| 1. |
- Koch, Markus, et al.
(författare)
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Frequency of breaks, amount of muscular rest, and sustained muscle activity related to neck pain in a pooled dataset
- 2024
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Ingår i: PLoS ONE. - 1932-6203. ; 19:6, s. 1-22
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Neck pain remains a persistent challenge in modern society and is frequently encountered across a wide range of occupations, particularly those involving repetitive and monotonous tasks. It might be expected that patterns of trapezius muscle activity at work, characterized by few breaks and prolonged periods of sustained muscle activity, are linked to neck pain. However, previous cross-sectional studies have generally failed to establish a definitive association. While some longitudinal studies have suggested that extended periods of heightened muscle activity could be a risk factor for neck pain, these findings often relied on limited participant numbers or specific professional groups. This study aimed to investigate the relationship between trapezius muscle activity and neck pain by pooling data from seven Scandinavian research institutes encompassing a diverse range of occupational backgrounds.METHODS: Electromyographic (EMG) data for the upper trapezius muscle, collected during working hours, were coupled with questionnaire responses pertaining to neck pain, individual characteristics, and potential confounding variables for a total of 731 subjects. Additionally, longitudinal data from 258 subjects were available. The various EMG datasets were consolidated into a standardized format, and efforts were made to harmonize inquiries about neck pain. Regression analyses, adjusting for sex and height, were conducted to explore the associations between muscle activity variables and neck pain. An exposure index was devised to quantify the cumulative neck load experienced during working hours and to differentiate between various occupational categories.RESULTS: The cross-sectional data displayed a distinct pattern characterized by positive associations for brief periods of sustained muscle activity (SUMA) and negative associations for prolonged SUMA-periods and neck pain. The longitudinal data exhibited a contrasting trend, although it was not as pronounced as the cross-sectional findings. When employing the exposure index, notable differences in cumulative muscle load emerged among occupational groups, and positive associations with longitudinal neck pain were identified.DISCUSSION: The results suggest that individuals with neck pain experience higher cumulative workloads and extended periods of muscle activity over the long term. In the short term, they appear to compensate by taking frequent short breaks, resulting in a lower cumulative workload. Regardless of their occupation, it is crucial to distribute work breaks throughout the workday to ensure that the cumulative load remains manageable.
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| 2. |
- Riva, Roberto, et al.
(författare)
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Catecholamines and heart rate in female fibromyalgia patients
- 2012
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Ingår i: Journal of Psychosomatic Research. - : Elsevier. - 0022-3999 .- 1879-1360. ; 72:1, s. 51-57
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fibromyalgia syndrome is a disease of unknown pathogenesis characterised by widespread chronic musculoskeletal pain. Fibromyalgia has been associated with dysregulation of the stress systems, but results are inconsistent.Purpose: To investigate autonomic nervous system activity (urinary noradrenaline, adrenaline, dopamine, and heart rate) of fibromyalgia patients and healthy controls.Methods: Urinary catecholamines and heart rate were assessed for a 24-hour period in a controlled hospital setting (including relaxation, a test with prolonged mental stress, and sleep), and during daily activity in 29 female fibromyalgia patients and 29 age-matched female healthy controls.Results: With repeated measures ANOVAs, catecholamine levels were lower in patients than controls (P = .035 for noradrenaline; P = .005 for adrenaline; P = .001 for dopamine). One-way ANOVAs for the single periods showed that patients compared to controls had significantly lower adrenaline levels during the night (P = .010) and the second day (P = .010), significantly lower dopamine levels during the first day (P = .008), the night (P = .001), and the second day (P = .004). However, single time point noradrenaline levels were not significantly different between the groups. Overall, heart rate was significantly higher in patients than controls (P = .014). Specifically, significant differences emerged during relaxation (P = .016) and sleep (P = .011), but not during stress provocation or daily activities.Conclusions: The results indicate an altered regulation of the autonomic nervous system in fibromyalgia patients, with attenuated activity of both the sympathetic (adrenal medulla component) and the parasympathetic branch.
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| 3. |
- Riva, Roberto, et al.
(författare)
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Comparison of the cortisol awakening response inwomen with shoulder and neck pain and women with fibromyalgia
- 2012
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Ingår i: Psychoneuroendocrinology. - : Elsevier. - 0306-4530 .- 1873-3360. ; 37:2, s. 299-306
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Tidskriftsartikel (refereegranskat)abstract
- Shoulder and neck pain (SNP) and fibromyalgia syndrome (FMS), two musculoskeletal conditions of unknown pathogenesis, share some common features in terms of altered neuroendocrine responses, pain and stress perception. However, the pain distribution in SNP is localized,whereas in FMS is more widespread. Because regional musculoskeletal pain may represent an intermediate stage along a continuum towards widespread musculoskeletal pain we compared the cortisol awakening response (CAR) in women with SNP with the CAR in FMS patients and healthy controls (HC) in a controlled hospital—hotel setting. The aim of the study was to investigate whether SNP is related to a deviant regulation of the hypothalamic—pituitary—adrenal (HPA) axis. Eighteen women with SNP, 29 female FMS patients, and 27 female HC participated in the study. Cortisol samples were collected upon awakening, 30 and 60 min later. Questionnaires measuring pain levels, sleeping problems, perceived stress, and psychological characteristics were administered to the participants. Compared with HC, women with SNP had a tendency towards higher cortisol levels, whereas FMS had lower cortisol levels. Adjustment for potential confounders did not influence the results. Women with SNP and FMS patients reported more health complaints, pain, and perceived stress than the HC, but women with SNP were less affected than the FMS patients. Women with SNP showed a tendency towards an elevated HPA axis activity compared with HC. The current findings may indicate that the hypercortisolism in regional musculoskeletal pain represent an intermediate stage towards the development of a hypocortisolism in widespread musculoskeletal pain.
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| 4. |
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| 5. |
- Riva, Roberto, et al.
(författare)
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Fibromyalgia syndrome is associated with hypocortisolism
- 2010
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Ingår i: International Journal of Behavioral Medicine. - : Springer Science and Business Media LLC. - 1070-5503 .- 1532-7558. ; 17:3, s. 223-233
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fibromyalgia syndrome (FMS) is a disease of unknown pathogenesis characterized by chronic musculoskeletal pain. FMS has been also associated with altered endocrinological responses, but findings are inconsistent. Purpose: The aim of the present study was to investigate free salivary cortisol levels in FMS patients compared with healthy controls with a particular focus on the Cortisol Awakening Response (CAR). The saliva samples were collected in a controlled hospital-hotel setting, in which the participants’ compliance was high and a number of potential confounders were analyzed. Method: Twenty-nine chronic female FMS patients and 29 age-matched healthy female controls were recruited. Salivary cortisol samples were investigated eight times: in the afternoon when participants arrived at the hospital, after stress provocation (to be reported separately), in the evening, before they went to sleep, upon awakening, 30 and 60 minutes later, and during the afternoon of the second day. Questionnaires measuring pain levels, sleeping problems, perceived stress and personality were administered to the participants. Other psychophysiological measurements were used to assess sleep quality and heart rate. Results: Patients with FMS had significantly lower cortisol levels during the day, most pronounced in the morning (CAR). The potential confounders analyzed did not influence the results. As expected, FMS patients reported more pain, stress, sleeping problems, anxiety and depression. Conclusions: The results lend support to the hypothesis of a dysfunction in the Hypothalamus-Pituitary-Adrenal axis in FMS patients, with generally lower cortisol values, most pronounced upon awakening (CAR).
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| 6. |
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| 7. |
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| 8. |
- Schiller, Bernt, 1934, et al.
(författare)
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“The Nordic model”: historical origins and its significance for the work place dialogue towards increased organizational sustainability
- 2017
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Ingår i: Dellve L., Wikström E., Björk L., Wolmesjö M., Larsson Fällmanand S. (Eds.) Abstract book of the 11th NOVO symposium. Gothenburg: 9-10 November. - Gothenburg : Gothenburg University. - 9789187876172
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The vision of the NOVO network is “a Nordic Model for development of more sustainable production systems in healthcare”. It is based on the assumption that the Nordic countries, through high levels of trust and justice (social capital), have unique opportunities to carry out dialogue-based change processes, cf. “the Nordic Model”. This seems important due to the frequent negative impact of rationalization on ergonomics and vice versa (see previous abstract by Winkel et al). The Nordic model has been the subject of extensive discussions and studies (e.g. Schiller et al., 1993). The Nordic exceptionalism might first be noticeable in the Middle Ages in the weak feudalism compared to the Continent. The peasants of the North were personally free and owned their land. They paid taxes and were the direct subjects of the Crown. Correspondingly, the nobility was weak. At the time of the industrial breakthrough in the 19th century, industrial workers were recruited from the landless, often sons and daughters of self-owning farmers. Before the advent of the labour movement, dialogue instead of violence was the trusted way for the popular movements to advance their cause. The international revolutionary orientation of the trade unions was already during the 1890s subordinated to negotiations with national employers. The collective agreement is the counterpart to the share contract (in Danish: “Andelskontrakt”), which created and structured social capital in the agricultural development in Denmark. The collective agreement also begun its successful spread in Denmark and became dominant in the whole of the North. The class conflicts took place in countries without major ethnic, cultural and religious splits. In a European comparison class differences were relative moderate. The state had a limited record of active repression and corruption. To-day we still have the best organized trade unions in the world, close cooperation with important social democratic parties, strong employer organizations, early recognition of trade unions and established policy of collective bargaining with close to total coverage of the labour market and a principle of no-state intervention in industrial conflicts. Thus, the industrial relations in the Nordic countries still seem to be exceptional. Key research issues are now to further investigate the Nordic Model in terms of: - critical prerequisites for a positive environment for dialogues based on workplace agreements, - how such insights can be measured and further developed, - how they can be made available to a wider audience in an applicable way
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| 9. |
- Takala, Esa-Pekka, et al.
(författare)
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Systematic evaluation of observational methods assessing biomechanical exposures at work
- 2010
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Finnish Institute of Occupational Health; National Research Centre for the  . - 0355-3140 .- 1795-990X. ; 36:1, s. 3-24
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This systematic review aimed to identify published observational methods assessing biomechanical exposures in occupational settings and evaluate them with reference to the needs of different users.Methods: We searched scientific databases and the internet for material from 1965 to September 2008. Methods were included if they were primarily based on the systematic observation of work, the observation target was the human body, and the method was clearly described in the literature. A systematic evaluation procedure was developed to assess concurrent and predictive validity, repeatability, and aspects related to utility. At least two evaluators independently carried out this evaluation.Results: We identified 30 eligible observational methods. Of these, 19 had been compared with some other method(s), varying from expert evaluation to data obtained from video recordings or through the use of technical instruments. Generally, the observations showed moderate-to-good agreement with the corresponding assessments made from video recordings; agreement was the best for large-scale body postures and work actions. Postures of wrist and hand as well as trunk rotation seemed to be more difficult to observe correctly. Intra- and inter-observer repeatability were reported for 7 and 17 methods, respectively, and were judged mostly to be moderate or good.Conclusions: With training, observers can reach consistent results on clearly visible body postures and work activities. Many observational tools exist, but none evaluated in this study appeared to be generally superior. When selecting a method, users should define their needs and assess how results will influence decision-making
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| 10. |
- Westgaard, Rolf Harald, et al.
(författare)
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Trapezius activity of fibromyalgia patients is enhanced in stressful situations, but is similar to healthy controls in a quiet naturalistic setting : a case control study
- 2013
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 14, s. 97-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Muscle activity and pain development of fibromyalgia (FM) patients in response to mental stress show inconsistent results, when compared to healthy controls (HCs). A possible reason for the inconsistent results is the large variation in stress exposures in different studies. This study compares muscle responses of FM patients and HCs for different modes and levels of imposed stress, to elucidate features in stress exposures that distinguish stress responses of FM patients from HCs. Methods: Upper trapezius (clavicular and acromial fibers), deltoid, and biceps surface electromyographic (sEMG) activity was recorded in FM patients (n=26) and HCs (n=25). Heart rate (HR) was recorded and used as indicator of autonomic activation. Tests included inspiratory breath holding (sympathetic activation procedure), mental stress tests (color-word test and backward counting; 28 min), instructed rest prior to stress test (30 min TV watching), and controlled arm movement. sEMG and HR was also recorded during an unrestrained evening stay at a patient hotel. The 5-min period with lowest trapezius muscle activity was determined. Pain (shoulder/neck, low back pain) and perceived tension were scored on VAS scales at the start and the end of the stress test and at bedtime. Results: Trapezius sEMG responses of FM patients were significantly higher than HCs during sympathetic activation, mental stress, and instructed rest, but similar during arm movement and unrestrained evening activity. HR of FM patients and HCs was similar during mental stress and in the evening, including the 5-min period with lowest trapezius activity. Muscle activity of FM patients during the stress test (with shoulder/neck pain development) and the evening stay (no pain development) was similar. Conclusions: FM patients show elevated muscle activity (in particular trapezius activity) in situations with imposed stress, including sympathetic activation, and putative anticipatory stress. Muscle activity and HR were similar to HCs in instructed arm movement and in a situation approaching low-stress daily living. Pain development of FM patients during the stress test may be due to activation of several stress-associated physiological systems, and not obviously caused by muscle activity in isolation.
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| 11. |
- Winkel, Jörgen, 1946, et al.
(författare)
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A Nordic work environment complement to Value Stream Mapping for sustainable patient flows at hospitals – A NOVO Multicenter study
- 2011
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Ingår i: Abstract at the Nordic Workshop: ’Nordiske perspektiver på arbejdsmiljø’, National Research Centre for the Working Environment, Copenhagen, Denmark. November 21-22, 2011.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The Nordic Council of Ministers (NCM) granted 2007-09 a project with the aim to establish and develop a Nordic Network for scientists (‘the NOVO network’) regarding research on work environment and efficiency in the health care sector. The vision is a “Nordic Model for sustainable systems” in health care. A “Sustainable system” is here defined as the joint consideration of competitive performance and working conditions in a long-term perspective (Westgaard & Winkel, 2009, 2011). A preliminary project plan for a Nordic Multicenter project focusing a specific aspect of the vision was developed as part of the above mentioned NCM project. This was entitled: “A Nordic work environment complement to Value Stream Mapping (VSM) for sustainable patient flows at hospitals – A NOVO Multicenter study”. In healthcare Value-Stream Mapping (VSM) is a common Lean tool used to identify and minimize non-VAW ( (Keyte & Locher, 2004). It is a participatory tool, i.e. those affected by this type of rationalization are performing the analyses and thereafter suggest the interventions. Participation has been shown to be crucial to obtain ownership of the suggested interventions and thereby increase impact. In addition, VSM has been shown to be a powerful rationalization tool. However, the resulting interventions may imply physical work intensification and impaired psychosocial work environment if the proportion of VAW is increased and management issues are not properly considered (e.g. Jonker et al 2011, Rolander et al submitted, Westgaard & Winkel 2011). In the rationalization process both physical and psychosocial working conditions should therefore be integrated to obtain a competitive performance in a long term perspective (Westgaard & Winkel 2011). In practice, this is rarely done. Thus, health of the employees and system performance goals often end up on a collision course with short-term performance demands as the winner (e.g. Winkel & Westgaard 1996, Westgaard & Winkel 2011). A management style based on dialog between the parties seems to be crucial in order to consider both competitive performance and health issues as part of the same intervention process (Westgaard & Winkel 2011). Due to this, we claim that the Nordic countries have special opportunities to develop sustainable production systems. This is based on the presence of "The Nordic model" which has regulated industrial relations in our part of the world (Guðmundsson 1993). It has evolved gradually over a period of over hundred years in the light of our special historical circumstances. The Nordic model has been the subject of extensive discussions and studies supported by the Nordic Council of Ministers (Schiller et al 1993, Fleming et al 1998, Fleming and Thörnqvist 2003). During the period 2002-10 an ergonomic intervention process tool (ErgoVSM) was developed in a series of Swedish projects, based on existing scientific evidence and in close co-operation with Swedish industry and the healthcare sector. The aim was to facilitate simultaneous consideration of waste minimization and health issues (i.e. risk factors for musculoskeletal and mental health)(Jarebrant et al 2004, 2009). This requires a high degree of consensus between the parties and it is presumed that the Nordic countries with a common anchoring in "The Nordic model" offer the best prerequisite for this kind of research and practice. A prototype of ErgoVSM is now available (Jarebrant et al 2010a, b), but proper validation and further development are needed. As part of the NCM-funded NOVO project 2009, Sweden suggested that this could be performed within the healthcare sector as a Nordic Multicenter study. September 2011 NCM decided to grant our project plan, thus allowing a Nordic co-ordination of the national studies and initiatives in Denmark, Iceland, Norway and Sweden. The present Nordic multicenter project adds to the national projects and initiatives by: -strengthening the empirical basis in the evaluation and further development of the tool -highlighting a practical example of the Nordic perspective on ergonomic (physical and mental) intervention research through a common Nordic scientific publication -potentially increasing the practical use of the process instrument to more/all Nordic countries By moving from a separate Swedish project to identical national studies in several countries extra demands are put on each project. The projects, each comprising several case and control patient flows, will be strictly co-ordinated into a Multicenter study to allow comparative analyses, further development of the tool and common conclusions. The final delivery will be a common Nordic version of the process tool ErgoVSM comprising the work from survey to development and implementation of solutions.
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| 12. |
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| 13. |
- Winkel, Jörgen, 1946, et al.
(författare)
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Development and implementations of interventions managing work related musculoskeletal disorders: Inadequacy of prevalent research framework and future opportunities
- 2019
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 45:3
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The position paper by van der Beek and coworkers (Scand J Work Environ. & Health, 2017) makes the point that workplace interventions have not been overly successful in preventing work-related musculoskeletal disorders (MSD). In the present Letter to the Editor, we argue that work-related MSD intervention based on the research framework of van der Beek and coworkers and others is unlikely to make much impact. It is concluded that most of the intervention research aimed at reducing occupational MSD seems to have ignored the impact of interventions aiming at improved production system performance. This suggests that we need an expansion of the traditional MSD intervention research paradigm; i.e. how to involve the stakeholders responsible for interventions aiming at improving production system performance.
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| 14. |
- Winkel, Jörgen, 1946, et al.
(författare)
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Scientific evidence suggests a changed approach in ergonomic intervention research
- 2017
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Ingår i: Osvalder A.-L., Blomé M. & Bodnar H. (Eds.) NES 2017, Conference Proceedings. - Lund. - 9789177531524
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Konferensbidrag (refereegranskat)abstract
- Ergonomic interventions have generally been unsuccessful in improving workers’ health, with concurrent rationalization efforts negating potentially successful intervention initiatives. We propose the two aims are considered simultaneously, aiming at the joint consideration of competitive performance and work environment in a long-term perspective (“organizational sustainability”). A prerequisite is a high level of dialogue between the different groups of stakeholders, and we argue that the Nordic countries, through high levels of trust and justice (social capital), have unique opportunity to carry out such research. The present authors bring forth the vision of “a Nordic Model for development of more sustainable production systems”.
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| 15. |
- Winkel, Jörgen, 1946, et al.
(författare)
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The NOVO network: A Research and Development Platform with the Vision of a Nordic Model for Sustainable Systems in Health Care
- 2021
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Ingår i: Interdisciplinary Journal of Partnership Studies. - : University of Minnesota. - 2380-8969. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Musculoskeletal and psychological/mental disorders are major causes of sick leave, threatening the welfare of individuals and the economics of companies and societies. The prevailing research and development (R&D) of ergonomic interventions show minimal long-term effects on health and wellbeing while interventions to improve production seem to have a dominant negative effect, particularly in the health-care sector. Scientific evidence suggests that improved partnership is needed between stakeholders with different and often opposing aims, i.e., organizational productivity vs. worker wellbeing. In 2006 a Nordic R&D network, the NOVO Network, was established highlighting the need for a new approach, integrating work environment and production needs in intervention R&D. Our hypothesis is that such an integration is more readily established in the Nordic countries, largely due to their leading positions in the world in terms of social capital. Through annual symposia and other activities, the NOVO Network brings together scholars and practitioners to share knowledge and experience and to suggest and develop new areas of collaboration towards increased organizational sustainability in health care. A multicenter study conducted within the framework of the NOVO network resulted in a new, practical tool. This tool aims to facilitate partnership instead of the prevalent domination orientation, thereby combining consideration of work environment and production needs. Based on our experiences so far, this article highlights some key future challenges. As a result, we hope to see development of a stronger Nordic R&D tradition towards increased organizational sustainability in health care.
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