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- Aasa, Ulrika, et al.
(författare)
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Stress monitoring of ambulance personnel during work and leisure time
- 2006
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Ingår i: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 0340-0131 .- 1432-1246. ; 80:1, s. 51-59
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of the present study was to assess physiological and subjective stress markers during a 24-h ambulance work shift and during the next two work-free days, and relate these parameters to self-reported health complaints. Methods: Twenty-six ambulance personnel were followed during a 24-h work shift and during the next two work-free days with electrocardiogram, cortisol assessments and diary notes. The ambulance personnel also performed tests of autonomic reactivity before and at the end of the work shift. The subjects were categorized into two groups according to their number of health complaints. Results: In general, stress markers did not show differences between the work shift and leisure time. However, a modest deviation in heart rate variability pattern and higher morning cortisol values during work in comparison with work-free days were observed in personnel with many health complaints. Conclusions: Subjective and physiological characteristics of ambulance personnel did not indicate distinctive stress during the 24-h work shift. Relationships between frequent health complaints and specific work-related factors require further prospective studies.
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| 4. |
- Bergfors, M, et al.
(författare)
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Short-term effects of repetitive arm work and dynamic exercise on glucose metabolism and insulin sensitivity.
- 2005
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Ingår i: Acta Physiologica Scandinavica. - 0001-6772 .- 1365-201X. ; 183:4, s. 345-356
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To detennine whether repetitive ann work, with a large component of static muscle contraction alters glucose metabolism and insulin sensitivity. Methad: Euglycemic clamps (2h) were started in ten healthy individuals 15 minutes after 37 minute periods of: 1) repetitive ann work in a simulated occupational setting; 2) dynamic concentric exercise on a cycle ergometer at 60% OfVO2 max and 3) a resting regime as a control. During the experimental periods, blood samples were collected, blood pressure was measured repeatedly and electrocardiogram (ECG) wasrecorded continuously. During the clamps, euglycemia was maintained at 5 mmo1/l and insulin was infused at 56 mU/m2/min for 120 min. Results: The insulin-mediated glucose disposal rate (M-value) for the steady state period (60- 120 min) of the clamp, tended to be lower following ann work than for both cycling and resting regimes. When dividing the steady state period into 20-minute intervals, the insulin sensitivity index, (ISI) was significantly lower for ann work compared with the resting control situation between 60-80 minutes (p=0.04) and 80-100 minutes (p=0.01) respectively. Catecholamines increased significantly for ann work and cycling compared with resting regime. .Data from heart rate variability (HRV) me asurements indicated significant sympathetic activation during repetitive ann work test. Canelusian: The results indicate that repetitive ann work might acutely promote insulin resistance, whereas no such effect on insulin resistance was produced by dynamic concentric exercise.
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- Kalezic, Nebojsa
(författare)
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Autonomic reactivity in muscle pain : clinical and experimental assessment
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There are numerous indications of possible involvement of the autonomic nervous system in the genesis of chronic pain. The possibility exists that sympathetic activation is related to motor dysfunction and changes in sensory processing, which have otherwise been implicated in musculoskeletal disorders.The primary aim of the thesis has been to investigate autonomic regulation at rest and in response to laboratory tests of autonomic function in subjects suffering from chronic pain in different localisations (lower back, neck-shoulder and neck-jaw), as well as to study the relations between autonomic regulation, proprioceptive acuity and clinical data. Secondary aim has been to assess autonomic regulation in fit, pain-free subjects in response to experimentally induced pain and in occupationally relevant settings.A total of 194 subjects suffering from chronic pain participated [low back pain (LBP) n=93; non-traumatic neck pain (NT) n=40, Whiplash associated disorder (WAD) n=40, Whiplash with temporomandibular dysfunction (WADj) n=21]. Each chronic pain group was subjected to a battery of autonomic function tests combining cognitive (Stroop Colour-Word conflict tests), physical (handgrip), sensory (unpleasant sound) and motor tasks (chewing tests) as well as the activation of reflex pathways (paced breathing and the orthostatic test) and compared to an age- and gender balanced control group. Autonomic regulation was also assessed in exposure to experimentally induced muscle pain in healthy subjects (n=24) in order to describe acute pain reaction. Further assessment was carried out during monotonous repetitive work and dynamic work in healthy subjects (n=10) and in a three-day monitoring of ambulance personnel (n=26) in occupational settings.Autonomic regulation was evaluated using cardiovascular (heart rate and heart rate variability, local blood flow and blood pressure), respiratory (breathing rate) electrodermal (skin conductance), muscular (trapezius and masseter EMG) and biochemical (insulin, cortisol, catecholamines) variables. Proprioceptive acuity was assessed using active-active repositioning tests. Pain levels were assessed using Visual-analogue or Numerical Rating scales. General health was evaluated through the Short-Form SF-36 Health Related Quality of Life questionnaire and Self-Efficacy Score questionnaires, whereas dysfunction was evaluated using the Oswestry Low Back Pain questionnaire, Pain Disability and Neck Disability Index questionnaires, the McKenzie evaluation and primary healthcare diagnoses. Self-reports of pain, stress and exertion were acquired prior to, during and post-testing.Chronic pain subjects were characterised by increased sympathetic and decreased parasympathetic activity as reflected in heart rate (LBP, WAD, WADj), heart rate variability (LBP, WAD, WADj), blood pressure (WADj) and electrodermal activity (LBP). In general, WAD showed more pain and dysfunction than NT, with lower self-efficacy and health-related quality of life. Differential reactivity was observed only in WAD, with increased responsiveness to sensory stimuli (heart rate variability, electrodermal activity), and motor tasks (heart rate) and a decreased response to cognitive challenge (heart rate variability, electrodermal activity). A significant part of WADj subjects showed sensorimotor impairment and low endurance in chewing tests, concomitant with a cardiovascular response that correlated with pain levels. Proprioceptive acuity was not found to be impaired among subjects suffering from chronic pain, and there were no indications of significant individual response specificity. Response to experimentally induced muscle pain in healthy subjects was also characterised by a prominent cardiovascular component. In simulated occupational settings autonomic activation and transient insulin resistance were detected in healthy subjects following monotonous repetitive work, with no similar effects following dynamic exercise. Modest deviations in circadian heart rate variability patterns during workdays were detected in ambulance personnel reporting more pronounced musculoskeletal symptoms, with no such effects on work-free days.Autonomic balance observed in chronic pain subjects was characterised by a trend towards increased sympathetic activity in comparison with pain-free controls. Moderate signs of affected reactivity to autonomic function tests were observed in patients with WAD, however no specific reaction patterns have been observed in any chronic pain group. Correspondence between the intensity of pain and autonomic activity was observed in acute pain and in chronic pain groups characterised by higher pain levels. As indicated by autonomic and neurohormonal changes in the recovery from real and simulated work, further studies with physiological monitoring of the effects of work-related stress are warranted for better understanding of the mechanism of musculoskeletal disorders.
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| 7. |
- Kalezic, Nebojsa, et al.
(författare)
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Cardiovascular and muscle activity during chewing in whiplash-associated disorders (WAD)
- 2010
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Ingår i: Archives of Oral Biology. - : Elsevier BV. - 0003-9969 .- 1879-1506. ; 55:6, s. 447-453
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The present study aimed to elucidate possible physiological mechanisms behind impaired endurance during chewing as previously reported in WAD. We tested the hypothesis of a stronger autonomic reaction in WAD than in healthy subjects in response to dynamic loading of the jaw-neck motor system. Design. Cardiovascular reactivity, muscle fatigue indicies of EMG, and perceptions of fatigue, exhaustion and pain were assessed during standardised chewing. Twenty-one WAD subjects and a gender/age matched control group participated. Baseline recordings were followed by two sessions of alternating unilateral chewing of a bolus of gum with each session followed by a rest period. Results. More than half of the WAD subjects terminated the test prematurely due to exhaustion and pain. In line with our hypothesis the chewing evoked an increased autonomic response in WAD exhibited as a higher increase in heart rate as compared to controls. Furthermore, we saw consistently higher values of arterial blood pressure for WAD than for controls across all stages of the experiment. Masseter EMG did not indicate muscle fatigue nor were there group differences in amplitude and mean power frequency. Pain in the WAD group increased during the first session and remained increased, whereas no pain was reported for the controls. Conclusion. More intense response to chewing in WAD might indicate pronounced vulnerability to dynamic loading of the jaw-neck motor system with increased autonomic reactivity to the test. Premature termination and autonomic involvement without EMG signs of muscle fatigue may indicate central mechanisms behind insufficient endurance during chewing.
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| 9. |
- Kalezic, Nebojsa, et al.
(författare)
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Physiological reactivity to functional tests in patients with chronic low back pain
- 2007
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Ingår i: Journal of Musculoskeletal Pain. - Binghamton : Haworth Press. - 1058-2452 .- 1540-7012. ; 15:1, s. 29-40
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of the present study was to investigate autonomic regulation at rest and in response to functional laboratory tests in patients with chronic low back pain [CLBP], as well as its possible relations to different characteristics of the clinical picture.Methods: Ninety-three CLBP patients [47 females, 45 males; age 38 +/- 7 years] and 32 healthy normal control subjects [15 females, 16 males: 36 +/- 9 years] participated. Subjects were examined according to the McKenzie procedure, and filled in Short Form 36 and Oswestry Disability Questionnaires in addition to self-reports of pain. An electrocardiogram, finger plethysmogram, respiration, and skin conductance were recorded. Functional tests included the Stroop Color-Word test, orthostatic test, paced breathing, and handgrip. A five-minute baseline recording was followed by four counterbalanced functional tests, separated by two- to three-minute long pauses.Results: An analysis of variance revealed higher baseline heart rate [P=0.011 in females only], low frequency spectral power [P=0.001] and electrodermal activity [P=0.048], and lower high frequency spectral power [P=0.001]. Each functional test evoked a response, without any group differences in physiological reactivity. There were no significant differences with respect to physiological reactivity between subgroups formed on the basis of prior diagnoses, McKenzie evaluation, VAS pain estimates, Short Form 36, and Oswestry Disability Questionnaire data. The patients did not show high levels of individual response specificity.Conclusions: Presented data show that patients with CLBP exhibit increased sympathetic tonus in comparison with the control group, regardless of CLBP patients' level of pain, functional disability, or clinical status indices.
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