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1.
  • Stjernbrandt, Albin, et al. (författare)
  • Occupational cold exposure and symptoms of carpal tunnel syndrome : a population-based study
  • 2022
  • Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 23:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Cold exposure is an underrecognized occupational hazard that may increase the risk of peripheral nerve entrapment. The aim of this study was to determine if self-reported occupational exposure to contact and ambient cooling was associated with symptoms of carpal tunnel syndrome (CTS).METHODS: In this mainly cross-sectional study, surveys were conducted on a population-based sample of men and women between 18 and 70 years of age, living in northern Sweden. Cold exposure and presence of symptoms suggestive of CTS were subjectively reported. Associations between exposure and outcome were evaluated using logistic regression.RESULTS: The study included 2,703 women and 2,314 men, with a median age of 60 years (interquartile range 19). Symptoms of CTS were reported by 453 (9.2%). Being highly occupationally exposed (almost always) to contact cooling of the hands was associated with reporting CTS (OR 3.20; 95% CI 1.62-6.33), as was ambient cooling (OR 2.00; 95% CI 1.03-3.88) and severe ambient cooling (OR 4.02 95% CI 2.09-7.71), after adjusting for age, gender, body mass index, current daily smoking, diabetes mellitus, joint disease, and hand-arm vibration exposure. The point estimates increased with longer daily exposure duration. For workers exposed to severe ambient cooling for more than half of their working hours, in addition to performing heavy manual handling every day, the OR for reporting CTS was 7.25 (95% CI 3.88-13.53), with a positive additive interaction effect (expressed as relative excess risk due to interaction) of 4.67.CONCLUSIONS: Self-reported occupational exposure to contact and ambient cooling was associated with symptoms suggestive of CTS. There were statistically significant positive exposure-response patterns for time spent exposed to contact and ambient cooling at work in relation to reporting symptoms of CTS. Positive additive interaction effects between cold exposure and heavy manual handling were also found. Since there was important potential uncontrolled confounding regarding repetitive wrist movements and forceful gripping, the results need to be confirmed by other studies, preferably with longitudinal design and more detailed exposure assessment.
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2.
  • Stjernbrandt, Albin, et al. (författare)
  • Occupational cold exposure is associated with upper extremity pain
  • 2023
  • Ingår i: Frontiers in Pain Research. - : Frontiers Media S.A.. - 2673-561X. ; 4
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Occupational cold exposure is common in Sweden but potential impacts on musculoskeletal disorders have not been thoroughly investigated. The primary aim of this study was to determine the associations between occupational contact and ambient cooling in relation to pain in the upper extremity.Methods: In this cross-sectional study, a digital survey was conducted on a population-based sample of women and men between 24 and 76 years of age, living in northern Sweden. Occupational cold exposure, heavy manual handling, work with vibrating tools as well as the presence of upper extremity pain at different sites were subjectively reported. Associations between exposure and outcome were evaluated using multiple binary logistic regression.Results: The final study sample included 2,089 (54.4%) women and 1,754 men, with a mean age of 56 years. Hand pain was reported by 196 (5.2%), lower arm pain by 144 (3.8%), and upper arm pain by 451 (11.9%). Severe ambient cooling for more than half of the working time was statistically significantly associated with hand pain (OR: 2.30; 95% CI: 1.23–4.29) and upper arm pain (OR: 1.57; 95% CI: 1.00–2.47) but not lower arm pain (OR: 1.87; 95% CI: 0.96–3.65) after adjusting for gender, age, body mass index, current daily smoking, heavy manual handling, and work with vibrating tools.Conclusions: Occupational cold exposure was statistically significantly associated with hand pain and upper arm pain. Therefore, occupational cold exposure should be recognized as a potential risk factor for musculoskeletal disorders in the upper extremity.
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3.
  • Burström, Lage, 1954-, et al. (författare)
  • White fingers, cold environment, and vibration : exposure among Swedish construction workers
  • 2010
  • Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 36:6, s. 509-513
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives The aim of this study was to examine the association between white fingers, cold environment, and exposure to hand–arm vibration (HAV). The hypothesis was that working in cold climate increases the risk of white fingers.Methods The occurrence of white fingers was investigated as a cross-sectional study in a cohort of Swedish male construction workers (N=134 757). Exposure to HAV was based on a job-exposure matrix. Living in the north or south of Sweden was, in a subgroup of the cohort, used as an indicator of the exposure to cold environment (ie, living in the north meant a higher exposure to cold climate). The analyses were adjusted for age and use of nicotine products (smoking and snuff).Results HAV-exposed workers living in a colder climate had a higher risk for white fingers than those living in a warmer climate [odds ratio (OR) 1.71, 95% confidence interval (95% CI) 1.42–2.06]. As expected, we found that HAV-exposed workers had an increased risk compared to controls (OR 2.02, 95% CI 1.75–2.34). The risk for white fingers increased with increased level of exposure to HAV and also age.Conclusions Cold environment increases the risk for white fingers in workers occupationally exposed to HAV. The results underscore the need to keep exposure to HAV at workplaces as low as possible especially in cold climate.
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4.
  • Carlsson, Daniel, 1982-, et al. (författare)
  • Can sensation of cold hands predict Raynaud's phenomenon or paraesthesia?
  • 2018
  • Ingår i: Occupational Medicine. - : Oxford University Press (OUP). - 0962-7480 .- 1471-8405. ; 68:5, s. 314-319
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Raynaud's phenomenon and neurosensory symptoms are common after hand-arm vibration exposure. Knowledge of early signs of vibration injuries is needed. Aims To investigate the risk of developing Raynaud's phenomenon and paraesthesia in relation to sensation of cold hands in a cohort of male employees at an engineering plant. Methods We followed a cohort of male manual and office workers at an engineering plant in Sweden for 21 years. At baseline (1987 and 1992) and each follow-up (1992, 1997, 2002, 2008), we assessed sensation of cold, Raynaud's phenomenon and paraesthesia in the hands using questionnaires and measured vibration exposure. We calculated risk estimates with univariate and multiple logistic regression analyses and adjusted for vibration exposure and tobacco usage. Results There were 241 study participants. During the study period, 21 individuals developed Raynaud's phenomenon and 43 developed paraesthesia. When adjusting the risk of developing Raynaud's phenomenon for vibration exposure and tobacco use, the odds ratios were between 6.0 and 6.3 (95% CI 2.2-17.0). We observed no increased risk for paraesthesia in relation to a sensation of cold hands. Conclusions A sensation of cold hands was a risk factor for Raynaud's phenomenon. At the individual level, reporting a sensation of cold hands did not appear to be useful information to predict future development of Raynaud's phenomenon given a weak to moderate predictive value. For paraesthesia, the sensation of cold was not a risk factor and there was no predictive value at the individual level.
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5.
  • Carlsson, Daniel, et al. (författare)
  • Neurosensory and vascular function after 14 months of military training comprising cold winter conditions
  • 2016
  • Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian journal of work, environment & health. - 0355-3140 .- 1795-990X. ; 42:1, s. 61-70
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: This study aimed to examine the effects of 14 months of military training comprising cold winter conditions on neurosensory and vascular function in the hands and feet.METHODS: Military conscripts (N=54) were assessed with quantitative sensory testing comprising touch, temperature, and vibration perception thresholds and finger systolic blood pressure (FSBP) after local cooling and a questionnaire on neurosensory and vascular symptoms at both baseline and follow-up. Ambient air temperature was recorded with body worn temperature loggers.RESULTS: The subjects showed reduced sensitivity to perception of touch, warmth, cold and vibrations in both the hands and feet except from vibrotactile perception in digit two of the right hand (right dig 2). Cold sensations, white fingers, and pain/discomfort when exposed to cold as well as pain increased in both prevalence and severity. There were no statistically significant changes in FSBP after local cooling.CONCLUSION: Fourteen months of winter military training comprising cold winter conditions reduced sensation from touch, warmth, cold, and vibrotactile stimulus in both hands and feet and increased the severity and prevalence of symptoms and pain. The vascular function in the hands, measured by FSBP after local cooling, was not affected.
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6.
  • da Silva, Marisa, et al. (författare)
  • Cohort profile : The Obesity and Disease Development Sweden (ODDS) study, a pooled cohort
  • 2024
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 14:7
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The Obesity and Disease Development Sweden (ODDS) study was designed to create a large cohort to study body mass index (BMI), waist circumference (WC) and changes in weight and WC, in relation to morbidity and mortality.PARTICIPANTS: ODDS includes 4 295 859 individuals, 2 165 048 men and 2 130 811 women, in Swedish cohorts and national registers with information on weight assessed once (2 555 098 individuals) or more (1 740 761 individuals), in total constituting 7 733 901 weight assessments at the age of 17-103 years in 1963-2020 (recalled weight as of 1911). Information on WC is available in 152 089 men and 212 658 women, out of whom 108 795 have repeated information on WC (in total 512 273 assessments). Information on morbidity and mortality was retrieved from national registers, with follow-up until the end of 2019-2021, varying between the registers.FINDINGS TO DATE: Among all weight assessments (of which 85% are objectively measured), the median year, age and BMI (IQR) is 1985 (1977-1994) in men and 2001 (1991-2010) in women, age 19 (18-40) years in men and 30 (26-36) years in women and BMI 22.9 (20.9-25.4) kg/m 2 in men and 23.2 (21.2-26.1) kg/m 2 in women. Normal weight (BMI 18.5-24.9 kg/m 2) is present in 67% of assessments in men and 64% in women and obesity (BMI≥30 kg/m 2) in 5% of assessments in men and 10% in women. The median (IQR) follow-up time from the first objectively measured or self-reported current weight assessment until emigration, death or end of follow-up is 31.4 (21.8-40.8) years in men and 19.6 (9.3-29.0) years in women. During follow-up, 283 244 men and 123 457 women died. FUTURE PLANS: The large sample size and long follow-up of the ODDS Study will provide robust results on anthropometric measures in relation to risk of common diseases and causes of deaths, and novel findings in subgroups and rarer outcomes.
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7.
  • Eklöf, Mats, et al. (författare)
  • Workplace intervention for improved risk perception and preventive activity among workers : using hand-held vibrating machines: a pilot study
  • 2023
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • This article presents a pilot study of a 1-h workplace educational intervention implemented among ten construction workers who were highly exposed to hand–arm vibration. The intervention combined risk communication and normative expert advice intended to reinforce preventive behaviour related to vibration, noise, and biomechanical loads. Data for this study comprised intervention notes and interview data from interventionists, and pre- and post-intervention interview data from participating workers.The results suggested that the intervention was sensitive to disturbances and should be directed only to motivated workers possessing sufficient self-efficacy, and only in circumstances in which exposure may be controlled on the local workplace level and by locally implemented measures. Unless these conditions are present, the studied intervention may fail to influence preventive behaviour, and may instead cause cognitive dissonance and frustration among participants and interventionists.
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8.
  • Jackson, Jennie A, et al. (författare)
  • Occupational biomechanical risk factors for surgically treated ulnar nerve entrapment in a prospective study of male construction workers
  • 2019
  • Ingår i: Scandinavian Journal of Work, Environment and Health. - : Nordic Association of Occupational Safety and Health (NOROSH). - 0355-3140 .- 1795-990X. ; 45:1, s. 63-72
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The aim of this study was to determine the association between occupational biomechanical exposures and occurrence of surgically treated ulnar nerve entrapment (UNE).Methods: A cohort of 229 689 male construction workers who participated in a national occupational health surveillance program (1971–1993) were examined prospectively over a 13-year case ascertainment period (2001–2013) for surgically treated UNE. Job title (construction trade), smoking status, height, weight and age were recorded on examination. Job titles were merged into occupational groups of workers performing similar work tasks and having similar training. Occupational biomechanical exposure estimates were assigned to each occupational group with a job exposure matrix (JEM) developed for the study. Negative binomial models were used to assess the relative risks for each biomechanical exposure and the sums of highly correlated biomechanical exposures. Surgical treatment of UNE was determined via a linkage with the Swedish Hospital Outpatient Surgery Register.Results: There were 555 cases of surgically treated UNE within the cohort. Workers exposed to forceful hand-grip factors had a 1.4-fold higher relative risk (95% CI 1.18–1.63) of undergoing surgical treatment for UNE compared to unexposed workers. Occupational groups comprising workers exposed to forceful hand-grip work showed the highest risks for UNE and included concrete workers, floor layers, ground preparatory workers, rock blasters, and sheet-metal workers.Conclusion: Forceful hand-grip work increases the risk for surgically treated ulnar nerve entrapment.
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9.
  • Jackson, Jennie, et al. (författare)
  • Biomechanical risk factors for surgically treated ulnar nerve entrapment in a cohort of Swedish male construction workers
  • 2018
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Background: The literature on occupational risk factors for ulnar nerve entrapment (UNE), also called cubital tunnel syndrome is sparse.Objectives: The aim was study the association between occupational biomechanical exposures and UNE.Methods: The occurrence of UNE was examined prospectively in a cohort of 229 689 Swedish male construction workers who participated in a nation-wide occupational health surveillance program between 1971 and 1996. UNE case status was defined on the basis of a surgical release of ulnar nerve entrapment; case data were obtained from a national outpatient database for a 13 year observation period (2001-2013). Individual risk factors considered were smoking status, BMI and age. Biomechanical exposure estimates were assigned at the occupational group level using a job exposure matrix developed specifically for the study and included 10 ergonomic (force/posture/repetition) and 2 hand-arm vibration exposure parameters determined a priori to be relevant to UNE. Relative risks (RR) for all biomechanical factors were modelled using negative binomial regression analyses and adjusted for age, smoking habits and BMI.Results: There were 555 cases of surgically treated UNE in the cohort and the average annual incidence was 19.2 cases per 100,000 person-years. Smoking status (ever vs. never smoker RR=1.28, 95% CI=1.07-1.54) and BMI (≥25 kg/m2 vs. < 25 kg/m2 RR=1.60 , 95% CI=1.34-1.91) were associated with increased risk of UNE. Increased grip force (RR=1.54, 95% CI =1.24-1.92), hand-Arm-vibration (RR=1.35, 95% CI=1.07-1.71) upper extremity load (RR=1.63, 95% CI=1.30-1.92), and increased frequency of hand tool use (RR =1.37, 95% CI=1.09-1.71), elbow flexion and extension (RR=1.36, 95% CI=1.10-1.68), and static work (RR=1.36, 95% CI=1.12-1.65) were also associated with increased risk of UNE.Discussion and Conclusions: Our findings demonstrate that multiple biomechanical factors were associated with increased risk of UNE. Many of the identified risk factors involved elevated hand grip force (grip force, upper extremity load, and frequency of hand tool use and hand-arm vibration) which may indicate it is a key etiological aspect of UNE.
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10.
  • Jackson, Jennie, et al. (författare)
  • Occupational biomechanical risk factors for radial nerve entrapment in a 13-year prospective study among male construction workers
  • 2019
  • Ingår i: Occupational and Environmental Medicine. - : BMJ Publishing Group. - 1351-0711 .- 1470-7926. ; 76:5, s. 326-331
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives The aim was to assess the association between occupational biomechanical exposure and the occurrence of radial nerve entrapment (RNE) in construction workers over a 13-year follow-up period. Methods A cohort of 229 707 male construction workers who participated in a national occupational health surveillance programme (1971-1993) was examined prospectively (2001-2013) for RNE. Height, weight, age, smoking status and job title (construction trade) were obtained on health examination. RNE case status was defined by surgical release of RNE, with data from the Swedish national registry for out-patient surgery records. A job exposure matrix was developed, and biomechanical exposure estimates were assigned according to job title. Highly correlated exposures were summed into biomechanical exposure scores. Negative binomial models were used to estimate the relative risks (RR) (incidence rate ratios) of RNE surgical release for the biomechanical factors and exposure sum scores. Predicted incidence was assessed for each exposure score modelled as a continuous variable to assess exposure-response relationships. Results The total incidence rate of surgically treated RNE over the 13-year observation period was 3.53 cases per 100 000 person-years. There were 92 cases with occupational information. Increased risk for RNE was seen in workers with elevated hand-grip forces (RR=1.79, 95% CI 0.97 to 3.28) and exposure to hand-arm vibration (RR=1.47, 95% CI 1.08 to 2.00). Conclusions Occupational exposure to forceful handgrip work and vibration increased the risk for surgical treatment of RNE.
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11.
  • Jackson, Jennie, et al. (författare)
  • Occupational risk factors for hospitalization due to cervical disc disorder in a 29-year prospective study of Swedish male construction workers
  • 2019
  • Ingår i: PREMUS 2019. ; , s. 168-168
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Background: The aim of this study was to assess the associations between individual and occupational exposure factors and hospitalization for cervical disc disorder (CDD).Methods: CDD was examined prospectively in a cohort of 278 319 Swedish male construction workers who participated in a national health surveillance program (1971-1993). Job title, smoking status, age, height, and weight were recorded on examination. Case data were obtained through linkage with the Swedish national in-patient hospital registry for the period 1987 – 2016; case status was defined by primary diagnosis code M50.0 (ICD-10) or 722.0, 722.4, or 722.7 (ICD-9). A job exposure matrix was developed and occupational exposure estimates were assigned by job title. Self-reported estimates of pain/discomfort from a subset of 87 500 workers were also linked to the database. Poisson regression models were used to estimate the relative risks (RR) for the biomechanical and self-reported factors with adjustment for smoking status, age, BMI and surgical time period.Results: There were 562 cases of hospitalization for CDD; the incidence rate was 8.0 cases per 100 000 during the 29-year follow-up period. Smoking status, age, BMI and height were all associated with increased risk (RR 1.21-3.16). Occupational exposure to static work in non-neutral or extreme neck postures, and time spent in awkward postures showed the highest associations with CDD hospitalization (RR = 1.62 – 2.10). Upper arm load and time with arms above shoulders were also associated with increased risk (RR = 1.50 – 1.58). Workers who reported experiencing pain ‘often’ or ‘very often’ during the previous year for any of the neck, shoulder or upper back regions had a 3-fold increase in risk relative to workers reporting no pain.Conclusions: Occupational non-neutral neck posture was associated with increased risk of hospitalization for CDD. Our data also suggest an exposure-response relationship for self-reported neck pain/discomfort and risk of hospitalization for CDD.
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12.
  • Jackson, Jennie, et al. (författare)
  • Risk factors for surgically treated cervical spondylosis in male construction workers: a 20-year prospective study
  • 2023
  • Ingår i: The spine journal. - : Elsevier. - 1529-9430 .- 1878-1632. ; 23:1, s. 136-145
  • Tidskriftsartikel (refereegranskat)abstract
    • Background ContextDegenerative changes due to cervical spondylosis (CS) can detrimentally affect work ability and quality of life yet understanding of how physical exposure affects disease progression is limited.PurposeTo assess the associations between occupational physical exposures and occurrence of surgically treated cervical spondylosis (ST-CS) and early exit from the labour market via disability pension.Study Design/SettingProspective register study with 20 year follow-up period.Patient SampleSwedish construction workers participating in a national health surveillance project conducted between 1971-1993.Outcome MeasuresSurgically treated cervical spondylosis (ST-CS) and early labour market exit at a minimum rate of 25% time on disability pension.MethodsAssociations between occupational physical exposures (job exposure matrix) and subsequent ST-CS (National Hospital in-patient register) and early labour market exit via disability pension (Swedish Social Insurance Agency register) were assessed in a cohort of male construction workers (n=237,699).ResultsA total of 1381 ST-CS cases were present and a 20-year incidence rate of 35.1 cases per 100,000 person years (95% confidence interval (CI) 33.2-36.9). Increased relative risk (RR) for ST-CS was found for workers exposed to non-neutral (RR 1.40, 95% CI 1.15-1.69) and awkward neck postures (1.52, 1.19-1.95), working with the hands above shoulder height (1.30, 1.06-1.60), and high upper extremity loading (1.35, 1.15-1.59). Increased risk was also present for workers who reported frequent neck (3.06, 2.18-4.30) and upper back (3.84, 2.57-5.73) pain in the 12 months prior to survey. Among workers with elevated arm exposure, higher risk was seen in those who also had more frequent neck pain. ST-CS cases took early retirement more often (41.3%) and at a younger age (53 years) than the total study cohort (14.8% and 56 years of age, respectively).ConclusionsOccupational exposure to non-neutral neck postures, work with hands above shoulders and high loads born through the upper extremities increased the risk for ST-CS and early retirement due to disability. Decreasing postural and load exposure is salient for primary, secondary, and tertiary prevention of CS. Neck pain was shown to be a prognostic factor for ST-CS, which stresses the importance of acting early and taking preventative action to reduce workplace exposure, and the need for systematic medical check-ups within primary or occupational care to mitigate disease progression and early labour market exit due to disability.
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13.
  • Lewis, Charlotte A., et al. (författare)
  • Occupational biomechanical risk factors for surgical treatment of subacromial impingement syndrome (SIS) in a 16-year prospective study among male construction workers
  • 2019
  • Ingår i: PREMUS 2019. ; , s. 165-165
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Shoulder disorders are common in the general population, with an annual prevalence up to over 40% per 1000 person-years. One common disorder is subacromial impingement syndrome (SIS), where a narrowing in the subacromial space causes compression of the tendons or bursa by the surrounding tissues. When conservative treatments are not effective, surgical treatments is often the alternative. The aim of the current study was to assess the association between occupational biomechanical exposures and the occurrence of surgically treated SIS in a large construction worker cohort over a 16-year follow-up period. Methods: A cohort of 280 747 male construction workers who participated in a national occupational health surveillance program (1971-1993) were examined prospectively (1987-2016) for SIS. SIS case status was defined by primary surgical treatment of diagnosis codes M75.1, M75.4, 726B, or 726C (ICD 10 and Swedish ICD 9 code systems), with data from the Swedish national registry for in- and out-patient surgery records. A job exposure matrix (JEM) was developed and biomechanical exposure estimates were assigned according to job title. Poisson regression models adjusted for age, BMI, smoking and a surgical time factor were used to estimate the relative risks (incidence rate ratios) of surgical treatment for SIS for each biomechanical factor.Results: There were 1381 cases in the cohort, which corresponded to an incidence rate of surgically treated SIS over the 16-year observation period of 46 cases per 100,000 person years. Increased risk for surgically treated SIS was shown for working with elevated arms (RR=1.27, 95% CI=1.02-1.58), heavy upper arm loads (RR=1.75, 95% CI=1.48-2.08), high grip force (RR=1.64, 95% CI=1.40-1.93), working with hand tools (RR=1.46, 95% CI=1.26-1.70), working with hand tools in a fixed posture (RR=1.28, 95% CI=1.14-1.44), and working with hand-arm vibration (RR=1.30, 95% CI=1.09-1.55).Conclusions: Working with elevated arms, high arm load, high grip force and vibrating handheld tools may increase the risk for SIS.
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14.
  • Lewis, Charlotte A., et al. (författare)
  • Surgery for subacromial impingement syndrome and occupational biomechanical risk factors in a 16-year prospective study among male construction workers
  • 2023
  • Ingår i: Scandinavian Journal of Work, Environment and Health. - Helsinki : NOROSH. - 0355-3140 .- 1795-990X. ; 49:2, s. 156-163
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. The aim of this study was to assess the association between occupational biomechanical exposures and the occurrence of surgical treatment for subacromial impingement syndrome (SIS).Methods. A cohort of 220 295 male constructions workers who participated in a national occupational health surveillance program (1971–1993) were examined prospectively over a 16-year follow-up period (2001–2016) for surgically treated SIS. Worker job title, smoking status, height, weight, and age were registered on health examination. Job titles were mapped to 21 occupational groups based on tasks and training. A job exposure matrix (JEM) was developed with exposure estimates for each occupational group. Surgical cases were determined through linkage with the Swedish national in- and outpatient registers. Poisson regression was used to assess the relative risks (RR) for each biomechanical exposure.Results. The total incidence rate of surgically treated SIS over the 16-year observation period was 201.1 cases per 100 000 person-years. Increased risk was evident for workers exposed to upper-extremity loading (push/pull/lift) (RR 1.45–2.30), high hand grip force (RR 1.47–2.23), using handheld tools (RR 1.52–2.09), frequent work with hands above shoulders (RR 1.62–2.11), static work (RR 1.77–2.26), and hand-arm vibration (RR 1.78–2.13). There was an increased risk for SIS surgery for all occupational groups (construction trades) compared with white-collar workers (RR 1.56–2.61).Conclusions. Occupational upper-extremity load and posture exposures were associated with increased risk for surgical treatment of SIS, which underlines the need for reducing workplace exposures and early symptom detection in highly exposed occupational groups.
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15.
  • Lewis, Charlotte A., et al. (författare)
  • The association between cold exposure and musculoskeletal disorders : a prospective population-based study
  • 2023
  • Ingår i: International Archives of Occupational and Environmental Health. - : Springer Nature. - 0340-0131 .- 1432-1246. ; 96, s. 65-575
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The aim of the study was to determine the association between occupational ambient cold exposure and neck–shoulder pain (NSP), low back pain (LBP), and radiating LBP.Methods: The study cohort comprised of 3,843 working subjects in northern Sweden who answered a baseline (spring 2015) and a follow-up questionnaire (spring 2021). NSP, LBP, and radiating LBP were assessed in both surveys. Occupational cold exposure was assessed at baseline, on a whole number numerical rating scale (NRS) and categorized in quartiles. Binary logistic regression determined the association between cold exposure at baseline and incident NSP, LBP, and radiating LBP, adjusted for age, gender, body mass index, smoking, mental stress, and physical workload.Results: There were statistically significant associations between high occupational ambient cold exposure (NRS 5–7 and NRS 8–10) and NSP (1.59; 95% CI 1.08–2.33 and OR 1.50; 95% CI 1.03–2.19); NRS 8–10 and LBP (OR 1.61; 95% CI 1.13–2.29); and NRS 5–7 and radiating LBP (OR 1.87; 95% CI 1.12–3.16). Gender-stratified analyses showed statistically significant associations between high occupational ambient cold exposure (NRS 5–7 and NRS 8–10) and NSP (OR 1.97; 95% CI 1.07–3.61 and OR 1.97; 95% CI 1.06–3.67) for men and between NRS 8–10 and LBP (OR 1.82; 95% CI 1.14–2.91) and NRS 5–7 and radiating LBP (OR 2.20; 95% CI 1.15–4.24) for women.Conclusions: Occupational ambient cold exposure was associated with NSP, LBP, and radiating LBP, and should be recognised as a possible occupational risk factor.
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16.
  • Lindegård, A., et al. (författare)
  • Can biofeedback training in combination with ergonomic information reduce pain among young adult computer users with neck and upper extremity symptoms? : A randomized controlled intervention study
  • 2024
  • Ingår i: Applied Ergonomics. - : Elsevier. - 0003-6870 .- 1872-9126. ; 114
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this randomized controlled study was to explore if an intervention with biofeedback training in combination with ergonomic discussions, could improve working technique and work postures, and reduce pain intensity and perceived exertion in young adult computer users with ongoing neck and upper extremity symptoms. 39 participants were divided into an intervention group and a control group. The intervention consisted of 4 sessions during a three-month period. Working technique, working postures, rated perceived exertion, pain intensity, and duration of computer use were measured at baseline and follow ups after 6 and 12 months. The intervention did not significantly improve working technique and working postures, nor reduce pain intensity and perceived exertion in the intervention group compared to the control group. However, there was a statistically significant reduction in reported pain intensity in the neck/shoulder for the whole group. Also, there was a trend that time spent with computer work without breaks was more reduced in the intervention group than in the control group.
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17.
  • Lindegård Andersson, Agneta, 1955, et al. (författare)
  • The impact of working technique on physical loads - an exposure profile among newspaper editors.
  • 2003
  • Ingår i: Ergonomics. - : Informa UK Limited. - 0014-0139 .- 1366-5847. ; 46:6, s. 598-615
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to investigate the possible associations between working technique, sex, symptoms and level of physical load in VDU-work. A study group of 32 employees in the editing department of a daily newspaper answered a questionnaire, about physical working conditions and symptoms from the neck and the upper extremities. Muscular load, wrist positions and computer mouse forces were measured. Working technique was assessed from an observation protocol for computer work. In addition ratings of perceived exertion and overall comfort were collected. The results showed that subjects classified as having a good working technique worked with less muscular load in the forearm (extensor carpi ulnaris p=0.03) and in the trapezius muscle on the mouse operating side (p=0.02) compared to subjects classified as having a poor working technique. Moreover there were no differences in gap frequency (number of episodes when muscle activity is below 2.5% of a reference contraction) or muscular rest (total duration of gaps) between the two working technique groups. Women in this study used more force (mean force p=0.006, peak force p=0.02) expressed as % MVC than the men when operating the computer mouse. No major differences were shown in muscular load, wrist postures, perceived exertion or perceived comfort between men and women or between cases and symptom free subjects. In conclusion a good working technique was associated with reduced muscular load in the forearm muscles and in the trapezius muscle on the mouse operating side. Moreover women used more force (mean force and peak force) than men when operating the click button (left button) of the computer mouse.
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18.
  • Lundmark, Robert, et al. (författare)
  • A joint training of healthcare line managers and health and safety representatives in facilitating occupational health interventions: a feasibility study protocol for the Co-pilot project
  • 2024
  • Ingår i: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 15
  • Tidskriftsartikel (refereegranskat)abstract
    • Healthcare employees are experiencing poor wellbeing at an increasing rate. The healthcare workforce is exposed to challenging tasks and a high work pace, a situation that worsened during and after the COVID-19 pandemic. In turn, exposure to these high demands contributes to poor health, increased turnover, reduced job satisfaction, reduced efficacy, and reduced patient satisfaction and safety. Therefore, it is imperative that we identify measures to mitigate this crisis. One piece of this puzzle is how to implement sustainable tools and processes to improve the work environment of healthcare organizations. In this paper, we present the study protocol for the outlining and piloting of a joint training for pairs of healthcare line managers and their associated health and safety representatives in a Swedish healthcare organization. The objective of the training is to aid and advance the implementation of interventions to improve the work environment at the unit level. Following recommendations in the literature, the training is based on a stepwise approach that considers the specific context and focuses on the involvement of employees in creating interventions based on their needs. A central component of the training is the development of the pairs’ collaboration in prioritizing, developing, implementing, and evaluating the interventions. The training is based on an on-the-job train-the-trainer approach in which participants are progressively trained during four workshops in the steps of a participatory intervention process. Between these workshops, the pairs follow the same progressive steps together with their employees to develop and implement interventions at their unit. The pilot will involve four pairs (i.e., eight participants) representing different parts and functions of the organization and will be conducted over a period of three months. We will use a mixed method design to evaluate preconditions, the process, and proximal transfer and implementation outcome factors of the training. The overall aim of the pilot is to appraise its feasibility and be able to adjust the training before a potential scale-up.
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19.
  • Marklund, Susanna, 1960-, et al. (författare)
  • Dentists working conditions : factors associated with perceived workload
  • 2021
  • Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 79:4, s. 296-301
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Dentists are often exposed to occupational health hazards such as stress, high workload, and ergonomic and mental strain. However, there are limited studies focussing on occupational health and factors associated with working conditions. The aim of this study was to identify possible gender differences and factors associated with a high workload.Method: The study population comprised of 187 dentists (123 women and 64 men) who had been working between 5 and 12 years. All participants completed a questionnaire regarding perceived workload and different working conditions. In the logistic regression analyses, gender and employment (employee or employer/manger), influence over work, social support, ergonomics, and working hours were used as independent covariates.Results: Poor satisfaction with ergonomic conditions and low influence on the work situation were reported by 40 and 47% of the participants, respectively. Female dentists were more often employees, reported lower influence over work situation, and more often worked part-time compared to male dentists. Those who reported a high workload significantly more often experienced that they had low influence over work, low levels of social support, and were not satisfied with ergonomic working conditions.Conclusion: Dentists with low influence over work, low levels of social support, and who were unsatisfied with the ergonomic conditions reported higher levels of workload. The dentists experienced a similar workload, regardless of employment and gender. Preventive actions at the workplace in order to maintain a moderate workload promote both individual and organizational measures, to minimize the risk of poor occupational health.
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20.
  • Marklund, Susanna, 1960-, et al. (författare)
  • Work ability and productivity among dentists : associations with musculoskeletal pain, stress, and sleep
  • 2020
  • Ingår i: International Archives of Occupational and Environmental Health. - : Springer. - 0340-0131 .- 1432-1246. ; 93:2, s. 271-278
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Work ability can be measured by the work ability index (WAI), and work-related questions measuring productivity loss in terms of quality and quantity of work. Dentists have high occupational risk of musculoskeletal pain and the exposure of ergonomic strain is already high during dental education. The aim was to evaluate work ability and productivity among dentists, and to identify gender differences and associations with sleep, stress, and reported frequent pain.Methods: The study population comprised 187 dentists (123 women and 64 men) who had been working as dentists between 5 and 12 years. Participants completed a questionnaire regarding sleep, stress, presence of pain at different sites, work ability assessed by WAI, and productivity in terms of quality and quantity of work.Results: Poor sleep quality and high level of stress were reported by 31% and 48.1% of participants, respectively, with no gender differences and no association with age. The prevalence of frequent pain ranged 6.4–46.5% with shoulders being the most prevalent site. Thirty-three percent reported reduced work ability. Poor sleep, high amount of stress, and multi-site pain were associated with decreased work ability.Conclusions: A high prevalence of pain was shown among dentists. Decreased work ability in terms of productivity loss was associated with poor sleep quality, high amount of stress, and multi-site pain. Preventive actions at the workplace should promote good musculoskeletal health, and measures taken, both individual and organizational, to minimize the risk of high, persistent stress and work-related pain.
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21.
  • Mboya, Innocent B, et al. (författare)
  • Time trends of the association of body mass index with mortality in 3.5 million young Swedish adults
  • 2024
  • Ingår i: Annals of Epidemiology. - : Elsevier. - 1047-2797 .- 1873-2585. ; 97, s. 23-32
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: We investigated time trends of the obesity-mortality association, accounting for age, sex, and causespecific deaths.Methods: We analysed pooled nationwide data in Sweden for 3,472,310 individuals aged 17-39 years at baseline in 1963-2016. Cox regression and flexible parametric survival models investigated BMI-mortality associations in sub-groups of sex and baseline calendar years (men: <1975, 1975-1985, ≥1985 and women: <1985, 1985-1994, ≥1995).Results: Comparing men with obesity vs. normal weight, all-cause and "other-cause" mortality associations decreased over periods; HR (95% CI) 1.92 (1.83-2.01) and 1.70 (1.58-1.82) for all-cause and 1.72 (1.58-1.87) and 1.40 (1.28-1.53) for "other-cause" mortality in <1975 and ≥1985, but increased for CVD mortality; HR 2.71 (2.51-2.94) and 3.91 (3.37-4.53). Higher age at death before 1975 coincided with more obesity-related deaths at higher ages. Furthermore, the all-cause mortality association for different ages in men showed no clear differences between periods (p-interaction=0.09), suggesting no calendar effect after accounting for attained age. Similar, but less pronounced, results were observed in women. Associations with cancer mortality showed no clear trends in men or in women.Conclusions: Accounting for differences in age and death causes between calendar periods when investigating BMI-mortality time trends may avoid misinterpreting the risks associated with obesity over time.
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22.
  • Peyre-Costa, David, et al. (författare)
  • Self-reported exposure to dust and diesel exhaust, respiratory symptoms, and use of respiratory protective equipment among Arctic miners
  • 2024
  • Ingår i: International Journal of Circumpolar Health. - : Taylor & Francis Group. - 1239-9736 .- 2242-3982. ; 83:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Arctic miners face significant risks from diesel exhaust and dust exposure, potentially leading to adverse respiratory health. Employers must limit harmful exposures, using personal protective equipment (PPE) as a last line of defense. This study explored the association between reported respiratory exposure and symptoms, and PPE training and usage. Data from the MineHealth study (2012–2014) included a total of 453 Arctic open pit miners in Norway, Sweden, and Finland. Participants answered questions on exposure to dust and diesel exhaust, respiratory symptoms, and PPE use, in addition to age, gender, BMI, smoking, and self-rated health. Estimated exposure to dust was common, reported by 91%, 80%, and 82% and that of diesel exhaust by 84%, 43%, and 47% of workers in Sweden, Finland, and Norway, respectively. Reported dust exposure was significantly related to respiratory symptoms (OR 2.2, 95% CI 1.3–3.7), diesel exposure increased the occurrence of wheezing (OR 2.6, 95% CI 1.3–5.4). PPE use varied between the studied mines. Non-use was common and related to reduced visibility, wetness, skin irritation and fogging of the respiratory PPE. Future research should employ more precise exposure assessment, respiratory function as well as explore the reasons behind the non-compliance of PPE use.
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23.
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24.
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25.
  • Schott, Kevin D., et al. (författare)
  • A cohort study of retinal detachment among Swedish construction workers
  • 2023
  • Ingår i: Scandinavian Journal of Work, Environment and Health. - : Nordic Association of Occupational Safety and Health. - 0355-3140 .- 1795-990X. ; 49:7, s. 518-525
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Retinal detachment (RD) has been associated with exposure to heavy lifting. Many occupations within the construction industry are likely to involve lifting tasks. We investigated the association between occupational heavy lifting and rhegmatogenous RD in a retrospective cohort study of Swedish construction workers.Methods: We studied Swedish construction workers who participated in an industry-wide health and safety program from 1971 to 1993. Individual occupation codes were linked to a job exposure matrix, assigning intensity of exposure to heavy lifting to each worker. The Swedish National Patient Register was used to identify cases of RD that occurred during follow-up through the end of 2012. We used Poisson regression modeling to calculate incidence rates of RD associated with heavy lifting, age and other covariates. A subcohort of those age ≤25 years at enrollment was studied to reduce bias from missing exposure information from work prior to enrollment.Results: Of 256 241 construction workers, 17% were classified with high exposure to heavy lifting in their occupation. Within the cohort, 1588 cases of RD were identified. Average exposure intensity of heavy lifting was not associated with risk of RD. However, RD risk increased with increasing cumulative exposure to heavy lifting, both in the full cohort and subcohort of those who were ≤25 years old at entry into the construction-worker cohort.Conclusion: Construction workers' risk of RD appeared to increase with time spent exposed to heavy lifting.
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26.
  • Stjernbrandt, Albin, 1985- (författare)
  • Cold exposure and health : A study on neurological and vascular hand symptoms in northern Sweden
  • 2021
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Living in a cold climate is associated with several adverse health effects. The main purpose of this thesis was to describe cold exposure characteristics in northern Sweden, and investigate the associations between such exposure and the reporting of neurological and vascular hand symptoms. One common cold-related hand symptom is Raynaud’s phenomenon, defined as episodic attacks of acral pallor or cyanosis. There is evidence to suggest that cold exposure can act both as a causal factor and a trigger for such vasospastic symptoms. Other important associated factors include exposure to hand-arm vibration and the presence of rheumatic disease. A somewhat similar clinical entity, cold sensitivity, is defined as a collection of acquired symptoms, resulting in an abnormal aversion to cold, with pain, sensory alterations, stiffness, or color changes, which may occur after a traumatic injury. The condition is hypothesized to mainly originate from nerve injury. The effects of cold exposure on hand function, the occurrence of cold sensitivity in the general population, the link between cold exposure and cold sensitivity, as well as the interface between cold sensitivity and Raynaud’s phenomenon are not fully understood. Therefore, this thesis was also intended to expand the knowledge on Raynaud’s phenomenon and cold sensitivity.Methods: Postal surveys were sent to a sample of men and women between 18 and 70 years of age, living in Norrbotten, Västerbotten, Västernorrland, and Jämtland, drawn from the national Swedish population register. The first survey collected data on 12,627 subjects, and the results were used to describe cold exposure characteristics, and broadly investigate the statistical associations with different neurological and vascular hand symptoms (Paper I). A follow-up survey was sent to a subset of responders, to form nested case–control studies on cold sensitivity (N=1,230; Paper II) and Raynaud’s phenomenon (N=1,400; Paper III). Subjects with cold sensitivity (N=12) from Paper II were subsequently recruited to a laboratory study, to investigate the vascular and neurosensory function of the hands, by means of physical examination, laser speckle contrast analysis before and after cold stress testing, and thermal quantitative sensory testing (Paper IV). Finally, healthy controls (N=1,239) from the case–control studies were used as a reference population for the Cold intolerance symptom severity questionnaire, to establish a cut-off for abnormal cold sensitivity (Paper V).Results: In Paper I, cold exposure was commonly reported, both during work and leisure time. Exposure was most pronounced in alpine regions, generally higher among men than women, and decreased with age. Highly cold-exposed occupational groups were militaries; agricultural, forestry and fishery workers; and crafts and related trades workers (e.g. construction workers). The correlation between occupational and leisure-time cold climate exposure was low. Men reported more occupational exposure to hand-arm vibration than women, but the correlation between occupational cold and vibration exposure was low. A range of neurological and vascular hand symptoms were statistically associated with high cold exposure, such as decreased perception to touch, warmth, and cold, as well as Raynaud’s phenomenon. In Paper II, cold sensitivity was significantly associated with previous frostbite affecting the hands, rheumatic disease, upper extremity nerve injury, migraine, vascular disease, and high body mass index (inversely), in a multiple conditional logistic regression model. In Paper III, Raynaud’s phenomenon was significantly associated with previous frostbite affecting the hands, first degree heredity, and high body mass index (inversely), in a similar model. Previous upper extremity nerve injury was suggested as a separating trait between Raynaud’s phenomenon and cold sensitivity. In Paper IV, laser speckle contrast analysis indicated disturbances in microvascular regulation, while physical examination and thermal quantitative sensory testing mainly yielded normal results. In Paper V, the 95th percentile for the Cold intolerance symptom severity score was 49.5 for men, and 53.0 for women.Conclusions: Cold exposure in the working-age population of northern Sweden varied with age, gender, occupation, and place of residence. Cold exposure was related to the reporting of neurological and vascular hand symptoms in the population as a whole. There was a major overlap between reporting cold sensitivity and Raynaud’s phenomenon, and the conditions shared several associated factors. Previous upper extremity nerve injury was suggested to be a separating trait, supporting the neurosensory pathophysiological hypothesis for cold sensitivity. Cold sensitivity was not effectively assessed by physical examination or thermal quantitative sensory testing. However, laser speckle contrast analysis could prove a useful tool in further studies on cold sensitivity. A Cold intolerance symptom severity score above 50 could be considered to indicate abnormal cold sensitivity, and be used to guide further care.
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27.
  • Stjernbrandt, Albin, et al. (författare)
  • Cold sensitivity and associated factors : a nested case–control study performed in Northern Sweden
  • 2018
  • Ingår i: International Archives of Occupational and Environmental Health. - : Springer-Verlag New York. - 0340-0131 .- 1432-1246. ; 91:7, s. 785-797
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim To identify possible risk factors for cold sensitivity, by comparing cases to controls with regard to demographic and anthropometric characteristics, previous illnesses and injuries as well as ambient exposures.Methods Through a questionnaire responded to by the general population (n=12,627) cold sensitivity cases (n=502) and matched controls (n=1,004) were identified and asked to respond to a second questionnaire with focus on different aspects of cold sensitivity, hereditary factors, previous diseases, medication, tobacco use as well as exposure to ambient cold climate and hand-arm vibration (HAV).Results In total, 997 out of 1506 study subjects answered the second questionnaire, 374 cases and 623 match controls. Identified risk factors among the cases were frostbite of the hands Odds Ratio (OR) 10.3 (95% confidence interval (CI) 5.5-19.3), rheumatic disease OR 3.1 (95% CI 1.7-5.7), upper extremity nerve injury OR 2.0 (95% CI 1.3-3.0), and vascular disease OR 1.9 (95% CI 1.2-2.9). Sex differences in risk factors were HAV exposure for men and cold exposure for women increased the risk of cold sensitivity. Rheumatic diseases and migraine increased the risk of cold sensitivity among women but not among men.Conclusions The present study shows that cold sensitivity is associated with both inherent factors, acquired conditions and external exposures. Among acquired conditions, frostbite, vascular disease, nerve injury, joint disorders and migraine are significantly related to the reporting of cold sensitivity. Among external exposures, both cold climate and HAV exposure are significantly associated to cold sensitivity, and thus suitable targets for primary preventive measures. There was a difference in risk factors related to sex. HAV exposure for men and cold exposure for women increased the risk of cold sensitivity.
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28.
  • Stjernbrandt, Albin, et al. (författare)
  • Defining abnormal cold sensitivity using the Cold Intolerance Symptom Severity questionnaire : a population study
  • 2021
  • Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 46:7, s. 731-737
  • Tidskriftsartikel (refereegranskat)abstract
    • Cold sensitivity, a common and disabling sequela of hand injury, can be assessed using the Cold Intolerance Symptom Severity (CISS) questionnaire, rating symptoms on a scale from 4 to 100. The primary objective of this study was to define a clinical cut-off for abnormal cold sensitivity based on the CISS score in a healthy working-age population. The secondary objective was to investigate how age, gender and previous injuries and diseases influence CISS scoring. In this study, 1239 out of 1582 selected healthy subjects of working age living in northern Sweden completed the questionnaire, yielding a response rate of 78%. The 95th percentile for the CISS score was 49.5 for men and 53.0 for women. The effects of age, gender and previous injuries and diseases were minor and not considered clinically relevant. The results support that a CISS score above 50 should be considered as abnormal cold sensitivity. Level of evidence: III
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29.
  • Stjernbrandt, Albin, et al. (författare)
  • Hand cold stress testing among Arctic open-pit miners : a clinical study
  • 2024
  • Ingår i: International Journal of Occupational Safety and Ergonomics. - : Taylor & Francis. - 1080-3548 .- 2376-9130.
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: This study aimed to evaluate the influence of individual characteristics (sex, age, body mass index [BMI] and smoking habits) on the tolerance time, pain ratings and rewarming time of hand cold stress testing (CST).Methods: We included 153 subjects (63% men) working in a Swedish open-pit mine (participation rate 41%). The right hand was immersed in 3 °C circulating water for up to 45 s. Pain ratings were registered every fifth second using a visual analog scale.Results: The tolerance time (mean ± standard deviation) was 35 ± 12 s for men and 29 ± 14 s for women (p = 0.007). The youngest age group (18–29 years) had the longest tolerance time, while the oldest group (54–65 years) had the shortest (p = 0.005). Women had significantly higher pain ratings than men after 5, 10 and 25 s. The group with the highest BMI had the shortest rewarming time (p < 0.001).Conclusions: Age and sex influenced the tolerance time of hand CST, while only sex affected the pain ratings and BMI the rewarming time. When performing CST in future studies, these parameters should be considered.
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30.
  • Stjernbrandt, Albin, et al. (författare)
  • Incidence, remission, and persistence of Raynaud’s phenomenon in the general population of northern Sweden : a prospective study
  • 2022
  • Ingår i: BMC Rheumatology. - : BioMed Central. - 2520-1026. ; 6:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Raynaud’s phenomenon is common condition, but little is known about the natural course. The primary aim of this study was to determine the incidence, remission, and persistence proportions of Raynaud’s phenomenon in the general population of northern Sweden. Secondary aims were to determine how individual and exposure factors affect the course of Raynaud’s phenomenon, and to assess gender differences.Methods: A prospective, survey-based, closed-cohort study was conducted on a sample of men and women between 18–70 years of age, living in northern Sweden. Data on Raynaud’s phenomenon characteristics and general health status were collected during the winters of 2015 (baseline) and 2021 (follow-up). Rates of incidence, remission, and persistence were calculated. Binary logistic regression was used to determine the association between baseline variables and the course of Raynaud’s phenomenon. Results: The study population consisted of 2703 women (53.9%) and 2314 men. There were 390 women (14.5%) and 290 men (12.7%) reporting Raynaud’s phenomenon in the follow-up survey. The annual incidence proportion was 0.7% among women and 0.9% among men (gender difference p = 0.04). The annual remission proportion was 4.4% and 5.5%, respectively (p = 0.05). Having sustained a cold injury affecting the hands since baseline was significantly associated with incident Raynaud’s phenomenon (OR 3.92; 95% CI 2.60–5.90), after adjusting for age and gender.Conclusions: In the general population of northern Sweden, Raynaud’s phenomenon is a common but variable condition, where symptoms may remit over time. Men had a higher incidence proportion than women. The results support a possible causal pathway where cold injury can precede the onset of Raynaud’s phenomenon.
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31.
  • Stjernbrandt, Albin, et al. (författare)
  • Manifestations of cold sensitivity : a case series
  • 2020
  • Ingår i: International Journal of Circumpolar Health. - : Taylor & Francis. - 1239-9736 .- 2242-3982. ; 79:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To characterise cold sensitivity using a semi-structured interview, physical examination, thermal quantitative sensory testing (QST), and laser speckle contrast analysis (LASCA).Methods: Eight women and four men, ages 22–74, with cold sensitivity were interviewed andexamined by an occupational physician. Thermal perception thresholds were established using QST, on the pulp of the index and little finger of the most affected hand. Skin perfusion in the dorsum of the hand was measured using LASCA, at baseline, after two-minute 12°C water immersion, and during rewarming.Results: The physical examination yielded few findings indicative of vascular or neurosensory pathology. One subject (8%) had impaired thermal perception thresholds. LASCA at baseline showed absent proximal-distal perfusion gradients in six subjects (50%), and a dyshomogeneousperfusion pattern in five (42%). Perfusion on a group level was virtually unchanged by cold stress testing (median 52.5 PU; IQR 9.0 before versus 51.3 PU; IQR 27.2 afterwards).Conclusions: Physical examination and thermal QST offered little aid in diagnosing cold sensitivity, which challenges the neurosensory pathophysiological hypothesis. LASCA indicated disturbances in microvascular regulation and could prove a useful tool in future studies on cold sensitivity.
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32.
  • Stjernbrandt, Albin, et al. (författare)
  • Neurosensory and vascular symptoms and clinical findings in the hands of Arctic open-pit miners in Sweden and Norway : a descriptive study
  • 2023
  • Ingår i: International Journal of Circumpolar Health. - : Taylor & Francis. - 1239-9736 .- 2242-3982. ; 82:1
  • Tidskriftsartikel (refereegranskat)abstract
    • This cross-sectional study aimed to describe exposure to cold climate and hand-arm vibration (HAV) as well as neurosensory and vascular symptoms and clinical findings among open-pit Arctic miners. It was based on data from questionnaires and physical examinations, including 177 men and 75 women from two open-pit mines in Sweden and Norway (response rate 54%). Working outdoors or in an unheated building or machine for at least two hours per day was reported by 44% and HAV exposure of the same duration by 10%. Neurosensory symptoms (e.g. reduced perception of touch) in the hands were reported by 47% and Raynaud’s phenomenon by 14%. In brief conclusion, the study showed that Arctic miners were commonly exposed to both cold temperatures and HAV. They also reported a broad range of neurosensory and vascular symptoms in their hands and had abnormal clinical findings related to the symptoms. The results emphasise the need for additional preventive measures in this occupational setting.
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33.
  • Stjernbrandt, Albin, et al. (författare)
  • Occupational cold exposure in relation to incident airway symptoms in northern Sweden : a prospective population-based study
  • 2022
  • Ingår i: International Archives of Occupational and Environmental Health. - : Springer. - 0340-0131 .- 1432-1246. ; 95:9, s. 1871-1879
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To determine if occupational exposure to cold environments is associated with incident airway symptoms in previously healthy workers.METHODS: A prospective, survey-based, closed-cohort study was conducted on a sample of 5017 men and women between 18 and 70 years of age, living in northern Sweden. Data on occupation, occupational and leisure-time cold exposure, airway symptoms, general health, and tobacco habits were collected during the winters of 2015 (baseline) and 2021 (follow-up). Stepwise multiple logistic regression was used to determine associations between baseline variables and incident airway symptoms.RESULTS: For individuals working at baseline, without physician-diagnosed asthma or chronic obstructive pulmonary disease, reporting any occupational cold exposure was associated with incident wheeze (OR 1.41; 95% CI 1.06-1.87) and incident productive cough (OR 1.37; 95% CI 1.06-1.77), but not incident long-standing cough (OR 0.98; 95% CI 0.74-1.29), after adjusting for age, body mass index, daily smoking, and occupational physical workload. Detailed analysis of the occupational cold exposure rating did not reveal clear exposure-response patterns for any of the outcomes.CONCLUSIONS: Occupational cold exposure was robustly associated with incident wheeze and productive cough in previously healthy workers. This adds further support to the notion that cold air is harmful for the airways, and that a structured risk assessment regarding occupational cold exposure could be considered for inclusion in the Swedish workplace legislation. Further studies are needed to elaborate on exposure-response functions, as well as suggest thresholds for hazardous cold exposure.
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34.
  • Stjernbrandt, Albin, et al. (författare)
  • Occupational exposure to whole-body vibration and neck pain in the Swedish general population
  • 2024
  • Ingår i: Ergonomics. - : Taylor & Francis. - 0014-0139 .- 1366-5847. ; 67:2, s. 136-147
  • Tidskriftsartikel (refereegranskat)abstract
    • The primary aim of this study was to determine if occupational exposure to whole-body vibration (WBV) was associated with reporting neck pain. A cross-sectional study was conducted on a sample of the general population living in northern Sweden, aged 24 to 76 years. Data was retrieved through a digital survey that collected information on exposure to WBV and biomechanical exposures as well as subjectively reported neck pain. The study included 5,017 participants (response rate 44%). Neck pain was reported by 269 men (11.8%) and 536 women (20.2%). There was a statistically significant association between reporting occupational exposure to WBV half the time or more (adjusted OR 1.91; 95% CI 1.22-3.00) and reporting neck pain. In gender-stratified analyses, the same pattern was observed in men, while there were too few women to determine any association. We conclude that occupational exposure to whole-body vibration was associated with neck pain in men.
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35.
  • Stjernbrandt, Albin, et al. (författare)
  • Raynaud's phenomenon in Northern Sweden : a population-based nested case-control study
  • 2019
  • Ingår i: Rheumatology International. - : Springer. - 0172-8172 .- 1437-160X. ; 39:2, s. 265-275
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to determine the association between individual and external exposure factors, and the reporting of Raynaud’s phenomenon, with or without concomitant cold sensitivity. In a population-based nested case–control study, cases with Raynaud’s phenomenon (N = 578), and matched controls (N = 1156), were asked to respond to a questionnaire focusing on different risk factors. Univariate and multiple conditional logistic regression were performed. Analyses were stratified according to whether the cases reported cold sensitivity or not. In total, 1400 out of 1734 study subjects answered the questionnaire (response rate 80.7%). In the final multiple model, the factor with the strongest association to Raynaud’s phenomenon, with and without cold sensitivity, was previous frostbite affecting the hands (OR 12.44; 95% CI 5.84–26.52 and OR 4.01; 95% CI 1.78–9.01, respectively). Upper extremity nerve injury was associated to reporting Raynaud’s phenomenon and cold sensitivity (OR 2.23; 95% CI 1.29–3.85), but not Raynaud’s phenomenon alone. Reporting any exposure to hand-arm vibration or cumulative cold exposure was significant in univariate analyses for cases with both Raynaud’s phenomenon and cold sensitivity, but not in the multiple model. Raynaud’s phenomenon is strongly associated to previous cold injury, with a larger effect size among those who also report cold sensitivity. The fact that only upper extremity nerve injury differed significantly between case groups in our multiple model offers additional support to the neural basis for cold sensitivity.
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36.
  • Stjernbrandt, Albin, et al. (författare)
  • Raynaud's phenomenon in the feet of Arctic open-pit miners
  • 2024
  • Ingår i: International Journal of Circumpolar Health. - : Taylor & Francis. - 1239-9736 .- 2242-3982. ; 83:1
  • Tidskriftsartikel (refereegranskat)abstract
    • The literature on Raynaud's phenomenon (RP) in the feet is scarce, especially in the occupational setting. The primary aim of our study was to investigate the occurrence of RP in the feet of miners. As part of the MineHealth project, written surveys and clinical examinations were completed by 260 Arctic open-pit miners working in northern Sweden and Norway (participation rate 53.6%). Data on RP were collected using standardised colour charts and questionnaire items. Clinical examination included assessing the perception of vibration and pain in both feet. There were eight women and three men who reported RP in the feet. Four also had RP in their hands but none acknowledged any first-degree relatives with the condition. Nine reported exposure to foot-transmitted vibration and one to hand-arm vibration. Seven showed signs of neurosensory injury in the feet. To conclude, the occurrence of RP in the feet of miners was 4.4%. Most cases with RP in the feet did not report the condition in the hands and were exposed to vibration transmitted directly to the feet. There were no reports of a hereditary component. Most cases with RP in the feet also had clinical findings suggestive of peripheral neuropathy in the feet.
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37.
  • Stjernbrandt, Albin, et al. (författare)
  • The impact of Raynaud's phenomenon on work ability : a longitudinal study
  • 2022
  • Ingår i: Journal of Occupational Medicine and Toxicology. - : BioMed Central (BMC). - 1745-6673. ; 17:1
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To determine if having Raynaud's phenomenon (RP) affects the work ability, job retainment, or occurrence of sick leave.METHODS: Surveys on the working-age general population of northern Sweden were conducted in 2015 and 2021, gathering data on RP, occupation and sick leave. Work ability was assessed using the Work Ability Score.RESULTS: The study population consisted of 2,703 women and 2,314 men, among which 390 women and 290 men reported RP at follow-up. For women, the mean [standard deviation (SD)] Work Ability Score was 8.02 (2.24) for subjects reporting RP and 7.68 (2.46) for those without RP. For men, the corresponding numbers were 7.37 (2.03) and 7.61 (2.14), respectively. Multiple linear regression did not show an association between RP status and work ability (p = 0.459 for women and p = 0.254 for men), after adjusting for age, body mass index, physical workload, cardiovascular disease, and perceived stress. Having retained the same main livelihood since baseline was reported by 227 (58.5%) women with RP, 1,163 (51.2%) women without RP, 152 (52.6%) men with RP, and 1,075 (54.1%) men without RP (p = 0.002 for women and p = 0.127 for men). At follow-up, any occurrence of sick leave during the last year was reported by 80 (21.4%) women with RP, 410 (18.6%) women without RP, 48 (17.1%) men with RP, and 268 (13.7%) men without RP (p = 0.208 for women and p = 0.133 for men). Among those reporting sick leave, the mean (SD) duration in months was 2.93 (3.76) for women with RP, 3.00 (4.64) for women without RP, 2.77 (3.79) for men with RP, and 2.91 (12.45) for men without RP (p = 0.849 for women and p = 0.367 for men).CONCLUSION: For neither women nor men was there a significant effect of having RP on work ability. Women with RP reported a slightly higher job retainment compared to those without the condition, while there was no difference in job retainment among men. For neither gender did the presence of RP influence the occurrence of recent sick leave, nor did it affect the length of time away from work.
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38.
  • Strandvik, Birgitta, 1938, et al. (författare)
  • Spectrum of mutations in the CFTR gene of patients with classical and atypical forms of cystic fibrosis from southwestern Sweden: identification of 12 novel mutations.
  • 2001
  • Ingår i: Genetic testing. - : Mary Ann Liebert Inc. - 1090-6576 .- 1557-7473. ; 5:3, s. 235-42
  • Tidskriftsartikel (refereegranskat)abstract
    • Cystic fibrosis (CF) is caused by mutations in the CFTR gene. The spectrum of CFTR mutations varies between populations and depends on different factors, such as ethnic background and geographical location. The extensive CFTR mutation screening of 129 patients with classical or atypical CF from the south-western region of Sweden revealed the presence of 37 CFTR mutations, including 12 novel alleles. The overall mutation detection rate in this study population was 92%, the highest among all tested regions in Sweden. Eight mutations with a frequency above 1% (DeltaF508, 394delTT, R117C, 3659delC, E60X, 1112delT, R764X, and 621 + 1G --> T) accounted for 78% of CF chromosomes and have been recommended for inclusion in the CFTR mutation screening panel for molecular diagnosis of CF in this region. The multiple occurrence of specific CFTR alleles less common than the predominant DeltaF508 mutation (394delTT, R117C, 3659delC) allowed for genotype-phenotype comparisons and revealed consistent relationships between these mutations and disease severity.
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39.
  • Sun, Ming, et al. (författare)
  • Body mass index and risk of over 100 cancer forms and subtypes in 4.1 million individuals in Sweden : the obesity and disease development Sweden (ODDS) pooled cohort study
  • 2024
  • Ingår i: The Lancet Regional Health. - : Elsevier. - 2666-7762. ; 45
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Obesity, assessed by body mass index (BMI), is an established risk factor for 13 cancers. We aimed to identify further potential obesity-related cancers and to quantify their association with BMI relative to that of established obesity-related cancers.Methods: Using Cox regression models on 4,142,349 individuals in Sweden (mean age 27.1 years at weight measurement), we calculated hazard ratios (HRs) for the association between BMI and the risk of 122 cancers and cancer subtypes, grouped by topography and morphology. Cancers with a positive association (i.e., HR >1) at an α-level of 0.05 for obesity (BMI ≥30 kg/m2) vs. normal weight (BMI 18.5–24.9 kg/m2) or per 5 kg/m2 higher BMI, for which obesity is not an established risk factor, were considered potentially obesity related.Findings: After 100.2 million person-years of follow-up, 332,501 incident cancer cases were recorded. We identified 15 cancers in men and 16 in women as potentially obesity related. These were cancers of the head and neck, gastrointestinal tract, malignant melanoma, genital organs, endocrine organs, connective tissue, and haematological malignancies. Among these, there was evidence of differential associations with BMI between subtypes of gastric cancer, small intestine cancer, cervical cancer, and lymphoid neoplasms (P values for heterogeneity in HRs <0.05). The HR (95% confidence interval) per 5 kg/m2 higher BMI was 1.17 (1.15–1.20) in men and 1.13 (1.11–1.15) in women for potential obesity-related cancers (51,690 cases), and 1.24 (1.22–1.26) in men and 1.12 (1.11–1.13) in women for established obesity-related cancers (84,384 cases). Interpretation: This study suggests a large number of potential obesity-related cancers could be added to already established ones. Importantly, the magnitudes of the associations were largely comparable to those of the already established obesity-related cancers. We also provide evidence of specific cancer subtypes driving some associations with BMI. Studies accounting for cancer-specific confounders are needed to confirm these findings.
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40.
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41.
  • Wahlström, Jens, 1972, et al. (författare)
  • Influence of time pressure and verbal provocation on physiological and psychological reactions during work with a computer mouse.
  • 2002
  • Ingår i: European journal of applied physiology. - : Springer Science and Business Media LLC. - 1439-6319 .- 1439-6327. ; 87:3, s. 257-63
  • Tidskriftsartikel (refereegranskat)abstract
    • The overall aim of this study was to investigate whether time pressure and verbal provocation has any effect on physiological and psychological reactions during work with a computer mouse. It was hypothesised that physiological reactions other than muscle activity (i.e. wrist movements, forces applied to the computer mouse) would not be affected when working under stressful conditions. Fifteen subjects (8 men and 7 women) participated, performing a standardised text-editing task under stress and control conditions. Blood pressure, heart rate, heart rate variability, electromyography, a force-sensing computer mouse and electrogoniometry were used to assess the physiological reactions of the subjects. Mood ratings and ratings of perceived exertion were used to assess their psychological reactions. The time pressure and verbal provocation (stress situation) resulted in increased physiological and psychological reactions compared with the two control situations. Heart rate, blood pressure and muscle activity in the first dorsal interosseus, right extensor digitorum and right trapezius muscles were greater in the stress situation. The peak forces applied to the button of the computer mouse and wrist movements were also affected by condition. Whether the increases in the physiological reactions were due to stress or increased speed/productivity during the stress situation is discussed. In conclusion, work with a computer mouse under time pressure and verbal provocation (stress conditions) led to increased physiological and psychological reactions compared to control conditions.
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42.
  • Wahlström, Jens, 1972-, et al. (författare)
  • Occupational risk factors for surgically treated carpal tunnel syndrome : a prospective cohort study of 220,610 Swedish construction workers
  • 2019
  • Ingår i: PREMUS 2019. ; , s. 141-141
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Carpal tunnel syndrome (CTS) is the most common upper extremity nerve entrapment syndrome . The aim of this study was to determine the association between occupational biomechanical exposures and occurrence of surgically treated CTS in construction workers over a 16-year follow-up.Methods: A cohort of 220 610 male construction workers who participated in a national occupational health surveillance program (1971–1992) were examined prospectively (2001–2016) for surgically treated CTS. Cases were determined via a linkage with the Swedish Hospital Outpatient Register. Job title (construction trade), smoking status, height, weight and age were recorded on examination. Job titles were merged into occupational groups of workers performing similar work tasks and having similar training. Occupational biomechanical exposure estimates were assigned to each occupational group using a job exposure matrix (JEM) developed for the study. Poisson regression models were used to assess the relative risks for each biomechanical exposure. Relative risks were adjusted for age, surgical time period, BMI, and smoking status at first examination.Results: There were 4048 cases of surgically treated CTS within the cohort which represented an incidence rate of 134 cases per 100 000 person years. Workers exposed to medium and high forceful handgrip factors had relative risks of 1.3 (95% CI 1.16-1.38) and 1.6 (95% CI 1.50-1.77), respectively, of undergoing surgical treatment for CTS compared to low exposed workers. Workers exposed to medium and high exposure to hand-arm vibration had relative risks of 1.3 (95% CI 1.19-1.34) and 1.2 (95% CI 1.07-1.28), respectively, of undergoing surgical treatment for CTS compared to low exposed workers.Conclusions: In conclusion, forceful hand-grip work and exposure to hand-arm vibration increased the risk for surgically treated carpal tunnel syndrome.
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43.
  • Wahlström, Jens, 1972, et al. (författare)
  • Perceived muscular tension, emotional stress, psychological demands and physical load during VDU work.
  • 2003
  • Ingår i: International archives of occupational and environmental health. - 0340-0131. ; 76:8, s. 584-90
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES. The aim of this study was to investigate whether perceived muscular tension, psychological demands and emotional stress were associated with physical load or working technique during visual display unit (VDU) work. METHODS. Subjects (28 women and 29 men) from two different organisations volunteered to participate in the study. The study design was cross-sectional, and the data were assessed when the subjects performed their usual work tasks at their usual work place. Multivariate linear and logistic regression models were used to investigate possible associations. The different outcome variables were: median muscle activity and muscular rest in the trapezius muscle bilaterally, wrist movements and working technique. The different explanatory variables were: perceived muscular tension (binary), emotional stress (binary), psychological demands (binary), organisation (binary) and gender (binary). Age (continuous) and present musculoskeletal pain (binary) were also controlled for in the multivariate models. Electromyography (EMG) and electrogoniometers were used to assess the physical load, and the data collection time was 15 min. An ergonomic checklist was used to assess working technique, i.e. work with lifted shoulders. RESULTS. Subjects who perceived muscular tension at least a few times per week the month before the measurements were made worked with higher muscle activity [expressed as per cent of a reference voluntary electrical activity (% RVE)] in the trapezius muscle bilaterally (5% RVE, P=0.05). High emotional stress during the measurement was associated with higher muscle activity in the trapezius muscle on the side not operating the computer mouse (8% RVE, P=0.006). Subjects who reported high levels of emotional stress worked more often with lifted shoulders (odds ratio 6.0, 95% CI 1.2-28.9). However, when present musculoskeletal pain was included in the multivariate model the odds ratio for high emotional stress decreased to 4.5 (95% CI 0.9-23.2). CONCLUSIONS. Perceived muscular tension and emotional stress were associated with physical load, in terms of muscle activity in the trapezius muscles, during VDU work in ordinary occupational settings.
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44.
  • Wahlström, Jens, 1972, et al. (författare)
  • Perceived muscular tension, job strain, physical exposure, and associations with neck pain among VDU users; a prospective cohort study.
  • 2004
  • Ingår i: Occupational and environmental medicine. - : BMJ. - 1470-7926 .- 1351-0711. ; 61:6, s. 523-8
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: To determine whether perceived muscular tension, job strain, or physical exposure are associated with increased risk of developing neck pain among VDU users. METHODS: A baseline questionnaire was answered by 1283 respondents, of whom 671 were free from neck pain at baseline. Perceived muscular tension, job strain, and physical exposure were assessed at baseline. Information about newly developed neck pain was collected in 10 follow up questionnaires and the case definition was the first report of such pain in any of the follow up questionnaires. Median follow up time was 10.9 months. RESULTS: Both men and women who perceived muscular tension at least a few times per week, compared to those who had not perceived muscular tension the preceding month, had an incidence rate ratio (IRR) of 1.9 (95% CI 1.25 to 2.93) for developing neck pain, when stratifying for sex. High perceived muscular tension was associated with an increased risk (IRR 1.6, 95% CI 1.02 to 1.91), even when controlling for job strain, physical exposure, and age in the model stratified by sex. CONCLUSIONS: Perceived muscular tension was associated with an increased risk of developing neck pain among VDU users. The combination of high job strain and high perceived muscular tension was associated with higher risk of developing neck pain than the combination of high physical exposure and high perceived muscular tension. There was an indication of an excess risk due to interaction between high physical exposure and high job strain.
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45.
  • Wahlström, Jens, 1972 (författare)
  • Physical load, psychosocial and individual factors in visual display unit work
  • 2003
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall aim of this thesis was to explore associations between physicalload, psychosocial and individual factors in visual display unit (VDU)work. Furthermore, the aim was to investigate whether perceived musculartension is a predictor of neck pain among VDU operators. The thesisis based upon five separate studies, two laboratory studies, two fieldstudies and one prospective cohort study.Several different methods were used to assess the physical load. Electromyography(EMG) was used to record muscle activity. Wrist postures andmovements were assessed by means of electrogoniometers. An instrumentedcomputer mouse was used to measure the forces applied to thecomputer mouse. Working technique was assessed with an observationprotocol. Perceived exertion, comfort, mental stress and perceivedmuscular tension were assessed with questionnaires.The results of this work are discussed in relation to a proposed model forVDU work and musculoskeletal symptoms. The first two studies (StudiesI and II) support an association between individual factors (workingtechnique and sex) and the physical load. In Study III we observed thatthe physical load increased as a result of mental stress and increasedproductivity. Besides an increase in muscle activity; increases in the forcesapplied to the computer mouse and increased repetitiveness of wristmovements were also observed. The results from the third study alsosupport an association between psychosocial factors and physical loadthrough increased physical demands. The fourth study (Study IV)supports an association between perceived muscular tension and physicalload and perceived muscular tension is hypothesized to be an early sign ofmusculoskeletal symptoms. In Study V an increased risk of developingneck pain was observed among subjects who perceived high musculartension, even when controlling for job strain, physical exposure and age.It is concluded that the physical load during VDU work is affected bypsychosocial and individual factors as well as physical demands. VDUusers who perceives muscular tension at least a few times per week appearto have an increased risk of developing neck pain.
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