The Cognitive Function at Work Questionnaire (CFWQ): A new scale for measuring cognitive complaints in occupational population.

Cognitive functioning is a relevant work and health related topic, however, validated methods to assess subjective cognitive complaints (SCC) at work are lacking. We introduce the Cognitive Function at Work Questionnaire (CFWQ) for measuring SCC in occupational settings. 1-year follow-up data of 418 employees from a Finnish public media service company was analyzed. Participants completed web-based CFWQ, cognitive tests and a broad set of questionnaires for evaluating depression, anxiety, insomnia, daytime sleepiness, burnout, stress, mental job burden, work ability, cognitive errors, and perceived health. The factor analysis yielded a model with the CFWQ subdomains: Memory, Language, Executive Function, Speed of Processing, Cognitive Control and Name Memory. The internal consistency (Cronbach's alpha = .87) and the test-retest constancy (ICC = .84) reflected good reliability. Correlation between the CFWQ and cognitive errors at work ranged from .25 to .64 indicating adequate concurrent validity. Employees with depression, insomnia and burnout symptoms had higher (p < .001) CFWQ scores than participants without these symptoms. Depression and burnout symptom severity as well as accumulation of mood, sleep, and psychosocial stressors were associated with higher CFWQ scores (p < .001 in all). The CFWQ appears psychometrically sound measure for the assessment of SCC in occupational population.

Self-reported sleep bruxism among Finnish symphony orchestra musicians: Associations with perceived sleep-related problems and psychological stress.

OBJECTIVE: This study aimed to evaluate whether self-reported sleep bruxism among musicians is associated with sleep-related problems and/or psychological stress. METHODS: Eight hundred-thirty-one Finnish orchestra musicians completed a questionnaire that covered, among others, indicators of sleep-related problems, possible sleep bruxism, and stress. RESULTS: In total, 488 questionnaires were completed. The single variable ordinal logistic regression models revealed at least moderate associations between frequency of sleep bruxism and female gender, shorter sleep duration, longer sleep latency, problems in sleeping during concert season, feeling more often tired during the daytime, restless legs, a poor self-rated sleep quality, and more stress experience. The variables that remained in the final model were sleep duration, gender, and stress. CONCLUSION: Musicians who sleep 7 hours or less per night report more sleep bruxism, as compared to those who sleep 8 hours or more. Female gender and high-stress experience were associated with more sleep bruxism.

Ecological Momentary Assessment of Awake Bruxism with a Smartphone Application Requires Prior Patient Instruction for Enhanced Terminology Comprehension: A Multi-Center Study.

The prevalence of awake bruxism (AB) has been reported as being 30%, with sleep bruxism (SB) at 9−15%. Most studies have focused on SB, emphasizing the importance of AB research. For epidemiological evaluations of AB, a smartphone application based on ecological momentary assessment (EMA) was introduced. The aims of this multi-center study were: (1) to investigate how well lay subjects comprehend the AB terminology used in the smartphone application, and (2) to find out whether professional instruction improved their comprehension. The study population consisted of lay subjects from Italy, Portugal, and Finland comprising 307 individuals (156 men, 151 women; 18−86 years). Subjects first completed a five-item questionnaire about the meanings of the five AB terms used in the smartphone application. Each question offered four answer options, with one being correct. Immediately afterwards, the meanings of the terms were instructed. Lastly, the subjects were re-tested with the same questionnaire. In Finland and Italy, the re-tested correct answer scores for the single terms were at 89−97% per term. Improved comprehension was seen across sex, education, and age groups. In the Portuguese data, no improvement was found. Significant differences were found between countries in the improved scores for all terms that were correct following the instruction (Finland, 16.3% to 72.1%; Italy, 32.3% to 83.8%; Portugal, 23.1% to 33.7%) (p < 0.001). In conclusion, standardized instruction on AB terminology prior to EMA is recommended to improve the reliability of collected data.

Oro-facial pain experience among symphony orchestra musicians in Finland is associated with reported stress, sleep bruxism and disrupted sleep-Independent of the instrument group.

BACKGROUND: To evaluate whether oro-facial pain experience was related to the type of musical instrument and to learn more about the roles of sleep and sleep-related issues in the pain among professional musicians. OBJECTIVES: A standard questionnaire was sent to all Finnish symphony orchestras (n = 19), with altogether 1005 professional musicians and other personnel. METHODS: The questionnaire covered descriptive data, instrument group, items on perceived quality of sleep, possible sleep bruxism, stress experience and oro-facial pain experience during the past 30 days. RESULTS: In the present study, which included the musicians only, the response rate was 58.7% (n = 488). All orchestras participated in the study, and there was no significant difference in the response rate between the orchestras. The mean age of men (52.3%) was 47.7 (SD 10.3) and of women (47.7%) was 43.4 (SD 9.8) years (P < 0.001). Overall, current pain in the oro-facial area was reported by 28.9%, frequent bruxism by 12.1% and frequent stress by 20.8%. According to Somers' d, there were statistically significant but moderate correlations between overall pain reports in the oro-facial area and disrupted sleep (d = 0.127, P = 0.001), sleep bruxism (d = 0.241, P < 0.001) and stress experiences (d = 0.193, P < 0.001). Logistic regression revealed, independent of the instrument group (string, woodwind, brass wind, percussion), that current oro-facial pain experience was significantly associated with disrupted sleep (P = 0.001), frequent sleep bruxism (P < 0.001) and frequent stress (P = 0.002) experiences. CONCLUSIONS: Among symphony orchestra musicians, oro-facial pain experience seems to be related to perceptions of stress, sleep bruxism and disrupted sleep rather than the instrument group.

Musculoskeletal Symptoms Among Finnish Professional Orchestra Musicians.

BACKGROUND: The prevalence of musculoskeletal symptoms is high among professional musicians (73-88%). AIMS: We investigated the prevalence of musculoskeletal symptoms in Finnish symphony orchestra musicians. We compared individual instruments as well as the perceived demands of orchestral programs and difficulties in recovering after performances. METHODS: In this cross-sectional questionnaire 920 of 2,785 members of the Finnish Musicians' Union (33%) completed the questionnaire, including 361 full-time members of symphony orchestras. Questions about pain symptoms and frequency were based on the national survey done in 2011. RESULTS: Among the 361 full-time orchestra musicians, those playing all instruments experienced frequent pain, both in the last 30 days and exceeding 30 days in the last 12 months, in their neck or upper extremities. Female musicians experienced significantly more neck (69%), elbow (31%), and wrist (30%) pain than males (neck 52%, elbow 23%, wrist 19%). The profiles varied according to the different instruments and their playing positions. Musculoskeletal symptoms correlated with perceived demand of the orchestral program and difficulties in recovering after performances. Professional musicians experienced nearly twice as often neck pain in the last 30 days (female musicians 69%, male musicians 52%) than persons of the same age in the Finnish working population (female 41%, male 27%). CONCLUSION: Symphony orchestra musicians experience nearly twice as much musculoskeletal symptoms of the neck and upper extremities as others their age. To prevent musicians' playing-related problems, special emphasis should be focused on recovery after concerts, including the special demands of different composers and the frequency of rehearsals and performances.

Cognitive behavioral therapy for chronic insomnia in occupational health services: analyses of outcomes up to 24 months post-treatment.

OBJECTIVE: Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for persistent insomnia. The purpose of this study was to examine the effectiveness of and response patterns to CBT-I among daytime and shift workers with insomnia over a 24-month follow-up in occupational health services (OHS). METHODS: The participants were 59 media workers with chronic insomnia, of whom 69% were reached at 24-month follow-up. Sleep diaries and questionnaires over seven measurement points were used as outcomes. Trained OHS nurses led the CBT-I groups. The study design was a non-randomized group intervention. RESULTS: Self-perceived severity of insomnia, sleep-related dysfunctional cognitions, and psychiatric symptoms in particular showed improvements over a 24-month follow-up. Working hour arrangements did not affect the results. Based on the Insomnia Severity Index (ISI), 62% of the participants showed a moderate improvement after CBT-I, whereas the remaining participants showed only a minor improvement. CONCLUSIONS: Our results indicate that CBT-I delivered by OHS leads to long-term improvements among both daytime and shift workers. Two groups were identified according to the degree of improvement of insomnia; one comprising two thirds of the participants with a moderate response and the other comprising one thirds of the participants with a modest response. The results need to be interpreted cautiously as insomnia was mild (ISI was on average under 15 points at all measurement points) and improvements were relatively small in the sample, and the study design was non-randomized.

The effects of plant stanol ester consumption on arterial stiffness and endothelial function in adults: a randomised controlled clinical trial.

BACKGROUND: The hypocholesterolemic effect of plant stanol ester consumption has been studied extensively, but its effect on cardiovascular health has been less frequently investigated. We studied the effects of plant stanol esters (staest) on arterial stiffness and endothelial function in adults without lipid medication. METHODS: Ninety-two asymptomatic subjects, 35 men and 57 women, mean age of 50.8±1.0 years (SEM) were recruited from different commercial companies. It was randomized, controlled, double-blind, parallel trial and lasted 6 months. The staest group (n=46) consumed rapeseed oil-based spread enriched with staest (3.0 g of plant stanols/d), and controls (n=46) the same spread without staest. Arterial stiffness was assessed via the cardio-ankle vascular index (CAVI) in large and as an augmentation index (AI) in peripheral arteries, and endothelial function as reactive hyperemia index (RHI). Lipids and vascular endpoints were tested using analysis of variance for repeated measurements. RESULTS: At baseline, 28% of subjects had a normal LDL cholesterol level (≤3.0 mmol/l) and normal arterial stiffness (<8). After the intervention, in the staest group, serum total, LDL, and non-HDL cholesterol concentrations declined by 6.6, 10.2, and 10.6% compared with controls (p<0.001 for all). CAVI was unchanged in the whole study group, but in control men, CAVI tended to increase by 3.1% (p=0.06) but was unchanged in the staest men, thus the difference in the changes between groups was statistically significant (p=0.023). AI was unchanged in staest (1.96±2.47, NS) but increased by 3.30±1.83 in controls (p=0.034) i.e. the groups differed from each other (p=0.046). The reduction in LDL and non-HDL cholesterol levels achieved by staest was related to the improvement in RHI (r=-0.452, p=0.006 and -0.436, p=0.008). CONCLUSIONS: Lowering LDL and non-HDL cholesterol by 10% with staest for 6 months reduced arterial stiffness in small arteries. In subgroup analyses, staest also had a beneficial effect on arterial stiffness in large arteries in men and on endothelial function. Further research will be needed to confirm these results in different populations. TRIAL REGISTRATION: Clinical Trials Register # NCT01315964.

Self-reported bruxism mirrors anxiety and stress in adults

Objectives: The aims were to analyze whether the levels of self-reported bruxism and anxiety associate among otherwise healthy subjects, and to investigate the independent effects of anxiety and stress experience on the probability of self-reported bruxism. Study Design: As part of a study on irregular shift work, a questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (number of subjects: n=750) and to an equal number of randomly selected employees in the same company with regular eight-hour daytime work. Results: The response rates were 82.3% (56.6 % men) and 34.3 % (46.7 % men), respectively. Among the 874 respondents, those aware of more frequent bruxism reported significantly more severe anxiety (p<0.001). Adjusted by age and gender, frequent bruxers were more than two times more likely to report severe stress (odds ratio 2.5; 95% confidence interval 1.5-4.2) and anxiety (odds ratio 2.2; 95% confidence interval 1.3-3.6) than non-or-mild bruxers. Conclusions: Present findings suggest that self-reported bruxism and psychological states such as anxiety or stress may be related in working age subjects (AU)

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Self-reported bruxism mirrors anxiety and stress in adults.

OBJECTIVES: The aims were to analyze whether the levels of self-reported bruxism and anxiety associate among otherwise healthy subjects, and to investigate the independent effects of anxiety and stress experience on the probability of self-reported bruxism. STUDY DESIGN: As part of a study on irregular shift work, a questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (number of subjects: n=750) and to an equal number of randomly selected employees in the same company with regular eight-hour daytime work. RESULTS: The response rates were 82.3% (56.6 % men) and 34.3 % (46.7 % men), respectively. Among the 874 respondents, those aware of more frequent bruxism reported significantly more severe anxiety (p<0.001). Adjusted by age and gender, frequent bruxers were more than two times more likely to report severe stress (odds ratio 2.5; 95% confidence interval 1.5-4.2) and anxiety (odds ratio 2.2; 95% confidence interval 1.3-3.6) than non-or-mild bruxers. CONCLUSIONS: Present findings suggest that self-reported bruxism and psychological states such as anxiety or stress may be related in working age subjects.

Cognitive behavioral therapy for shift workers with chronic insomnia.

OBJECTIVE: Shift work is a challenge in the screening and treatment of chronic insomnia. The aim of this study was to examine the implementation and effectiveness of a cognitive behavioral group intervention for insomnia (CBT-I) among shift workers with chronic insomnia. We also studied whether insomnia symptoms and intervention effects differed on work days and days off. METHODS: The study design was a non-randomized group intervention, including a waiting period prior to CBT-I as a control condition. A total of 19 media workers who worked irregular hours and had non-organic insomnia with features of psychological insomnia completed the study. We followed up with the results for a period of 6 months. Outcomes were assessed using a sleep diary, questionnaires, and actigraphy. The CBT-I groups were led by trained nurses of occupational health services (OHS). RESULTS: The post-intervention results showed significant improvements in self-reported and actigraphic sleep onset latency, and in self-reported sleep efficiency, sleep quality, and restedness. In addition, the perceived severity of insomnia, sleep-related dysfunctional cognitions, psychiatric and somatic symptoms, and the mental component of health-related quality of life improved significantly. The improvements lasted and even strengthened over the follow-up period. The participants generally slept significantly better on days off than on work days, but the treatment improved sleep on both. CONCLUSIONS: The study showed that non-pharmacological treatment of insomnia can be implemented among shift workers with chronic insomnia, and delivery of the treatment by trained OHS nurses yields promising results. Some caution, however, is needed when interpreting the results because of the non-randomized study design and small sample size.

Attenuation of vagal recovery during sleep and reduction of cortisol/melatonin ratio in late afternoon associate with prolonged daytime sleepiness among media workers with irregular shift work.

BACKGROUND: Media work is characterized by information flow, deadlines, and 24/7 alertness. Good recovery prevents stress-related disorders. METHODS: The standardized questionnaire included items about health, health habits, sleep, work conditions, and work stress. Recordings of 24-hr heart rate variability (HRV) and four salivary samples for cortisol and melatonin levels were analyzed from 70 randomly selected workers with irregular shift work, and 70 workers with normal daytime work. RESULTS: Irregular shift work increased the risk of insufficient recovery when compared to normal daytime work (OR 2.0; P < 0.05). In the group of workers with insufficient subjective recovery, HRV was attenuated (P < 0.05) during the early hours of night, and cortisol/melatonin ratio was decreased (P < 0.05) in the afternoon. CONCLUSIONS: Physiological changes underlying subjective feelings of insufficient recovery are measurable. Attenuated HRV during sleep reflects prolonged sympathetic drive and/or impaired parasympathetic recovery. Interactions between cortisol and melatonin hormones might be involved in the development of chronic exhaustion.

Cognitive behavior therapy for chronic insomnia in occupational health services.

INTRODUCTION: The aim of this study was to examine the implementation and effectiveness of a cognitive behavioral group intervention model for chronic insomnia (CBT-I) in occupational health services (OHS). We also studied if insomnia symptoms and intervention effects differed on work days and days off. METHODS: The study design was a non-randomized group intervention, including a waiting period prior to CBT as a control condition. We followed up the results for a period of 6 months. Outcomes were assessed using a sleep diary, questionnaires, and actigraphy. The CBT-I groups were led by trained OHS nurses. RESULTS: A total of 26 participants completed the study. The intervention improved significantly participants' different self-reported sleep variables, perceived severity of insomnia, sleep-related dysfunctional cognitions, and psychiatric and somatic symptoms. The effects lasted, and partly increased during the follow-up. The participants generally slept significantly better on days off than on work days, but the treatment improved sleep on both. CONCLUSIONS: The study showed that a non-pharmacological treatment of insomnia can be implemented into OHS with a reasonable amount of effort and that the treatment delivered by trained OHS nurses yields promising results. These findings, however, need to be interpreted cautiously, due to the non-randomized design and small sample size.

Morning cortisol levels and perceived stress in irregular shift workers compared with regular daytime workers.

The 24/7 work environment and irregular shifts may markedly enhance the psychological pressure of media work. Changes in the hypothalamic-pituitary-adrenal axis reflect adaptation to stress. We analysed the correlation between subjective stress, sleep, salivary cortisol, and melatonin hormones among Finnish media workers with regular daytime work (RDW) and with irregular shift work (ISW) while controlling confounders. From 874 employees with regular daytime work or with irregular shift work, 70 employees from both groups were randomly selected. The final number of employees with a complete salivary cortisol profile was 66 in the RDW group and 65 in the ISW group. Five saliva samples were gathered from each subject before and during a working day. The salivary cortisol level of the sample taken 60 minutes after awakening (T1) was compared to the salivary cortisol level taken immediately after awakening (T0, T1/T0 ratio). The ratio was higher in the ISW group than in RDW group. Irregular shift work (P < 0.001), severe stress (P < 0.05), and less sleep (P < 0.05) were independently associated with an augmented cortisol response after awakening. A stressful work environment and irregular shift work enhance cortisol excretion after waking. In the long run, this may become detrimental to health.

High job control enhances vagal recovery in media work.

BACKGROUND: Job strain has been linked to increased risk of cardiovascular diseases. In modern media work, time pressures, rapidly changing situations, computer work and irregular working hours are common. Heart rate variability (HRV) has been widely used to monitor sympathovagal balance. Autonomic imbalance may play an additive role in the development of cardiovascular diseases. AIMS: To study the effects of work demands and job control on the autonomic nervous system recovery among the media personnel. METHODS: From the cross-sectional postal survey of the employees in Finnish Broadcasting Company (n = 874), three age cohorts (n = 132) were randomly selected for an analysis of HRV in 24 h electrocardiography recordings. RESULTS: In the middle-aged group, those who experienced high job control had significantly better vagal recovery than those with low or moderate control (P < 0.01). Among young and ageing employees, job control did not associate with autonomic recovery. CONCLUSIONS: High job control over work rather than low demands seemed to enhance autonomic recovery in middle-aged media workers. This was independent of poor health habits such as smoking, physical inactivity or alcohol consumption.

Associations of reported bruxism with insomnia and insufficient sleep symptoms among media personnel with or without irregular shift work.

BACKGROUND: The aims were to investigate the prevalence of perceived sleep quality and insufficient sleep complaints, and to analyze whether self-reported bruxism was associated with perceptions of sleep, and awake consequences of disturbed sleep, while controlling confounding factors relative to poor sleep. METHODS: A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (n = 750) and to an equal number of randomly selected controls in the same company with regular eight-hour daytime work. RESULTS: The response rate in the irregular shift work group was 82.3% (56.6% men) and in the regular daytime work group 34.3% (46.7% men). Self-reported bruxism occurred frequently (often or continually) in 10.6% of all subjects. Altogether 16.8% reported difficulties initiating sleep (DIS), 43.6% disrupted sleep (DS), and 10.3% early morning awakenings (EMA). The corresponding figures for non-restorative sleep (NRS), tiredness, and sleep deprivation (SLD) were 36.2%, 26.1%, and 23.7%, respectively. According to logistic regression, female gender was a significant independent factor for all insomnia symptoms, and older age for DS and EMA. Frequent bruxism was significantly associated with DIS (p = 0.019) and DS (p = 0.021). Dissatisfaction with current work shift schedule and frequent bruxism were both significant independent factors for all variables describing insufficient sleep consequences. CONCLUSION: Self-reported bruxism may indicate sleep problems and their adherent awake consequences in non-patient populations.

Reported bruxism and restless legs syndrome in media personnel with or without irregular shift work.

A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (n = 750) and to an equal number of randomly selected controls in the same company with regular 8-h daytime work. The questionnaire covered demographic items, employment details, general health experience, physical status, psychosocial status, stress, work satisfaction and performance, tobacco use, bruxism, and restless legs symptoms (RLS). The aim was to investigate among a multiprofessional media personnel the associations between reported bruxism and RLS, while simultaneously controlling the effects of gender, age, tobacco use, shift work, and dissatisfaction with current workshift schedule. The overall response rate was 58.3% (53.7% men). The response rate in the irregular shift work group was 82.3% (56.6% men) and in the regular daytime work group 34.3% (46.7% men). In the bivariate analyses, RLS was more prevalent in workers at either end of the studied age range (p < 0.05). Self-reported frequent bruxism was significantly associated with younger age (p < 0.05). Females reported RLS (11.4%) slightly more often than males (7.7%) (NS). In logistic regression, frequent bruxism (p < 0.05) and older age (p < 0.05) were significantly positively associated with RLS. Dissatisfaction with one's current workshift schedule (p < 0.05) and RLS (p < 0.05) were significantly positively associated with frequent bruxism, while age (p < 0.05) was significantly negatively associated. In conclusion, perceived bruxism may be a sign of a stressful situation or dissatisfaction, while RLS as a more stable trait may in itself negatively affect sleep quality and further enhance the problem.

Perceived orofacial pain and its associations with reported bruxism and insomnia symptoms in media personnel with or without irregular shift work.

A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (n = 750) and to an equal number of randomly selected controls in the same company with regular 8-hour daytime work. The aims were to investigate the prevalence and severity of perceived orofacial pain (Research Diagnostic Criteria for Temporomandibular Disorders Axis II) and to analyze whether current orofacial pain was associated with reported bruxism and insomnia symptoms (Diagnostic and Statistical Manual of Mental Disorders-IV and the International Classification of Sleep Disorders Revised). The response rate in the irregular shift-work group was 82.3% (56.6% men) and in the regular daytime-work group 34.3% (46.7% men). Current orofacial pain was found overall in 19.6%, of which 88.3% had experienced the pain over 6 months. All claimed that their pain fluctuated. No subjects with chronic orofacial pain reported disabling pain, and grades III and IV were not found. Insomnia symptoms and frequent bruxism were significantly more prevalent in chronic pain grade II than in lower grades. According to logistic regression, current orofacial pain was significantly positively associated with frequent bruxism (p < 0.001), female gender (p < 0.001), and disrupted sleep (p < 0.01), and significantly negatively associated with age over 45 years (p < 0.01). Our results revealed a clear-cut association between perceived orofacial pain and reported bruxism. The association held with both chronic orofacial pain intensity and current pain. Based on the multivariate analyses, it can be concluded that disrupted sleep and bruxism may be concomitantly involved in the development of orofacial pain.

Associations of perceived pain and painless TMD-related symptoms with alexithymia and depressive mood in media personnel with or without irregular shift work.

The aim of the present study was to analyze whether previously emerged pain symptoms and painless temporomandibular disorder (TMD) symptoms are associated with alexithymia and self-rated depression among media personnel in or not in irregular shift work. A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company in irregular shift work (n = 750) and to an equal number of randomly selected controls in regular 8-h daytime work. The questionnaire covered demographic items, employment details, general health experience, physical status, psychosomatic symptoms, psychosocial status, stress, work satisfaction and performance, and health-care use. Studied age groups, marital status, gender or perceived health were not significantly associated with alexithymia in the bivariate analyses. Most studied painless TMD symptoms associated significantly with alexithymia. Alexithymia was also significantly more prevalent among those who reported having more often than average neck pain (P < 0.05), head pain (P < 0.05), and tender teeth (P < 0.01). According to logistic regression, the probability of alexithymia was significantly positively associated with pain symptoms (P < 0.05) and painless TMD-related symptoms (P < 0.01), and significantly negatively associated with female gender (P < 0.01). Additionally, depressive mood was significantly positively associated with dissatisfaction of one's work-shift schedule (P < 0.05), and poorer health experience (P < 0.01). Neither alexithymia nor depression was associated with irregular shift work in itself. In conclusion, depressive mood may be a sign of dissatisfaction and impaired well-being. In the case of perhaps less disabling but common physical symptoms alexithymia as a possible underlying factor may be relevant in the diagnosis and management of such disorders.

Active or passive treatment for neck-shoulder pain in occupational health care? A randomized controlled trial.

AIMS: To compare the effectiveness of thoracic manipulations with instructions for physiotherapeutic exercises for the treatment of neck pain in occupational health care. METHODS: Seventy-five subjects aged 30-55 years from a random sample of 241 employees of the Finnish Broadcasting Company were randomly allocated to treatment in the form of four thoracic manipulations (n = 43), or instructions for physiotherapeutic exercises (n = 32). The subjects reported neck-shoulder pain on a structured pain questionnaire using a visual analogue scale (VAS, 0-10). Muscle tenderness and tender thoracic levels were evaluated by a blinded investigator (A.S.) at 6- and 12 month follow-ups. RESULTS: A statistically significant difference was found in self-reported worst pain by VAS at the 12 month follow-up in favour of the thoracic manipulation group. CONCLUSIONS: The natural course of the neck-shoulder pain in this study appears benign; pain was also reduced in the drop-out group. Both treatments were found effective at the 12 month follow-up. The effect of four manipulations was more favourable than the personal exercise program in treating the more intense phase of pain.

Chronic myofascial pain, disk displacement with reduction and psychosocial factors in Finnish non-patients.

This study aimed to determine chronic groups of myofascial pain and chronic disk displacement with reduction over a 1-year period, and to study the relationship between psychological status and these chronic subgroups of temporomandibular disorders (TMD) in non-patients. A total of 211 subjects (males 47%, mean age 46 years; standard deviation 6) attended examinations in 1999 and 2000 performed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Chronic myofascial pain was found in 7% and chronic disk displacement with reduction in 11% of subjects; new diagnoses were made in only 4% and 1% of the subjects, respectively. An increase in the level of somatization by 1 step increased the probability of having chronic myofascial pain by over 3 times (P = 0.006). Myofascial pain and disk displacement with reduction seem to be relatively common and fluctuating in nature in non-patients. As somatization associated significantly with myofascial pain, this should be borne in mind in the management of TMD. The results strengthen the rationale of the biopsychosocial orientation in health care.