Prevalence of suicide attempt and associations with deliberate self-harm, mental health problems, drug misuse and traumatic experiences - a cross sectional survey of the Norwegian population.

BACKGROUND: Monitoring self-reported suicide attempts (SA) with nationally representative surveys is important to initiate suicide prevention strategies. The aim of the study was to assess the prevalence of SA and compare deliberate self-harm, (DSH), mental health, drug misuse and traumas between SA and non-suicide attempters (NSA). METHODS: In this cross-sectional survey of a representative sample (N=1757) of the Norwegian population, we compared people with self-reported SA (n=54) to NSA (n=1703) regarding sociodemographic data, mental health problems, drug misuse and exposure to trauma. RESULTS: The prevalence of SA was 3.1 %. There was a higher proportion of welfare recipients and more deliberate self-harm, mental health problems, drug misuse and traumas in the SA group compared to NSA. CONCLUSION: This national study confirms the association between suicide attempt and deliberate self-harm, mental health problems, drug misuse and traumas.

Towards an exposure-dependent model of post-traumatic stress: longitudinal course of post-traumatic stress symptomatology and functional impairment after the 2011 Oslo bombing.

BACKGROUND: Our understanding of the dynamics of post-traumatic stress symptomatology and its link to functional impairment over time is limited. METHOD: Post-traumatic stress symptomatology (Post-traumatic Checklist, PCL) was assessed three times in 1-year increments (T1, T2, T3) following the Oslo bombing of 22 July, 2011, in directly (n = 257) and indirectly exposed (n = 2223) government employees, together with demographics, measures of exposure and work and social adjustment. The dynamics of post-traumatic stress disorder symptom cluster interplay were examined within a structural equation modelling framework using a cross-lagged autoregressive panel model. RESULTS: Intrusions at T1 played a prominent role in predicting all symptom clusters at T2 for the directly exposed group, exhibiting especially strong cross-lagged relationships with avoidance and anxious arousal. For the indirectly exposed group, dysphoric arousal at T1 played the most prominent role in predicting all symptom clusters at T2, exhibiting a strong relationship with emotional numbing. Emotional numbing seemed to be the main driver behind prolonged stress at T3 for both groups. Functional impairment was predominately associated with dysphoric arousal and emotional numbing in both groups. CONCLUSIONS: For directly exposed individuals, memories of the traumatic incident and the following intrusions seem to drive their post-traumatic stress symptomatology. However, as these memories lose their potency over time, a sequela of dysphoric arousal and emotional numbing similar to the one reported by the indirectly exposed individuals seems to be the main driver for prolonged post-traumatic stress and functional impairment. Findings are discussed using contemporary models within an exposure-dependent perspective of post-traumatic stress.

Alcohol consumption in the aftermath of a natural disaster: a longitudinal study.

OBJECTIVES: In this study, we examined changes in alcohol consumption in the aftermath of a natural disaster, as well as possible predictors of both increased and decreased drinking. STUDY DESIGN: Observational longitudinal study. METHODS: Repatriated Norwegian adults who resided in areas affected by the 2004 Southeast Asia tsunami completed a questionnaire at 6 and 24 months postdisaster (N = 649). RESULTS: Weekly alcohol consumption and frequency of intoxication did not change significantly from 6 to 24 months postdisaster at the population level: 18.3% (n = 116) increased their alcohol consumption while 21.1% (n = 125) showed a reduction. Increased drinking was not predicted by severity of disaster exposure, post-traumatic stress, or measures of psychological functioning. Reduced alcohol consumption was predicted by younger age and social withdrawal, but not by any of the other study variables. CONCLUSION: Our findings indicate that the tsunami experience had only minor effects on alcohol consumption, in contrast to some studies suggesting a relationship between trauma exposure and increased alcohol consumption.

Post-traumatic stress among rescue workers after terror attacks in Norway.

BACKGROUND: On 22 July 2011, Norway was struck by two terror attacks. Seventy-seven people were killed, and many injured. Rescue workers from five occupational groups and unaffiliated volunteers faced death and despair to assist victims. AIMS: To investigate the level of, and associations between, demographic variables, exposure and work-related variables and post-traumatic stress symptoms (PTSS). METHODS: A cross-sectional study of general and psychosocial health care personnel, police officers, firefighters, affiliated and unaffiliated volunteers were conducted ~10 months after the terror attacks. The respondents answered a self-reported questionnaire. Post-traumatic stress disorder (PTSD) Checklist - specific (PCL-S) assessed PTSS. RESULTS: There were 1790 participants; response rate was 61%. About 70% of the professional rescue workers had previous work experience with similar tasks or had participated in training or disaster drills. They assessed the rescue work as a success. Firefighters and unaffiliated volunteers reported more perceived threat compared with the other groups. Among the professional personnel, the prevalence of sub-threshold PTSD (PCL 35-49) was 2% and possible PTSD (PCL ≥ 50) 0.3%. The corresponding figures among the unaffiliated volunteers were 24% and 15%, respectively. In the multivariate analysis, female gender (ß = 1.7), witnessing injured/dead (ß = 2.0), perceived threat (ß = 1.1), perceived obstruction in rescue work (ß = 1.6), lower degree of previous training (ß = -0. 9) and being unaffiliated volunteers (ß = 8.3) were significantly associated with PTSS. CONCLUSIONS: In the aftermath of a terror attack, professional rescue workers appear to be largely protected from post-traumatic stress reactions, while unaffiliated volunteers seem to be at higher risk.

Work-related post-traumatic stress disorder.

BACKGROUND: Work-related post-traumatic stress disorder (PTSD) is an important condition encountered by many occupational health practitioners. AIMS: To carry out an in-depth review of the research on occupational groups that are at particular risk of developing work-related PTSD. METHODS: A literature search was conducted in the databases OVID MEDLINE, OVID Embase, Ovid PsycINFO, ISI Web of Science and CSA Health and Safety Science Abstracts. RESULTS: Professionals such as police officers, firefighters and ambulance personnel often experience incidents that satisfy the stressor criterion for the PTSD diagnosis. Other professional groups such as health care professionals, train drivers, divers, journalists, sailors and employees in bank, post offices or in stores may also be subjected to work-related traumatic events. Work-related PTSD usually diminishes with time. CONCLUSIONS: Mental health problems prior to the traumatic event and weak social support increase the risk of PTSD. Prevention of work-related PTSD includes a sound organizational and psychosocial work environment, systematic training of employees, social support from colleagues and managers and a proper follow-up of employees after a critical event.

Overweight as predictor of long-term mortality among healthy, middle-aged men: a prospective cohort study.

OBJECTIVES: Large epidemiological studies of non-smokers have demonstrated an association between overweight during midlife and increased mortality. However, little is known about whether this association may be explained by physical fitness. Thus, we aimed to examine this association in a long-term follow-up, with adjustment for fitness. METHODS: We prospectively studied mortality in relation to overweight in 2014 healthy Norwegian men 40-59 years of age at enrollment in 1972-1975, and recorded cardiovascular and non-cardiovascular mortality during 25-27 years follow-up. Physical fitness was measured in a maximal exercise tolerance bicycle test. RESULTS: At baseline 717 men had overweight (body mass index 25.0-29.9) and 1221 had normal weight (body mass index<25.0). During follow-up 746 men died, 377 from cardiovascular causes. Among non-smokers with overweight/normal weight, cardiovascular death rates were 19.4%/11.3%, and non-cardiovascular death rates were 13.2%/14.4%. Overweight was related to cardiovascular mortality, even after adjustment for age, physical fitness, blood pressure and cholesterol level (RR: 1.52, p=0.010), but not to non-cardiovascular mortality (RR: 0.84, p=0.32). Among smokers overweight was not associated with cardiovascular or non-cardiovascular mortality. The difference in cardiovascular mortality between non-smokers with overweight and normal weight first appeared after 15 years of follow-up. CONCLUSION: Overweight appears to be an independent long-term predictor of cardiovascular mortality in middle-aged healthy non-smoking men, even after adjustment for physical fitness.

Response to Intravenous Glucose-Tolerance Test and Risk of Cancer: A Long-Term Prospective Cohort Study.

BACKGROUND: Impaired glucose regulation, measured with an oral glucose-tolerance test, has been associated with the risk of cancer. Here, we explored whether the response to an intravenous glucose-tolerance test (IVGTT) is associated with the risk of cancer. METHODS: A cohort of 945 healthy men, aged 40-59years in 1972-75, was followed for 40years. An IVGTT was performed at baseline. Blood samples for glucose determinations were drawn immediately before glucose injection and thereafter every 10min for 1h. Associations were assessed with incidence rate ratios (IRR) and Cox models. FINDINGS: Cancer incidence was higher among men with 10-min glucose levels below the median than in men with levels above the median (IRR: 1.5, 95% CI: 1.2-1.9). This association remained significant after adjusting for relevant confounders (HR: 1.6, 95% CI: 1.3-2.1) and when excluding the first 10years of follow-up to minimize the possibility of reverse causality (HR: 1.5, 95% CI: 1.2-2.0). INTERPRETATION: Healthy middle-aged males that responded to an intravenous glucose injection with rapid glucose elimination during the first phase had an elevated risk of cancer during 40years of follow-up. First phase response to a glucose load might be related to cancer development.

Musculoskeletal injuries in officer training: one-year follow-up.

This study attempts to map the incidence and types of musculoskeletal injury during officer training. Officer cadets from three training schools (N = 321) were monitored through a 1-year training course. A total of 278 injuries were sustained by 194 of the 321 cadets (60%). The incidence was highest during an introductory 5- or 6-week period of intensive basic training. During this period, rates at various training schools ranged from 26.7 to 45.5 injuries per 100 cadet-months, which was five to nine times higher than during the rest of the year. The most common types of injury were overuse knee injuries, periostitis or compartment syndromes, Achilles tendinitis, and sprains of joint capsules or ligaments. Women and older cadets sustained more injuries than their respective male (p = 0.02) or younger (p = 0.02) counterparts. The study shows that musculoskeletal injuries occur frequently during officer training, especially during the first weeks. Recommendations for injury prevention include a more gentle start with slower progression in strain, slow introduction of combat boots, and differentiation of strain according to individual risk factors such as age and gender.

Use of and satisfaction with support received among survivors from three Scandinavian countries after the 2004 Southeast Asian tsunami.

INTRODUCTION: There is limited guidance regarding effective preventions for post-disaster mental health problems and what kind of support is preferred by disaster survivors. AIM: To describe the use of and satisfaction with support in three Scandinavian countries after the tsunami and analyzing the association between support and posttraumatic stress reactions. METHOD: The sample comprises 6772 responders who returned to Scandinavia from the tsunami-struck countries of Southeast Asia in 2004. RESULTS: Most were satisfied with informal support on site. Support from embassies/consulates was not received well, leaving about 64% of the Danes/Norwegians and 73% of the Swedes dissatisfied. After returning home, support from close relatives rendered highest degree of satisfaction. Consultation with general practitioner (GP) was reported by 63% of Norwegians, 40% of Danes, and 16% of Swedes. Most responders (60-77%) were satisfied with their GP, although Norwegians were least satisfied. Using support was associated with higher levels of posttraumatic stress symptoms. CONCLUSIONS: Informal support was used to a high degree and rendered considerable satisfaction in all three countries, while the use of and satisfaction with formal support varied more. Lack of satisfaction with embassies and consulates may indicate deficiencies in the authorities' preparedness in assisting disaster stricken citizens abroad.

Epidemiology of musculoskeletal injuries among Norwegian conscripts undergoing basic military training.

Compulsory military service entails a change in the patterns of physical activity of many conscripts, and an accompanying risk of musculoskeletal injury. The present study was carried out to determine the incidence and types of musculoskeletal injury among Norwegian conscripts, and their consequences in the form of sick leave and discharge from the service. The study population consisted of 6488 conscripts in all, drawn from the Army, the Air Force and the Navy. They were monitored through an initial 6-10-week period of basic military and physical training. Every injury for which a conscript had to consult a doctor was registered. Slightly more than every fourth Army, every fifth Air Force and every eighth Navy conscript suffered one or more injuries during basic training. Incidence rates for the Army, Air Force and Navy respectively were 15.3, 13.4 and 9.3 injuries per 100 conscripts-months. The sites of the majority of the injuries were in the lower limbs (63%). The most common types of injury were low back pain; overuse knee injuries; Achilles tendinitis; sprains of joint capsules or ligaments; and periostitis or compartment syndromes of lower leg. In the doctors' opinions, contributory or triggering causes of the injuries could be attributed to organized service activities in 67% of the cases. The number of days of partial or total sick leave as a result of injury amounted to 3.4% and 0.2% respectively of the total basic training period. Of Army, Air Force and Navy conscripts, 23%, 16% and 11% respectively had sick leave. Injury was also the direct cause of the discharge of 2.1% of the Army conscripts and 0.1% of the Air Force and Navy conscripts. The results of the study show that musculoskeletal injuries occur frequently during basic training and that injuries contribute to lost training time.

Age, body composition, aerobic fitness and health condition as risk factors for musculoskeletal injuries in conscripts.

Musculoskeletal injuries occur frequently in connection with physical activity. More information was sought on pretraining factors that may predispose to such injuries. Data were obtained on the age, height, weight, aerobic fitness as measured by a 3000-m run test, and health as assessed on the basis of a medical examination, of 912 male conscripts prior to an 8-week period of basic military and physical training. Injuries were registered as they occurred by doctors attached to the training camp. Every fourth to fifth conscript suffered one or more musculo-skeletal injuries during basic training. Achilles tendinitis, low back pain, periostitis or compartment syndromes, and overuse knee injuries were the most frequent diagnosis groups. In 74% of the injuries, a tentative cause was related to organized service activities. According to univariate analyses, risk factors were age over 23 years, high body mass index (BMI), slow run times and dysfunctions of the back or lower limbs. A lower classification of mental health, but not dysfunctions of the lower limbs, was an additional risk factor if only injuries with causes connected with organized service activities were considered. Height and weight were not associated with injuries. In multiple logistic regression analysis, age and 3000-m run times were masked by correction for BMI, while BMI, dysfunctions of the back and lower limbs, and reduced mental health showed the same significance as in the univariate analyses.

Injury proneness in infantry conscripts undergoing a physical training programme: smokeless tobacco use, higher age, and low levels of physical fitness are risk factors.

Musculoskeletal injuries represent an adverse event of strenuous physical activity. The aim of the present study was to identify pretraining factors that may predispose to such injuries. Risks of injury according to age, body composition, previous physical activity, physical fitness, use of smokeless tobacco (moist snuff) and smoking habits were determined in a population of 480 male conscripts in the army. Data were obtained by questionnaire, height and weight measurements, and from a 3000-metre run test prior to a 10-week period of basic military and physical training. Injuries were registered by doctors attached to the training camp. Every fourth conscript sustained one or more musculoskeletal injuries during the training period. Low back pain, overuse knee injuries, Achilles tendinitis, and sprains of joint capsules or ligaments were the most frequent diagnosis groups. Subjects aged 22 years and more, the least active persons before call-up, those who thought they were less fit than the average, the slowest one-third in the 3000-metre run test, smokers of more than 10 cigarettes a day, and snuff-takers suffered more injuries according to univariate analyses. Multiple logistic regression analysis showed that age, self-assessed physical fitness and snuff-taking were mutually independent risk factors of high statistical significance.

The influence of training intensity, airway infections and environmental conditions on seasonal variations in bronchial responsiveness in cross-country skiers.

The influence of physical training, airway infections and environmental conditions on changes in bronchial responsiveness to methacholine during a training and competitive season was studied in 19 high-performance male cross-country skiers 19-21 years old. The longitudinal changes in the methacholine concentration required for a 10% fall in FEV1 (PC10) were negatively correlated with the changes in the volume of physical activity at an intensity level above 90% of maximal heart rate. The variation in physical activity at this intensity level accounted for 54.8% of the change in PC10. No association was found, however, with regard to physical activity at lower intensity levels. Seasonal variation in PC10 was not associated with the changes in occurrence or duration of airway infections provided that the PC10 measurement was postponed for 3-6 weeks after the onset of a recent infection. Seasonal variation in PC10 seemed not to be associated with variations in ambient levels of air pollutants or aeroallergens. PC10 was lowest at the end of the coldest part of the year. In conclusion, seasonal variation in bronchial responsiveness in high-performance cross-country skiers could to a great extent be explained by changes in the volume of physical activity at a very high intensity level.

Salbutamol and high-intensity treadmill running in nonasthmatic highly conditioned athletes.

Salbutamol is a widely used drug among elite athletes. We wanted to provide more information on the effects of salbutamol in nonasthmatic athletes. Seventeen highly conditioned male athletes (VO2max > 70 ml.kg-1.min-1) participated in a randomized, double-blind and placebo-controlled cross-over study. Nebulized salbutamol (0.05 mg/kg) or placebo was inhaled prior to a high intensity (110% of VO2max) treadmill run to exhaustion. The measured variables included endurance time, oxygen uptake, ventilation, breathing rate, heart rate, and oxygen saturation. Lung function was measured as forced expiratory volume in the first second (FEV1) before and after medication, and during the recovery from the run. The high intensity runs led to total exhaustion after 4-10 min. A close-to-significant shortening in endurance time was found when salbutamol was given. During the running (0-4 min) the oxygen uptake was slightly lower and the heart rate was slightly higher when salbutamol was given. No differences were found in peak oxygen uptake, peak heart rate, ventilation, breathing rate or oxygen saturation. FEV1 reflected an increase in airway caliber after the inhalation of salbutamol. These changes were still present in the recovery from the test run with the exception of the measurement immediately after the exercise. Although evidence for beta-adrenergic stimulation was found, it was concluded that a therapeutic dose of nebulized salbutamol does not improve performance in highly trained athletes during a high-intensity run to exhaustion.

Respiratory tract infection and bronchial responsiveness in elite athletes and sedentary control subjects.

To assess the effect of physical exercise during an acute respiratory tract infection (RTI) on bronchial responsiveness, methacholine bronchial challenge tests were performed prospectively in 19 nonasthmatic male cross-country skiers and 22 healthy control subjects with minimal physical activity. Twelve skiers and 10 controls contracted RTI and were studied before and 1, 3 and 6 weeks after the onset of symptoms. The skiers were given no restrictions in their training routines during the period of illness. The geometric mean provocation concentration of methacholine causing a 10% fall in the forced expiratory volume in the first second (PC10), was lower 1 week after onset of infection than at the initial test in the skiers. From the level at 1 week, PC10 increased to levels at 3 and 6 weeks after infection. The PC10 values at 3 and 6 weeks were not significantly different from the initial test. No significant changes in PC10 occurred after infection in the control group. No significant changes in pulmonary function tests were found during the study period in either of the two groups. In conclusion, RTI was associated with a transient increase in bronchial responsiveness in athletes performing physical training during the symptomatic period of respiratory illness but not in nonactive control subjects.