| 11. |
- Brorsson, Camilla, et al.
(författare)
-
Saliva stimulation with glycerine and citric acid does not affect salivary cortisol levels
- 2014
-
Ingår i: Clinical Endocrinology. - : Wiley. - 0300-0664 .- 1365-2265. ; 81:2, s. 244-248
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:In critically ill patients with hypotension, who respond poorly to fluids and vasoactive drugs, cortisol insufficiency may be suspected. In serum over 90% of cortisol is protein-bound, thus routine measures of total serum cortisol may yield 'false lows' due to hypoproteinaemia. Thus, the occurrence of cortisol insufficiency could be overestimated in critically ill patients. Salivary cortisol can be used as a surrogate for free serum cortisol, but in critically ill patients saliva production is decreased, and insufficient volume of saliva for analysis is a common problem. The aim of this study was to investigate if a cotton-tipped applicator with glycerine and citric acid could be used for saliva stimulation without affecting salivary cortisol levels.DESIGN:Prospective, observational study.PARTICIPANTS:Thirty-six volunteers (six males, 30 females), age 49 ± 9 years, without known oral mucus membrane rupture in the mouth.MEASUREMENTS:Forty-two pairs of saliva samples (22 paired morning samples, 20 paired evening samples) were obtained before and after saliva stimulation with glycerine and citric acid. Salivary cortisol was analysed using Spectria Cortisol RIA (Orion Diagnostica, Finland).RESULTS:The paired samples correlated significantly (P < 0·0001) and there was no significant difference between un-stimulated and stimulated salivary cortisol levels.CONCLUSIONS:Saliva stimulation with a cotton-tipped applicator containing glycerine and citric acid did not significantly influence salivary cortisol levels in healthy volunteers. This indicates that salivary cortisol measurement after saliva stimulation may be a useful complement when evaluating cortisol status in critically ill patients.
|
|
| 12. |
- Brorsson, Camilla, 1967-
(författare)
-
Trauma - logistics and stress response
- 2014
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Trauma is a major cause of death and disability. Adverse events, such as prolonged prehospital time, hypoxia, hypotension and/or hyperventilation have been reported to correlate to poor outcome.Adequate cortisol levels are essential for survival after major trauma. In hypotensive critically ill patients, lack of sufficient amount of cortisol can be suspected, and a concept of critical illness related corticosteroid insufficiency has been proposed. Corticosteroid therapy has many adverse effects in critically ill patients and should only be given if life-saving. Correct measurement of serum cortisol levels is important but difficult in critically ill patients with capillary leakage. Estimation of the free and biologically active cortisol is preferable. In serum less than 10% of cortisol is free and biologically active and not possible to measure with routine laboratory methods. Salivary cortisol can be used as a surrogate for free cortisol, but salivary production is reduced in critically ill patients. Liver resection could reduce cortisol levels due to substrate deficiency.Aims: 1. Evaluate the occurrence of early adverse events in patients with traumatic brain injury and relate them to outcome. 2. Assess cortisol levels over time after trauma and correlate to severity of trauma, sedative/analgesic drugs and cardiovascular function. 3. Evaluate if saliva stimulation could be performed without interfering with salivary cortisol levels. 4. Assess cortisol levels over time after liver resection in comparison to other major surgery.Results: There was no significant correlation between prehospital time ³60 minutes, hypoxia (saturation <95%), hypotension (systolic blood pressure <90 mmHg), or hyperventilation (ETCO2 <4.5 kPa) and a poor outcome (Glasgow Outcome Scale 1-3) in patients with traumatic brain injury. Cortisol levels decreased significantly over time after trauma, but there was no correlation between low (<200 nmol/L) serum cortisol levels and severity of trauma.Infusion of sedative/analgesic drugs was the strongest predictor for a low (<200 nmol/L) serum cortisol. The odds ratio for low serum cortisol levels (<200 nmol/L) was 8.0 for patients receiving continuous infusion of sedative/analgesic drugs. There was no significant difference between unstimulated and stimulated salivary cortisol levels (p=0.06) in healthy volunteers. Liver resection was not associated with significantly lower cortisol levels compared to other major surgery.Conclusion: There was no significant correlation between early adverse events and outcome in patients with traumatic brain injury. Cortisol levels decreased significantly over time in trauma patients. Low cortisol levels (<200 nmol/L) were significantly correlated to continuous infusion of sedative/analgesic drugs. Saliva stimulation could be performed without interfering with salivary cortisol levels. Liver resection was not associated with low cortisol levels compared to other major surgery.
|
|
| 13. |
- Cluff, AH, et al.
(författare)
-
Prolonged labour associated with lower expression of syndecan 3 and connexin 43 in human uterine tissue
- 2006
-
Ingår i: Reproductive Biology and Endocrinology. - : Springer Science and Business Media LLC. - 1477-7827. ; 4
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Prolonged labour is associated with greater morbidity and mortality for mother and child. Connexin 43 is a major myometrial gap junction protein found in human myometrium. Syndecan 3 seems to prevail in the human uterus among heparan sulphate proteoglycans, showing the most significant increase during labour. The aims of the present study were to investigate syndecan 3 and connexin 43 mRNA expressions and protein distributions in human uterine tissue during normal and prolonged labour. Methods: Uterine isthmic biopsies were collected from non-pregnant (n = 7), term pregnant women not in labour (n = 14), in normal labour (n = 7) and in prolonged labour (n = 7). mRNA levels of syndecan 3 and connexin 43 were determined by real time RT-PCR. The localization and expression were demonstrated by immunohistochemistry and confocal microscopy. Results: In women with prolonged labour, the mRNA expressions of syndecan 3 and Connexin 43 were considerably lower than the expression level at normal labour (p < 0.05). In term-pregnant tissue, the expression of syndecan 3 and connexin 43 did not differ significantly compared to nonpregnant and normal labour. The immunoreactivity of syndecan 3 was strong at normal labour, in contrast to prolonged labour, where both a weaker expression and an irregular distribution were detected. The immunoreactivity of connexin 43 increased until term and further stronger staining occurred at normal labour. At prolonged labour, the immunoreactivity was weaker and more unevenly distributed. At labour, a co-localization of syndecan 3 and connexin 43 could be demonstrated in the smooth muscle by confocal microscopy. Conclusion: The high expression of syndecan 3 and connexin 43 and their co-localization to the smooth muscle bundles during normal labour, together with the significant reduction in prolonged labour, may indicate a role for these proteins in the co-ordination of myometrial contractility.
|
|
| 14. |
- Dahlqvist, Camilla, et al.
(författare)
-
Arbetsbelastning vid städning av hotellrum
- 2017
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Enligt Arbetsmiljöverkets rapport ”Arbetsmiljön 2013” har 40 procent av alla hotell- och kontorsstädare ont i nacke, rygg, axlar eller armar varje vecka. 60 procent av dem känner sig uttröttade i kroppen. Arbets- och miljömedicin (AMM) Syd har tagit fram åtgärdsnivåer för ett antal belastningsmått, ”AMM Syds åtgärdsnivåer för ergonomisk belastning”, och om man överstiger dessa, anser vi att risken för belastningsskada är stor. Vi har studerat hotellrumsstädares belastning och jämfört med våra åtgärdsnivåer.Vi mätte den fysiska arbetsbelastningen hos fjorton kvinnliga hotellrumsstädare under en vanlig arbetsdag, på en deltagare åt gången. De arbetade på sju olika hotell i södra Sverige. Några var anställda av städföretag och några direkt av hotellen.Vi fann att hotellrumsstädare har en väldigt hög arbetsbelastning i övre delen av kroppen, både vad gäller rörelsehastighet, arbetsställningar och muskelansträngning (se Tabell på sid 3). Samtliga deltagare hade för hög rörelsehastighet i överarm och handled och för lite vila i underarmens muskler i jämförelse med våra åtgärdsnivåer. Även vad gäller framåtböjningen av huvudet, överarmens arbetsställning och underarmens muskelbelastning fann vi för höga nivåer. Hotellrumsstädning överskrider nio av våra elva åtgärdsnivåer för ergonomisk belastning. Detta betyder att hotellrumsstädare har en väldigt hög risk att drabbas av belastningsskador.RekommendationerFör att minska risken för belastningsskador bland hotellrumsstädare måste arbetstempot sänkas, genom att minska antalet rum som ingår i en hotellrumsstädares arbetsdag.Personalen bör erbjudas regelbundna medicinska kontroller avseende ergonomiskt belastande arbete så att man tidigt sätter in åtgärder för den arbetstagare eller grupp av arbetstagare som är på väg att utveckla skada i muskler och/eller leder. Arbetsplatsen rekommenderas att ha företagshälsovård knuten till sig, som kan genomföra de medicinska kontrollerna och som kontinuerligt gör riskbedömningar av arbetet. De bör också ha som uppgift att utbilda städpersonalen i ergonomi.
|
|
| 15. |
|
|
| 16. |
- Dahlqvist, Camilla, et al.
(författare)
-
Comparing two methods to record maximal voluntary contractions and different electrode positions in recordings of forearm extensor muscle activity : refining risk assessments for work-related wrist disorders
- 2018
-
Ingår i: Work. - : IOS Press. - 1051-9815. ; 59:2, s. 231-242
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Wrist disorders are common in force demanding industrial repetitive work. Visual assessment of force demands have a low reliability, instead surface electromyography (EMG) may be used as part of a risk assessment for work-related wrist disorders. For normalization of EMG recordings, a power grip (hand grip) is often used as maximal voluntary contraction (MVC) of the forearm extensor muscles. However, the test-retest reproducibility is poor and EMG amplitudes exceeding 100% have occasionally been recorded during work. An alternative MVC is resisted wrist extension, which may be more reliable.Objective: To compare hand grip and resisted wrist extension MVCs, in terms of amplitude and reproducibility, and to examine the effect of electrode positioning.Methods: Twelve subjects participated. EMG from right forearm extensors, from four electrode pairs, was recorded during MVCs, on three separate occasions.Results: The group mean EMG amplitudes for resisted wrist extension were 1.2-1.7 times greater than those for hand grip. Resisted wrist extension showed better reproducibility than hand grip.Conclusions: The results indicate that the use of resisted wrist extension is a more accurate measurement of maximal effort of wrist extensor contractions than using hand grip and should increase the precision in EMG recordings from forearm extensor muscles, which in turn will increase the quality of risk assessments that are based on these.
|
|
| 17. |
- Dahlqvist, Camilla
(författare)
-
Improving technical methods for assessment of workplace ergonomic exposure
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Repetitive work, work performed in awkward and constrained postures and work with excessive or sustained muscular load is common in many occupational settings. Such work is known to be risk factors for developing musculoskeletal disorders in the neck/shoulder region and in arms and hands. One method that can be used to assess the exposure to these risk factors is technical recordings that rely on sensors attached directly to a subject. However, there is a commonly held belief that the methods are time consuming, require expensive equipment and also demand technical knowledge to perform and are therefore not suitable for all. Aims: To simplify the inclinometry method in order to make it easier to use for different actors in the work environment field, and to refine the surface electromyography (sEMG) method of the forearm extensor muscles for more accurate estimates of recorded muscular load. Methods: For the inclinometry method in the laboratory, one model of the new generation of triaxial accelerometers with integrated data loggers (GC inclinometer) were validated against traditional ones (LT inclinometer). Also the deviation angles of two simplified reference postures for upper arms from a standard reference posture were evaluated. For the field study, self-recordings of upper arm elevations were evaluated by analysing each recording twice; once with a simplified reference posture and once with a standard reference posture. For the sEMG method in the laboratory, the electrical activity of right forearm extensor muscles was recorded from four electrode pair positions during two maximal voluntary contractions (MVC; hand grip and resisted wrist extension). In the field study, the electrical activity was recorded using two electrode pair positions and the two MVCs during one working day of hotel room cleaning. Each recording was analysed twice; once with hand grip as reference contraction and once with resisted wrist extension as reference. Results: For the inclinometry method in the laboratory, all group mean absolute differences of simulated work tasks and body parts between the two inclinometers were less than 2.5°. In the field study, the upper arm elevations during work (50th percentile) were almost identical (group mean difference of 0.2°) for the two analyses using different reference postures. For sEMG in the laboratory, resisted wrist extension showed 1.2 – 1.7 times higher EMG amplitudes and lower coefficient of variation than hand grip. In the field study, the workload during cleaning was lower when using resisted wrist extension as the reference than when using hand grip. The workload (99th percentile) was overestimated in two subjects when hand grip was used as reference contraction. Conclusions: For the inclinometry method, the obtained data from the GC inclinometers were fully comparable to the data from the LT inclinometers. The simplified reference posture deviated somewhat from the standard reference, but the effect of this deviation on group recordings of work was negligible. The hotel room cleaners managed to perform self-recordings of upper arm elevations and velocities. For the sEMG, the use of resisted wrist extension may be a more accurate maximal effort of forearm extensor contraction than using hand grip. Problems associated with poorly activated forearm extensors can be overcome by using resisted wrist extension as reference.
|
|
| 18. |
|
|
| 19. |
- Dahlqvist, Camilla, et al.
(författare)
-
Self-recordings of upper arm elevation during cleaning - comparison between analyses using a simplified reference posture and a standard reference posture
- 2018
-
Ingår i: BMC Musculoskeletal Disorders. - : BMC. - 1471-2474. ; 19
-
Tidskriftsartikel (refereegranskat)abstract
- Background To reduce ergonomic risk factors in terms of awkward and constrained postures and high velocities, it is important to perform adequate risk assessments. Technical methods provide objective measures of physical workload. These methods have so far mainly been used by researchers. However, if written instructions how to apply the sensors and how to adopt the reference posture are provided, together with triaxial accelerometers, it may be possible for employees to record their own physical workload. The exposure in terms of e.g. upper arm elevations could then easily be assessed for all workers in a workplace. The main aims of this study were: 1) to compare analyses for self-recording of upper arm elevation during work using a simplified reference posture versus using a standard reference posture, and 2) to compare the two reference postures.MethodsTwenty-eight cleaners attached an accelerometer to their dominant upper arm and adopted a simplified reference according to a written instruction. They were thereafter instructed by a researcher to adopt a standard reference. Upper arm elevations were recorded for 2 or 3 days. Each recording was analysed twice; relative to the simplified reference posture and relative to the standard reference posture. The group means of the differences in recorded upper arm elevations between simplified and standard reference analyses were assessed using Wilcoxon signed ranks test. Furthermore, we calculated the group mean of the differences between the simplified reference posture and the standard reference posture.ResultsFor arm elevation during work (50(th) percentile), the group mean of the differences between the two analyses was 0.2 degrees (range-7 - 10 degrees). The group mean of the differences between the two references was 9 degrees (range 1-21 degrees). The subjects were able to follow the instructions in the protocol and performed self-recording of upper arm elevation and velocity.ConclusionsThe small difference between the two analyses indicates that recordings performed by employees themselves are comparable, on a group level, with those performed by researchers. Self-recordings in combination with action levels would provide employers with a method for risk assessment as a solid basis for prevention of work-related musculoskeletal disorders.
|
|
| 20. |
- Dahlqvist, Camilla, et al.
(författare)
-
The effect of two types of maximal voluntary contraction and two electrode positions in field recordings of forearm extensor muscle activity during hotel room cleaning
- 2020
-
Ingår i: International Journal of Occupational Safety and Ergonomics. - : Informa UK Limited. - 1080-3548 .- 2376-9130. ; 26:3, s. 595-602
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose. This study aimed to investigate the effects of using hand grip or resisted wrist extension as the reference contraction, and two electrode positions, on field recordings of forearm extensor muscle activity. Materials and methods. Right forearm extensor muscle activity was recorded using two electrode pairs (over the most prominent part (position 2) and proximal to that (position 1)) during one working day in 13 female hotel housekeepers. Each subject performed the two maximal voluntary contractions (MVCs), and the electrical activity obtained during these (maximal voluntary electrical activity (MVE)) was used for normalization. Each set of recordings was analysed twice, once using hand grip as the MVC and once using resisted wrist extension. Results. Resisted wrist extension showed a higher group mean MVE than hand grip. Position 2 had higher correlation between MVE and force during the MVCs. The workload during cleaning was lower when using resisted wrist extension as reference than when using hand grip (24%MVE vs 46%MVE; p = 0.002 at position 2) for the 90th percentile. The workload (99th percentile) was overestimated in two subjects when using hand grip as reference. Conclusions. Problems associated with poorly activated forearm extensors can be overcome by using resisted wrist extension as reference.
|
|
