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1.  Effects of coffee on driving performance during prolonged simulated highway driving 
Psychopharmacology  2012;222(2):337-342.
Rationale
Coffee is often consumed to counteract driver sleepiness. There is limited information on the effects of a single low dose of coffee on prolonged highway driving in non-sleep deprived individuals.
Objectives
The aim of this study was to examine the effects of a single cup of coffee (80 mg caffeine) on simulated highway driving performance.
Methods
Non-sleep deprived healthy volunteers (n = 24) participated in a double-blind, placebo-controlled, crossover study. After 2 h of monotonous highway driving, subjects received caffeinated or decaffeinated coffee during a 15-min break before continuing driving for another 2 h. The primary outcome measure was the standard deviation of lateral position (SDLP), reflecting the weaving of the car. Secondary outcome measures were speed variability, subjective sleepiness, and subjective driving performance.
Results
The results showed that caffeinated coffee significantly reduced SDLP as compared to decaffeinated coffee, both in the first (p = 0.024) and second hour (p = 0.019) after the break. Similarly, the standard deviation of speed (p = 0.024; p = 0.001), mental effort (p = 0.003; p = 0.023), and subjective sleepiness (p = 0.001; p = 0.002) were reduced in both the first and second hour after consuming caffeinated coffee. Subjective driving quality was significantly improved in the first hour after consuming caffeinated coffee (p = 0.004).
Conclusions
These findings demonstrate a positive effect of one cup of caffeinated coffee on driving performance and subjective sleepiness during monotonous simulated highway driving.
doi:10.1007/s00213-012-2647-7
PMCID: PMC3382640  PMID: 22315048
Caffeine; Automobile driving; Fatigue; Sleepiness
2.  The modulation of upper extremity musculoskeletal disorders for a knowledge worker with chiropractic care and applied ergonomics: a case study 
Objective
This report describes the case management of musculoskeletal disorders for an employee in a college work environment using both chiropractic care and applied ergonomics.
Clinical Findings
A 54-year-old male office worker presented with decreased motor function in both wrists; intermittent moderate-to-severe headaches; and pain or discomfort in the neck, both shoulders, left hand and wrist, and lumbosacral region resulting from injuries sustained during recreational soccer and from excessive forces and awkward postures when interacting with his home and office computer workstations.
Intervention and Results
Ergonomic training, surveillance, retrofitted equipment with new furniture, and an emphasis on adopting healthy work-style behaviors were applied in combination with regular chiropractic care. Baseline ergonomic job task analysis identified risk factors and delineated appropriate control measures to improve the subject's interface with his office workstation. Serial reevaluations at 3-month, 1-year, and 2-year periods recorded changes to the participant's pain, discomfort, and work-style behaviors. At end of study and relative to baseline, pain scale improved from 4/10 to 2/10; general disability improved from 4 to 0; and hand grip strength (pounds) increased from 20 to 105 (left) and 45 to 100 (right). Healthy work habits and postures adopted in the 3-month to 1-year period regressed to baseline exposures for 3 of 6 risk priorities identified in the ergonomic job task analysis.
Conclusion
The patient responded positively to the intervention of chiropractic care and applied ergonomics.
doi:10.1016/j.jcm.2013.02.002
PMCID: PMC3610949  PMID: 23997724
Human engineering; Chiropractic; Musculoskeletal pain; Posture
3.  Short-term effects of implemented high intensity shoulder elevation during computer work 
Background
Work-site strength training sessions are shown effective to prevent and reduce neck-shoulder pain in computer workers, but difficult to integrate in normal working routines. A solution for avoiding neck-shoulder pain during computer work may be to implement high intensity voluntary contractions during the computer work. However, it is unknown how this may influence productivity, rate of perceived exertion (RPE) as well as activity and rest of neck-shoulder muscles during computer work. The aim of this study was to investigate short-term effects of a high intensity contraction on productivity, RPE and upper trapezius activity and rest during computer work and a subsequent pause from computer work.
Methods
18 female computer workers performed 2 sessions of 15 min standardized computer mouse work preceded by 1 min pause with and without prior high intensity contraction of shoulder elevation. RPE was reported, productivity (drawings per min) measured, and bipolar surface electromyography (EMG) recorded from the dominant upper trapezius during pauses and sessions of computer work. Repeated measure ANOVA with Bonferroni corrected post-hoc tests was applied for the statistical analyses.
Results
The main findings were that a high intensity shoulder elevation did not modify RPE, productivity or EMG activity of the upper trapezius during the subsequent pause and computer work. However, the high intensity contraction reduced the relative rest time of the uppermost (clavicular) trapezius part during the subsequent pause from computer work (p < 0.04).
Conclusion
Since a preceding high intensity shoulder elevation did not impose a negative impact on perceived effort, productivity or upper trapezius activity during computer work, implementation of high intensity contraction during computer work to prevent neck-shoulder pain may be possible without affecting the working routines. However, the unexpected reduction in clavicular trapezius rest during a pause with preceding high intensity contraction requires further investigation before high intensity shoulder elevations can be recommended as an integrated part of computer work.
doi:10.1186/1471-2474-10-101
PMCID: PMC2731070  PMID: 19664264
4.  Can coffee prevent caries? 
Aim:
To determine the anti-carious effect of coffee in humans. Coffee represents one of the most consumed products by the population.
Materials and Methods:
A random sample of 1000 individuals, of both sexes, who consumed only coffee as a beverage and who visited the Out-Patient Department of KLE Society's Institute of Dental Sciences, with a dental complaint and no history of any major illness, were considered as subjects. The patients' histories with regard to the coffee intake, such as, period of consumption, frequency of consumption, whether taken with milk or wihout milk, with sugar or without sugar, and the brand make, was noted. History of the type of diet, consumption of sweets, periodicity of brushing, and whether they had undergone fluoride applications were also noted. A thousand patients who consumed beverages other than coffee were taken as the control.
Results:
The results showed that coffee most consumed was roasted coffee, and the frequency on an average was about three cups per day, for an average period of 35 years. The Decayed/Missing/Filled Surface (DMFS) scores varied from 2.9, in subjects who drank black coffee, to 5.5 in subjects who consumed coffee together with sweeteners and creaming agents. The DMFS score was 3.4 in subjects who consumed coffee together with milk but no sugar. The DMFS score of the control subjects was 4, indicating that coffee if consumed alone had anticaries action, but in the presence of additives the antibacterial and anticaries action was totally minimized.
Conclusion:
Thus coffee can help in prevention of dental caries if consumed without additives.
doi:10.4103/0972-0707.53336
PMCID: PMC2848806  PMID: 20379435
Caries; coffee; DMFS score; milk; sugar; Streptococcus mutans
5.  Human coffee drinking: manipulation of concentration and caffeine dose. 
In a residential research ward coffee drinking was studied in 9 volunteer human subjects with histories of heavy coffee drinking. A series of five experiments was undertaken to characterize adlibitum coffee consumption and to investigate the effects of manipulating coffee concentration, caffeine dose per cup, and caffeine preloads prior to coffee drinking. Manipulations were double-blind and scheduled in randomized sequences across days. When cups of coffee were freely available, coffee drinking tended to be rather regularly spaced during the day with intercup intervals becoming progressively longer throughout the day; experimental manipulations showed that this lengthening of intercup intervals was not due to accumulating caffeine levels. Number of cups of coffee consumed was an inverted U-shaped function of both coffee concentration and caffeine dose per cup; however, coffee-concentration and dose-per-cup manipulations did not produce similar effects on other measures of coffee drinking (intercup interval, time to drink a cup, within-day distribution of cups). Caffeine preload produced dose-related decreases in number of cups consumed. As a whole, these experiments provide some limited evidence for both the suppressive and the reinforcing effects of caffeine on coffee consumption. Examination of total daily coffee and caffeine intake across experiments, however, provides no evidence for precise regulation (i.e., titration) of coffee or caffeine intake.
doi:10.1901/jeab.1986.45-133
PMCID: PMC1348223  PMID: 3958660
6.  Association between Neck/Shoulder Pain and Trapezius Muscle Tenderness in Office Workers 
Pain Research and Treatment  2014;2014:352735.
Background. Neck/shoulder pain is a common musculoskeletal disorder among adults. The pain is often assumed to be related to muscular tenderness rather than serious chronic disease. Aim. To determine the association between neck/shoulder pain intensity and trapezius muscle tenderness in office workers. Methods. 653 employees from two large office workplaces in Copenhagen, Denmark, replied to a questionnaire on health and working conditions (mean: age 43 years, body mass index 24 kg·m−2, computer use 90% of work time, 73% women). Respondents rated intensity of neck/shoulder pain during the previous three months on a scale of 0–10 and palpable tenderness of the upper trapezius muscle on a scale of “no tenderness,” “some tenderness,” or “severe tenderness.” Odds ratios for tenderness as a function of neck/shoulder pain intensity were determined using cumulative logistic regression controlled for age, gender, and chronic disease. Results. The prevalence of “no,” “some,” and “severe” tenderness of the trapezius muscle was 18%, 59%, and 23% in women and 51%, 42%, and 7% in men, respectively (chi-square, P < 0.0001). Participants with “no,” “some,” and “severe” tenderness of the trapezius muscle, respectively, rated their neck/shoulder pain intensity to 1.5 (SD 1.6), 3.8 (SD 2.0), and 5.7 (SD 1.9) for women and 1.4 (SD 1.4), 3.1 (SD 2.2), and 5.1 (SD 1.7) for men. For every unit increase in neck/shoulder pain intensity, the OR for one unit increase in trapezius tenderness was 1.86 (95% confidence interval 1.70 to 2.04). Conclusion. In office workers, a strong association between perceived neck/shoulder pain intensity and trapezius muscle tenderness exists. The present study provides reference values of pain intensity among office workers with no, some, and severe tenderness of the trapezius muscle.
doi:10.1155/2014/352735
PMCID: PMC3985383  PMID: 24800070
7.  A Prospective Cohort Study of Coffee Consumption and Risk of Endometrial Cancer over a 26-year of Follow-Up 
Background
Coffee has been reported to lower levels of estrogen and insulin, two hormones implicated in endometrial carcinogenesis, but prospective data on the relation between coffee consumption and risk of endometrial cancer are limited.
Methods
We prospectively assessed coffee consumption in relation to endometrial cancer risk in the Nurses’ Health Study (NHS) with 67,470 female participants aged 34–59 in 1980. Cumulative average coffee intake was calculated with all available questionnaires to assess long-term effects. Cox regression models were used to calculate incidence rate ratios (RR), controlling for other risk factors.
Results
Fewer than 4 cups of coffee per day were not associated with endometrial cancer risk. However, women who consumed 4 or more cups of coffee had 25% lower risk of endometrial cancer than those who consumed less than 1 cup per day (multivariable RR=0.75; 95% CI =0.57–0.97; Ptrend = 0.02). We found the similar association with caffeinated coffee consumption (RR for ≥ 4 vs. <1 cup/day = 0.70; 95% CI = 0.51–0.95). For decaffeinated coffee consumption, a suggestive inverse association was found among women who consumed 2 or more cups per day vs. <1 cup/month. Tea consumption was not associated with endometrial cancer risk.
Conclusions
These prospective data suggest that 4 or more cups of coffee per day are associated with a lower risk of endometrial cancer.
Impact
Drinking of coffee, given its widespread consumption, might be an additional strategy to reduce endometrial cancer risk. However, addition of substantial sugar and cream to coffee could offset any potential benefits.
doi:10.1158/1055-9965.EPI-11-0766
PMCID: PMC3237942  PMID: 22109346
coffee; caffeine; tea; endometrial cancer; prospective cohort study
8.  Acute caffeine effect on repeatedly measured P300 
The acute effect of a single-dose of caffeine on the P300 event-related brain potential (ERP) was assessed in a study using a repeatedly presented auditory oddball button-press task. A dose (5mg/kg body-weight) of either caffeine or placebo lactose, dissolved in a cup of decaffeinated coffee, was administered double-blindly to coffee drinkers who had abstained from coffee for 24hrs, with the presentation order of the sessions counterbalanced and separated by 2–4 weeks. The caffeine-treatment condition demonstrated a smaller P300 amplitude and a shorter latency overall than the placebo treatment condition. The mean P300 amplitude value difference (caffeine minus placebo) increased with the successive trial blocks. Caffeine ingestion appears to yield a lower resource-consumption and a net increase in allocating attention resources for task performance across repeated measurements.
doi:10.1007/BF02935910
PMCID: PMC2723445  PMID: 21432205
caffeine; event-related brain potential (ERP); repeated measurement; P300; oddball
9.  Further evidence of the positive effects of an educational and physical program on headache, neck and shoulder pain in a working community 
The Journal of Headache and Pain  2010;11(5):409-415.
In a controlled trial to evaluate the effectiveness of a simple educational and physical program administered to a large cohort of public servants, we previously found that 6 months following treatment the monthly frequency of headache and neck and shoulder pain and drug intake was reduced by 40% in the experimental compared with controls. These results were stable at a 12-month follow up. The program consists of brief shoulder and neck exercises to be performed several times a day, a relaxation exercise, and instructions on how to reduce parafunction and hyperfunction of the craniofacial and neck muscles during the day. The purpose of this work was to investigate whether the data previously obtained could be confirmed also in the group of 192 subjects that served as controls in first phase of the study and received the intervention in the second phase of the study. The primary endpoint was the change in frequency of headache and neck and shoulder pain expressed as the number of days per month with pain, and as the proportion of subjects with a ≥50% reduction of frequency (responder rate) at the last 2 months of the 6-month intervention period compared to the 2 months preceding the intervention (baseline). The number of days of analgesic drug consumption was also recorded. Days per month with headache at the baseline and at the end of intervention period were 6.40 and 4.58 (mean change −1.81, p < 0.0001), respectively; days with neck and shoulder pain were 7.48 and 6.18 (mean change −1.30, p = 0.0179); days of analgesic consumption were 1.67 and 1.17 (mean change −0.50, p = 0.0222). The responder rate was 42.3% for headache, 42% for neck and shoulder pain and 58.3% for drug consumption. In conclusion, this study adds further evidence on the efficacy of our program and its high acceptability in a large, unselected, working population.
doi:10.1007/s10194-010-0231-2
PMCID: PMC3452277  PMID: 20563879
Headache; Migraine; Neck pain; Education; Exercise
10.  Effect of specific resistance training on forearm pain and work disability in industrial technicians: cluster randomised controlled trial 
BMJ Open  2012;2(1):e000412.
Objectives
To determine the effect of specific resistance training on forearm pain and work disability in industrial technicians.
Design and setting
Two-armed cluster randomised controlled trial of 20 weeks performed at two industrial production units in Copenhagen, Denmark.
Participants
Working-age industrial technicians both with and without pain and disability.
Interventions
The training group (n=282) performed specific resistance training for the shoulder, neck and arm muscles three times a week. The control group (n=255) was advised to continue normal physical activity.
Outcome
All participants rated forearm pain intensity (Visual Analogue Scale, 0–100 mm) once a week (primary outcome) and replied to a questionnaire on work disability (Disability of the Arm Shoulder and Hand, 0–100) at baseline and follow-up (secondary outcome).
Results
Questionnaires were sent to 854 workers of which 30 (n=282) and 27 (n=255) clusters were randomised to training and control, respectively. Of these, 211 and 237 participants, respectively, responded to the follow-up questionnaire. Intention-to-treat analyses including both individuals with and without pain showed that from baseline to follow-up, pain intensity and work disability decreased more in the training group than in the control group (4–5 on a scale of 0–100, p<0.01–0.001). Among those with pain >30 mm Visual Analogue Scale at baseline (n=54), the OR for complete recovery at follow-up in the training group compared with the control group was 4.6 (95% CI 1.2 to 17.9). Among those with work disability >30 at baseline (n=113), the OR for complete recovery at follow-up in the training group compared with the control group was 6.0 (95% CI 1.8 to 19.8).
Conclusion
Specific resistance training of the shoulder, neck and arm reduces forearm pain and work disability among industrial technicians.
Trial registration number
NCT01071980.
Article summary
Article focus
Forearm pain is associated with work disability and healthcare costs.
Specific resistance training effectively reduces neck and shoulder pain, but its effect on forearm pain is only scarcely investigated.
Our study determines the effect of specific resistance training on forearm pain and work disability in industrial technicians.
Key message
Specific resistance training of the shoulder, neck and arm reduces forearm pain and work disability among industrial technicians.
Strengths and limitations of this study
The cluster randomised controlled design with high statistical power strengthens our study.
As we included both public and private sector companies of which most of the invited employees agreed to participate, the external validity of our findings is high.
The inclusion and exclusion criteria limit the generalisability to technicians with non-specific forearm pain.
A limitation is the loss to follow-up of more than 20% of the participants in the training group.
doi:10.1136/bmjopen-2011-000412
PMCID: PMC3282287  PMID: 22331386
11.  Factors Affecting the Musculoskeletal Symptoms of Korean Police Officers 
] This study was conducted to investigate efficient, systematic management of the Korean police and to examine the status and prevention of musculoskeletal disorders in Korean police officers. [Subjects and Methods] A survey of police officers (353 subjects) who visited the National Police Hospital from March 2013 to May 2013 was conducted using a structured questionnaire. [Results] The incidence of pain was 44.2% in the shoulder, 41.4% in the waist, 31.2% in the neck, 26.1% in the legs/foot, 16.7% in the hand/wrist/finger, and 14.7% in the arm/elbow. The comparative risk of the relevant part factors was analyzed by multiple regression analysis. The shoulder had a 4.87 times higher risk in police lieutenants compared with those under the rank of corporal and a 1.78 times higher risk in people with chronic diseases than those without chronic diseases. The arm/elbow had a 2.37 times higher risk in people who exercised than those who did not exercise and a 1.78 times higher risk in people with a chronic disease than those without chronic diseases. Generally, people with a chronic disease showed a higher risk than those without chronic diseases. [Conclusion] The results of this study could be useful as basic data for improvement of police welfare, specialized treatment for the health safety of the police, and efficient management of police resources.
doi:10.1589/jpts.26.925
PMCID: PMC4085223
Police officers; Musculoskeletal disorders; Factors
12.  Who Needs Cream and Sugar When There Is Eco-Labeling? Taste and Willingness to Pay for “Eco-Friendly” Coffee 
PLoS ONE  2013;8(12):e80719.
Participants tasted two cups of coffee, decided which they preferred, and then rated each coffee. They were told (in lure) that one of the cups contained “eco-friendly” coffee while the other did not, although the two cups contained identical coffee. In Experiments 1 and 3, but not in Experiment 2, the participants were also told which cup contained which type of coffee before they tasted. The participants preferred the taste of, and were willing to pay more for, the “eco-friendly” coffee, at least those who scored high on a questionnaire on attitudes toward sustainable consumer behavior (Experiment 1). High sustainability consumers were also willing to pay more for “eco-friendly” coffee, even when they were told, after their decision, that they preferred the non-labeled alternative (Experiment 2). Moreover, the eco-label effect does not appear to be a consequence of social desirability, as participants were just as biased when reporting the taste estimates and willingness to pay anonymously (Experiment 3). Eco labels not only promote a willingness to pay more for the product but also lead to a more favorable perceptual experience of it.
doi:10.1371/journal.pone.0080719
PMCID: PMC3851458  PMID: 24324623
13.  Short term influence of mechanical factors on regional musculoskeletal pain: a study of new workers from 12 occupational groups 
OBJECTIVES—To determine the influence of short term exposure to mechanical factors on regional musculoskeletal pain.
METHODS—Full time newly employed workers were recruited from 12 occupational groups and information collected by questionnaire. Subjects indicated on a blank body manikin any low back, shoulder, wrist or forearm or both, or knee pain which had occurred during the past month and had lasted more than 1 day. Data were also collected with a previously validated questionnaire on working postures, manual handling activities, and repetitive movements of the upper limb. The relations between mechanical factors and each area of pain were calculated as odds ratios (ORs) with 95% confidence intervals (95% CIs). Adjustment was made for age and sex.
RESULTS—1081 subjects (median age 23; interquartile range 20-27) were recruited to the study (a participation rate of 91%). 261 (24%) reported low back pain, 221 (20%) shoulder pain, 93 (9%) wrist or forearm pain, and 222 (21%) knee pain. Several specific manual handling activities were found to be associated with low back, shoulder, and knee pain. Carrying weights of more than 50 lbs (23 kg) on one shoulder was the factor which was most strongly associated with low back pain (OR 2.4 (95% CI 1.5 to 3.8)), shoulder pain (OR 3.1 (95% CI 1.9 to 4.8)), and knee pain (OR 3.5 (95% CI 2.2 to 5.5)), whereas forearm pain was most strongly associated with repetitive movements of the wrists (OR 1.8 (95% CI 1.04 to 3.1)). By contrast very few postures were associated with regional pain, although bending forwards in an uncomfortable position for at least 15 minutes was associated with shoulder pain (OR 1.6 (95% CI 1.2 to 2.2)) and kneeling for at least 15 minutes was associated with knee pain (OR 1.8 (95% CI 1.2 to 2.6)). Exposure to mechanical factors was most strongly associated with pain at multiple sites rather than with pains in individual regions.
CONCLUSIONS—Even among workers with only short term exposure to mechanical factors, musculoskeletal pain is increased.


Keywords: epidemiology; manual handling; questionnaire
doi:10.1136/oem.58.6.374
PMCID: PMC1740140  PMID: 11351052
14.  Effect of brief daily resistance training on rapid force development in painful neck and shoulder muscles: randomized controlled trial 
Objective: To determine the effect of small daily amounts of progressive resistance training on rapid force development of painful neck/shoulder muscles.
Methods: 198 generally healthy adults with frequent neck/shoulder muscle pain (mean: age 43·1 years, computer use 93% of work time, 88% women, duration of pain 186 day during the previous year) were randomly allocated to 2- or 12 min of daily progressive resistance training with elastic tubing or to a control group receiving weekly information on general health. A blinded assessor took measures at baseline and at 10-week follow-up; participants performed maximal voluntary contractions at a static 90-degree shoulder joint angle. Rapid force development was determined as the rate of torque development and maximal muscle strength was determined as the peak torque.
Results: Compared with the control group, rate of torque development increased 31·0 Nm s−1 [95% confidence interval: (1·33–11·80)] in the 2-min group and 33·2 Nm s−1 (1·66–12·33) in the 12-min group from baseline to 10-week follow-up, corresponding to an increase of 16·0% and 18·2% for the two groups, respectively. The increase was significantly different compared to controls (P<0·05) for both training groups. Maximal muscle strength increased only ∼5–6% [mean and 95% confidence interval for 2- and 12-min groups to control, respectively: 2·5 Nm (0·05–0·73) and 2·2 Nm (0·01–0·70)]. No significant differences between the 2- and 12-min groups were evident. A weak but significant relationship existed between changes in rapid force development and pain (r = 0·27, P<0·01), but not between changes in maximal muscle strength and pain.
Conclusion: Small daily amounts of progressive resistance training in adults with frequent neck/shoulder pain increases rapid force development and, to a less extent, maximal force capacity.
doi:10.1111/cpf.12041
PMCID: PMC3799013  PMID: 23758661
fear; gate control; neck and shoulder pain; rehabilitation; resistance training; threat
15.  Effects of Ambulant Myofeedback Training and Ergonomic Counselling in Female Computer Workers with Work-Related Neck-Shoulder Complaints: A Randomized Controlled Trial 
Objective: To investigate the effects of ambulant myofeedback training including ergonomic counselling (Mfb) and ergonomic counselling alone (EC), on work-related neck-shoulder pain and disability. Methods: Seventy-nine female computer workers reporting neck-shoulder complaints were randomly assigned to Mfb or EC and received four weeks of intervention. Pain intensity in neck, shoulders, and upper back, and pain disability, were measured at baseline, immediately after intervention, and at three and six months follow-up. Results: Pain intensity and disability had significantly decreased immediately after four weeks Mfb or EC, and the effects remained at follow up. No differences were observed between the Mfb and EC group for outcome and subjects in both intervention groups showed comparable chances for improvement in pain intensity and disability. Conclusions: Pain intensity and disability significantly reduced after both interventions and this effect remained at follow-up. No differences were observed between the two intervention groups.
doi:10.1007/s10926-007-9066-3
PMCID: PMC1915628  PMID: 17260162
Work-related neck-shoulder complaints; Myofeedback training; Neck-shoulder region
16.  Computer work and musculoskeletal disorders of the neck and upper extremity: A systematic review 
Background
This review examines the evidence for an association between computer work and neck and upper extremity disorders (except carpal tunnel syndrome).
Methods
A systematic critical review of studies of computer work and musculoskeletal disorders verified by a physical examination was performed.
Results
A total of 22 studies (26 articles) fulfilled the inclusion criteria. Results show limited evidence for a causal relationship between computer work per se, computer mouse and keyboard time related to a diagnosis of wrist tendonitis, and for an association between computer mouse time and forearm disorders. Limited evidence was also found for a causal relationship between computer work per se and computer mouse time related to tension neck syndrome, but the evidence for keyboard time was insufficient. Insufficient evidence was found for an association between other musculoskeletal diagnoses of the neck and upper extremities, including shoulder tendonitis and epicondylitis, and any aspect of computer work.
Conclusions
There is limited epidemiological evidence for an association between aspects of computer work and some of the clinical diagnoses studied. None of the evidence was considered as moderate or strong and there is a need for more and better documentation.
doi:10.1186/1471-2474-11-79
PMCID: PMC2874766  PMID: 20429925
17.  Influence of frequency and duration of strength training for effective management of neck and shoulder pain: a randomised controlled trial 
British Journal of Sports Medicine  2012;46(14):1004-1010.
Background
Specific strength training can reduce neck and shoulder pain in office workers, but the optimal combination of exercise frequency and duration remains unknown. This study investigates how one weekly hour of strength training for the neck and shoulder muscles is most effectively distributed.
Methods
A total of 447 office workers with and without neck and/or shoulder pain were randomly allocated at the cluster-level to one of four groups; 1×60 (1WS), 3×20 (3WS) or 9×7 (9WS) min a week of supervised high-intensity strength training for 20 weeks, or to a reference group without training (REF). Primary outcome was self-reported neck and shoulder pain (scale 0–9) and secondary outcome work disability (Disability in Arms, Shoulders and Hands (DASH)).
Results
The intention-to-treat analysis showed reduced neck and right shoulder pain in the training groups after 20 weeks compared with REF. Among those with pain ≥3 at baseline (n=256), all three training groups achieved significant reduction in neck pain compared with REF (p<0.01). From a baseline pain rating of 3.2 (SD 2.3) in the neck among neck cases, 1WS experienced a reduction of 1.14 (95% CI 0.17 to 2.10), 3WS 1.88 (0.90 to 2.87) and 9WS 1.35 (0.24 to 2.46) which is considered clinically significant. DASH was reduced in 1WS and 3WS only.
Conclusion
One hour of specific strength training effectively reduced neck and shoulder pain in office workers. Although the three contrasting training groups showed no statistical differences in neck pain reduction, only 1WS and 3WS reduced DASH. This study suggests some flexibility regarding time-wise distribution when implementing specific strength training at the workplace.
doi:10.1136/bjsports-2011-090813
PMCID: PMC3596862  PMID: 22753863
18.  Bronchial reactivity in green coffee exposure. 
Respiratory symptoms and lung function were studied in nine coffee workers who complained of job related respiratory symptoms. Six described symptoms characteristic of occupational asthma. Lung function data showed obstructive changes mostly in the smaller airways with no impairment in diffusing capacity. Bronchoprovocation testing with green coffee allergen provoked immediate asthmatic reactions with acute reductions of ventilatory capacity in four workers. The relative fall in FEF25-75% (ranging from 28% to 66%) was greater than in FEV1 (ranging from 18% to 62% of the control values). Eight of the nine workers had an increased total IgE serum level; five had positive intradermal skin tests to green coffee allergen. Most of the six healthy subjects experimentally exposed to green coffee dust in the working environment showed an acute fall in flow rates on maximum expiratory flow-volume curves. These results indicate that bronchoprovocation with green coffee allergen or green coffee dust may be used to identify subjects sensitive to green coffee.
PMCID: PMC1007501  PMID: 4005196
19.  The Tromsø heart study: coffee consumption and serum lipid concentrations in men with hypercholesterolaemia: an randomised intervention study. 
In a 10 week trial to assess the effects of coffee consumption and coffee brewing methods on serum cholesterol concentrations 33 men with hypercholesterolaemia were randomly assigned to: continue with their usual coffee intake; stop drinking coffee altogether; or stop drinking coffee for five weeks, thereafter drinking either boiled or filter coffee. Cholesterol concentrations fell significantly in all subjects abstaining for the first five weeks compared with subjects not giving up and continued to fall in those abstaining for 10 weeks. Cholesterol concentrations rose again in subjects returning to boiled coffee but remained the same in those returning to filter coffee. Abstention from heavy coffee drinking is an efficient way of reducing serum cholesterol concentrations in men with hypercholesterolaemia. The extent to which the brewing method affects this relation requires further study.
Images
PMCID: PMC1417717  PMID: 3919832
20.  Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain 
Background
Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain.
Methods
Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years) with nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'.
Results
In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%). In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%). In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations.
Conclusions
A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius.
Trial Registration
ISRCTN60264809
doi:10.1186/1471-2474-12-169
PMCID: PMC3161919  PMID: 21777478
21.  An ergonomic study of women workers in a woolen textile factory for identification of health-related problems 
The observational cross-sectional study conducted on a sample of 100 women workers who volunteered, outlines their cardio-respiratory and musculo-skeletal profile before, during and at end of work. In addition, information on their health status in general was collected in advance.
Contrary to expectation, there was no significant change in respiratory function. However, the musculo-skeletal problems were found to be abundantly present with pain in 91% of the subjects. Region-wise mapping of pain revealed that postural pain in low back was present in 47% while in neck was 19%. Scapular muscles on the right side were involved in stabilizing shoulder, which never went overhead. On the contrary, left shoulder was raised as high (>90 degrees) in spinning action, while pulling thread. This muscle work involved trapezius, deltoid and triceps action concentrically in lifting and while coming to starting position slowly, eccentrically. There was no pause since the wheel continued to spin the thread continuously, unless a worker opted to stop the work. Accordingly, left wrist and hand were in holding contraction while the right wrist and hand holding the handle were also in a fixed position with wrist in flexion with supinated forearm. Though the overall job was light as per peak HR, there was pain due to fatigue and grip strength weakened by around 10%, at the end of the day's work. In conclusion, pain and fatigue were found to be the main problems for women in the spinning section of the small-scale industry under this study. Women have to take up dual responsibility of a full-time job as well as the domestic work. It was considered that ergonomic factors such as provision of a backrest and frequent rest periods could remediate the musculo-skeletal symptoms.
doi:10.4103/0019-5278.40810
PMCID: PMC2796762  PMID: 20040992
Ergonomics; health hazards; pain; posture; women workers; woolen industry
22.  A randomised controlled trial evaluating the effects of two workstation interventions on upper body pain and incident musculoskeletal disorders among computer operators 
Background
Call centre work with computers is associated with increased rates of upper body pain and musculoskeletal disorders.
Methods
This one year, randomised controlled intervention trial evaluated the effects of a wide forearm support surface and a trackball on upper body pain severity and incident musculoskeletal disorders among 182 call centre operators at a large healthcare company. Participants were randomised to receive (1) ergonomics training only, (2) training plus a trackball, (3) training plus a forearm support, or (4) training plus a trackball and forearm support. Outcome measures were weekly pain severity scores and diagnosis of incident musculoskeletal disorder in the upper extremities or the neck/shoulder region based on physical examination performed by a physician blinded to intervention. Analyses using Cox proportional hazard models and linear regression models adjusted for demographic factors, baseline pain levels, and psychosocial job factors.
Results
Post‐intervention, 63 participants were diagnosed with one or more incident musculoskeletal disorders. Hazard rate ratios showed a protective effect of the armboard for neck/shoulder disorders (HR = 0.49, 95% CI 0.24 to 0.97) after adjusting for baseline pain levels and demographic and psychosocial factors. The armboard also significantly reduced neck/shoulder pain (p = 0.01) and right upper extremity pain (p = 0.002) in comparison to the control group. A return‐on‐investment model predicted a full return of armboard and installation costs within 10.6 months.
Conclusion
Providing a large forearm support combined with ergonomic training is an effective intervention to prevent upper body musculoskeletal disorders and reduce upper body pain associated with computer work among call centre employees.
doi:10.1136/oem.2005.022285
PMCID: PMC2092482  PMID: 16621849
musculoskeletal; computer; upper extremity; intervention; RCT
23.  Computer work and self-reported variables on anthropometrics, computer usage, work ability, productivity, pain, and physical activity 
Background
Computer users often report musculoskeletal complaints and pain in the upper extremities and the neck-shoulder region. However, recent epidemiological studies do not report a relationship between the extent of computer use and work-related musculoskeletal disorders (WMSD).
The aim of this study was to conduct an explorative analysis on short and long-term pain complaints and work-related variables in a cohort of Danish computer users.
Methods
A structured web-based questionnaire including questions related to musculoskeletal pain, anthropometrics, work-related variables, work ability, productivity, health-related parameters, lifestyle variables as well as physical activity during leisure time was designed. Six hundred and ninety office workers completed the questionnaire responding to an announcement posted in a union magazine. The questionnaire outcomes, i.e., pain intensity, duration and locations as well as anthropometrics, work-related variables, work ability, productivity, and level of physical activity, were stratified by gender and correlations were obtained.
Results
Women reported higher pain intensity, longer pain duration as well as more locations with pain than men (P < 0.05). In parallel, women scored poorer work ability and ability to fulfil the requirements on productivity than men (P < 0.05). Strong positive correlations were found between pain intensity and pain duration for the forearm, elbow, neck and shoulder (P < 0.001). Moderate negative correlations were seen between pain intensity and work ability/productivity (P < 0.001).
Conclusions
The present results provide new key information on pain characteristics in office workers. The differences in pain characteristics, i.e., higher intensity, longer duration and more pain locations as well as poorer work ability reported by women workers relate to their higher risk of contracting WMSD. Overall, this investigation confirmed the complex interplay between anthropometrics, work ability, productivity, and pain perception among computer users.
doi:10.1186/1471-2474-14-226
PMCID: PMC3751662  PMID: 23915209
Computer use; Musculoskeletal complaints; Arm-shoulder pain; Gender; Sex
24.  Effects of Alcohol, Coffee, and Tobacco, Alone or in Combination, on Physiological Parameters and Anxiety in a Young Population 
Journal of Caffeine Research  2012;2(2):70-76.
Objective
The objective was to evaluate the effects of a single dose of alcohol, caffeine, and nicotine, alone or in combination, on physiological parameters (systolic and diastolic blood pressure [SBP and DBP] and heart rate [HR]) and state-trait anxiety in healthy young volunteers.
Method
The procedure reproduces the conditions under which the subjects (n=76) usually ingest alcohol (through an alcoholic beverage), caffeine (through a cup of coffee), and nicotine (by smoking a cigarette), separately or in combination, according to their consumption habits of each individual. SBP and DBP, HR, and state anxiety (SA) were registered before (phase 1) and after (phase 2) treatment.
Results
Intake of alcohol or alcohol-nicotine reduced DBP. Comparisons between control and combined treatment (coffee-alcohol-nicotine) groups revealed a decrease in HR in the former group but not in the latter. The coffee consumers alone exhibited a tendency toward an increase in SA, while the control group showed a tendency toward a decrease in this measure. When Phase 1 and Phase 2 were compared, a decrease was observed in SBP (alcohol and coffee-alcohol groups), DBP (alcohol and alcohol-nicotine groups), HR (all groups, except coffee-alcohol and coffee-alcohol-nicotine groups), and SA (coffee-alcohol-nicotine group).
Conclusions
(i) A low dose of alcohol, either alone or in combination with a cigarette, decreases DBP but not SBP; (ii) the polyconsumption of coffee, alcohol, and nicotine blocks the adaptation response (the reduction in HR in control subjects in the second phase); (iii) an increase of SA is observed after consuming coffee, while the opposite occurs in control subjects (a decrease of SA).
doi:10.1089/jcr.2012.0018
PMCID: PMC3621324  PMID: 24761267
25.  The Effect of a New Neck Support Tying Method Using Thera-Band on Cervical ROM and Shoulder Muscle Pain after Overhead Work 
[Purpose] This study proposed a new neck support tying (NST) method using Thera-Band for the prevention of neck and shoulder pain in workers doing overhead work. The purpose of this study was to investigate the effect of the new NST method using Thera-Band on cervical ROM and shoulder pain after overhead work. [Subjects] Fourteen male subjects were recruited. [Methods] This study measured the cervical ROM and pressure pain threshold (PPT) of the upper and middle trapezius (UT and MT) muscles after the control and NST groups had performed overhead work. [Results] The cervical flexion, extension, and lateral flexion angles of the NST group were significantly larger than those of the control group. The PPTs of UT and MT of the NST group were significantly higher than those of the control group [Conclusion] The NST prevented ROM reduction and pain in the cervical and shoulder regions.
doi:10.1589/jpts.25.843
PMCID: PMC3820395  PMID: 24259866
Neck supporter; Overhead work; Thera-Band

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