Objectives: In a previous pilot studies it was indicated that the prevalence of musculoskeletal pain (MSP) is high among reindeer herders. The main objective of the present study was to explore potential relations between self-reported MSP, perceived dysfunction and quality of life among Swedish reindeer herding Sami, with particular emphasis on gender comparisons.

Study Design: Cross-sectional, semi-randomised, cohort study.

Methods: A total of 154 reindeer herders (86 men, 68 women) were offered participation in the study. They were semi-randomly selected from 7 Sami communities and represented herders who were older than 18 years of age, and belonged to households where reindeer husbandry constituted a major source of income. They answered questionnaire on pain intensity, duration and frequency in 10 separate body regions, on functional disturbances (SF-36 and Neck Disability Index), and on quality of life (in four domains - physical, social, mental and health). The questionnaires were distributed via mail to complement clinical data acquired during health examination executed by physiotherapists and GPs.

Results: Preliminary analyses revealed a high prevalence of MSP, particularly of the back, neck, shoulder, elbows and wrists, both among men and women. Significant functional impairments and poor quality of life were reported by a majority of the participants.

Conclusions: Detailed results and general conclusions will be presented at the conference

Objective. To investigate the prevalence and to identify causes of musculoskeletal pain (MSP) among reindeer herding Sami, and to evaluate the impact on the MSP symptoms elicited by an intervention-pre- vention programme (lP programme). Study Design. A prospective cohort study in which alterations in MSP symptoms were documented over a two-year period. Methods. Data were collected from 51 rein- deer herders (26 men, 25 w omen) before and af ter a two-year lP programme. Information on MSP cha- racteristics (affected body regions, pain duration and pain intensity) and exposure to a number of phy- sical and psychosocial risk factors were collected as part of comprehensive health examinations. Cli- nical examinations and interviews complemented self-reported data collected through questionnaires. Results. MSP symptoms were prevalent, both among w omen and men. High exposure to physical risk factors, to a large extent related to extensive use of snowmobiles and motorcycles, was the main cau- se of MSP among men, while psychosocial risk factors were suggested to be more important among wo- men. About one-third of the reindeer herders reported fewer MSP symptoms as a resull of the lP programme. Conclusions. This pilot study suggests that it is possible to reduce the number and the se- verity of the MSP symptoms among reindeer herders by implementing suitably tailored intervention- prevention measures.

Objective: To investigate the occurrence of psychosocial, clinical and behavioural risk factors for cardiovascular diseases (CVD) among reindeer herding and non-reindeer herding Sami. The results on psychosocial risk factors are presented here.

Materials and Methods: A cohort of 611 Swedish Sami (276 men and 335 women) was constructed from national population registers and compared with a twice as large control population of non-Sami, matched by age, gender and area of residency. Information on quality of life, social support and Karasek and Theorell`s job-strain indices was obtained from a database containing information from a regional CVD-preventive program. The data was collected from the period of 1990–2001.

Results: The Sami people reported lower quality of life and higher demand and intellectual discretion at work than the non-Sami. The Sami women, the reindeer herding as well as the non-reindeer herding, had lower scores on intellectual discretion and social support at work compared with the Sami men.

Conclusions: Regarding the psychosocial risk factors investigated here it seems that the Sami women are at higher risk than the Sami men.

Objective. To investigate the occurrence of clinical, psychosocial and behavioural risk factors for cardiovascular di seases (C VD) among reindeer herding (RS) and non-reindeer herding Sami (NRS). Study Design. A retrospective cohort study, comparing risk factors behind C VD between Sami and non-Sami, RS and NRS, and Sami men and w omen. Methods. A cohort of 611 Swedish Sami (276 men and 335 w omen) was constructed from national population registers. A twice as large control co- hort of non-Sami was created, matched by age, gender and area of residence. Information on risk factors was obtained from a database containing clinical and psychosocial-behavioural data from a regional C VD preventive programme for the period 1990-2001. Results. The Sami and thenon-Sa- mi showed similar risk factor patterns. The main differences were related to working conditions and lifestyle factors of the RS. The RS men had lower blood pressure, were more physically active and had higher job demand and decision latitude. The RS w omen showed more negative scores on the in- dices of the job strain model. Conclusions. Previously reported differences in C VD mortality between Sami and non-Sami, and Sami men and w omen, can only partly be explained by different exposure to the psychosocial and behaviour risk factors investigated in this study.

BACKGROUND: Indigenous people often have a pattern of mortality that is disadvantageous in comparison with the general population. The knowledge on causes of death among the Sami, the natives of northern Scandinavia, is limited. The aim of the present study was to compare gender and cause specific mortality patterns for reindeer herding Sami, non-herding Sami, and non-Sami between 1961 and 2000. METHODS: A Sami cohort was constructed departing from a group of index-Sami identified as either reindeer herding Sami or Sami eligible to vote for the Sami parliament. Relatives of index-Sami were identified in the National Kinship Register and added to the cohort. The cohort contained a total of 41 721 people (7482 reindeer herding Sami and 34 239 non-herding Sami). A demographically matched non-Sami reference population four times as large, was compiled in the same way. Relative mortality risks were analysed by calculating standardized mortality ratios (SMRs). RESULTS: The differences in overall mortality and life expectancy of the Sami, both reindeer herding and non-herding, compared with the reference population were relatively small. However, Sami men showed significantly lower SMR for cancers but higher for external causes of injury. For Sami women, significantly higher SMR was found for diseases of the circulatory system and diseases of the respiratory system. An increased risk of dying from subarachnoid haemorrhage was observed among both Sami men and women. CONCLUSIONS: The similarities in mortality patterns are probably a result of centuries of close interaction between the Sami and the non-Sami, while the observed differences might be due to lifestyle, psychosocial and/or genetic factors.

Objectives: In previous Nordic studies it has been reported that the overall cancer incidence is lower among the Sami compared to the rest of the population living in the same area. But the relative risk varies among different Sami groups with a lower overall risk among reindeer herders compared to other Sami groups. Diet and lifestyle factors such as physical activity has been suggested to explain these differences together with genetical factors. The objective of this study is to describe the cancer incidence among different Sami groups in Sweden between 1961 and 2003 and to evaluate the effect of demographical changes on risk factors related to Sami lifestyle and heritage.

Study Design: Prospective cohort study

Methods: The study cohort constitutes of a total of 7 482 reindeer herders and 34 239 non-herders from which subgroups were genealogically defined, carrying with them assumptions of different levels of influence of a traditional Sami life style. Follow up was from 1961 to 2003 and standard incidence ratios (SIR) were calculated using a demographically matched control population as the standard of comparison.

Results:Overall lower cancer risk was observed for reindeer herding men compared to the control population while the relative risk for non-herding women was significantly higher. Significantly lower rates of prostate was observed among reindeer herders and higher rates of stomach and ovary was observed among non-herding women.

Conclusions: Protective factors in an active, more traditional life style in combination with genertical factors is suggested to explain the lower cancer rates among reindeer herding men. An assumption of declining protective influence of a traditional life style in different Sami groups is supported by an demographical and genealogical analysis of the constitution of different Sami groups. It is indicated that demographical changes resulting in various levels of integration and/or assimilation should be considered when analysing the health status of the Sami.

Research on the health and living conditions of the Swedish Sami population was initiated at the Southeffi Lapland Research Department in 1998 with the objective to collect and analyse data on lifestyle,environmental exposure, and incidence of various diseases and risk factors that could be used to promote a healthy Sami population. In order to analyse the epidemio.logical data on the Sami population that already exists in national demographic and health registers, a specific database has been constructed containing Swedish Sami. The basis for the construction of the database is the two definitions of Sami identity that are found in Swedish law and are used to regulate the right to register to the electoral register of the Sami parliament, and to regulate the right to breed reindeers. The registers that are connected to these defInitions functions as index registers in the creation of the database. That is, they serve as the starting point from which the expansion of the database takes place. By flnding all household members of the same household as the index persons, the database has expanded from 10 000 individuals in the index registers to a total of more than 150 000 individuals. Local kinship register within the database has also been established making the database more functional in forming Sami cohorts bUilt on family relations. A control part of the database consisting of non-Sami individuals was also formed. The Sami index regi~ters were matched with regard to sex, age and living area to form an index register of non Sami controls which then was extended in a similar way as for the Sami part of the database. An example on how the database can be used is the reconstruction of a Sami population, built on family relations that produced a Sami population that for 1998 amounted to about 44 000 individuals. By opening up new possibilities in seeking information and knowledge, the database can hopefully be come a important tool in the work to improve the health and living conditions of the Sami population of Sweden.

Objective. Over the last decades, reindeer-herding management has experienced drarnatic changes, e.g. increased motorization and socio-econornic pressure. The airn of the present study was to investigate whether these changes have increased the risk of fatal, work-related accidents and suicide between 1961 and 2000. Study design and methods. A c oh ort containing 7,482 members of reindeer-herding Sami families was extracted from national population registers. Information on fatal accidents and suicide was obtained from the Swedish Causes of Death Register, and compared to the expected number of deaths in a dernographica11y matched control population of non-Sami. Results. The ffiale reindeer her- ding Sami showed a significantly increased risk of dying from accidents such as vehicle accidents and poisoning. No significant increased risk of suicide was observed. A comparison between the periods of 1961-1980 and 1981- 2000 showed non-significant differences in risk, although a trend towards incre- ased risks was observed for most types of external causes of death except suicide. Conclusions. It is suggested that the increased socio-econornic pressure and the extensive use of terrain vehicles have increased the risk for fatal accidents arnong Swedish reindeer herders, and that commercial reindeer ma- nagement is one of the most dangerous occupations in Sweden

Over the years a lot of research of attitudes towards mental disorders, towards people with mental illness and towards psychiatric services and treatment have shown a persistent negative attitude. There are, however, few studies on changes over time. The aim of this study was to compare responses to a questionnaire on attitudes towards mental disorders and psychiatric patients and the perception of psychiatric treatment in a community in northern Sweden in 1976 and 2003. In 1976 a random sample of 391 persons 18-70 years of age were asked and in 2003 a new sample of 500 persons from the same community were approached with the same questions. There are considerable changes over time. In 2003, almost 90% agree to the statement that mental illness harms the reputation more than physical illness, compared with 50% in 1976. In 2003, 51% agreed to the statement "Most people with mental disorders commit violent acts more than others" compared with 24% in 1976. There is an apparent ambivalence towards psychiatric treatment. Whilst 88% would advice a person with mental problems to contact a psychiatrist, still 26% would not like themselves to be referred to a psychiatrist. We argue that improving treatment methods is as important as changing attitudes through accurate information.

The pattern of linkage disequilibriurn (LD) is affected by a number of factors, including population dernography. High LD is seen in populations with a relatively limited and constant size, presurnably due to genetic drift. We have examined the extent of LD arnong over 300 genome-wide pattern microsatellite loci in 29 populations from around the world. The pattern of LD vari ed between populations, with larger extent of LO in populations with limited size relative to larger populations. In addition, the LD between 88 less spaced microsatellite ffiarkers from 10 different genornic regions were examined in the Sami compared to the general Swedish population. For the se ffiarkers increased LD extending up to 5 Mb was detected in the Sami. The arnount of LD also differed between the chrornosornal regions. The arnount of LD in the Sami makes this population suited for mapping ofcornplex genetic traits

Objectives. The objective of this study was to investigate symptoms and predicting factors of depression and anxiety among reindeer-herding Sami in Sweden. Study design. A total of 319 reindeer-herding Sami (168 men, 151 women) were compared with urban and rural reference populations comprising 1,393 persons (662 men, 731 women). Methods. A cross-sectional questionnaire study on mental health, which included the Hospital Anxiety and Depression Scale (HADS). Data were analysed with regard to population, gender, age group, education and work-related stress. Results. The Sami population disclosed higher mean values for both depression and anxiety than the reference groups, with Sami men reporting the highest rates. Work-related stress was associated with anxiety and depression in the Sami group. Conclusions. By comparing Sami men and women with reference groups of men and women living in urban and rural areas in northern Sweden, this study identified that reindeer-herding Sami men require special attention with regard to mental health problems.

OBJECTIVES: To determine whether treatment related pain reduction on the short- and long-term is predicted by different baseline variables, and with different accuracy, in patients with chronic low back pain as compared with those with chronic neck pain. DESIGN AND METHODS: A single blinded prospective cohort study based on patients with chronic musculoskeletal pain in the lower back (N = 167) or the neck (N = 136) who completed a 4-week multimodal rehabilitation program. At admission, each patient was evaluated on 17 potential predictors, including pain characteristics and physical, sociodemographic, and psychosocial-behavioral variables. Changes in self-reported pain intensity in the lower back or the neck between the pretreatment evaluation and those performed immediately after, and 12 months after the rehabilitation program, were assessed. RESULTS: Logistic regression models revealed that change in pain intensity could be predicted with good specificity but with poor sensitivity both for patients with chronic low back pain and chronic neck pain. Significant predictors among the neck pain patients were high endurance, low age, high pain intensity, few other symptoms, low need of being social, to do things with others, and to be helped, along with optimistic attitudes on how the pain will interfere with daily life. Among the low back pain patients, high pain intensity, low levels of pain severity, and high affective distress were important predictors. Variables such as sex, sick leave history, working status, accident, pain duration, and depressive symptoms demonstrated no predictive value. Short- and long-term pain outcome was equally predictable and predicted by almost the same variables. CONCLUSIONS: Patients who reported unchanged or increased pain after multimodal treatment could be predicted with good accuracy, whereas those who reported decreased pain were more difficult to identify. Treatment-related pain alteration in chronic low back pain seems to be predicted by partly different variables than in chronic neck pain.

Objectives. To compare the nutrient and food intake of Sami still engaged in reindeer herding (traditional lifestyle or reindeer-herding Sami [RS]) and Sami not involved in reindeer herding (industrialized lifestyle or non-reindeer-herding Sami [NRS]) with other northern Swedish populations. Study design. Cross-sectional analysis of data from a prospective cardiovascular intervention program in northern Sweden. Methods. Data were used from a prospective cardiovascular intervention program in northern Sweden. Sami recruited into this study were divided according to whether they were involved in reindeer herding (traditional lifestyle, RS) (66 females, 79 males) or not (NRS) (255 females, 195 males), and compared to non-Sami from the same area taking part in the same study (controls) (499 females, 501 males). Subjects completed a Food Frequency Questionnaire (FFQ) and clinical parameters were analysed. Results. RS had a higher overall intake of energy for both females (P<0.01) and males (P<0.05), but not total food intake compared to controls and NRS. The overall Sami diet was characterized by a higher proportion of energy from protein and fat. RS had a lower energy adjusted intake of vitamins A and E, and fibre, and a higher intake of sodium. RS and NRS both had a lower intake of vegetables and a higher intake of meat, and for RS, fish. Nutrient and food-intake patterns were similar for males and females. Conclusions. Classification of Sami into RS and NRS indicates that a traditional lifestyle defined by occupation is reflected in differences in food and nutrient intake.

OBJECTIVE: To resolve the debate over whether lumbar repositioning acuity is reduced in patients with chronic low back pain (CLBP) by using a study design and methodology to minimize the effects of potential confounders. DESIGN: A single-blinded, controlled, multigroup comparative study.

SETTING: Vocational rehabilitation center.

PARTICIPANTS: Ninety-two patients with CLBP, divided into subgroups based on severity of symptoms and diagnostic characteristics. An age- and sex-matched group (n=31) of healthy subjects were the control. I

NTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: We measured repositioning errors (variable, constant) at 3 positions of the lumbar spine. Subjects were guided to a sitting target posture and asked to perform lumbar flexion before reproducing the target posture. Self-assessed pain, self-efficacy, and functional ability were addressed through questionnaires.

RESULTS: There were no differences in repositioning errors between the patients with CLBP or the subgroups of patients and the control group. We found only weak correlations between the repositioning errors and the self-reported data on functional disability, self-efficacy, and pain.

CONCLUSIONS: We suggest that sensorimotor dysfunctions in CLBP should be evaluated with methods other than repositioning tests in order to generate data relevant to the development of rational diagnostic methods and rehabilitation programs.