.

BACKGROUND: Although an inverse relationship between pain sensitivity and hypertension has been described, it is still unknown whether hypertension may protect against chronic musculoskeletal complaints (MSCs). The aim of this study was to evaluate the relationship between blood pressure (BP) and prevalence of chronic MSCs at various anatomical sites. METHODS: Two consecutive public health studies within the county of Nord-Trøndelag, Norway, were conducted between January 5, 1984, and February 15, 1986 (Nord-Trøndelag Health Study [HUNT] 1), and from August 1995 to June 1997 (HUNT-2). Among 46 901 adults who participated in both surveys, 24 127 (51.4%) in HUNT-2 who reported MSCs continuously for at least 3 months during the past year were defined as having chronic MSCs. The prevalence of chronic MSCs was estimated using multiple logistic regression, with odds ratio and 95% confidence interval as measures of association with systolic and diastolic BP. RESULTS: A high systolic and diastolic BP was associated with a 10% to 60% lower prevalence of chronic MSCs, and there was a strong linear trend (P<.001) of decreasing prevalence of chronic MSCs with increasing BP values. The findings were remarkably consistent at all anatomical sites, for both sexes, across all age groups, and for systolic and diastolic BP measured in HUNT-1 and HUNT-2. CONCLUSIONS: Individuals with a high BP had a lower prevalence of chronic MSCs than individuals with a normal BP. One possible explanation may be the phenomenon of hypertension-associated hypalgesia, due to an interaction between the cardiovascular and pain regulatory systems. The effect of antihypertensive medication on this interaction should be evaluated in further studies.

Consequences of Laughter Upon Trunk Compression and Cortical Activation: Linear and Polynomial Relations.

Results from two studies of biological consequences of laughter are reported. A proposed inhibitory brain mechanism was tested in Study 1. It aims to protect against trunk compression that can cause health hazards during vigorous laughter. Compression may be maximal during moderate durations and, for protective reasons, moderate in enduring vigorous laughs. Twenty-five university students volunteered to see a candid camera film. Laughter responses (LR) and the superimposed ha-responses were operationally assessed by mercury-filled strain gauges strapped around the trunk. On average, the thorax compression amplitudes exceeded those of the abdomen, and greater amplitudes were seen in the males than in the females after correction for resting trunk circumference. Regression analyses supported polynomial relations because medium LR durations were associated with particularly high thorax amplitudes. In Study 2, power changes were computed in the beta and alpha EEG frequency bands of the parietal cortex from before to after exposure to the comedy "Dinner for one" in 56 university students. Highly significant linear relations were calculated between the number of laughs and post-exposure cortical activation (increase of beta, decrease of alpha) due to high activation after frequent laughter. The results from Study 1 supported the hypothesis of a protective brain mechanism that is activated during long LRs to reduce the risk of harm to vital organs in the trunk cavity. The results in Study 2 supported a linear cortical activation and, thus, provided evidence for a biological correlate to the subjective experience of mental refreshment after laughter.

Do high TSH values protect against chronic musculoskeletal complaints? The Nord-Trøndelag Health Study (HUNT).

The aim of this large cross-sectional population-based study was to examine a possible positive or negative association between thyroid dysfunction and chronic musculoskeletal complaints (MSC). Between 1995 and 97, all 94,197 adults in Nord-Trøndelag County in Norway were invited to participate in a health survey. A total of 64,787 (69%) responded to questions related to MSC, whereof thyroid-stimulating hormone (TSH) was measured in 34,960 individuals. These included a 5% random sample of women and men 20-40 years of age (n=2165), nearly all women above 40 (n=19,308), a random sample which included 50% of men older than 40 years (n=9983), and 3504 (97%) with self-reported thyroid dysfunction. Among the 64,787 participants, 30,158 (47%) who reported MSC continuously for at least 3 months during the past year where defined as having chronic MSC. Associations between thyroid dysfunction and chronic MSC were assessed in multivariate analyses, estimating prevalence odds ratios (ORs) with 95% confidence intervals (CIs). High TSH values were associated with lower prevalence of chronic MSC at ten anatomical sites among women with no history of thyroid dysfunction. Among these, chronic MSC was less likely (OR=0.6, 95% CI 0.4-0.8) if TSH >or=10 mU/L than in women with normal TSH (0.2-4 mU/L). Chronic MSC was less likely among women with high TSH values. The mechanism is unclear and, theoretically, may reflect a fundamental gender-specific relationship between TSH and pain perception in the central nervous system.

Effects on sick-leave of a multidisciplinary rehabilitation programme for chronic low back, neck or shoulder pain: comparison with usual treatment.

OBJECTIVE: To test the outcome of active multidisciplinary treatment in an outpatient setting upon sick-leave status among patients with neck, shoulder and low back pain. DESIGN: Multidisciplinary treatment was administered to 121 patients (intervention group) over 4 weeks of structured intervention, followed by 8 weeks of less structured consultations. Effects of treatment were compared with usual treatment (control group: n = 97). PATIENTS: All patients were in the chronic stage of pain (average sick-leave: 6 months) with different diagnoses: neck-shoulder pain, low back pain or low back pain with radiating extremity pain. METHOD: The intervention group programme included posture corrections, pain perception, skills to cope with pain, aerobic and fitness-promoting activities and relaxation techniques administered to groups of 8-10 patients. The Local National Insurance Office referred the patients who were diagnosed by general practitioners. A 12-month follow-up by the Local National Insurance Office provided feedback about sick-leave status of all 218 patients. RESULTS: There was a significant treatment difference in proportion taken off the sick list after 12 months (intervention group: 78.5%; control group: 50.5%; p < 0.001). The difference was greater among low back pain (p < 0.001) than among neck-shoulder (p < 0.053) and low back pain with radiating extremity pain (p < 0.031) patients. CONCLUSION: Long-term effects of active multidisciplinary treatment were superior to treatment as usual in all diagnostic groups.

A 7-year prospective study of sense of humor and mortality in an adult county population: the HUNT-2 study.

OBJECTIVE: To prospectively explore the significance of sense of humor for survival over 7 years in an adult county population. METHODS: Residents in the county of Nord-Trøndelag, Norway, aged 20 and older, were invited to take part in a public health survey during 1995-97 (HUNT-2), and 66,140 (71.2 %) participated. Sense of humor was estimated by responses to a cognitive (N = 53,546), social (N = 52,198), and affective (N = 53,132) item, respectively, taken from the Sense of Humor Questionnaire (SHQ). Sum scores were tested by Cox survival regression analyses applied to gender, age, and subjective health. RESULTS: Hazard ratios were reduced with sense of humor (continuous scale: HR = 0.73; high versus low by median split: HR = 0.50) as contrasted with increase of HR with a number of classical risk factors (e.g., cardiovascular disease: HR = 6.28; diabetes: HR = 4.86; cancer: HR = 4.18; poor subjective health: HR = 2.89). Gender proved to be of trivial importance to the effect of sense of humor in survival. Subjective health correlated positively with sense of humor and therefore might have presented a spurious relation of survival with humor, but sense of humor proved to reduce HR both in individuals with poor and good subjective health. However, above age 65 the effect of sense of humor on survival became less evident. CONCLUSION: Sense of humor appeared to increase the probability of survival into retirement, and this effect appeared independent of subjective health. Age under 65 mediated this effect, whereas it disappeared beyond this age.

[Health and sense of humour: morbidity]. / Helbred og humoristisk sans: sygelighed.

Three components may be identified in the sense of humour: A cognitive, social and an affective. The cognitive factor appears to be most important for health outcome parameters. Studies of small samples in a laboratory context as well large-scale population samples have failed to prove a simple and direct effect of sense of humour on health. More success has been achieved in studies of persons exposed to real life stressors. Sense of humour appears to be a buffer against stress-related morbidity, and the mechanisms may be aspects of the immune function and pain-modulating mechanisms of the brain.

[Health and sense of humour: mortality]. / Helbred og humoristisk sans: dødelighed.

Four studies have tested the association between sense of humour and longevity. One reported that comedians and serious entertainers on average die earlier than authors. Two publications from the Terman Life-Cycle Study reported a negative association. Cheerfulness (sense of humour and optimism) was the index variable in the first study. In the second study, optimism was taken out, but the negative association prevailed. The fourth study reported a 31% reduction of mortality risk among patients with end-stage renal failure provided that they scored above the median on a test of sense of humour.

Some health effects of implementing school nursing in a Norwegian high school: a controlled study.

The effects of a school nursing service on health complaints and mood were investigated in a Norwegian high school. The school nursing service was delivered to students in 1 high school, and students in a comparable high school served as the comparison group. There were 41 students in the treatment group and 63 in the comparison group. All students completed a survey at the beginning of 2 successive fall terms. The survey had items on common health complaints, perceived stress, efforts to cope, moods, and sense of humor. Results from multivariate analyses of variance found that test-retest variance was stable for all measures. Level of complaints tended to be reduced as an effect of access to the school nursing service. Sense of humor at follow-up tended to buffer health complaints and negative moods.

Breathing exercises with vagal biofeedback may benefit patients with functional dyspepsia.

OBJECTIVE: Many patients with functional dyspepsia (FD) have postprandial symptoms, impaired gastric accommodation and low vagal tone. The aim of this study was to improve vagal tone, and thereby also drinking capacity, intragastric volume and quality of life, using breathing exercises with vagal biofeedback. MATERIAL AND METHODS: Forty FD patients were randomized to either a biofeedback group or a control group. The patients received similar information and care. Patients in the biofeedback group were trained in breathing exercises, 6 breaths/min, 5 min each day for 4 weeks, using specially designed software for vagal biofeedback. Effect variables included maximal drinking capacity using a drink test (Toro clear meat soup 100 ml/min), intragastric volume at maximal drinking capacity, respiratory sinus arrhythmia (RSA), skin conductance (SC) and dyspepsia-related quality of life scores. RESULTS: Drinking capacity and quality of life improved significantly more in the biofeedback group than in the control group (p=0.02 and p=0.01) without any significant change in baseline autonomic activity (RSA and SC) or intragastric volume. After the treatment period, RSA during breathing exercises was significantly correlated to drinking capacity (r=0.6, p=0.008). CONCLUSIONS: Breathing exercises with vagal biofeedback increased drinking capacity and improved quality of life in FD patients, but did not improve baseline vagal tone.

Incidence of musculoskeletal complaints in a large adult Norwegian county population. The HUNT Study.

STUDY DESIGN: Cross-sectional study. Between 1995 and 1997, all inhabitants aged 20 years and older in the Nord-Trøndelag county in Norway were invited to fill in 2 different questionnaires at different times concerning musculoskeletal complaints. OBJECTIVE: To estimate the incidence of musculoskeletal complaints lasting at least 15 days during the past month at 9 different anatomic sites in relation to age and gender. SUMMARY OF BACKGROUND DATA: Incidence data of musculoskeletal complaints are scarce. METHODS: Individuals who reported no musculoskeletal complaints lasting for at least 3 months during the past year were defined as a population at risk and were subjects for the incidence estimates. RESULTS: Of 49,720 individuals (response rate 53.5%), the overall age-adjusted incidence of musculoskeletal complaints was 7.9% (95% confidence interval 7.5% to 8.2%) (women: 7.1%, men: 8.7%). The highest incidence rate was found for the lower back (women: 2.3%, men: 2.8%). The incidence of spinal complaints declined after age 60 years, whereas the incidence of complaints in lower limbs and distal upper limbs tended to be stable or increase in the older age groups. CONCLUSIONS: In this, to our knowledge, first large-scale population-based study evaluating the incidence of musculoskeletal complaints, nearly 1 in 12 individuals reported musculoskeletal complaints lasting at least 15 days during the past month.

Sense of humor and survival among a county cohort of patients with end-stage renal failure: a two-year prospective study.

OBJECTIVE: To explore the significance of sense of humor for survival in a county cohort of patients diagnosed with end-stage renal failure. This diagnosis is a life-threatening condition that calls upon coping skills and regular dialysis. METHOD: All patients receiving dialysis in the county of Sør-Trøndelag during February of one year (N= 52) were invited. Forty-one completed the survey and had complete data (78.9%). Predictors were related to survival status two years later. Three blocks of predictors were tested: 1) age, gender and education; 2) duration of disease, number of dialyses per week, and co-morbidity; and 3) quality of life and sense of humor. Confounding effects of variables in blocks one and two were controlled for using Cox survival analysis. RESULTS: Nineteen patients (46.3 %) died over the 2-year observation period. Survival decreased with higher age at time of survey (p < .044), but was not significantly predicted by variables in block two. A highly significant increase in survival was due to the psychological variables of block three (p <.001) essentially accounted for by sense of humor (p < .005). Those who scored above the median in sense of humor increased their odds for survival by on average 31%. CONCLUSIONS: Sense of humor appeared to mediate better coping and, therefore, protected against detrimental effects of disease-related stressors upon survival.

Low socioeconomic status is associated with chronic musculoskeletal complaints among 46,901 adults in Norway.

AIMS: A study was undertaken to evaluate the relationship between socioeconomic status (SES) and chronic musculoskeletal complaints (MSC), and to determine how this relationship is influenced by change in SES. METHODS: Two consecutive public health surveys within the county of Nord-Trøndelag, Norway, were conducted in 1984-86 (HUNT-1) and 1995-97 (HUNT-2). Among 46,901 adults who participated in both surveys, 24,127 persons (51%) in HUNT-2 who reported MSC continuously for at least 3 months during the past year were defined as having chronic MSC. Prevalence of chronic MSC was estimated at nine anatomical sites using multiple logistic regression with odds ratio (OR) and 95% confidence interval (CI) as measures of association with SES. RESULTS: When defining SES by educational level, type of occupation, or income, low status was associated with increased prevalence of chronic MSC (age-adjusted analyses). The negative influence of low education or low occupation level was not eliminated by increasing the level of education or occupation from HUNT-1 to HUNT-2, in contrast with what was found for individuals with higher income level in HUNT-2 than in HUNT-1. The relationship with SES was more evident among individuals with musculoskeletal symptoms 15 days during the past month than among those with less than 15 days, evident at all nine different anatomical sites. The strongest relationship was found between low SES and prevalence of widespread chronic MSC. CONCLUSIONS: Individuals with low SES had higher prevalence of chronic MSC than those with high SES. Future studies should try to clarify whether chronic MSC are a cause or consequence of low SES.

Attention to affective pictures in closed head injury: event-related brain potentials and cardiac responses.

We examined whether closed head injury patients show altered patterns of selective attention to stimulus categories that naturally evoke differential responses in healthy people. Self-reported rating and electrophysiological (event-related potentials [ERPs], heart rate [HR]) responses to affective pictures were studied in patients with mild head injury (n = 20; CT/MRI negative), in patients with predominantly frontal brain lesions (n = 12; CT/MRI confirmed), and in healthy controls (n = 20). Affective valence similarly modulated HR and ERP responses in all groups, but group differences occurred that were independent of picture valence. The attenuation of P3-slow wave amplitudes in the mild head injury group indicates a reduction in the engagement of attentional resources to the task. In contrast, the general enhancement of ERP amplitudes at occipital sites in the group with primarily frontal brain injury may reflect disinhibition of input at sensory receptive areas, possibly due to a deficit in top-down modulation performed by anterior control systems.