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1.
  • Arumugam, Ashokan, et al. (författare)
  • Effects of neuromuscular training on knee proprioception in individuals with anterior cruciate ligament injury : A systematic review and GRADE evidence synthesis
  • 2021
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:5
  • Forskningsöversikt (refereegranskat)abstract
    • Objective: To systematically review and summarise the evidence for the effects of neuromuscular training compared with any other therapy (conventional training/sham) on knee proprioception following anterior cruciate ligament (ACL) injury.Design: Systematic Review.Data sources: PubMed, CINAHL, SPORTDiscus, AMED, Scopus and Physical Education Index were searched from inception to February 2020.Eligibility criteria: Randomised controlled trials (RCTs) and controlled clinical trials investigating the effects of neuromuscular training on knee-specific proprioception tests following a unilateral ACL injury were included.Data extraction and synthesis: Two reviewers independently screened and extracted data and assessed risk of bias of the eligible studies using the Cochrane risk of bias 2 tool. Overall certainty in evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool.Results: Of 2706 articles retrieved, only 9 RCTs, comprising 327 individuals with an ACL reconstruction (ACLR), met the inclusion criteria. Neuromuscular training interventions varied across studies: whole body vibration therapy, Nintendo-Wii-Fit training, balance training, sport-specific exercises, backward walking, etc. Outcome measures included joint position sense (JPS; n=7), thresholds to detect passive motion (TTDPM; n=3) or quadriceps force control (QFC; n=1). Overall, between-group mean differences indicated inconsistent findings with an increase or decrease of errors associated with JPS by ≤2°, TTDPM by ≤1.5° and QFC by ≤6 Nm in the ACLR knee following neuromuscular training. Owing to serious concerns with three or more GRADE domains (risk of bias, inconsistency, indirectness or imprecision associated with the findings) for each outcome of interest across studies, the certainty of evidence was very low.Conclusions: The heterogeneity of interventions, methodological limitations, inconsistency of effects (on JPS/TTDPM/QFC) preclude recommendation of one optimal neuromuscular training intervention for improving proprioception following ACL injury in clinical practice. There is a need for methodologically robust RCTs with homogenous populations with ACL injury (managed conservatively or with reconstruction), novel/well-designed neuromuscular training and valid proprioception assessments, which also seem to be lacking.PROSPERO registration number CRD42018107349.
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2.
  • Chowdhury, Mohammad Rocky Khan, et al. (författare)
  • Differences in risk factors associated with single and multiple concurrent forms of undernutrition (stunting, wasting, or underweight) among children under 5 in Bangladesh : A nationally representative cross-sectional study
  • 2021
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The current study aims at differentiating the risk factors of cooccurrence and the single dimension of undernutrition among under-5 children in Bangladesh. Design: A nationally representative cross-sectional study. Setting: Bangladesh.Participants: Children age under 5 years of age. Outcome measure: A child is considered to have cooccurrence of undernutrition if he/she has either coexistence of stunting and underweight; wasting and underweight at the same time or the coexistence of stunting, wasting, and underweight. Also, a child with a single dimension of undernutrition includes having stunting, wasting, and being underweight independently.Methods: A Chi-square test was used to assess the prevalence of undernutrition. Odds ratio (OR) and confidence interval (CI) of potential risk factors were quantified using logistic regression analysis. Results: Two out of five under-5 children are suffering undernutrition in Bangladesh. The prevalence of cooccurrence and the single dimension of child undernutrition in Bangladesh was 19.3% (95% CI: 18.2, 20.5) and 18.9 (95% CI:17.9, 19.7) respectively. The key risk factors of cooccurrence of undernutrition were children born with small birth weight [AOR-3.40, 95% CI-2.52, 5.57], socio-economically poorest households [AOR-2.29, 95% CI-1.74, 3.01] and children age group 48-59 months [AOR-2.18, 95% CI-1.80, 2.63], on the other hand, children age group 12-23 months [AOR-161, 95% CI-1.35, 1.92], socio-economically poorer households [AOR-1.41, 95% CI-1.09, 1.82] and paternal illiteracy [AOR-1.19, 95% CI-1.01, 1.42] was significantly associated with single dimension of undernutrition. Conclusion: One-fifth of the children are suffering cooccurrence of undernutrition and that is similar as measured by the single dimension of undernutrition. Parental education, mother’s undernutrition status, father’s employment status, children’s age, birth order, and small birth are the main differentiating risk factors of cooccurrence and the single dimension of undernutrition among under-5 children in Bangladesh which should be taken into consideration to formulate an evidence-based strategy to reduce undernutrition among under-5 children. 
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3.
  • Dantoft, Thomas M., et al. (författare)
  • Gene expression profiling in persons with multiple chemical sensitivity before and after a controlled n-butanol exposure session
  • 2017
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 7:2
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To investigate the pathophysiological pathways leading to symptoms elicitation in multiple chemical sensitivity (MCS) by comparing gene expression in MCS participants and healthy controls before and after a chemical exposure optimised to cause symptoms among MCS participants.The first hypothesis was that unexposed and symptom-free MCS participants have similar gene expression patterns to controls and a second hypothesis that MCS participants can be separated from controls based on differential gene expression upon a controlled n-butanol exposure.DESIGN: Participants were exposed to 3.7 ppm n-butanol while seated in a windowed exposure chamber for 60 min. A total of 26 genes involved in biochemical pathways found in the literature have been proposed to play a role in the pathogenesis of MCS and other functional somatic syndromes were selected. Expression levels were compared between MCS and controls before, within 15 min after being exposed to and 4 hours after the exposure.SETTINGS: Participants suffering from MCS and healthy controls were recruited through advertisement at public places and in a local newspaper.PARTICIPANTS: 36 participants who considered themselves sensitive were prescreened for eligibility. 18 sensitive persons fulfilling the criteria for MCS were enrolled together with 18 healthy controls.OUTCOME MEASURES: 17 genes showed sufficient transcriptional level for analysis. Group comparisons were conducted for each gene at the 3 times points and for the computed area under the curve (AUC) expression levels.RESULTS: MCS participants and controls displayed similar gene expression levels both at baseline and after the exposure and the computed AUC values were likewise comparable between the 2 groups. The intragroup variation in expression levels among MCS participants was noticeably greater than the controls.CONCLUSIONS: MCS participants and controls have similar gene expression levels at baseline and it was not possible to separate MCS participants from controls based on gene expression measured after the exposure.
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4.
  • Ernesäter, Annica, 1970-, et al. (författare)
  • A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish Healthcare Direct : a case–control study
  • 2014
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 4:10, s. e005961-
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. Setting: In many countries, telephone advice nursing is patients' first contact with healthcare. Telenurses' assessment of callers' symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported. Participants: A total sample of all reported medical errors (n=33) during the period 2003-2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected. Results: Male patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases. Conclusions: The present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems.
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5.
  • Hallman, David, 1979-, et al. (författare)
  • Are trajectories of neck-shoulder pain associated with sick leave and work ability in workers? A 1-year prospective study
  • 2019
  • Ingår i: BMJ Open. - : BMJ Journals. - 2044-6055. ; 9
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesThe study aimed to determine the extent to which latent trajectories of neck–shoulder pain (NSP) are associated with self-reported sick leave and work ability based on frequent repeated measures over 1 year in an occupational population.MethodsThis longitudinal study included 748 Danish workers (blue-collar, n=620; white collar, n=128). A questionnaire was administered to collect data on personal and occupational factors at baseline. Text messages were used for repeated measurements of NSP intensity (scale 0–10) over 1 year (14 waves in total). Simultaneously, selfreported sick leave (days/month) due to pain was assessed at 4-week intervals, while work ability (scale 0–10) was assessed using a single item (work ability index) at 12-week intervals over the year. Trajectories of NSP, distinguished by latent class growth analysis, were usedas predictors of sick leave and work ability in generalised estimation equations with multiple adjustments.ResultsSick leave increased and work ability decreased across all NSP trajectory classes (low, moderate, strong fluctuating and severe persistent pain intensity). In the adjusted model, the estimated number of days on sickleave was 1.5 days/month for severe persistent NSP compared with 0.1 days/month for low NSP (relativ risk=13.8, 95% CI 6.7 to 28.5). Similarly, work ability decreased markedly for severe persistent NSP (OR=12.9,95% CI 8.5 to 19.7; median 7.1) compared with low NSP (median 9.5).ConclusionSevere persistent NSP was associatedwith sick leave and poor work ability over 1 year amongworkers. Preventive strategies aiming at reducing severepersistent NSP among working populations are needed.
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6.
  • Hallman, David, et al. (författare)
  • Is prolonged sitting at work associated with the time course of neck-shoulder pain? : A prospective study in Danish blue-collar workers
  • 2016
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 6:11
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesThis study aimed to determine the extent to which objectively measured sitting time at work is associated with the course of neck-shoulder pain across one year in blue-collar workers.MethodsData was analyzed from 625 blue-collar workers in the Danish DPHACTO cohort study (2012-2013). Objective data on sitting time were collected at baseline using accelerometry. Self-reported pain intensity (numeric rating scale 0-10) in the neck-shoulder region was registered for one year using repeated text messages (14 in total). Linear Mixed Models were used to determine the relationship between percent time in sitting at work and trajectories of neck-shoulder pain, with and without adjustment for demographic, occupational and lifestyle factors, and baseline pain intensity.ResultsMore sitting time at work was associated with a faster decline in pain intensity over 12-months, as indicated by a statistically significant effect of sitting on pain trajectories in the crude (p=0.020) and fully adjusted models (p=0.027).Conclusion                              In blue-collar workers, more sitting time at work was associated with a favorable development of pain intensity over time. The relationship between sitting at work and pain needs further investigation before explicit recommendations and guidelines on sedentary behavior among blue-collar workers can be developed.
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7.
  • Jackson, Jennie, et al. (författare)
  • Assessing the efficacy of a job rotation for improving occupational physical and psychosocial work environment, musculoskeletal health, social equality, production quality, and resilience at a commercial laundromat: Protocol for a longitudinal case study
  • 2023
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 13:5
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Job rotation is a work organization strategy used to reduce work‐related exposures and musculoskeletal complaints, yet evidence for the efficacy of the approach is weak. Mismatch between job rotation and company needs, lack of full implementation, lack of exposure variation in included tasks, and failure to assess variation may underlie inconclusive research findings to date. The study aims to develop a job rotation with company stakeholders, perform a process evaluation of the implementation, and determine the extent to which the intervention improves the physical and psychosocial work environment, indicators of health, gender and social equality among workers, and production quality and resilience.Methods and analysis: Approximately 60 production workers at a Swedish commercial laundromat will be recruited. Physical and psychosocial work environment conditions, health, productivity and gender and social equality will be assessed pre‐ and post‐ intervention using surveys, accelerometers, heart rate, electromyography and focus groups. A task‐based exposure matrix will be constructed, and exposure variation estimated at the level of the individual worker pre‐ and post‐ intervention. An implementation process evaluation will be conducted. Job rotation efficacy will be assessed in terms of improvement in work environment conditions, health, gender and social inequality, and production quality and resilience. This study will provide novel information on the effects of the job rotation on physical and psychosocial work environment conditions, production quality and rate, health, and gender and social inequality among blue‐collar workers in a highly multicultural workplace.Ethics and dissemination: The study received approval from the Swedish Ethical Review Authority. Results of the project will be shared directly with the employees, managers and union representatives from the participating company, other relevant labour market stakeholders, and with researchers at national and international conferences and via scientific publication.Trial registration: The study is pre‐registered with the Open Science Framework (https://osf.io/zmdc8/).
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8.
  • Kaltenbrunner, Monica, 1975-, et al. (författare)
  • Associations between lean maturity in primary care and musculoskeletal complaints among staff : a longitudinal study
  • 2023
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:2
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveThis study had two aims: (1) to determine the prevalence of musculoskeletal complaints among staff in primary care and (2) to determine to what extent lean maturity of the primary care unit can predict musculoskeletal complaints 1 year later.DesignDescriptive, correlational and longitudinal design.SettingPrimary care units in mid-Sweden.ParticipantsIn 2015, staff members responded to a web survey addressing lean maturity and musculoskeletal complaints. The survey was completed by 481 staff members (response rate 46%) at 48 units; 260 staff members at 46 units also completed the survey in 2016.Outcome measuresAssociations with musculoskeletal complaints were determined both for lean maturity in total and for four Lean domains entered separately in a multivariate model, that is, philosophy, processes, people and partners, and problem solving.ResultsThe shoulders (12-month prevalence: 58%), neck (54%) and low back (50%) were the most common sites of 12-month retrospective musculoskeletal complaints at baseline. Shoulders, neck and low back also showed the most complaints for the preceding 7 days (37%, 33% and 25%, respectively). The prevalence of complaints was similar at the 1-year follow-up. Total lean maturity in 2015 was not associated with musculoskeletal complaints, neither cross-sectionally nor 1 year later, for shoulders (1 year beta: -0.002, 95% CI -0.03 to 0.02), neck (beta: 0.006, 95% CI -0.01 to 0.03), low back (beta: 0.004, 95% CI -0.02 to 0.03) and upper back (beta: 0.002, 95% CI -0.02 to 0.02).ConclusionThe prevalence of musculoskeletal complaints among primary care staff was high and did not change within a year. The extent of lean maturity at the care unit was not associated with complaints among staff, neither in cross-sectional analyses nor in a 1-year predictive analysis.
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9.
  • Magnusson, Peter, et al. (författare)
  • Health-related quality of life in patients with implantable cardioverter defibrillators in Sweden : a cross-sectional observational trial
  • 2021
  • Ingår i: BMJ Open. - : BMJ Journals. - 2044-6055. ; 11:7
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: Decisions regarding implantable cardioverter defibrillators (ICDs) must consider information about presumed health-related quality of life (HRQL). The purpose of the study was to assess HRQL in patients with ICD and compare it to a Swedish age-matched and sex-matched population.DESIGN: Cross-sectional observational trial.SETTING: Swedish ICD cohort.INTERVENTIONS: Short form 36 (SF-36) questionnaires from ICD recipients implanted 2007-2017 (response rate 77.2%) were analysed using Mann-Whitney U test and effect size (ES).RESULTS: In total, 223 patients (mean age 71.1±9.7 years, 82.1% men) were included. In most SF-36 domains (physical functioning (PF), role physical, general health (GH), vitality, social functioning and mental health), the score for patients with ICD was significantly lower (ES range 0.23-0.41, ie, small difference) than norms, except for bodily pain and role emotional. Both the physical component summary (PCS) and the mental component summary (MCS) scores had ES=0.31. Men and women had similar scores. Primary and secondary prevention patients scored similarly, except for worse GH in primary prevention (p=0.016, ES=0.35). Atrial fibrillation was associated with worse PF (ES=0.41) and PCS (ES=0.38). Appropriate therapy, inappropriate shock or complications requiring surgery were not associated with lower scores in any domain. In primary prevention due to ischaemic versus non-ischaemic cardiomyopathy, no domain was significantly different. PCS decreased with higher age strata (p=0.002) in contrast to MCS (p=0.986).CONCLUSIONS: Patients with ICDs have lower physical and mental HRQL than age-matched and sex-matched norms; however, the ESs are small. HRQL is similar regardless of sex, primary/secondary prevention indication, appropriate therapy, inappropriate shock or complications, but decreases with advancing age.
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10.
  • Mathiassen, Svend Erik, et al. (författare)
  • Equal health at work? Protocol for an observational study of work organisation, workload and musculoskeletal complaints among women and men in grocery retail
  • 2020
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 10:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction Women generally report more work-related musculoskeletal complaints than men and have higher rates of sickness absence, even within occupations. One likely reason is that work tasks within the occupation are gendered, i.e. women and men have different tasks, even when sharing the same job title. Retail is an appealing sector for studying working conditions and work environment in a gender context. The prevalence of work-related complaints is high, physical loads may differ considerably between tasks, and the distribution of tasks is likely gendered. The overall aim of this study in retail is to examine factors at the organisational and individual level that may, in a gender perspective, explain working conditions, work tasks, workloads, and musculoskeletal health. Methods and analyses Data will be collected in two grocery stores, each with 50-70 workers, at two occasions interspersed by about one year. In each of these four waves, data collection will include a web-based questionnaire to all workers addressing, e.g. work tasks, psychosocial factors, fatigue and pain; semi-structured interviews with managers and around 10 workers addressing, e.g. competences and decision levels; and technical measurements of postures, movements and heart rate in about 30 workers. The study is novel in combining an organisational gender perspective addressed through qualitative methods with a quantitative analysis of tasks, workload and health. The design allows an examination of both how genders may differ, and why they may differ, as well as analyses of the extent to which gendered working conditions change over time in the two participating stores.Ethics and dissemination Approval of the study by the Swedish Ethical Review Authority (reference number 2017/404) has been obtained. This work will be disseminated by publication of peer-reviewed papers in scientific journals, presentations at scientific conferences, and in meetings with representatives from Swedish retail, including unions and employers’ organisations.
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